tag:blogger.com,1999:blog-8198390912401056862.post488080019882959899..comments2023-10-14T06:19:18.000-05:00Comments on Rocket Scientist: If I Were DictatorStephanie Barrhttp://www.blogger.com/profile/17772217449161603561noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-8198390912401056862.post-10328091745369000562009-06-18T13:07:43.054-05:002009-06-18T13:07:43.054-05:00You are correct. I never have. Let's not con...You are correct. I never have. Let's not confuse poor implementation with a poor idea. Like my non-profit organization, doctors are paid (and paid well) but costs are directly correlated to costs of facilities, materials and salaries vis-a-vis fees without siphoning off some percentage or portion to make money for those not directly involved. Nor have I ever caviled at doctors and other medical practitioners be given a good return for their years of work and and their expertise and time.<br /><br />Can you say doctors always reap all the benefits of the profit from a for-profit hospital? No doubt that is sometimes the case, but it's the need to generate profit among investors and stockholders and business managers that are probably driving the profit margins for many hospital chains and the like.<br /><br />When a hospital sends million/billion dollar bonuses/dividends to CEOs, upper management and stockholders, that is someone profiting from someone else's suffering.<br /><br />In my opinion.Stephanie Barrhttps://www.blogger.com/profile/17772217449161603561noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-89289262888828876662009-06-18T12:52:40.365-05:002009-06-18T12:52:40.365-05:00Obviously, Stephanie, you have never worked in a V...Obviously, Stephanie, you have never worked in a VA hospital. The waste and abuse would astound you.<br /><br />I don't think doctors see it as "profiting" from other people's suffering.<br /><br />I think we see it as being reasonably reimbursed for our expertise, educational expenses, and all those years when we were NOT out there making a living.The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-60793336328599050772009-06-18T11:20:17.095-05:002009-06-18T11:20:17.095-05:00I would love to see affluence and celebrity elimin...I would love to see affluence and celebrity eliminated as factors in the level and speed of health care and, if you're asking my opinion, I love the idea of government hospitals or any other non-profit hospitals. I have no problem with the notion of providing a decent living for medical practitioners, but it's hard to get behind the notion of people who profit from the suffering of others. (Doctors might very well disagree with me).<br /><br />You not only subsidize other people's health insurance (if you're healthy), you also provide profits to health insurance companies and subsidize uninsured people's healthcare. And huge class action malpractice suits. Except, it's pretty untraceable and unregulated today.Stephanie Barrhttps://www.blogger.com/profile/17772217449161603561noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-24743063335964525742009-06-18T11:07:47.579-05:002009-06-18T11:07:47.579-05:00I see in the news this morning that Hillary Clinto...I see in the news this morning that Hillary Clinton fell and broke her elbow. The article said she was treated at nearby George Washington University Hospital. I'm guessing for free, or at least that they didn't make her wait until she showed her insurance card. I'm also guessing she didn't have to wait as long as some of our veterans who are seeking treatment.<br /><br />But, sarcasm aside, this brings up another area crying out for improvement, and which perhaps might offer another source of greater economy: government hospitals. (OK, GWUH is not a Government hospital, but you know the ones I mean.) When I say economy, I mean efficiency - not closing needed hospitals and clinics. They are already too far and few, at least in the West. But there is so much there to clean up.<br /><br />Okay, sarcasm picked back up again: I wish Hillary well.<br /><br />I will still watch our president though. He seems intent on outspending even the Republicans. Wow.<br /><br />And, if I ever get an irresistible urge to pay for other people's health insurance, I'll be sure and let you know.<br /><br />I guess I already do. Never mind.Relax Maxhttps://www.blogger.com/profile/01051381168322495999noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-89067442482789202052009-06-18T09:21:34.532-05:002009-06-18T09:21:34.532-05:00Melissa:
Hospitals and nursing homes are underst...Melissa: <br /><br />Hospitals and nursing homes are understaffed because they are under-reimbursed. If you aren't making enough money to pay your staff, the staff is the first to go. That's the same reason you can never find a clerk in a discount store.<br /><br />Electronic records are great. Yes, they will cut out mistakes. But you missed the crux of the argument. The HIPAA regulations that went into effect a few years ago (Health Insurance Portability and Accountable Act) effectively sunk e records for most purposes, because it's virtually impossible to guarantee patient privacy when you're blasting the patient's records onto the web. Only the most lucrative of practices have been able to meet the 20 standards and 36 specifications set forth by HIPAA. Others have simply deemed it untenable until something else happens. Ditto emailing patients--HIPAA standards apply and must be met.<br /><br />The end of life issue was part of my long conversation with Stephanie, and she did paraphrase it in her posts. Depending on which study you read and in which decade it was done, 70-90% of health care dollars are spent in that last year of life. <br /><br />That's an enormous number. But patients expect that care. I can't count the number of times my husband (who is the one of us in patient care medicine) told a family that further care was futile and potentially painful, only to be informed that he was to do everything possible to "keep grandma alive" or he would be facing a lawsuit.<br /><br />We are going to have to lose this mentality. It is simply not done anywhere else in the world--in any nationalized/managed healthcare system, the docs have the final say on when enough is enough.<br /><br />And yet, in America, the patients, who are often ill informed and running on emotions, make that call. And they have the weight of the courts behind them. It's the reason that we develop more and bigger and nastier surgeries for pancreatic cancer, in the futile attempt to keep people alive for 6 months instead of the usual 4, two of which are spent in the ICU (and that gets reported as a 33% survival increase!).<br /><br />I'd rather be drinking margaritas on the beach. And until the rest of America gets that, healthcare costs are NOT going to come down.The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-50690748934342017452009-06-18T05:45:50.490-05:002009-06-18T05:45:50.490-05:00The mother, I agree I do not agree with every aspe...The mother, I agree I do not agree with every aspect of Obama's plan. Tort reform, and medical malpractice issues must be addressed. He is a lawyer and he should know that. However hospitals, and nursing homes need to start brunting some of the responsibility where malpractice is concerned. Low staff ratios to high patients, is never safe. Giving assignments to nurses who are uncomfortable, or untrained only increase the risk. There are so many issues, for malpractice not just the docs. As for electronic records, it will be no less secure than any other form of electronic filings. It is faster,more efficient, and will cut down on mistakes. If it is too expensive, then they can offer some kind of assistance to get it done, esp since they want it so bad. As for end of life care, I am unsure of your issue because you did not clarify that.Melissahttps://www.blogger.com/profile/17553319266378782849noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-33112163724310697282009-06-17T15:12:43.180-05:002009-06-17T15:12:43.180-05:00I agree with you, the Mother. I have no idea if O...I agree with you, the Mother. I have no idea if Obama does or not but I know the democrats in Congress do not. He couldn't offer it to you because it's just not possible in the first go round. Even if he were willing to champion it, he can't get it without hard numbers proving what you know is true - which you and I know no one can produce because no one can admit to CYA practices. In the news, they still say it only makes 0.5% difference to overall costs - without data to back it, people won't want to believe (and, yes, even though many people demand unnecessary procedures). (Yes, I'm rolling my eyes)<br /><br />I know you're right. I know real tort reform (well overdue) will be required before we can get this problem licked. I don't know if it is possible (short of something miraculous) in the first go round. I'd certainly support it (and will dictate it if I become dictator), but I can't tell you it will happen as soon as it should. I wish I could.Stephanie Barrhttps://www.blogger.com/profile/17772217449161603561noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-24170435825546110842009-06-17T15:04:53.245-05:002009-06-17T15:04:53.245-05:00Granted. All of that.
But Obama made a pretty big...Granted. All of that.<br /><br />But Obama made a pretty big faux pas when, with one breath, he told doctors to cut costs, and with the other, he told them that he would not support tort reform. <br /><br />People don't realize how big a problem this is.It's not just the cost of the malpractice insurance and the big payouts. CYA medicine is practiced routinely. There's no getting around it. If it's even REMOTELY possible that you might miss something, no matter how remote, you have no choice but to order the test. There's a reason that I got an MRI every 6 months when I had migraines. NO ONE wanted to miss that brain tumor in a young mother of four.<br /><br />But that costs $$$. And telling docs that they have to cut costs, without giving them the tools to do that, is pretty bad policy. And it means stiff opposition from the guys Obama really needs on his side.The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-51900194379951949582009-06-17T11:16:31.148-05:002009-06-17T11:16:31.148-05:00The Mother, I think a big part of why any reform i...The Mother, I think a big part of why any reform is going to be challenging is that most people perceive doctors/hospitals as the problem - cause they're the ones sending the bills. People don't see the insurance money squirreled away as a cost because it's never in their hands, it's taken out of their paychecks and augmented (often silently) by employers.<br /><br />Health care costs is bigger than telling doctors: don't do tests you don't need and charge us less. There are reasons they cost so much and reasons why more tests might be performed than necessary (Try telling a patient who's convinced herself she needs an MRI not to get one).<br /><br />If steps aren't taken to address the root causes for the high cost in addition to the other changes, the problem won't be solved, we'll just have more victimized doctors and, folks, that means even fewer doctors.<br /><br />But, I maintain, sticking to the status quo is not going to do anything but increase the perception of doctors as the bad guys.Stephanie Barrhttps://www.blogger.com/profile/17772217449161603561noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-21912412439474821022009-06-17T10:59:30.539-05:002009-06-17T10:59:30.539-05:00Okay. Melissa: electronic records are a grand idea...Okay. Melissa: electronic records are a grand idea, and most doctors support them. But the HIPPA regulations (from the government) make e records exceptionally difficult. Which is why most offices still use paper. That plus, of course, the massive costs to the doc to switch over, which is hard to bear when the practice is barely making it as it is.<br /><br />The problem I have with the plan as outlined is that it does NOT address the major costs of healthcare--malpractice, end of life care, etc. It just fiats low costs--and fiats never work.<br /><br />If docs are supposed to roll over on this, cut costs, cut unnecessary expenses and procedures, it seems that they should at least get the protection of not getting sued because they DID.<br /><br />Putting the cart before the horse is never the best idea.The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-22302343466889630712009-06-17T06:48:28.758-05:002009-06-17T06:48:28.758-05:00Obama has had things he wanted passed, but almost ...Obama has had things he wanted passed, but almost never in the form he proposed. In almost every case, key concessions have robbed the bills of much of their power. <br /><br />Everyone resists change, not just doctors. I think one problem is that electronic records, with sufficient safeguards to protect the privacy we demand, are expensive and it's one more expense when many doctors are already struggling. I personally think the potential good far outweighs the inconvenience.Stephanie Barrhttps://www.blogger.com/profile/17772217449161603561noreply@blogger.comtag:blogger.com,1999:blog-8198390912401056862.post-37201255585278208762009-06-17T05:25:00.764-05:002009-06-17T05:25:00.764-05:00Actually I think he is going to have it pretty eas...Actually I think he is going to have it pretty easy, just like everything else he had done. He has the majority votes, and it will probably go right through. You have a good feel of how things should work. Electronic dr orders, are something that should have happened long ago, but doctors resist change.Melissahttps://www.blogger.com/profile/17553319266378782849noreply@blogger.com