What To Do About Healthcare

[Guest]

There is a long thread on "where do you stand on universal healhcare" that prompted lots of interesting replies. Clearly some are "for" and some are "against" universal healthcare--whatever that is.

But there are a couple of problems that remain that everyone agrees need to be addressed. "Everyone" includes Democrats, Republicans, ultra conservatives and flaming liberals. The problems everyone agrees on are...

-- Healthcare in the U.S. is too expensive, and it is getting even more expensive at a rate that is simply not economically sustainable over a relatively short timeframe. Healthcare in the U.S. costs 50% more per capita than any other developed country, and the quality of care is not that much better.

-- Far too many Americans have no form of healthcare insurance whatsoever. For one of the most well-developed countries in the world to have almost 50 million people--almost 20% of it's population--with no form of healthcare insurance is not only unbelievable, but bordering on criminal.

So, presuming that regardless of our political leanings, I'm assuming that everyone here on this forum lines up with their political representatives in recognition of these two problems. The problems cited above are real and need to be addressed.

So, if you were a member of Congress, what sort of plan to address these problems would be acceptable to you? We've heard from our elected representatives ad infinitum in recent days. Their comments range from "these are the general concepts that President Obama wants in any plan passed by Congress" to "xxx makes any healthcare bill a non-starter for our party".

Recognizing the confusion of "the 545" regarding this issue, maybe we can enlighten one another with just a few important points in whatever plan we might find acceptable? Specificity would be helpful.

Let the creativity begin.

[Guest]

Single payor, similar to Canadian system.

[Guest]

Any existing models of universal health care, involves rationing. I am against rationing. Most health care is needed the closer to the end of life that we get. I am not for some snot nosed RMV caliber worker determining that I am not worth the expense. Perhaps I don't pay enough taxes? Perhaps I voted the wrong way.

Call me selfesh but, I WANT TO LIVE.

Yoda

A member of the loyal opposition

[Guest]

Random thoughts for starters.

First order of business - a full frontal assault on tort reform with a concentration on medical malpractice. It is obvious that these claims drive a significant part of medical costs.

Our educational system needs to increase opportunities for talented young Americans to receive their medical training in this country. Concurrently, we need more doctors to create more competition and hopefully lower costs.

Major incentives for businesses small and large to adequately insure their employees.

Restructure medicare

Stop treatment of illegal immigrants - very tough decision because it goes against the values we preach and live by. However, the drain on our system is clearly demonstrated in California's predicament. If rationing is the current administration's plan for the future of medical care in the USA, ration by taking Americans first. Their taxes support the system.

Form a special task force to work with every major drug company in America and the FDA to find creative ways to reduce costs for those in difficult financial circumstance. Explore tax incentives for those companies that participate.

Create a task force of medical professionals, insurance professionals, business and financial professionals to develop a serious single payer system NOT under government control. Government oversight? Possibly.

Excuse the hipshooting style.....this serious subject needs a lot more thought.

[Guest]

I think that the government's history of respecting life is not a good recommendation for overseeing a "Health" plan. The government "sanctions" sacrificing lives in war and also looks the other way when millions are aborted.
With that track record...how long do you think it would take before the elderly were expendable?:shrug:

[Guest]

Any existing models of universal health care, involves rationing. I am against rationing. Most health care is needed the closer to the end of life that we get. I am not for some snot nosed RMV caliber worker determining that I am not worth the expense. Perhaps I don't pay enough taxes? Perhaps I voted the wrong way.

Call me selfesh but, I WANT TO LIVE.

Yoda

A member of the loyal oppositionEverything you described ALREADY exists in our health industry. I deal with 'snot nosed RMV's daily telling me it's "not medically necessary". Almost everybody WANTS TO LIVE. So the 32 year old who stuck the palm trees in your yard who is trying to start his own business has a serious injury on the job... medical bills of over 20 K. What say you?

[Guest]

I think that the government's history of respecting life is not a good recommendation for overseeing a "Health" plan. The government "sanctions" sacrificing lives in war and also looks the other way when millions are aborted.
With that track record...how long do you think it would take before the elderly were expendable?:shrug:

Keedy, I cannot argue with your logic because I agree. You are succinctly on the mark. What a sad commentary on our government.

[Guest]

....
The problems everyone agrees on are...

-- Healthcare in the U.S. is too expensive, and it is getting even more expensive at a rate that is simply not economically sustainable over a relatively short timeframe. Healthcare in the U.S. costs 50% more per capita than any other developed country, and the quality of care is not that much better.

-- Far too many Americans have no form of healthcare insurance whatsoever. For one of the most well-developed countries in the world to have almost 50 million people--almost 20% of it's population--with no form of healthcare insurance is not only unbelievable, but bordering on criminal.

So, presuming that regardless of our political leanings, I'm assuming that everyone here on this forum lines up with their political representatives in recognition of these two problems. The problems cited above are real and need to be addressed.

......

I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are they evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.

[Guest]

I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are the evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.Not having health insurance absolutely and most definitely does mean uninsured people do not get health care services. What is the first question you get asked when you call a new provider for an appointment? "what kind of insurance do you have?" Do you think the example I gave above.. the young fellow who stuck the palms in your yard... is a rare, uncommon, poor example? he can't get medicaid (makes too much), he's too old for medicare, his monthly premium for his family of 4 would be over 1000 dollars and last year he made 26 thousand.

BTW, the "pool" you refer to above has a limited amount of money. As such, those that manage the pool (aka... "managed care") will tell you what you can or cannot take out of the pool. Thus, rationing. There is only 1 group that has no rationing at all--> those that pay cash for all of their care. For that group this debate has no meaning or impact on their care.

[Guest]

Not having health insurance absolutely and most definitely does mean uninsured people do not get health care services. What is the first question you get asked when you call a new provider for an appointment? "what kind of insurance do you have?" Do you think the example I gave above.. the young fellow who stuck the palms in your yard... is a rare, uncommon, poor example? he can't get medicaid (makes too much), he's too old for medicare, his monthly premium for his family of 4 would be over 1000 dollars and last year he made 26 thousand.

BTW, the "pool" you refer to above has a limited amount of money. As such, those that manage the pool (aka... "managed care") will tell you what you can or cannot take out of the pool. Thus, rationing. There is only 1 group that has no rationing at all--> those that pay cash for all of their care. For that group this debate has no meaning or impact on their care.

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/probono/directory.html# )

[Guest]

1. Tort reform. Eliminate the large settlements, force arbitration, and set a maximum allowable amount that a doctor could be sued. Eliminate bad doctors, and create subsidized insurance pools. When 40% of someones income goes to insurance, cost of medical care will never be contained.

2. Insurance payment reform. When a $20,000 bill gets settled for $2000 the system has already failed. First because the bill is so high and second because the payment is so low. Attack the cost side with number 1, attack the income side here and provide reasonable reimbursement for services provided.

3. Education reform. Help bright young people pay for college and medical school with the provision that they spend X number of years as a GP. Most doctors who graduate today will not become general practitioners. Not enough money to be made to pay for their education. So incentives to get doctors in these roles is needed. More nurse practitioners as well. Need to pay them more so they get to this role. Without addressing this issue we will have rationing of health care weather you can afford it or not.

4. Drug cost reform. It costs to much to develop a drug today. To much testing, the maintaining of a validated environment, meeting FDA rules, time from development to on the shelf, and also part of tort reform.

5. 50 million without insurance does need to be resolved. However if you are here "illegal", we need a different solution. It is not up to the American tax payer to take care of someone who broke our laws. If you are here legally and do not have insurance then we do need to create some sort of basic care and make it available at an affordable price to those in need. Clinics, pro bono work, generic drugs, some way to care for those in need.

6. Keep the government out of the solution except for these 5 things. A government run system will fail worse then the current system. I have not heard a single politician even mention tort reform and to me that is the number one problem.

[Guest]

I heard just this morning in order to sell his plan, Obama is offering the AMA malpractice reform. Question is, if it's good for the system, why not just do it anyway?

On forums we have spammers. In Washington we have scammers.

[Guest]

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/probono/directory.html# )Excellent idea--pro bono. Following your idea... pts pay for ALL time the physician spends on their case. You know, "the meter is running" concept.... "billable hours".... phone calls, reviewing lab results, consulting with other physicians, talking with attorneys, filling out forms are all billable to the patient.... in fact, everything is billable to the patient since physicians will now be like attorneys and simply charge per unit of time, directly to the pt.... there are actually a growing # of physicians doing exactly this. When you call their office you are not asked what type of insurance you have.... instead you are told, "DR Smith does not accept any insurance.... he accepts cask, Mastercard and Visa. " Also, if we are going to "mitigate health care the same way legal care is" we need to keep the playing field level... so malpractice ins needs to be on an even plane too.

[Guest]

"The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem."

This is part of an article written by a respected business writer, Robert Samuelson, and the link to the entire article is below...

http://www.realclearpolitics.com/articles/2009/06/15/wrong-way_health_reform_96997.html

I have been trying hard to get a bit of "smarts" on this subject, but it sure gets confusing.

Seems most, if not all, want some kind of REFORM, but the shape is quite a debate. There are even those who feel that the reform being touted will REDUCE the care for the most needy folks in society.

Thought I would drop this article off for comments as it was the first I had heard this particular viewpoint !

[Guest]

Thanks for the thoughtful list of what can and maybe should be "done about healthcare". Hopefully many more of our colleagues here will produce their lists to give us all something to think about. Too often we revert to doing the same things that our elected representatives do most of the time--argue about what we wouldn't do, as opposed to presenting some ideas for consideration, discussion, negotiation and maybe legislation.

If the electorate would take the time to figure out what we think is necessary as individuals, we'd be in a lot better shape when the time came to choose who we intend to vote for the next time around.

The top item on your list would be tops on mine, as well--tort reform. But as I'm remembering, that isn't among anyone's plans for reforming healthcare, is it? Or have I just missed someone's proposal?

[Guest]

1. Tort reform. Eliminate the large settlements, force arbitration, and set a maximum allowable amount that a doctor could be sued. Eliminate bad doctors, and create subsidized insurance pools. When 40% of someones income goes to insurance, cost of medical care will never be contained. People want $$-Limits on medical malpractice claims until they are harmed. When the GP made house calls, claims were rare, as the family patients and the GP had a relationship which provided understanding. Once the house calls ended and was replaced with the multi-exam-room approach where the patient became a "file folder with a number" and expected to endure waiting-room-itis and made to feel unimportant, the expectation of care quality jumped in response, as the "family doctor and the family" relationship deteriorated into nothingness. Physicians for the most part have forgotten that medical services is a "personal services" business, and without the "personal" factor, perfection becomes the expected occupational standard. Put "personal" back into the service equation, and claims will drop like a grand piano falling from a rooftop.

2. Insurance payment reform. When a $20,000 bill gets settled for $2000 the system has already failed. First because the bill is so high and second because the payment is so low. Attack the cost side with number 1, attack the income side here and provide reasonable reimbursement for services provided. When high bills are settled for whatever, the next person billed finds their bill a little higher to make it up. That's the same in every business.

3. Education reform. Help bright young people pay for college and medical school with the provision that they spend X number of years as a GP. Most doctors who graduate today will not become general practitioners. Not enough money to be made to pay for their education. So incentives to get doctors in these roles is needed. More nurse practitioners as well. Need to pay them more so they get to this role. Without addressing this issue we will have rationing of health care weather you can afford it or not. That exists already. The military has been doing that forever, and so has the US Public Health Service. If making the most money possible is the only incentive, then the Hippocratic Oath needs to be replaced with the preamble to TARP. And medical schools are businesses, too. They charge whatever the market will bear, and as long as student applications outnumber seats, it's a seller's market.

4. Drug cost reform. It costs to much to develop a drug today. To much testing, the maintaining of a validated environment, meeting FDA rules, time from development to on the shelf, and also part of tort reform. I remember Thalidomide and a host of other drugs whose performance did not match the plan. When one takes shortcuts with the scientific process (especially in the evaluation phase), the risks can become deadly.

5. 50 million without insurance does need to be resolved. However if you are here "illegal", we need a different solution. It is not up to the American tax payer to take care of someone who broke our laws. If you are here legally and do not have insurance then we do need to create some sort of basic care and make it available at an affordable price to those in need. Clinics, pro bono work, generic drugs, some way to care for those in need. But is this a federal problem? The fed cannot manage local use programs. There are many ways to resolve this without more inefficient federal programs which only reward politicians and appointees.

6. Keep the government out of the solution except for these 5 things. A government run system will fail worse then the current system. I have not heard a single politician even mention tort reform and to me that is the number one problem. If the federal government is involved 1%, they control things 100% - every businessman who has ever dealt with federal regulation knows this painfully well.

[Guest]

Excellent idea--pro bono. Following your idea... pts pay for ALL time the physician spends on their case. You know, "the meter is running" concept.... "billable hours".... phone calls, reviewing lab results, consulting with other physicians, talking with attorneys, filling out forms are all billable to the patient.... in fact, everything is billable to the patient since physicians will now be like attorneys and simply charge per unit of time, directly to the pt.... there are actually a growing # of physicians doing exactly this. When you call their office you are not asked what type of insurance you have.... instead you are told, "DR Smith does not accept any insurance.... he accepts cask, Mastercard and Visa. " Also, if we are going to "mitigate health care the same way legal care is" we need to keep the playing field level... so malpractice ins needs to be on an even plane too.
Malpractice insurance matches the expectation of care standard, and physicians have screwed themselves on this by dehumanizing their relationship with their customers. When the customer is treated as less-than-important, the expectation of perfection rises accordingly. When physicians stop treating their customers impersonally, the playing field changes big-time. Attorneys, accountants and other professionals who are in a competitive environment know this and nurture their client relationship, and the insurance costs reflect this business practice.

And the medical profession does use the "taxi meter" approach now. Try to get a physician to spend longer than the 10-minutes-per-examination-room - they follow the meter, and ration the time to match the money. The exception are those on the per-session basis.

[Guest]

...If the federal government is involved 1%, they control things 100%...
...your proposal is that the federal government do nothing about the "healthcare problem", whether real or just perceived.

You also suggest that some part of the issue appears to be for the individual states to resolve. But government being government, when it came to that, would we want to keep state government's fingerprints off of healthcare, as well?

I agree with a lot of what you write, but not this time. These problems have been festering for decades. Doing nothing--something our Congress is really good at--has been the easy way out for Congress for a long while. Things aren't getting any better. Healthcare costs and the resultant insurance premiums have skyrocketed to the point that the number of uninsured Americans is far more likely to increase than decrease. Medicare is going broke.

These don't seem to be problems that "doing nothing" will fix. The free market approach has lead us to this point. Is it reasonable to believe that letting the free market work will ultimately correct them?

[Guest]

If the government had an ounce of common sense or competency (let me rephrase that) a gram of common sense I’d maybe say let’s give it a go and see if we can fix this.

Problem is, the government AWAYS makes it worse. They NEVER fix anything. Everyone knows that even if you don’t want to admit it.

[Guest]

VK says...

"The top item on your list would be tops on mine, as well--tort reform. But as I'm remembering, that isn't among anyone's plans for reforming healthcare, is it? Or have I just missed someone's proposal? "


Maybe....

"Daschle: Tort Reform "On The Table"

"As if taking his case to the most powerful physicians group in the United States to push his controversial health care proposals wasn't a big enough headline, a New York Times report says President Obama has been working behind the scenes to protect doctors from malpractice. lawsuits.

"Tort reform is going to be on the table," Mr. Obama's initial nominee for Health and Human Services Secretary and former Senate Majority Leader Tom Daschle told The Early Show Monday."

http://www.cbsnews.com/blogs/2009/06/15/politics/politicalhotsheet/entry5088733.shtml

[Guest]

"The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem."

This is part of an article written by a respected business writer, Robert Samuelson, and the link to the entire article is below...

http://www.realclearpolitics.com/articles/2009/06/15/wrong-way_health_reform_96997.html

I have been trying hard to get a bit of "smarts" on this subject, but it sure gets confusing.

Seems most, if not all, want some kind of REFORM, but the shape is quite a debate. There are even those who feel that the reform being touted will REDUCE the care for the most needy folks in society.

Thought I would drop this article off for comments as it was the first I had heard this particular viewpoint !:agree:Fee for service or a financial incentive to get paid more for doing more procedures is an invitation for trouble

[Guest]

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/probono/directory.html# )

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

[Guest]

"The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem."

This is part of an article written by a respected business writer, Robert Samuelson, and the link to the entire article is below...

http://www.realclearpolitics.com/articles/2009/06/15/wrong-way_health_reform_96997.html

I have been trying hard to get a bit of "smarts" on this subject, but it sure gets confusing.

Seems most, if not all, want some kind of REFORM, but the shape is quite a debate. There are even those who feel that the reform being touted will REDUCE the care for the most needy folks in society.

Thought I would drop this article off for comments as it was the first I had heard this particular viewpoint !

Healthcare providers exist in a price controlled environment, dictated by government payers and private insurance companies. You get what they say you get...period.
For those of you that have owned your own business, how would this fly for you...to be told what you could charge and what you would be reimbursed for you goods and services?

[Guest]

Malpractice insurance matches the expectation of care standard, and physicians have screwed themselves on this by dehumanizing their relationship with their customers. When the customer is treated as less-than-important, the expectation of perfection rises accordingly. When physicians stop treating their customers impersonally, the playing field changes big-time. Attorneys, accountants and other professionals who are in a competitive environment know this and nurture their client relationship, and the insurance costs reflect this business practice.

And the medical profession does use the "taxi meter" approach now. Try to get a physician to spend longer than the 10-minutes-per-examination-room - they follow the meter, and ration the time to match the money. The exception are those on the per-session basis. "Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

[Guest]

...The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change....

Thanks, Serenity. It's always good to hear from someone who have first-hand knowledge of some of the things we discuss here. All too often, we wind up trading the soundbites provided by others far less knowledgable and experienced.

The purpose of my original posting was to get all of us thinking about what changes in our healthcare system would be important to each of us. Once each of us had a few such thoughts, I thought it would be far easier for us to understand and assess the plans being circulated by the various members of Congress or other entertainers, many of whom have special interests that we all don't share.

Thanks again for the insight.

[Guest]

Thanks, Serenity. It's always good to hear from someone who have first-hand knowledge of some of the things we discuss here. All too often, we wind up trading the soundbites provided by others far less knowledgable and experienced.

The purpose of my original posting was to get all of us thinking about what changes in our healthcare system would be important to each of us. Once each of us had a few such thoughts, I thought it would be far easier for us to understand and assess the plans being circulated by the various members of Congress or other entertainers, many of whom have special interests that we all don't share.

Thanks again for the insight.

VK,

My comments were not directed to you at all. It is a very timely post and certainly worth discussion in detail. I think I am also voicing some frustration at the folks that make unfounded assumptions and present them as fact, without an inkling of what truly goes on behind the scenes. I am also troubled by the attitude of "I'vr got mine, you worry about yours" attitude from many that are blessed enough to have good healthcare coverage.

You are completely on point about the special interests, and unfortunately their influence appeals on emotion and popularity basis.

This is indeed a multifaceted problem, but there are inherent simplicities also.
Malpratice is out of control and a gigantic player here. Estimated costs of overhead in health care are 30% at large. Lack of not only maintainence care but self accountability from patients contributes greatly to cost (read compliance with medication, smokers, obesity etc etc). We are innapropriate and inneffective as a society with regard to end of life care and appropriate utilization of resources. As a society we want the best of everything and we want it yesterday in medicine, but is has to be paid for.

As usual you have raised a timely topic in an articulate manner and as always I appreciate it.

[Guest]

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.
My point is, when there was a human-to-human relationship between the family physician and the family members, there were no lawsuits. The family physician, even if he screwed up, was known for having tried his best, was at the wake, and cried at the funeral as loud as any mourner - and meant it. Once health care delivery became an emotion-free action, and "Mr. Jones and Mrs. Smith and young Johnny" became "the patients in Examining Rooms A, B & C," whose relationship with the physician was a brief encounter after an hour in a waiting room, the physician became as faceless as the insurance company, and given the same amount of leeway.

The medical industry, in finding a way to be more profitable by greater "office efficiency," also acquired an additional liability in that the leeway given to the Dr. Welby's of old was lost in the bottom line. It was a perfect example of "for every action, there is an equal and opposite reaction." A "wall" was created between the physician and the customer/patient where that "have a cup of coffee after the home visit - which friends do" was replaced with the medical experience having as much human sensitivity as an oil change at Jiffy Lube. That "wall" between health care provider and recipient is the problem - and it's that "wall" that has made medical malpractice as much of an item on the health care scene as Viagra commercials.

And VK - yes I think the health care matter is one for the states, not the fed. There is nothing wrong with different states trying different ways to better the lives of their citizenry. Several states already have health risk pools for uninsurables (see http://www.healthinsurance.org/risk_pools/ ), several also have either enacted or in the process of enacting their own version of health care reform (see http://www.kff.org/uninsured/kcmu_statehealthreform.cfm ), and the experiences from these efforts give the rest of the states an opportunity to see what's best for them based on real data, and not just on political hyperbole. The fed always ends up with a "one size fits all" solution, and it usually fits no one other than those within the DC beltway who get rich off it. So, unless we want another TARP and bailout "the bill is too long and confusing, so I'll just vote for it and hope for the best," the states are still the best bet to get it right for what works with their constituencies. And since the states already are in the medical oversight business via licensing and other regulation, it's better to work within one existing body of law than try adding more layers.

[Guest]

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.


Thank you, Dr. Serenityseeker. Your post is outstanding. And it comes with great credibility. Your points are excellent. You are speaking from the reality zone, not the comfort zone.

Boomer

[Guest]

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

Couldn't agree more. It simply becomes a theatrical contest between sides, and the attitude in today's society is "somebodies gonna pay" regardless of whether any real malpractice occured or not. Whoever puts on the best show wins.
Lawyers know this and manipulate the system, even making good living on lawsuits without merit, because the insurance companies and the lawyers all know it is cheaper to give up a settlement than to fight in court. It is a sickening game in a perverted system and there is no end in sight. Without meaningful change there is no hope of improving the healthcare system.

[Guest]

Single payor, similar to Canadian system.

the great general once said in ww11

[Guest]

Couldn't agree more. It simply becomes a theatrical contest between sides, and the attitude in today's society is "somebodies gonna pay" regardless of whether any real malpractice occured or not. Whoever puts on the best show wins.
Lawyers know this and manipulate the system, even making good living on lawsuits without merit, because the insurance companies and the lawyers all know it is cheaper to give up a settlement than to fight in court. It is a sickening game in a perverted system and there is no end in sight. Without meaningful change there is no hope of improving the healthcare system.
Unfortunately this is change you can't believe in.... lawyers control Congress.

The notion that "if we all were like Marcus Welby" malpractice would no longer be a problem is completely foolish. The highest claims in malpractice are in neurosurgery, orthopedics and OB-GYN--the surgical specialties. Orthopods and neurosurgeons often have their first contact with a pt in a trauma setting, the pt is busted in pieces and unconscious. The patients only concern should be the technical competence of the surgeon. That aside, there is good data to support the notion that pts who "like" their doctors are less likely to sue. The multimillion dollar lawsuits that hit neurosurgeons and the other surgical specialties are unlikely to be mitigated by a Marcus Welby personna ( a fictitious TV creation). BTW, I grew up in the 50's. My family doc didn't take appts... first come, first serve... waiting room often spilling out into the streets.... lots of penicillin shots... ave time face to face with the doc--- I recall about 1-2 minutes....not the TV image of the paternal Marcus Welby siting down for a casual hand holding chat... not sure if he was ever sued back then... it wasn't part of the culture. Now that is the culture.

[Guest]

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Great post. Thank you

[Guest]

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.
The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

[Guest]

The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

Sorry, when it comes to who "jurys hate most".... the lawyers are in good company. See attached.

http://www.times-standard.com/davestancliff/ci_11971293

[Guest]

The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

Simply put you are wrong, and with all due respect out of touch with the subject as it exists in todays world.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

To generalize all physicians in this matter is innaccurate and irresponsible. Do you have any idea why wait times are long, why visits are rushed, and why so many doctors are leaving the fold? No, you obviously don't. And your movie reference is a great example of people being swayed by the media and making poorly informed decisions based on such.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

"All"?? That statement in and of itself deprives the post of credibility. Again, no disrespect, simply stating the facts. Absolute statements are rarely accurate, and unless you have struggled to survive in this environment you have no accurate basis for such an outlandish claim. Tens of thousands of people involved in this legal morass/lottery system live every day with the reality that no matter how good they are, how thorough or compassionate, there is ALWAYS an attorney willing to scrounge nuisance money from health care providers and insurance companies. That is reality, that is truth. I have seen many colleagues mowed down by this process, most of them kind, caring and empathetic physicians. And good interpersonal relationships don't hold a candle to jackpot money. Patients have even apologized to physicians as they stated they knew the doc did no wrong, but this was their chance for money.

Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Not sure where you get that, I can't even begin to fathom. Access how, and with who, and who would pay for all this etherial support? Give me a break.


As someone that appears well read and very intelligent I expected more from you. Little or none of what you say above has basis in fact, it is conjecture and anectdotal, with a lot of idealized memories. If you truly want to accurately comment and contribute do some research, talk with and spend some time with those you so freely castigate. Walk a couple of miles in the shoes of health care providers so that you may accurately comment.
Why do I even care? Because frankly you insult me and many of my colleagues that do what we do with honor and compassion every day. We have and continue to sacrifice personally, emotionally, spritually and financially in an effort to truly personify what a physician should be, and we are NOT the minority. I also will not stand by while more and more misinformation on such an important subject is bandied about.

[Guest]

Sorry, when it comes to who "jurys hate most".... the lawyers are in good company. See attached.

http://www.times-standard.com/davestancliff/ci_11971293

But the real problem for all - and I do mean "all" - is when the lovers/haters march into the jury box. So, the goal should be to eliminate the reason for litigation before it gets to that point.

The point is still, how can the medical profession give the "litigious public" the confidence in its professional actions so suits don't occur? When that happens, malpractice claims drop, and insurance premiums accordingly.

You were dead on the money with which medical specialties get tagged the heaviest with claims, and most of those claims are based on exigent circumstance actions with nobody ever having met the other, and the patient/family having to make on-the-spot decisions with nothing but the do-it-or-else advice of a stranger. All of this is a recipe for litigation when perfection doesn't occur.

My comments about tort reform not solving the litigation problem is knowing full well that litigators can and do get around dollar-limit restrictions. California has had a $250K cap on medical malpractice claims for years, but that hasn't stopped jury awards of amounts much higher, and eventual collection by the suing party of amounts much greater than $250K. So, if tort reform doesn't prove to be the "silver bullet" (and it hasn't where in effect), what else?

I too am tired of health insurance premiums of over $1k/month for my family, and know full well that malpractice claims constitute a measurable chunk of that $1k. I also know too well why people sue, and the medical profession not accepting the "human factor" as a major reason why lawsuits happen is unrealistic and arrogant. There are many ways, especially for those one-contact specialties, to radically increase its public trust factor (and thus reduce lawsuits), but those ways require time and effort to educate the public and nurture (yes, nurture) trust. Until that happens, the lawsuits will happen with regularity and nothing ever changes.

[Guest]

Simply put you are wrong, and with all due respect out of touch with the subject as it exists in todays world.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

To generalize all physicians in this matter is innaccurate and irresponsible. Do you have any idea why wait times are long, why visits are rushed, and why so many doctors are leaving the fold? No, you obviously don't. And your movie reference is a great example of people being swayed by the media and making poorly informed decisions based on such.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

"All"?? That statement in and of itself deprives the post of credibility. Again, no disrespect, simply stating the facts. Absolute statements are rarely accurate, and unless you have struggled to survive in this environment you have no accurate basis for such an outlandish claim. Tens of thousands of people involved in this legal morass/lottery system live every day with the reality that no matter how good they are, how thorough or compassionate, there is ALWAYS an attorney willing to scrounge nuisance money from health care providers and insurance companies. That is reality, that is truth. I have seen many colleagues mowed down by this process, most of them kind, caring and empathetic physicians. And good interpersonal relationships don't hold a candle to jackpot money. Patients have even apologized to physicians as they stated they knew the doc did no wrong, but this was their chance for money.

Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Not sure where you get that, I can't even begin to fathom. Access how, and with who, and who would pay for all this etherial support? Give me a break.


As someone that appears well read and very intelligent I expected more from you. Little or none of what you say above has basis in fact, it is conjecture and anectdotal, with a lot of idealized memories. If you truly want to accurately comment and contribute do some research, talk with and spend some time with those you so freely castigate. Walk a couple of miles in the shoes of health care providers so that you may accurately comment.
Why do I even care? Because frankly you insult me and many of my colleagues that do what we do with honor and compassion every day. We have and continue to sacrifice personally, emotionally, spritually and financially in an effort to truly personify what a physician should be, and we are NOT the minority. I also will not stand by while more and more misinformation on such an important subject is bandied about.

I'm the first to admit how often I can be wrong. But, just a little, you may not be totally right, either.

However, I do know why people sue. When the technical jargon is stripped away, the underlying story is almost always the same - disrespect, disbelief and lack of trust.

The "jackpot" mentality does exist, but why? How does one convince a population that there is going to be no gain to such suits because the suit will fail due to jury empathy with the physician? And until the medical profession can regain that public confidence, juries will continue to see the suing party as one-of-their-own and the physician as the outsider. That is not right in any sense of the law, but it is what happens.

Are there attorneys who encourage and take cases they shouldn't? Yes! No profession is perfect. Just as there are physicians who perform needless tests for no medical reason, but do so as back-up evidence in case they are sued, and that small minority of others who practice money-collection rather than medicine. We all wish we could rid ourselves of the scurrilous minority in the professions who gets the bulwark of the publicity and we all defend against.

The "walk a couple miles in my shoes" comment goes both ways. I've seen the public after-the-litigious-event and am only sharing what I have received. Of course there are dedicated medical professionals, as there are dedicated all-kinds-of-professionals (including lawyers). However, not wanting to recognize why a problem exists usually results in no change in the situation - or worse.

There was never an intent to insult. And I'm sure your comments regarding lawyers were not meant either as a castigation of the entire legal profession. We all need to examine our professional worlds for where they work, are out of kilter, and where change is necessary for the betterment of all. We are indeed proud of those within our profession - and that is a large majority - who perform ethically and admirably every day. We also loathe those who put us in the position of having to purge them from our ranks and explain to a confused public why these slugs have licenses.

So, if the medical profession sincerely wants to reduce malpractice claims, talk to those to whom the claimants come for the why and how of these claims. When we work together, and willing to amend how we do business accordingly so claims are prevented versus litigated, then costs are indeed affected for everyone.

[Guest]

I'm the first to admit how often I can be wrong. But, just a little, you may not be totally right, either.

However, I do know why people sue. When the technical jargon is stripped away, the underlying story is almost always the same - disrespect, disbelief and lack of trust.

The "jackpot" mentality does exist, but why? How does one convince a population that there is going to be no gain to such suits because the suit will fail due to jury empathy with the physician? And until the medical profession can regain that public confidence, juries will continue to see the suing party as one-of-their-own and the physician as the outsider. That is not right in any sense of the law, but it is what happens.

Are there attorneys who encourage and take cases they shouldn't? Yes! No profession is perfect. Just as there are physicians who perform needless tests for no medical reason, but do so as back-up evidence in case they are sued, and that small minority of others who practice money-collection rather than medicine. We all wish we could rid ourselves of the scurrilous minority in the professions who gets the bulwark of the publicity and we all defend against.

The "walk a couple miles in my shoes" comment goes both ways. I've seen the public after-the-litigious-event and am only sharing what I have received. Of course there are dedicated medical professionals, as there are dedicated all-kinds-of-professionals (including lawyers). However, not wanting to recognize why a problem exists usually results in no change in the situation - or worse.

There was never an intent to insult. And I'm sure your comments regarding lawyers were not meant either as a castigation of the entire legal profession. We all need to examine our professional worlds for where they work, are out of kilter, and where change is necessary for the betterment of all. We are indeed proud of those within our profession - and that is a large majority - who perform ethically and admirably every day. We also loathe those who put us in the position of having to purge them from our ranks and explain to a confused public why these slugs have licenses.

So, if the medical profession sincerely wants to reduce malpractice claims, talk to those to whom the claimants come for the why and how of these claims. When we work together, and willing to amend how we do business accordingly so claims are prevented versus litigated, then costs are indeed affected for everyone.

Never said I was totally right, wouldn't be so delusional as to think so.

Never once did I castigate the entire legal profession.

I also know very well that greed and sloth are bigger reasons for lawsuits than non compassionate or non empathetic physicians. I live and breath in this world every day, and know very well of what I speak. It is pie in the sky mentality to think that if all physicians could somehow have behavior reform that this plague would be arrested. Perhaps (and likely) in the past those were bigger reasons for suits, that simply is not the way it is in today's world. You don't have to agree, but speaking with the experience I have accrued and continue to accrue it is the truth to a great degree. One only need look at all of the commercials promising money for malpractice and drug reactions. It is a part of our culture at this point. That being said, poor communication can increase one's odds of being sued, it simply is no longer the primary reason by any stretch.
I have seen countless patients come in after minor fender benders, slight slips in walmart, and a plethora of other "non injuries" becuase "my lawyer told me to come get checked out". Most of these will get a small settlment to make them go away.
I have seen families sue for expected poor outcomes on terminally ill patients, sue for normal post op complications, nearly all of them without merit and simply for a quick settlement check. Thats the real world. I really hope everyone takes the time to do a little research before making blanket pronouncments that simply are not accurate.

Probably as important as anything else in all of this is what it shows on a larger scale. The problems with health care in general are broad and complicated in some ways. People with little experience or knowledge of the inner workings of this mess will ultimately not take the time to be open minded and the effort to learn. They will base opinions on what the media, politicians, and other ill informed sources offer. It really takes patience, effort , and an open mind to begin to view other aspects of the bigger picture at large. I don't purport to know everything, but I will speak of what I do know without hesitation and with honesty, and hope that it affords people that are willing to learn a little insight they might otherwise have missed. I have found that when I partake in others real world knowledge and experiences I am enlighted in ways I might have otherwise missed.

[Guest]

Obama got booed by the AMA today. Looks like he's going to learn what it's like to not be worshipped by everyone he steps in front of. He put the nail in the coffin today with the AMA. I seriously doubt that anything will change in healthcare. Politicians , including Obama, pander so much to special interests that this healthcare fiasco will follow the same demise as Clintons.

[Guest]

Never said I was totally right, wouldn't be so delusional as to think so.

Never once did I castigate the entire legal profession.

I also know very well that greed and sloth are bigger reasons for lawsuits than non compassionate or non empathetic physicians. I live and breath in this world every day, and know very well of what I speak. It is pie in the sky mentality to think that if all physicians could somehow have behavior reform that this plague would be arrested. Perhaps (and likely) in the past those were bigger reasons for suits, that simply is not the way it is in today's world. You don't have to agree, but speaking with the experience I have accrued and continue to accrue it is the truth to a great degree. One only need look at all of the commercials promising money for malpractice and drug reactions. It is a part of our culture at this point. That being said, poor communication can increase one's odds of being sued, it simply is no longer the primary reason by any stretch.
I have seen countless patients come in after minor fender benders, slight slips in walmart, and a plethora of other "non injuries" becuase "my lawyer told me to come get checked out". Most of these will get a small settlment to make them go away.
I have seen families sue for expected poor outcomes on terminally ill patients, sue for normal post op complications, nearly all of them without merit and simply for a quick settlement check. Thats the real world. I really hope everyone takes the time to do a little research before making blanket pronouncments that simply are not accurate.

Probably as important as anything else in all of this is what it shows on a larger scale. The problems with health care in general are broad and complicated in some ways. People with little experience or knowledge of the inner workings of this mess will ultimately not take the time to be open minded and the effort to learn. They will base opinions on what the media, politicians, and other ill informed sources offer. It really takes patience, effort , and an open mind to begin to view other aspects of the bigger picture at large. I don't purport to know everything, but I will speak of what I do know without hesitation and with honesty, and hope that it affords people that are willing to learn a little insight they might otherwise have missed. I have found that when I partake in others real world knowledge and experiences I am enlighted in ways I might have otherwise missed.

And there is no single "fix" or pie-in-the-sky action that will resolve the health care debate. As usual, several actions can contribute to a better situation, but depending on one or two without the rest is false hope.

That's one of the blessings and curses of getting to our ages. We can remember better (and worse) times, and have seen many of the situations we have discussed develop an-inch-at-a-time over time, and know the odds of quick reversals to better circumstances are very long indeed. We see things as they are now, and know it's just not right.

The advertising in the marketplace, whether for drug reaction to the negative or anticipated drug reaction to the positive (the long list of potential side effects notwithstanding), definitely muddies the waters. People today seem to have simultaneous expectations of miracles and no personal responsibility -all fostered by a moral climate centered on "me first, and you never." In our respective professions we can patch some of the holes, but the societal pot has definitely been turned into a moral colander.

We are knowledgeable and experienced in our respective areas. I agree with you that open minds - and the willingness to share our respective knowledge and experience - makes the potential of "fixes" to some degree possible.

As always, the first $1.75 Margarita at LSL happy hour is on me....

[Guest]

TORT REFORM!
I don't know exactly what the limitations might be to such reform. As a non-lawyer, I might suggest the following...
A limit of $250,000 for any claim that does not involve a death or permanent disability.
A limit of $500,000 for a claim involving a death or permanent disability.
A requirement that the plaintiff pay the legal expenses of the defendant as well as the court costs if the case brought is unsuccessful.

Unless I've missed something very important, these three simple rules should slow down to flow of medical malpractice lawsuits considerably.

If nothing other than these simple rules were enacted into law, I'd think that he cost of healthcare would drop pretty dramatically. Maybe not enough--but pretty significantly.

[Guest]

TORT REFORM!
I don't know exactly what the limitations might be to such reform. As a non-lawyer, I might suggest the following...
A limit of $250,000 for any claim that does not involve a death or permanent disability.
A limit of $500,000 for a claim involving a death or permanent disability.
A requirement that the plaintiff pay the legal expenses of the defendant as well as the court costs if the case brought is unsuccessful.

Unless I've missed something very important, these three simple rules should slow down to flow of medical malpractice lawsuits considerably.

If nothing other than these simple rules were enacted into law, I'd think that he cost of healthcare would drop pretty dramatically. Maybe not enough--but pretty significantly.

Would that also apply to any claim initiated due to "death or permanent injury" where auto accidents, golf cart collisions, airplane crashes, use of firearms, or any other event was the underlying cause? Or is this strictly to provide legal protection only for hospitals and physicians?

And if the third item was law, why would there be any need for the first two?

[Guest]

I'll restrain myself on tort reform. I just hope tomorrow's paper doesn't have another report of a jury awarding $144 million to some unemployed guy in the hills of Tennessee, who smoked since he was thirteen and now claims he wouldn't have lung cancer if the cigarette companies had warned him properly. After all, we should leave some way for the PI lawyers to make a living.

For a little while at least.

[Guest]

I'll restrain myself on tort reform. I just hope tomorrow's paper doesn't have another report of a jury awarding $144 million to some unemployed guy in the hills of Tennessee, who smoked since he was thirteen and now claims he wouldn't have lung cancer if the cigarette companies had warned him properly. After all, we should leave some way for the PI lawyers to make a living.

For a little while at least.
What happens when massive (or excessive in any manner per the insured) awards are by juries is always the same - and PI or any other kind of lawyer are always excused from sitting on juries (judges don't like to be critiqued in the jury room by any lawyer).

When a state court jury decides, with award, to the injured person, the one being sued (and insurance company, who normally defends) immediately appeals. Once the appeal is filed, the original decision (and award) is now on hold until the appeals court has ruled. This can take a couple years, depending on appellate docket. In the meantime, the injured party is no better off than the day day before the lower court decision. If the appellate court rules in favor of the injured party, the insured appeals to the next higher court (often, a state supreme court). That court too has a significant docket, so the clock keeps running. So, despite an original court decision, the injured person still doesn't have a dime all this time.

Enter the insured again - this time offering a deal: For an amount much lower than the original jury award), but paid immediately, the insured will drop all appeals. The injured party, with bills to pay, may haggle to some avail (usually not much) and take the deal. Insurers' negotiation range usually has a base (cost of future litigation, less a couple percent) and a ceiling (policy limit), with the goal to have the injured party take the former. All counsel (and the courts) know this, and it has been often insinuated that courts drag appeals to give the parties time to resolve the matter in pre-appellate settlement negotiations, as courts rarely want to place themselves in positions to reverse jury decisions.

So, payoffs of these jury awards which sound like a PowerBall winner, are rarer than hen's teeth. Thus, while the original jury award made great press, the actual cash exchanging hands is much less.

[Guest]

What happens when massive (or excessive in any manner per the insured) awards are by juries is always the same - and PI or any other kind of lawyer are always excused from sitting on juries (judges don't like to be critiqued in the jury room by any lawyer).

When a state court jury decides, with award, to the injured person, the one being sued (and insurance company, who normally defends) immediately appeals. Once the appeal is filed, the original decision (and award) is now on hold until the appeals court has ruled. This can take a couple years, depending on appellate docket. In the meantime, the injured party is no better off than the day day before the lower court decision. If the appellate court rules in favor of the injured party, the insured appeals to the next higher court (often, a state supreme court). That court too has a significant docket, so the clock keeps running. So, despite an original court decision, the injured person still doesn't have a dime all this time.

Enter the insured again - this time offering a deal: For an amount much lower than the original jury award), but paid immediately, the insured will drop all appeals. The injured party, with bills to pay, may haggle to some avail (usually not much) and take the deal. Insurers' negotiation range usually has a base (cost of future litigation, less a couple percent) and a ceiling (policy limit), with the goal to have the injured party take the former. All counsel (and the courts) know this, and it has been often insinuated that courts drag appeals to give the parties time to resolve the matter in pre-appellate settlement negotiations, as courts rarely want to place themselves in positions to reverse jury decisions.

So, payoffs of these jury awards which sound like a PowerBall winner, are rarer than hen's teeth. Thus, while the original jury award made great press, the actual cash exchanging hands is much less.
For some reason, knowing this doesn't make me feel any better...

[Guest]

trying to get enough constituents to get off their duffs to get after their lawmakers to reform the tort laws.....so here we are 30 + years later working on tort reform....:1rotfl:

Forty years ago we were on a kick for energy independence....get away from foreign oil dependence (our amount import now VS then has doubled) and so now we are doing what about energy independence? :1rotfl:

Health care reform is back from the 80's and 90's and today we are going to do what....cover everybody...what ever that means and costs...:1rotfl:

I do believe there is a pattern emerging. All POTUS say the same thing (promise and talk up a good game) results = nothing....reaction of we the people also nothing.

If you think Obama's speech on health care was a bomb (using the telepromter) you should have heard....both content (ridiculous) and delivery (no telepromter today just notes where he lost his place several times).

We are currently being spoon fed a diet of words. When they are wrong (as in health care or N. Korea)....the politicians rely on we the people....TO DO NOTHING.....and we sure do not disappointbarf

btk

[Guest]

For some reason, knowing this doesn't make me feel any better...

Totally understandable. Not many things are as stressful as being a defendant in a lawsuit, and worse when the jury trial comes back with a lunatic-level award. Even knowing what the long-term outcome is going to be isn't comforting.

ABut, whenever one must rely on a "jury of your peers," it's never a good day.

[Guest]

wait until its free.

Sometimes bumper stickers offer profound insight into real life.

[Guest]

maybe I missed some earlier posts on health care but I must say
that I cannot believe that in a retirement community like TV
nobody has mentioned that in order to get the saving from Medicare
that Obama is talking about Medicare Advantage Plans that so many
Villages now have will be alot more expensive or go away altogether
Say so long to no or $20 per month premiums.

And by the way how will you feel about that prospect of not
getting or waiting months for the joint replacements, mri's cat scans
etc that we now take for granted. remember we are old and these things
don't pay off in the long run because we are going to die soon anyway.

Be ready to pay much more and get much less:cus:

[Guest]

I have been chiding for weeks whether those over 65 getting benefits from the government today....think they are not involved. There is no way to open health care up to everybody and us to keep what we have. They aren't going to give everybody what we currently have....we would have to start using numbers bigger than trillions. Therefore a system that is viewed as fair and eqitable by all the wizards in Washington will have to be a watered down version of today's benefits. Of course there will be supplements available at a price to get what an individual wants or needs to get back to where they were.

I do not understand why this is not a concern. It has to be the folks who have what they do today are taking comfort in the belief it does not involve them. Isn't this the main reason the new legislation excludes government employee benefits. They want to keep what they have...can it be any more obvious?

Well it will and they are in for a surprise.

And once again the silent majority will get what it deserves.

btk

[Guest]

I often wonder what the "polls" would look like if people realized that the care they receive today will not be the same in the future if these "reforms" go into effect. Does the term "watered-down" come to mind? All I can say is that I hope my knees and hips hold up. I exercise and walk an hour each day. Preventive medicine is the only recourse that I feel I have some control.

[Guest]

As a side note here's a little article about the company I work for. I actually work on the Take Care Health side of the company.

http://www.fastcompany.com/magazine/137/not-a-mickey-mouse-operation.html

[Guest]

As a side note here's a little article about the company I work for. I actually work on the Take Care Health side of the company.

http://www.fastcompany.com/magazine/137/not-a-mickey-mouse-operation.html

Excellent! That's using American ingenuity rather than simply throwing money at an issue and hoping something positive occurs. Even better, they showed that following established business and scientific models - analyze, design, develop, prototype, evaulate, remodel, evaluate, beta test, evaluate, implement small-scale, evaluate, implement medium-scale, evaluate, implement large-scale, continue evaluation and revise accordingly - really works.

Beats the daylights out of writing a bill nobody reads, do a quick vote before anybody gets smart, and a select few make a fortune from taxpayer pain.

[Guest]

As always there are solutions other than government. CVS and others are doing similar projects. There are many promising things on the horizon for health care but I fear too many just roll over and expect the government to fix it which of course they never do and in fact always make it worse.

It's a simple question really.

Social Security - bankrupt
Medicare - bankrupt
Medicaid - bankrupt
Government treasury -bankrupt
Economy - toilet
Job market - trashed.
Stimulus - total failure

Why then does anyone in their right mind believe government can take over and run health care?

Why oh why don't people wake up?

[Guest]

First, all anyone has to do is to look at the UK and Canadian health care programs to get a quick picture of what America can expect with a Gov't program. Second, when is America going to wake up that the person leading these charges is Pelosi who is from the State with more than 11% unemployment, bankrupt and getting worse as we speak. It continues to vilolate the illegal immigration laws (e.g.San Fran) and has a crime rate that is very high. If CA is the standard we are going after "look out". As the SS system starts to go belly up rather than trying to save it the investments are going towards an energy system (cap and trade) which will save 1.4M gallons of oil while China, which is the largest poluter of the world does not change. In cap and trade key on the "trade" as more jobs will be going overseas. Isn't it about time that America woke up and smelled the junk politics going on..?

[Guest]

Whats wrong with Canadian Health Care??
The have the choice of either Provincial Health Care or if they have Company Health Plans they can subscribe to whichever one they want. True there are wait times, but this is true with almost everything, but their Health Care Expenses are paid for by whichever plan they have and they have Medicare in each Province.

[Guest]

You may be right. I am only going by what I read?

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market

The failure of Canada's experiment with socialist medicine is readily apparent: long waiting lists and wait times for specialized services, conveyor-belt treatment for routine services, chronic shortages of family doctors and hospital beds, gross inefficiencies, slow innovation, stifling and wasteful bureaucracies, warring "special-interest" groups, and the exodus of good doctors to greener, freer pastures.

It's still illegal in Canada for private healthcare providers to compete with the government monopoly. Only North Korea and Cuba—two impoverished, brutal, communist dictatorships—still retain such restrictions. And there have been increasing accounts of Canadians suffering severe pain and even dying while waiting months or years for treatments that are readily available in countries that allow private healthcare.

[Guest]

You may be right. I am only going by what I read?

Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market

The failure of Canada's experiment with socialist medicine is readily apparent: long waiting lists and wait times for specialized services, conveyor-belt treatment for routine services, chronic shortages of family doctors and hospital beds, gross inefficiencies, slow innovation, stifling and wasteful bureaucracies, warring "special-interest" groups, and the exodus of good doctors to greener, freer pastures.
It's still illegal in Canada for private healthcare providers to compete with the government monopoly. Only North Korea and Cuba—two impoverished, brutal, communist dictatorships—still retain such restrictions. And there have been increasing accounts of Canadians suffering severe pain and even dying while waiting months or years for treatments that are readily available in countries that allow private healthcare.


Funny, that sounds in many ways like the system I work in..right here the U.S.

[Guest]

Funny, that sounds in many ways like the system I work in..right here the U.S.

Interesting. Do you work in the health care system?

[Guest]

Sure do Keedy

[Guest]

Sure do KeedyMe too... but we do NOT have a "health care system"... In America we have a "health care industry"... it is a commodity. It is not a "system".

[Guest]

Me too... but we do NOT have a "health care system"... In America we have a "health care industry"... it is a commodity. It is not a "system".

Absolutely correct.

[Guest]

...the Take Care Health side of the company....
I think the Walgreens idea is terrific. If all the big companies in America did something similar, it seems to me that would go a long way towards making working people healthier and reducing the cost of healthcare.

But there are two key words in my complimentary statement..."big companies" and "working people".

If the idea of company-sponsored healthcare became common, that would be great. But the number of people it would affect would be too small, I think. How many people these days work for companies that can afford such a program? Even if they do work for a large company, do they work in an office of sufficient size to justify an on-site medical professional? Then there's the question of "working people". What happens when the employee who has grown to trust and depend on the company program gets laid off, quits or retires? What do they do then?

Overall, I think what Walgreens is doing is wonderful. But it a supplementary program, not the total answer to healthcare for the wide range of working and non-working Americans.

[Guest]

I think the Walgreens idea is terrific. If all the big companies in America did something similar, it seems to me that would go a long way towards making working people healthier and reducing the cost of healthcare.

But there are two key words in my complimentary statement..."big companies" and "working people".

If the idea of company-sponsored healthcare became common, that would be great. But the number of people it would affect would be too small, I think. How many people these days work for companies that can afford such a program? Even if they do work for a large company, do they work in an office of sufficient size to justify an on-site medical professional? Then there's the question of "working people". What happens when the employee who has grown to trust and depend on the company program gets laid off, quits or retires? What do they do then?

Overall, I think what Walgreens is doing is wonderful. But it a supplementary program, not the total answer to healthcare for the wide range of working and non-working Americans.

The idea with regard to Walgreen's is ok at best. The clinics like many other "minuite clinic" set ups are staffed primarily by nurse practitioners and are primarily (even according to their own site) for minor conditions such as colds, flu, upper respiratory track infections, and minor skin conditions. While any or all of these may be bothersome most don't require any treatment beyond symptomatic relief from over the counter medications. The setting provides decent potential for profitability because of just those reasons and the fact that an NP is paid less.
As much as it may be magnanemous and somewhat innovative on their part, it really does very little to address issues with our health care industry at large. It could be considered wasting resources by knowledgable people as is much of the rest of our system. What it does not address is the incredibly large problem of people with multiple co-morbidities (the diabetes, hypertension, high cholesterol, heart disease collection that so many have for example). There are also so many other things that a system like this can never adaquately address.
This for the most part is sort of "feel good" medicine that appeals the segment of society (pretty large I think) that thinks they need a doctor and a pill for everything or they just are not getting their money's worth. That's what I mean by waste.
I bring none of this up to knock their program, but to make sure some other aspects of it and the system at large are factored in.

[Guest]

The idea with regard to Walgreen's is ok at best. The clinics like many other "minuite clinic" set ups are staffed primarily by nurse practitioners and are primarily (even according to their own site) for minor conditions such as colds, flu, upper respiratory track infections, and minor skin conditions. While any or all of these may be bothersome most don't require any treatment beyond symptomatic relief from over the counter medications. The setting provides decent potential for profitability because of just those reasons and the fact that an NP is paid less.
As much as it may be magnanemous and somewhat innovative on their part, it really does very little to address issues with our health care industry at large. It could be considered wasting resources by knowledgable people as is much of the rest of our system. What it does not address is the incredibly large problem of people with multiple co-morbidities (the diabetes, hypertension, high cholesterol, heart disease collection that so many have for example). There are also so many other things that a system like this can never adaquately address.
This for the most part is sort of "feel good" medicine that appeals the segment of society (pretty large I think) that thinks they need a doctor and a pill for everything or they just are not getting their money's worth. That's what I mean by waste.
I bring none of this up to knock their program, but to make sure some other aspects of it and the system at large are factored in.
The clinics like many other "minuite clinic" set ups are staffed primarily by nurse practitioners and are primarily (even according to their own site) for minor conditions such as colds, flu, upper respiratory track infections, and minor skin conditions. While any or all of these may be bothersome most don't require any treatment beyond symptomatic relief from over the counter medications.
I think a clinic like Walgreen could act as a good triage because an experiences nurse could detect things and advise patient to seek further help.
What it does not address is the incredibly large problem of people with multiple co-morbidities (the diabetes, hypertension, high cholesterol, heart disease collection that so many have for example). There are also so many other things that a system like this can never adaquately address.
People with those ailments would probably already have their own source for treatment. they would not bother going there.

[Guest]

People with those ailments would probably already have their own source for treatment. they would not bother going there.

I think a clinic like Walgreen could act as a good triage because an experiences nurse could detect things and advise patient to seek further help.

You could be right, though my experience tells me otherwise.

[Guest]

Many people use the emergency rooms as their prime care physician. These clinics are certainly less expensive then ER's. Have you ever seen an ER bill for a relatively simple procedure?
I do not have many answers to the health care situation but they say that 70% of treatments-ailments could have been avoided using preventative medicine.
Maybe some courses in high school could go a long ways.

[Guest]

Many people use the emergency rooms as their prime care physician. These clinics are certainly less expensive then ER's. Have you ever seen an ER bill for a relatively simple procedure?
I do not have many answers to the health care situation but they say that 70% of treatments-ailments could have been avoided using preventative medicine.
Maybe some courses in high school could go a long ways.

I don't think there was an issue regarding whether these clinics would be cheaper than the E.R. Have I ever seen the the E.R. bill? Yeah, and then some. As a physician that has practiced in the E.R. setting and the inpatient hospital setting for some time now I feel fairly familiar with this. That really wasn't the thrust of my post though.

I don't know about your 70% statistic, might be pretty close though I'm not sure how that figure came about nor what all it refers to.

To reiterate, my point was not denigrate their plan, simply to shed more light and perspective on it.

[Guest]

I don't think there was an issue regarding whether these clinics would be cheaper than the E.R. Have I ever seen the the E.R. bill? Yeah, and then some. As a physician that has practiced in the E.R. setting and the inpatient hospital setting for some time now I feel fairly familiar with this. That really wasn't the thrust of my post though.

I don't know about your 70% statistic, might be pretty close though I'm not sure how that figure came about nor what all it refers to.

To reiterate, my point was not denigrate their plan, simply to shed more light and perspective on it.

OK..I didn't know you were a saw bone. My only medical experience was courtesy of the US army. In their infinite wisdom they determined that I would make a good combat medic. I was privy to many triage and ER type situations due to the many patients and few doctors. I had to do alot of on the job training.
As for the 70% figure..I have seen it many times in articles but could not really offer a link to anything official. I have seen it many times in real life, though. I have seen the effects of bad lifestyle choices. On the other hand, I have seen the smaller percentage, too. There are people who think they do everything healthy but still succumb to cancer, heart disease etc.
Still, I firmly believe in educating people on preventive medicine.

[Guest]

OK..I didn't know you were a saw bone. My only medical experience was courtesy of the US army. In their infinite wisdom they determined that I would make a good combat medic. I was privy to many triage and ER type situations due to the many patients and few doctors. I had to do alot of on the job training.
As for the 70% figure..I have seen it many times in articles but could not really offer a link to anything official. I have seen it many times in real life, though. I have seen the effects of bad lifestyle choices. On the other hand, I have seen the smaller percentage, too. There are people who think they do everything healthy but still succumb to cancer, heart disease etc.
Still, I firmly believe in educating people on preventive medicine.

Could not agree more. Perhaps a little accountability along with the education? Do you get to keep getting repeat cardiac caths or bypass surgery if you continue to smoke? Do you get unlimited hospitalizations for continued alcohol abuse and it's complications if you refuse treatment for the addiction? Do you get another knee rplacement at age 50 if you didn't lose part of the 300 lbs that caused the first one? A lot of people don't care for this philosophy but I think it warrants discussion.

On a separate note, my thanks for your service to this country and my admiration for doing it in such a difficult role. Appreciate it.

[Guest]

Could not agree more. Perhaps a little accountability along with the education? Do you get to keep getting repeat cardiac caths or bypass surgery if you continue to smoke? Do you get unlimited hospitalizations for continued alcohol abuse and it's complications if you refuse treatment for the addiction? Do you get another knee rplacement at age 50 if you didn't lose part of the 300 lbs that caused the first one? A lot of people don't care for this philosophy but I think it warrants discussion.

On a separate note, my thanks for your service to this country and my admiration for doing it in such a difficult role. Appreciate it.

And a sincere welcome. I know it is very difficult to change human behavior so more emphasis on preventative health at an earlier age seems prudent. Of course, I also believe that a course in basic business in high school should be mandatory. Knowing how to balance a checkbook and some simple investing would go further then algebra. IMHO

[Guest]

And a sincere welcome. I know it is very difficult to change human behavior so more emphasis on preventative health at an earlier age seems prudent. Of course, I also believe that a course in basic business in high school should be mandatory. Knowing how to balance a checkbook and some simple investing would go further then algebra. IMHO


Again, speaking from my experience only, a very small select few will actually learn an attempt to participate in preventive care, because it too will require change and adhering to certain behaviors.

[Guest]

How many of you speaking with such venom about the Federal Government's inequitable distribution of wealth, and it's botching of all things federal willingly receive Medicare, Veteran's Benefits and Social Security?

If you've spent more on your Medicare than you've paid in- welcome to Socialism, as you define it. If you have received more Social Security than you paid in- welcome to socialism, as you call it.

It seems only fair to me, as a baby-boomer, that you should not get one penny more than you have put into our "Socialistic" systems. Isn't that what you're saying- as long as it's someone else?

Our Declaration states that "Life" is one of the cardinal responsibilities and gifts given by our creator. Somehow, it gets lost when that affects some greedy geezer's pocketbook.

[Guest]

How many of you speaking with such venom about the Federal Government's inequitable distribution of wealth, and it's botching of all things federal willingly receive Medicare, Veteran's Benefits and Social Security?

If you've spent more on your Medicare than you've paid in- welcome to Socialism, as you define it. If you have received more Social Security than you paid in- welcome to socialism, as you call it.

It seems only fair to me, as a baby-boomer, that you should not get one penny more than you have put into our "Socialistic" systems. Isn't that what you're saying- as long as it's someone else?

Our Declaration states that "Life" is one of the cardinal responsibilities and gifts given by our creator. Somehow, it gets lost when that affects some greedy geezer's pocketbook.

Hmmmm Sounds like an anger issue to me. How about this? I will take every penny I put into it with compound interest since the government started taking it out of my paycheck and not ask for another dime. How's that? 46 years of my money earning interest. I'll take it and never ask my government for another "hand-out". OK? Oh yea, my wife has been self-employed for the last 22 years so she has been paying the Social Security tax of approximately 15 % I would like her's compounded too.
Oh, wait a minute..we had to pay for Johnson"s "War on Poverty." How did that work out? Oh yea, the government decided to "borrow" from the SS money to pay for that little expenditure....tell us again how many SS billions were borrowed for the infamous "War on Poverty"?
Oh...wasn't it the same administration that decided to borrow more money from social security to pay for the Vietnam war that a democrat started?
Let's see..who went over there to fight the Kennedy-Johnson War? Oh yea...THE GREEDY BABY BOOMERS. Imagine that.......

[Guest]

How many of you speaking with such venom about the Federal Government's inequitable distribution of wealth, and it's botching of all things federal willingly receive Medicare, Veteran's Benefits and Social Security?

If you've spent more on your Medicare than you've paid in- welcome to Socialism, as you define it. If you have received more Social Security than you paid in- welcome to socialism, as you call it.

It seems only fair to me, as a baby-boomer, that you should not get one penny more than you have put into our "Socialistic" systems. Isn't that what you're saying- as long as it's someone else?

Our Declaration states that "Life" is one of the cardinal responsibilities and gifts given by our creator. Somehow, it gets lost when that affects some greedy geezer's pocketbook.

As far as Veterans Benefits go, they have been earned and many who receive them would gladly love to have the clock turned back and swap places with anyone who complains about the cost.

As far as Social Security goes, the odds of ever fully collecting back what has been placed into the fund are very long indeed.

As far as Medicare is concerned, have no idea whether what I've "contributed" to Medicare will match what I receive in care. Time will tell.

With regards to anyone in the previous generation(s) who do depend on Social Security, Medicare or anything else, before you condemn those "greedy geezers," first thank them for letting you grow up in freedom and not having to speak German, Japanese or Russian as your national language. They sacrificed a lot - more than most folk will ever appreciate - so that their progeny would not live under tyranny, and it's beginning to look like the subsequent "me first" generation(s) lack respect and appreciation.

[Guest]

How many of you speaking with such venom about the Federal Government's inequitable distribution of wealth, and it's botching of all things federal willingly receive Medicare, Veteran's Benefits and Social Security?

If you've spent more on your Medicare than you've paid in- welcome to Socialism, as you define it. If you have received more Social Security than you paid in- welcome to socialism, as you call it.

It seems only fair to me, as a baby-boomer, that you should not get one penny more than you have put into our "Socialistic" systems. Isn't that what you're saying- as long as it's someone else?

Our Declaration states that "Life" is one of the cardinal responsibilities and gifts given by our creator. Somehow, it gets lost when that affects some greedy geezer's pocketbook.

Your points and the spirit you gave them in are well taken. I don't really hear anger, and you do make some valid points.

[Guest]

Your points and the spirit you gave them in are well taken. I don't really hear anger, and you do make some valid points.
Somehow, it gets lost when that affects some greedy geezer's pocketbook.


You could be right. Maybe anger is not the best description. Maybe...choler,ire,animosity,resentment. I tried to say "greedy geezer's pocketbook" a few times but kept getting this picture in my mind of a grouchy old man....probably my overactive imagination......Hmmmmmm

[Guest]

As a "baby boomer" I am sure you worked hard, lived real frugal, maybe in a low rent area and did not have a car for a few years after you married as you were saving for a car and home when you could afford it !! I am sure you did not buy a car on credit and you financed only a portion of the home with the commitment that you would pay the mortgage before you tried to "trade up"?
That when you retired you paid cash for your home as you saved for retirement. When called on to support your community through personal commitments and need to work on its social programs, (e.g. United Way, Jaycees, YMCA, etc.) that you stepped up to the plate and dedicated a good portion of your time to better the community. And for 40-50 years you paid into SS and only accepted Medicare as a goverhment program to let some air out of the high costs for new equipment that was being brought to the medical field, (e.g. Cat Scans, MRI's, etc.) which was funded before the liberals decided to use the money for something else and then claim poverty.Life is good but before you challenge the "older generation" remember that we tried to live responsibility as I am sure some "baby boomers" have done and deserve credit for those that did.

[Guest]

I didn't ask to be in Social Security. I wasn't given a choice. I would much rather have had the money to invest the way I saw fit. Did you ever hear of the Galvestan Project? These people were allowed to opt out of SS. They put their money in bonds and annuities that had guaranteed fixed interest rates. They are getting considerably more money than if they had put their money in SS. Why does the government always think they know better how to spend our money???

[Guest]

I didn't ask to be in Social Security. I wasn't given a choice. I would much rather have had the money to invest the way I saw fit. Did you ever hear of the Galvestan Project? These people were allowed to opt out of SS. They put their money in bonds and annuities that had guaranteed fixed interest rates. They are getting considerably more money than if they had put their money in SS. Why does the government always think they know better how to spend our money???

Sally Jo....Can you tell me more about the Galvestan Project? I did a few searches but came up empty. It sure sounds interesting.

[Guest]

Keedy, My info came from "Let Freedom Ring," by Hannity. Pages 244 and 245. Also, google Social Security / Galveston, Texas. There are several articles listed. Some pro and some con. I have read about this project in several other books, but its late. I'll try to find them tomorrow.

[Guest]

Keedy, My info came from "Let Freedom Ring," by Hannity. Pages 244 and 245. Also, google Social Security / Galveston, Texas. There are several articles listed. Some pro and some con. I have read about this project in several other books, but its late. I'll try to find them tomorrow.

Sally Jo..

Thanks..I always wondered how much money I would have if I could have diverted all the money that me and my employer put into the Social security fund into an investment. Heck, just throwing it into the bank for 46 years would make me a rich man....well maybe not rich biy maybe secure.:icon_hungry:

[Guest]

How many of you speaking with such venom about the Federal Government's inequitable distribution of wealth, and it's botching of all things federal willingly receive Medicare, Veteran's Benefits and Social Security?

If you've spent more on your Medicare than you've paid in- welcome to Socialism, as you define it. If you have received more Social Security than you paid in- welcome to socialism, as you call it.

It seems only fair to me, as a baby-boomer, that you should not get one penny more than you have put into our "Socialistic" systems. Isn't that what you're saying- as long as it's someone else?

Our Declaration states that "Life" is one of the cardinal responsibilities and gifts given by our creator. Somehow, it gets lost when that affects some greedy geezer's pocketbook.

Just thought I would bump this up in case anybody missed it last night.:shrug:

[Guest]

Actually, anyone who has read my past posts knows that I am an unabashed and proud progressive! I just get a kick out of people misrepresenting the words "socialism" or "fascism" just to inflame a talking point.

I firmly belive that goverment has a role to play in providing universals that not everyone can access- and I am proud to pay more taxes if necessary to provide better services. That includes education, police fire, roads and safety, as well as a minimum of quality health care, Veteran's care, and dignity for seniors.

We pay our amenity fees in The Villages- they are taxes- and yet don't begrudge the possibility that the Morses may owe hundreds of millions of dollars in shady tax exempt shelters. As I've said before, taxes are the country club fee you pay to live in the greatest nation in the world. Our priorities are different than other nations, and SOME individuals have the choice to move, but the vast majority have no choice or desire to move. Yet their attempt at change is viewed by the narroe-minded as threatening or unAmerican.

But millions of Americans cannot simply say "Oh, I'll choose my own health care plan" simply because the health care industry, making obscene profits, isn't interested in insuring individuals. Why is it fine for the head of United Health to make $139 million dollars a year (2005), but then you complain about Medicare being wasteful?

Many Villagers are totally out of touch with the mainstream of this nation. We live in a wonderful middle-class fantasy world. We cheer Oliver North's patriotism, even though he sold 1000 stinger missiles to Iran AFTER the hostage crisis. We cheer Anne Coulter even as she calls for genocide, murdering college students and blowing up newspaper buildings. We crow about Republicans being the party of "family values" even as hypocrite after hypocrite gets caught with his zipper down- gay and straight. (Democrats do it just as much- but they don't get all self-righteous about it towards others!)

We listen to radicals like Joe Angione, Ruthie Kelly and Rush Limbaugh use coded anti-semetic language (Intellectuals, socialists, bankers and elitists are all words the Nazis used to label Jews) and then "tsk, tsk," when white supremisists act out on their hateful cheerleading.

So as a baby-boomer, I am PROUD to pay taxes, Proud of my country and her values. I am ashamed, however of how many of the "Korean" generation do a dis-service to "The Greatest Generation" and the current generations by engaging in nothing but navel-gazing anger toward anything that doesn't resemble "life" like "Father Knows Best" or "Leave it to Beaver."

No matter how much you'd like to just bury your heads in the 13th hole of Hemmingway, there is a big world around us with huge, inhumane problems that need to be worked on.

Enjoy this great life, but don't assume it's available to "anyone" who works hard enough to get it. Life doesn't work that way, and our system ahs become only more and more skewed to favor those of us who start with money in the first place.

[Guest]

Actually, anyone who has read my past posts knows that I am an unabashed and proud progressive! I just get a kick out of people misrepresenting the words "socialism" or "fascism" just to inflame a talking point.

I firmly belive that goverment has a role to play in providing universals that not everyone can access- and I am proud to pay more taxes if necessary to provide better services. That includes education, police fire, roads and safety, as well as a minimum of quality health care, Veteran's care, and dignity for seniors.

We pay our amenity fees in The Villages- they are taxes- and yet don't begrudge the possibility that the Morses may owe hundreds of millions of dollars in shady tax exempt shelters. As I've said before, taxes are the country club fee you pay to live in the greatest nation in the world. Our priorities are different than other nations, and SOME individuals have the choice to move, but the vast majority have no choice or desire to move. Yet their attempt at change is viewed by the narroe-minded as threatening or unAmerican.

But millions of Americans cannot simply say "Oh, I'll choose my own health care plan" simply because the health care industry, making obscene profits, isn't interested in insuring individuals. Why is it fine for the head of United Health to make $139 million dollars a year (2005), but then you complain about Medicare being wasteful?

Many Villagers are totally out of touch with the mainstream of this nation. We live in a wonderful middle-class fantasy world. We cheer Oliver North's patriotism, even though he sold 1000 stinger missiles to Iran AFTER the hostage crisis. We cheer Anne Coulter even as she calls for genocide, murdering college students and blowing up newspaper buildings. We crow about Republicans being the party of "family values" even as hypocrite after hypocrite gets caught with his zipper down- gay and straight. (Democrats do it just as much- but they don't get all self-righteous about it towards others!)

We listen to radicals like Joe Angione, Ruthie Kelly and Rush Limbaugh use coded anti-semetic language (Intellectuals, socialists, bankers and elitists are all words the Nazis used to label Jews) and then "tsk, tsk," when white supremisists act out on their hateful cheerleading.

So as a baby-boomer, I am PROUD to pay taxes, Proud of my country and her values. I am ashamed, however of how many of the "Korean" generation do a dis-service to "The Greatest Generation" and the current generations by engaging in nothing but navel-gazing anger toward anything that doesn't resemble "life" like "Father Knows Best" or "Leave it to Beaver."

No matter how much you'd like to just bury your heads in the 13th hole of Hemmingway, there is a big world around us with huge, inhumane problems that need to be worked on.

Enjoy this great life, but don't assume it's available to "anyone" who works hard enough to get it. Life doesn't work that way, and our system ahs become only more and more skewed to favor those of us who start with money in the first place.

put the rest of us down because we do not have the affluence that you do. We paid and paid dearly into SS for over 50 years and are still paying into Medicare, thank you very much. Would you rather see all of our hard earned dollars go to the illegals, etc.? I sure hope not. Until you have walked in my shoes, do not presume to tell me how they fit. My husband is a Korean Vetand I have 2 sons that served proudly and retired from the Navy. They are both now in the private sector working toward a second retirement so please, don't even go there.

[Guest]

It is interesting to see how many who tout their belief in Gov't handouts, (which is really our money) do it as a feeling of a sense of entitlement and believe they actually have a right to the other guys earning from hard work.
The gov't has no money. It is our money and redistribution of wealth..well I guess I don't have to say what that is !!!

[Guest]

Yes, I know we have 46 million uninsured Americans. But who are they and can they really NOT afford medical care? Are some of them the ones who don't take health insurance that is offered by their employer (this goes on where my mother works), the ones with the latest gadgets- best cell phone, car, pick-up, vacation, flat screen TV, etc. or they think it is a right to be provided care (go to an ER for something minor) and have the rest of us pay for it???
We make health insurance a financial priority in our household - no I am not on Medicare and am "uninsurable" for private insurance but pay for a high risk pool.
I enjoy the right and want to be able to make my own decisions regarding my health care and do not want the goverment telling me what, when and where.
I am also a RN and have seen how some on Indian Reservations must wait due to lack of funds, have taken care of Canadians who come to the USA and have waited in ER's while the staff needs to care for someone's cold.
So, that is my two cents worth.
I am just waiting the the goverment to change the federal law preveting transferring of health insurance across state lines. And we will be there in a heartbeat.

[Guest]

Actually, anyone who has read my past posts knows that I am an unabashed and proud progressive! I just get a kick out of people misrepresenting the words "socialism" or "fascism" just to inflame a talking point.

I firmly belive that goverment has a role to play in providing universals that not everyone can access- and I am proud to pay more taxes if necessary to provide better services. That includes education, police fire, roads and safety, as well as a minimum of quality health care, Veteran's care, and dignity for seniors.

We pay our amenity fees in The Villages- they are taxes- and yet don't begrudge the possibility that the Morses may owe hundreds of millions of dollars in shady tax exempt shelters. As I've said before, taxes are the country club fee you pay to live in the greatest nation in the world. Our priorities are different than other nations, and SOME individuals have the choice to move, but the vast majority have no choice or desire to move. Yet their attempt at change is viewed by the narroe-minded as threatening or unAmerican.

But millions of Americans cannot simply say "Oh, I'll choose my own health care plan" simply because the health care industry, making obscene profits, isn't interested in insuring individuals. Why is it fine for the head of United Health to make $139 million dollars a year (2005), but then you complain about Medicare being wasteful?

Many Villagers are totally out of touch with the mainstream of this nation. We live in a wonderful middle-class fantasy world. We cheer Oliver North's patriotism, even though he sold 1000 stinger missiles to Iran AFTER the hostage crisis. We cheer Anne Coulter even as she calls for genocide, murdering college students and blowing up newspaper buildings. We crow about Republicans being the party of "family values" even as hypocrite after hypocrite gets caught with his zipper down- gay and straight. (Democrats do it just as much- but they don't get all self-righteous about it towards others!)

We listen to radicals like Joe Angione, Ruthie Kelly and Rush Limbaugh use coded anti-semetic language (Intellectuals, socialists, bankers and elitists are all words the Nazis used to label Jews) and then "tsk, tsk," when white supremisists act out on their hateful cheerleading.

So as a baby-boomer, I am PROUD to pay taxes, Proud of my country and her values. I am ashamed, however of how many of the "Korean" generation do a dis-service to "The Greatest Generation" and the current generations by engaging in nothing but navel-gazing anger toward anything that doesn't resemble "life" like "Father Knows Best" or "Leave it to Beaver."

No matter how much you'd like to just bury your heads in the 13th hole of Hemmingway, there is a big world around us with huge, inhumane problems that need to be worked on.

Enjoy this great life, but don't assume it's available to "anyone" who works hard enough to get it. Life doesn't work that way, and our system ahs become only more and more skewed to favor those of us who start with money in the first place.

Wow...Quite the rant...you have so much misinformation that I would not know where to begin.
First of all..what a private corporation makes a in profits and what they pay their CEO is part of our free enterprise system.
Second...Tell me what is wrong with "Father Knows Best" and "Leave it to Beaver"? What bothers you about those situations? Is it the stable marriage they have? Is it the strong father figure...you know that one that goes to work every day and takes an interest in their children? Is it part of the morals that each episode tries to present?
Or do you like the lack of morals today with the divorce rate at 50% and the kids brought up with no father and receiving welfare handouts? I personally would rather take the "Beaver" approach then the single mother with 6 kids and no income and no father approach. There are all kinds of television programs out there now that portray the father as some kind of idiot and the kids as loud-mouthed morons. Yea, that's what we need.
And finally...your little fable about Rush and company being anti-Semitic is totally wrong...The left-leaning liberals are the ones that are against Israel. Obama and Clinton have proved many times that they are not fond of our Jewish friends.
AS far as the system being skew to the people who have money in the first place...that is a down right lie. Immigrants still come to America with nothing and make a success of it. Explain to me why people from impoverished nations come here and work hard and make something of themselves yet we have citizens who cling to the ideals of socialism and all they do is squack how unfair everything is here in the USA.
My rant is over...my only hope is that we survive the present administration's attempts to re-form the USA into some kind of third-world rat hole!!!

[Guest]

...
Many Villagers are totally out of touch with the mainstream of this nation. We live in a wonderful middle-class fantasy world.
....
No matter how much you'd like to just bury your heads in the 13th hole of Hemmingway, there is a big world around us with huge, inhumane problems that need to be worked on.

Enjoy this great life, but don't assume it's available to "anyone" who works hard enough to get it. Life doesn't work that way, and our system ahs become only more and more skewed to favor those of us who start with money in the first place.
These "out of touch" Villagers happen to consist of many people who currently work full and/or part time in every aspect of the society. Those who don't currently work-for-money have several decades in the "real world," and still spend incalculable numbers of hours as hospital volunteers, soup kitchen aides, prison ministry counselors, guardians ad litem, and a myriad of other "in-the-street" situations which take advantage of their life experience.

As far as "enjoying the great life," as demonstrated by these wonderful people, it includes an awful lot of giving-back by folk who have lived through those huge, inhumane problems are are indeed still involved in solving them firsthand. So, if they do spend some time taking care of themselves, as they are still spending a lot of what they have left in life for the sake of others, they've earned it!

[Guest]

Keedy, you couldn't have said it better. I have listened to Rush (never heard of the other two) a good many years and have never heard him be anything, but pro Israel. I just finished the chapter, in Mark Levin's book, "Liberty and Tyranny," about illegal immigration. My blood is boiling.

[Guest]

Keedy, you couldn't have said it better. I have listened to Rush (never heard of the other two) a good many years and have never heard him be anything, but pro Israel. I just finished the chapter, in Mark Levin's book, "Liberty and Tyranny," about illegal immigration. My blood is boiling.

Sally Jo

Thank-you for your kind words. That is a real good book. I started it a few weeks ago but had to put it aside until I finished what I started on two other books. My problem is that I read in bed and usually fall asleep before I have read very much. LOL