So now we got health care

[atheisticmystic]

Please enlighten us on the REAL problem as to why Greece is failing...

Be enlightened:

http://www.stratfor.com/weekly/germanys-role-europe-and-european-debt-crisis

As for my language "softening the blame of a shit storm"...

Having a medicinal marijuana card does not excuse excessive use Mirror.

HTH

[Mirror]

Be enlightened:

http://www.stratfor....ean-debt-crisis

As for my language "softening the blame of a shit storm"...

Having a medicinal marijuana card does not excuse excessive use Mirror.

HTH

From your article:

"There were two causes. The first was that Greek democracy, like many democracies, demands benefits for the people from the state, and politicians wishing to be elected must grant these benefits. There is accordingly an inherent pressure on the system to spend excessively. The second cause relates to Germany's status as the world's second-largest exporter. About 40 percent of German gross domestic product comes from exports, much of them to the European Union. For all their discussion of fiscal prudence and care, the Germans have an interest in facilitating consumption and demand for their exports across Europe. Without these exports, Germany would plunge into depression.

Read more: Germany's Role in Europe and the European Debt Crisis | Stratfor

[David Waelder]

At this point, there’s not much chance that a post from me will persuade anyone not already won over so my contribution is really just an opportunity to stand in good faith with some of my associates.

We’ve all heard the stories about farmers working in the various agricultural collectives in the Soviet Union. It’s always the same: the yield from the personal gardens is prodigious while the communal fields produce barely enough to cover expenses. While it’s tempting to conclude that all enterprises work just the same way, producing a profit only when the participants are rewarded exactly in proportion to their efforts, the world isn’t quite that neat and simple.

Becoming a doctor is a pretty difficult process and has been for a long time. Because admission to medical school is competitive and there are relatively few slots, only candidates with top grades, particular in challenging subjects like organic chemistry, are eligible. Once admitted, they have a grueling study schedule. And on graduation, they still face at least two years of additional training in internship/residency programs. It’s a long and difficult slog before they can make the big bucks.

If making money were the sole motivation, better earnings are available in investment banking on Wall Street. The doctors I’ve known (full disclosure: many in my family are physicians) are highly motivated by the opportunity to live a purposeful life that makes a real contribution. That’s not to say that they don’t appreciate earning good wages, just that it isn’t necessarily the primary motivator.

Many physicians, either because of intellectual curiosity or to fulfill that goal of living a purposeful life, devote considerable time to medical research. In some cases this is done for a pharmaceutical company and is well rewarded. But most medical research is done in association with a university and funded from government or private foundation grants. This work does not pay nearly as much as private practice but it is reasonably well paid. Grants from government agencies put a cap on salaries but it’s not a parsimonious figure. The exact caps vary with discipline but they are at least $200,000 per year and often more. That’s not a great fortune and certainly less than what a surgeon earns but it’s hardly a meager living.

There are some factors that tend to drain the pleasure from the practice of medicine and make if difficult for a doctor to perform at his best. But these forces are already present in the marketplace today. Most doctors will spend a significant portion of their professional lives working for HMOs or managed care organizations of some sort. Every physician I know feels unreasonably bound by demands to see a certain number or patients every day and to spend minimal time with each patient. It’s much like working a low budget television series.

I don’t cry too many tears for them; it’s still a good life even when it’s demanding. I just wanted to shift the focus a bit; things aren’t as great in the private health care system as is being suggested, Furthermore, many doctors have more complicated motivations than either pure altruism or desire for high earnings.

David

[Olle Sjostrom]

Great post David! And billy and Robert you all wrote great things.

[jason porter]

http://www.buzzfeed.com/daves4/people-moving-to-canada-because-of-obamacare

[atheisticmystic]

Your highlighting stops after the cause that confirms your own biased opinion, but as your quote shows, there is a second cause as well. This is my problem with you Mirror, you don't seem to consider the entirety of the situation.

[Jay Rose]

I can only speak about people I personally know in Mass... People I know up there seem happy with it.

+1. Boston, self-employed for most of my career (no union, no company health plan). Works fine for me, my adult children, and everybody I know in similar situations.

[Jay Rose]

Update to the post immediately above:

I just got an invoice from my insurance company: $111 CREDIT!

One of the things Massachusetts Romneycare and National Obamacare both provide is "honesty checking" on the insurance companies: if they're making too much profit because they're not paying a certain percentage of the premium out in claims, they have to give some of the premium back!

That's the kind of "tax" I can live with.

[RandyHall]

And here I thought this board was all about sound.

Okay, the so-called "tax" is really for freeloaders who believe they don't need healthcare coverage when they can afford it. This does not raise taxes on people who carry health insurance already. Quit complaining about your taxes being raised, because if you can afford to buy health insurance and you aren't, you're already an asshat who needs a boot to the head. Man up and pay for it.

Costs are not controlled either way (with or without Obamacare), so claiming that it's increasing costs is something of a non-sequitur. Costs have been increasing at breakneck speed, and increasing the number of people (healthy ones as well as sick ones) is likely to level the risk pool and help control costs.

Funny thing is that a bunch of opponents are now trotting out the argument that doctors are going to somehow be in short supply, since they are all going to quit in protest of Obamacare surviving the Supreme Court.

[dfisk]

Funny thing is that a bunch of opponents are now trotting out the argument that doctors are going to somehow be in short supply, since they are all going to quit in protest of Obamacare surviving the Supreme Court.

Speaking from personal experience (I have family and a lot of close friends that work in medicine), there are a lot of doctors retiring early, not necessarily out of protest, but because they deal with medicare billing, and they see the writing on the wall with the government subsidized option. It's a really long reason, but the short of it is, doctors don't get paid for a really long time and they only get paid a really small percentage of their bills when they deal with medicare. If you a bunch of people that sign up for the low cost government health care program, now that problem has grown by a huge number. The cost of doing business isn't going to go down because the government makes everyone get health care, but the income coming in will go down. In fact, the cost of doing business is going up. Malpractice insurance is through the roof, even if you've never filed a claim, and the riskier the "job" you do (think heart surgery or brain surgery), the higher your cost. We are seeing people retire early, and there is a need for new blood in the medical field, and it's not being met. My dad has actually pushed his retirement because there aren't enough physician's assistants in his group, and he's still pulling 70 hours a week at 63 years old. He was going to retire at 65, but the prospects don't look good for new people, so he's pushing it to 67. It's hard to get people right now because the barrier to entry is so high, and the hours are grueling, and dealing with billing is a pain in the butt. So, when they do get someone new, it's usually someone not from cardiac surgery. Their latest PA came from pediatrics, and it was a year until she could take call by herself. I guess what I'm getting at is there are all kinds of inner workings in medicine that most people have no clue about, and the people that we should really be talking with this about are the doctors and nurses and physician's assistants and the billing departments. THOSE are the people who really know how this will affect the world of health care. Not the insurance companies, or us, or the government.

[RandyHall]

they deal with medicare billing, and they see the writing on the wall with the government subsidized option.

Love your signature, BTW

I disagree that the answer is to do nothing.

The answer certainly isn't just tort reform. Doctors and healthcare providers are human and make mistakes, the difference from other industries being that when they make mistakes, peoples' lives are adversely affected or even ended. There should be accountability there. So-called "frivolous" lawsuits are usually addressed by the losing party having to cover the legal costs of the prevailing party. Why can't reform also include putting limits on liability insurers to prevent them from gouging doctors?

This whole subject is one big ugly Gordian knot, with no Alexander the Great to come along and cut it.

[dfisk]

I agree, I didn't mean to suggest that nothing be done, but I think the people that should be consulted on fixing the problem are the people on the front lines of health care, not politicians. I certainly don't have a good answer, I just know the inner workings of the problem reasonably well, and know that it is a lot more complicated than most people realize.

[RandyHall]

I think the people that should be consulted on fixing the problem are the people on the front lines of health care, not politicians.

If only the people on the front lines of health care were able to make policy. Sheesh.

[dfisk]

I'm not trying to take a side here, I'm just stating what's really going on. I'm not suggesting those people make policies, but they should at least be consulted, and I'm not talking about one or two people. I'm talking about a larger sampling of medical professionals.

[bigmaho]

I'm not trying to take a side here, I'm just stating what's really going on. I'm not suggesting those people make policies, but they should at least be consulted, and I'm not talking about one or two people. I'm talking about a larger sampling of medical professionals.

What makes you think they weren't?

[dfisk]

There were some people "consulted", but not like the way it should have been. My father had been to medical conferences where pretty much everyone there (we're talking LOTS of people) were very upset with how the legislation was drafted and passed. I don't know all the nitty gritty details, I just know there was much displeasure among the medical crowd. Again, I'm not taking sides here, I'm just stating what is going on from the perspective of the people that actually do the work. Most all of them agree there needs to be some sort of reform, though.

[Jay Rose]

My father had been to medical conferences where pretty much everyone there (we're talking LOTS of people) were very upset with how the legislation was drafted and passed.

Making laws is like making sausages... you'd be disgusted if you knew how it was done.

(Come to think of it, doesn't that apply to a lot of surgery as well?)

[dfisk]

(Come to think of it, doesn't that apply to a lot of surgery as well?)

Yeah, it does. I've seen it. Brain surgery is the eeriest thing I've seen. Your brain actually pulsates...and seeing a human heart beating while the chest is open is...well...interesting...

[OmahaAudio]

There were some people "consulted", but not like the way it should have been.

The AMA were consulted and came out in favor of the Affordable Car Act. As did the American College of Physicians, the American Academy of Family Physicians, the American College of Surgeons, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology...

Looks like a lot of consultation to me.

[dfisk]

That list is very deceptive. Again, I'm not for or against anything here. Basically, you had a small group of people from the organizations you listed hand picked (this is what I was told from medical professionals, so I cannot vouch for its validity) by the government to give their opinions on the bill. The actual working people, had no voice in this. Most of the folks I have talked with have said they want some sort of reform, but they have differeing ideas on how to do it. There's more than one way to skin a cat.

In the end, it doesn't really matter. The supreme court has made its ruling, and depending on how the election goes this fall, it'll either be repealed (maybe) or go into effect in 2014. We can speculate all we want about what will really happen, but the outcome remains to be seen. I will add...I found the "obamacare upheld. screw this. i'm moving to canada" posts on facebook pretty funny.

[bigmaho]

The medical establishment doesn't have lobbyists? MD's didn't write their congressmen and senators? or letters to the editors? If there weren't so many people involved it wouldn't be a 4000 page bill. It's a mess, but so is democracy. Big money medical can buy their way in, smaller money medical and the patients they deal with made their voices heard via their representatives or the voting booth. I'm curious what your doctor friends who weren't listened to would have told their representatives if they took the time to contact them (or were they such important doctors that they were waiting for President Obama to call them. Maybe he did but couldn't get an appointment).

[bigmaho]

That list is very deceptive. Again, I'm not for or against anything here. Basically, you had a small group of people from the organizations you listed hand picked (this is what I was told from medical professionals, so I cannot vouch for its validity) by the government to give their opinions on the bill. The actual working people, had no voice in this. Most of the folks I have talked with have said they want some sort of reform, but they have differeing ideas on how to do it. There's more than one way to skin a cat.

In the end, it doesn't really matter. The supreme court has made its ruling, and depending on how the election goes this fall, it'll either be repealed (maybe) or go into effect in 2014. We can speculate all we want about what will really happen, but the outcome remains to be seen. I will add...I found the "obamacare upheld. screw this. i'm moving to canada" posts on facebook pretty funny.

It won't be repealed. They would have to get the presidency and 60 Senate seats to even make a stab at it, plus they would have to come up with an alternative which they have no intention of doing. In any event it would be politically impossible to take away what has already been given (no more lifetime caps, no dropping people for pre-existing conditions, etc). I have no doubts the law will be modified in the coming years. As it is implemented its strengths and weaknesses will become apparent. If the Republicans ever decide to re-join the political process (as opposed to my way or the highway) they may actually have some creative future input.

[old school]

It won't be repealed. They would have to get the presidency and 60 Senate seats to even make a stab at it, plus they would have to come up with an alternative which they have no intention of doing. In any event it would be politically impossible to take away what has already been given (no more lifetime caps, no dropping people for pre-existing conditions, etc). I have no doubts the law will be modified in the coming years. As it is implemented its strengths and weaknesses will become apparent. If the Republicans ever decide to re-join the political process (as opposed to my way or the highway) they may actually have some creative future input.

Mr Big, you are right IMO. I do hope the Regressive Party returns to it's Republican roots and re join the political process. We need a functioning government that represents all the people and their wide range of POV's and not just the $$$ interests. As messy as it is, the people want a democracy that works.

CrewC

[Solid Goldberger]

I had an interesting conversation with my dermatologist after going in to have a mole removed, where he basically said what you're saying Dave, about the costs going up and the reimbursements going down. I feel for them, as nobody likes to make less money or work harder then they were for any reason. Additionally, most American doctors fit into the tax bracket the most appeals to the political party that was trying to shut down this legislation, so its hard for me to imagine that as a whole they are exactly impartial on this subject. Your father sounds like a good dude, but I'm not quite ready to shed tears for the poor doctors quite yet. Where I come from they're still driving Benzes and Audis, while I take the subway.

[dfisk]

The medical establishment doesn't have lobbyists? MD's didn't write their congressmen and senators? or letters to the editors? If there weren't so many people involved it wouldn't be a 4000 page bill. It's a mess, but so is democracy. Big money medical can buy their way in, smaller money medical and the patients they deal with made their voices heard via their representatives or the voting booth. I'm curious what your doctor friends who weren't listened to would have told their representatives if they took the time to contact them (or were they such important doctors that they were waiting for President Obama to call them. Maybe he did but couldn't get an appointment).

Actually, yes, many of them did write letters, or e-mails, and made phone calls, but they fall on deaf ears.