For the socialized medicine bunch

[jerryzflies 0]

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was putting herself through grad school, and supporting herself working half-time (without benefits) as a sales clerk.

What is a person with a Bachelors degree doing working half-time as a sales clerk. She put herself in this situation by taking a low paying job when she had the ability to get a higher job to afford the insurance. There was a choice here. She went the risky route of going underemployed to get that degree faster. Also, going for a graduate degree does not automatically erase the "slacker" title.

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In this recession (unlike the previous few) people having degrees are just as likely to lose their jobs as those without degrees. Saying anyone "put themselves in this situation" when over 1/2 million jobs have been lost every month for several months now is just plain silly.

White-collar jobs have been among the most severely hit in recent months as the recession spreads throughout the economy. Roughly 180,000 professional and business jobs were lost in February, according to the Labour Department. That compared with a 168,000 drop in manufacturing employment and 104,000 in construction.

The number of people with a university degree claiming unemployment insurance in New York has doubled in the last year. By contrast, the number of claimants who had less than a high-school education increased by half as much.

“We've never had anything quite like what we are seeing now in terms of the impact [of the recession] on well-educated people,” said James Parrott, chief economist at the New York-based Fiscal Policy Institute.

Damian Birkel knows all about being laid off from white-collar positions. He's been laid off four times during his career, including just six months ago. He now runs Professionals in Transition, a non-profit group in Winston-Salem, N.C., that helps unemployed white-collar workers. Attendance at the group's weekly meetings has recently jumped from around 20 to about 100. “It is unbelievable,” he said Friday.

He and others noted that many workers have been forced to take part-time jobs to make ends meet.

According to the Labour Department, the number of these underemployed people is rising almost as fast as the number of unemployed. The department said Friday the number of “involuntary part-time workers” rose by 3.7 million in the last 12 months. If they were included in the overall unemployment figure, the unemployment rate would increase to 14.8 per cent, the highest since the underemployment figures were first used in 1994.

If you can't fix it with a hammer, the problem's electrical.

[jcd11235 0]

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That's where pursuit of happiness comes in.

Would you kindly show us where the Constitution mentions the "pursuit of happiness", please?

I didn't say it was. Sorry if you didn't catch the point.

The only point I caught was that you apparently have little understanding of the Constitution, as you are unable to support your assertions relating to the document.

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[jcd11235 0]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

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[jcd11235 0]

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Hmmmm, the responsible member of society takes care of securing their own medical and other needs before luxuries.

The irresponsible member of society becomes a drain on the resources of the responsible member and somehow not only thinks this is acceptable but expects more of a hand out.

Why should I shoulder the load for slackers?

Can we assume that you require proof of medical insurance before you are willing to take a tandem passenger on a skydive? Or do you apply your principles only applied when it's convenient for you, ignoring them when it means you can make a buck?

Math tutoring available. Only $6! per hour! First lesson: Factorials!

[kbordson 8]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

Compare the rates by this CDC site vs. data from the WHO as an attachment (I tried to get it as a link, but it was just a download)

[nanook 1]

If the person originally had a job(during this period) and was let go, then no she isn't a slacker. But she still took a risk. Getting a higher form of degree was more important to her than healthcare. Finding a good job is harder now; not impossible.

_____________________________

"The trouble with quotes on the internet is that you can never know if they are genuine" - Abraham Lincoln

[MartinOlsson 0]

A problem with comparing these kind of statistics is that in a publicly funded system health prevention is payed with the same hand that is later producing health care. This is a great incentive. But one that in direct comparison makes it look that the people just simply makes better choices. Even though i believe many European countries have a healthier culture, I don't think that is the sole reason. I believe the system in itself makes people healthier because there is a clearer incentive to keep people healthy.

[jcd11235 0]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

Compare the rates by this CDC site vs. data from the WHO as an attachment (I tried to get it as a link, but it was just a download)

I think it goes far beyond just obesity. There are many things that Americans could, and should, learn from our European friends. The American way is not always the best way. That's not to say that it isn't sometimes the best way, but it certainly isn't always the best way.

Healthcare is just one area for which there is evidence that there are better systems than the one in place in the US.

Math tutoring available. Only $6! per hour! First lesson: Factorials!

[jerryzflies 0]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

And an unhealthy attachment to our current healthcare system.

If you can't fix it with a hammer, the problem's electrical.

[kbordson 8]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

And an unhealthy attachment to our current healthcare system.

And developing an unhealthy sense of entitlement

[lawrocket 3]

There are things we can learn and the other way around. Let us look at a typical European 0socialized medicine country. Face it - white folks have their diseases. There are some diseases typical of races. Look at Japan - they smoke like chimneys and live a long time because Japanese have certain health risk profiles. A vanilla health system is fine there.

Same with France and Italy and Spain, etc. Fairly homogenous. It's easy to set up a "system" that responds ti the same people having the same problems. A diverse place like the US is a different story.

Different CVAs for different folks. We can learn. But recall - this aint Europe.

My wife is hotter than your wife.

[jcd11235 0]

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There are things we can learn and the other way around.

Agreed.

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Let us look at a typical European 0socialized medicine country. Face it - white folks have their diseases. There are some diseases typical of races. Look at Japan - they smoke like chimneys and live a long time because Japanese have certain health risk profiles. A vanilla health system is fine there.

I'm pretty sure that there are racially diverse countries in Europe.

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We can learn. But recall - this aint Europe.

I agree. I'm not advocating trying to implement a carbon copy of another country's healthcare system. But, denying that our system is broken and needs an overhaul isn't productive.

Math tutoring available. Only $6! per hour! First lesson: Factorials!

[Andy9o8 0]

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And there's always life expectancy too!

Which is much more dependent upon lifestyle choices and heredity than medical efficacy.

So, are you suggesting that Europeans generally make better lifestyle choices than Americans?

it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

And an unhealthy attachment to our current healthcare system.

And developing an unhealthy sense of entitlement

And an unhealthy tendency to miss the forest for the trees in the worship of catch-all slogans and sound bytes.

[kbordson 8]

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. But, denying that our system is broken and needs an overhaul isn't productive.

I have NEVER said that it isn't broken or that it doesn't need to be fixed. I try from the inside to help my patients.... which are mostly medicaid by my CHOICE. Currently in Kansas City, there are only a handful of physicians that take pregnant medicaid patients. AND... if you had regular insurance at the beginning of the pregnancy, but lost your job (or he lost his job) and lost the insurance, then many of the ob/gyn groups will drop those patients. I try to offer an alternative to those women other than going to the teaching hospitals (publicly funded and VERY inefficient).

BUT.... with some of those women, it IS a challenge to keep them in my caselist.

Some have problems that are harder to treat with Medicaid - example: hyperemesis (puking and puking and puking... typically limited to the first trimester) My goal is to limit the dehydration and try to keep her out of the hospital. I use different medications (phenergan, reglan, pepcid, vit B6, unisom) but I can't write a prescription for zofran (which is an EXCELLENT anti-nausea med with very few side effects... I can admit her and give it to her IV, but I cant write a rx for it and have her use it as an outpatient... now honestly, which costs more, a hospital admission and IV medication or a prescription) Or lets talk about dental issues in pregnancy. How many dentist take medicaid for adults? Here in the KC area... only one or two. So finding them care for that part of her health and wellness is quite a challenge. (Note: she could have always gone and paid out of pocket of routine dental care, which would have been A LOT cheaper than having to find someone to do a root canal or extraction during the pregnancy)

Another example: Intrauterine Devices (Mirena) This is a VERY good and VERY reliable method of contraception that medicaid had said that they were going to drop. I FOUGHT against that decision. I was PISSED that the government was going to take away this option for a VALID AND RELIABLE contraception because the upfront cost was more than a few pack of pills. The gov'ts argument was that some of the women take them out before 5 yrs and they don't get the monies worth out of it. BAD argument.... so the government is saying that just cuz some women don't tolerate it and want it removed or because some women have changes to their life situations and feel that they are ready for another child before the 5yr mark, they are no longer providing it? But with medicaid, the government CAN AND DOES say that. And doctors have to FIGHT the government. That gets very tiring and not many do.

And some of these patients are VERY non-compliant. (generally it's only a handful that fall into this category) But with the system as it stands, I can tell her: "Ms. Smith, you NEED to keep your appointment and your referrals that we schedule for you OR I WILL fire you as a patient and you will need to go to Truman for your care." Why am I so harsh on this? Because if you have a history of drug use, and your pregnant and you complain about intermittent chest pain - I NEED you to be seen and evaluated by cardiology. If you're not having the pain at that moment, you don't need to go to the ER, but you DO NEED to be evaluated!!! To just decide not to and then to have a catastrophic event during labor puts me in SUCH a legal risk!!! And yes... there is some of this that is about me. I don't want to be sued of everything and lose my licence because of non-compliance. In theory could I "win" that case? Maybe. Depends on the lawyer and the jury. If she dies... my malpractice insurance might decide to settle despite whether or not I was "right." If they settle, that looks bad on my record for the rest of my career. So I want to maintain the right to fire her. Other reasons to fire patients: intolerable rudeness. My staff does NOT deserved to be sworn at or work in a hostile environment. I do not deserve to be threatened by an angry father that has an incorrect sense of entitlement (NO, sir. It is NOT your "right" to do that)

I deal with this.

Do you?

Or do you just sit on a computer and whine about those that are trying to fix thing?

[MartinOlsson 0]

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Same with France and Italy and Spain, etc. Fairly homogenous. It's easy to set up a "system" that responds ti the same people having the same problems. A diverse place like the US is a different story.

Please define "fairly homogeneous". I would venture to say that in a way Europe has become more diverse than America. Most European countries have fugitive laws that probably makes it "easier" to come to Europe, because of humanitarian reasons, than the US. There is for example small cities in Sweden that has taken more Iraqi fugitives than the whole of America. The same goes for Somalis a couple of years back. Where i live 20 % of the residents are not native.

/Martin

[jerryzflies 0]

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Same with France and Italy and Spain, etc. Fairly homogenous. It's easy to set up a "system" that responds ti the same people having the same problems. A diverse place like the US is a different story.

Please define "fairly homogeneous". I would venture to say that in a way Europe has become more diverse than America. Most European countries have fugitive laws that probably makes it "easier" to come to Europe, because of humanitarian reasons, than the US. There is for example small cities in Sweden that has taken more Iraqi fugitives than the whole of America. The same goes for Somalis a couple of years back. Where i live 20 % of the residents are not native.

/Martin

A stroll down Charing Cross Road in London would surprise him too.

If you can't fix it with a hammer, the problem's electrical.

[MartinOlsson 0]

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I try to offer an alternative to those women other than going to the teaching hospitals (publicly funded and VERY inefficient).

Just a thought from someone that has worked at both publicly funded teaching hospitals and just plain publicly funded: The inefficiency don't seem to be because of the funding rather the teaching and the subsequent super specialization and academically vain atmosphere.

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Why am I so harsh on this? Because if you have a history of drug use, and your pregnant and you complain about intermittent chest pain - I NEED you to be seen and evaluated by cardiology. If you're not having the pain at that moment, you don't need to go to the ER, but you DO NEED to be evaluated!!! To just decide not to and then to have a catastrophic event during labor puts me in SUCH a legal risk!!! And yes... there is some of this that is about me. I don't want to be sued of everything and lose my licence because of non-compliance. In theory could I "win" that case? Maybe. Depends on the lawyer and the jury. If she dies... my malpractice insurance might decide to settle despite whether or not I was "right." If they settle, that looks bad on my record for the rest of my career. So I want to maintain the right to fire her. Other reasons to fire patients: intolerable rudeness. My staff does NOT deserved to be sworn at or work in a hostile environment. I do not deserve to be threatened by an angry father that has an incorrect sense of entitlement (NO, sir. It is NOT your "right" to do that)

Wouldn't it be nice to take most of the lawyer and funding crap out of this equation? Would that really make it less efficient?

/Martin

[nerdgirl 0]

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it's a side note... but I would agree with that statement when comparing "average" populations of both cultures. We have higher rates of obesity.

Actually, higher obesity rate (& smoking rate) should correlate with *decreased* cost overall for a national healthcare system.
Sounds counter-intuitive at first, eh?

Healthy (non-smoking, non-obese) people cost more over a lifetime. Perhaps not per year … but they live longer and the amassed cost of living longer and diseases of old age make them cost more, e.g., 10 years at $5K is still less than 14 years at $1K + 1 year at $50K. Health care costs increase as one get older. If you die young, one avoids long-term care (that costs more) and diseases of old age, Parkinson’s, Alzheimer’s, etc.

Primary Data “Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure”

“The obese cohort has the highest health-care costs for diabetes and musculoskeletal diseases compared to the other cohorts. Lifetime costs for cancers other than lung cancer are equal for all cohorts. Despite differences in life expectancy, the costs for stroke are similar for all cohorts. The most pronounced difference in costs occurs in the category ‘costs of other diseases,’ which is purely the result of different life expectancies.

“Despite the higher annual costs of the obese and smoking cohorts, the healthy-living cohort incurs highest lifetime costs, due to its higher life expectancy, as shown in Table 1 (attached). Furthermore, the greatest differences in health-care costs are not caused by smoking- and obesity-related diseases, but by the other, unrelated, diseases that occur as life-years are gained. Therefore, successful prevention of obesity and smoking would result in lower health-care costs in the short run (assuming no costs of prevention), but in the long run they would result in higher costs.”

Secondary accounts,

Science Daily “Lifetime Medical Costs Of Obese People Actually Lower Than Costs For Healthy And Fit, Mathematical Model Shows

NPR “Study: Healthy People Cost Governments More”

MSNBC “Actually, it's a long, healthy life that costs more”

The model is purely monetary driven and does not make attempts to value quality of life or opportunity costs either from longer, healthier years, on public health concerns, or from quality medical care. Nonetheless, it does suggest that the perceived correlation between American “cultural” tendencies and healthcare cost needs more examination.

And while I agree that American "cultural" tendencies does suggest certainly suggest variables worth investigating, a limited set (there are others beside smoking and obesity, we just fixate on those two, imo) of behavioral traits do not appear to be the (an?) independent variable in determining healthcare costs.

[semi-facetious/farcical]
Us non-smoking, healthy-eaters -- & vegetarians are worse , stair-climbers, should get down off our high-horses … because on average we’re going to cost the healthcare system more in the long run. T
he economically responsible thing to do is to die at age 65.
(Logan’s Run anyone?)
[/semi-facetious/farcical]

Now am I going to start smoking, stop eating healthy, and stop climbing stairs? No.
I like having a resting heart rate in the 50s. When I had more free time and was running a lot more I tried to get it down to the 40s (never made it).
I’m going to maintain those behavioral choices not because I irresponsibly want to cost more in healthcare (statistically) but because, admittedly quite selfishly, I like climbing mountains and trekking to really big ones in other countries.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[jerryzflies 0]

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I like climbing mountains and trekking to really big ones in other countries.

/Marg

OK, BUT WHERE DO YOU JUMP?

If you can't fix it with a hammer, the problem's electrical.

[nerdgirl 0]

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Another example: Intrauterine Devices (Mirena) This is a VERY good and VERY reliable method of contraception that medicaid had said that they were going to drop. I FOUGHT against that decision. I was PISSED that the government was going to take away this option for a VALID AND RELIABLE contraception because the upfront cost was more than a few pack of pills. The gov'ts argument was that some of the women take them out before 5 yrs and they don't get the monies worth out of it. BAD argument.... so the government is saying that just cuz some women don't tolerate it and want it removed or because some women have changes to their life situations and feel that they are ready for another child before the 5yr mark, they are no longer providing it? But with medicaid, the government CAN AND DOES say that. And doctors have to FIGHT the government. That gets very tiring and not many do.

Maybe I'm reading it differently, but doesn't that example show that the system worked?

As I recall the Mirena IUD was approved by the FDA in 2001.

It is still available (another source from Jan 07) and paid for by Medicaid, yes? (Like commercial/private sector providers, Medicaid has a formulary that determines what will be paid and what won’t, as you know.)

And the Mirena IUD is still available on health-based, not purely money-based reasons, yes?

Sounds like the system worked: metaphorical ‘bean-counters’ proposed a rule-change based purely on economic models; doctors said no, that’s not a complete picture of the issue. Doctors with the best interest of patients well being and public health advocates presided.

Opposition, or probably more accurately issues of prioritizing economic benefit over women's health, has also come from the private insurance industry:

“According to the Alan Guttmacher Institute, a not-for-profit group specializing in reproductive health issues, half [i.e., half don’t-nerdgirl] of traditional indemnity policies or managed care plans that allow a choice of providers cover prescription contraceptives, including IUDs. However, virtually all cover the pricier, riskier, irreversible surgical option, which nets doctors $1,950 on average, compared with only $345 for IUD insertion and related office visits, according to the Reproductive Health and Technologies Project.”

Opposition also came from the folks who are opposed to Medicaid in general, Medicaid paying for any reproductive health-related services, or any form of birth control. Remember the DHHS draft rule change effort last summer that would have re-defined -- non-medically -- oral contraceptives and IUDs as abortion devices? That had the potential, if enacted, to severely restrict or eliminate all access to oral contraceptives and IUDs by Medicaid recipients. And that was neither driven by economic models nor medicine.

/Marg

Act as if everything you do matters, while laughing at yourself for thinking anything you do matters.
Tibetan Buddhist saying

[GeorgiaDon 340]

So professional careers that require a degree beyond the batchelors should be restricted to people who are wealthy enough to not have to work their way through grad school. As a general rule part-time jobs don't come with benefits. Also, at least in the sciences, grad school is (or should be, if the student actually hopes to finish and have a career subsequently), at least a full-time job in itself. Grad school and part-time job adds up to a 60-70 hr work week. It doesn't get much slacker than that!

Anyway, in your opinion "come from a low-income family"="learn your place, don't bother to try for that career, McDonalds is good enough for your sort". Got it.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[jcd11235 0]

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I deal with this.

Do you?

Or do you just sit on a computer and whine about those that are trying to fix thing?

Yes, I deal with it by being informed and voting for elected officials who will make every attempt to correct the problems with the system, such as Obama. I vote for what is best for the nation as a whole, not just what is best or most convenient for me.

One does not need to be a doctor to understand that the healthcare system is broken, or to understand why the private, for profit model is very unlikely to be successful.

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[kbordson 8]

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Another example: Intrauterine Devices (Mirena) This is a VERY good and VERY reliable method of contraception that medicaid had said that they were going to drop. I FOUGHT against that decision. I was PISSED that the government was going to take away this option for a VALID AND RELIABLE contraception because the upfront cost was more than a few pack of pills. The gov'ts argument was that some of the women take them out before 5 yrs and they don't get the monies worth out of it. BAD argument.... so the government is saying that just cuz some women don't tolerate it and want it removed or because some women have changes to their life situations and feel that they are ready for another child before the 5yr mark, they are no longer providing it? But with medicaid, the government CAN AND DOES say that. And doctors have to FIGHT the government. That gets very tiring and not many do.

Maybe I'm reading it differently, but doesn't that example show that the system worked?

/Marg

Yes. But only because physicians had to FIGHT the decision of the government. Why do we have to battle the "bean counters" to give good care? Because I don't want to be the evil one to tell these ladies - "There are other options that might be best for you.... but you don't get to have it.... unless you pay out of pocket."

[jcd11235 0]

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Yes. But only because physicians had to FIGHT the decision of the government. Why do we have to battle the "bean counters" to give good care? Because I don't want to be the evil one to tell these ladies - "There are other options that might be best for you.... but you don't get to have it.... unless you pay out of pocket."

Don't look now, but you're making an argument supporting universal healthcare over private, for profit care.

Math tutoring available. Only $6! per hour! First lesson: Factorials!

[kbordson 8]

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Yes. But only because physicians had to FIGHT the decision of the government. Why do we have to battle the "bean counters" to give good care? Because I don't want to be the evil one to tell these ladies - "There are other options that might be best for you.... but you don't get to have it.... unless you pay out of pocket."

Don't look now, but you're making an argument supporting universal healthcare over private, for profit care.

No ... I'm not. I'm saying that I do not WANT to and MANY physicians do NOT fight the decisions by the government. In that situation, the patients will be limited in their options.... and the physicians will have to be the evil ones to tell them "no."