kbordson

I'm getting a bit side stepped now but, I would rather get rid of all corporate power in decisions concerning health care. Insurance companies, lawyers and lobbyists. I was just trying to point out that basically the same group that you are accusing of destroying healthcare are the ones you trust the most. /Martin No...as I have said above. It's MUCH easier for me as the physician to get an insurance company to approve something than it is to get the government to approve. In reality, I would RATHER not have to fight either.

I'd prefer to take my chances with the government, who may be lobbied, than with the corporations that hire the lobbyists. The lobbyists may influence decision making, but the worst case of such influence is what the corporations would decide on their own. You also are selectively forgetting that you, as the customer, get to decide which corporation/ insurance company you want. If you think coventry sucks - drop them and go for Blue Cross. While we do get a vote in government, in reality if "the government" mandates, you have no choices.

HELL NO!

Who do you believe those special interest groups are? I'm guessing corporations looking out for their shareholders. /Martin So you would rather let a lobbyiest decide what medical care you should get?

I'm not that well educated in american corporate law but I'm pretty sure it's a criminal offense for a company board not to work in the best interest of the shareholders. Maybe Lawrocket can help us out here. Much in the same way the government should be working for the best interest of the people. Intentionally not doing that is in most cases also a criminal offense (i.e. corruption). You might disagree on the outcome of a shift in policies. But if you are implying that the corporate sphere is more interested in what's best for the people is just wrong. Both comments bolded are where my concern lie. The government "should be" working for the best interest of the people... but the reality is that it doesn't. Lobbies and special interest groups have shown that they can completely distract the government from what "should be." And "best interest of the people" might not be "best interest of my patient." See my posts above of the problems that I have already encountered with government resistance to providing appropriate patient care.

I would rather it be the government than for-profit insurance companies or HMO's. Why? Because being for-profit causes a conflict of interests. For-profit entities operate with the owners' best interests in mind, not the customers'. A for-profit insurance company's reason for existence is to maximize income for shareholders, not to ensure patients get the best care possible. While the government may not be perfect, that conflict of interest does not exist. I disagree

I would rather it be the government than for-profit insurance companies or HMO's. Why?

don't have to. a national health service is coming to the usa - get ready! So says dreamdancer, son of Nostradamus. Well. that settles that.

where's a link? I haven't been able to find one on google and not to say that I don't trust your word... but being able to back up statements with the source is nicer. I should insert a

I agree that defending our infant mortality rate does make us look even worse, which is why I haven't gone that route. But... he is correct in the difference in definitions. But... in Missouri, the definition of "live birth" includes those infants that either had a movement, a pulsating cord or any attempt at breathing. This includes those infants at 16weeks (ABSOLUTELY PRE-VIABLE) that have a gasp as it's delivered. Or a twitch of the leg on a 350g infant.... Those all count as "live birth." And I don't know if they were reporting neonatal deaths (babies born alive and dying during the first 27 days of life) or perinatal deaths (which is fetal deaths 20 or more week's gestation plus neonatal deaths.) Missouri DHSS

Not saying that all will... but in many cases, buying chinese imports from Walmart does not help the American infrastructure. Raising the minimum wage may just further raise the cost of US production without an actual rise in US production of resources.

Maybe the velocity of money is different over there. km/hr v. mph differences. And I still stand by the fact that OVER HERE, Bush DID in fact raise the minimum wage over the past three years. And the fact that it isn't all sunshine and roses and bunny rabbits. Not directly correlating cause and effect, just stating that your comments regarding raising the minimum wage will be so wonderful might not be entirely truthful and may in fact further hurt businesses.

Not me, I get enough of a pain just thinking of US issues. I am amazed out how many out siders care about internal US politics..... Sorry. I was agreeing WITH you but directing my further comments to Mr. Dreamer

Agreed. If a different country chooses to raise their minimum wage, I have no opinion on what that country might choose to do. If you were honestly discussing raising the minimum wage over there, have fun.

That's fair. But, private insurance companies never try to tell you what they think is cost effective, or what they think their customers are entitled to? Aside from the relativly small clientelle who can afford out of pocket any treatment you may feel is best, isn't "cost effectiveness"always going to be an issue? Don Granted. But it's far easier for me to convince an insurance company to give one of my patients a trial of DepoLupron than it is to change the Medicaid standing on Zofran. Cost effectiveness is important. I do believe that. But sometimes you have to spend more for some patients in ways that aren't cost effective. Some on here claim that I don't see the forest for the trees.... I work with the "trees." I see her pain. I feel her anger and her frustration. I DO NOT LIKE IT. I do not trust the government to help this situation. -edited for grammar

As you chose to. And I owe you no explanation of my beliefs - whether you see them as inconsistent or not. I'm just giving MY opinion based on MY experience and personal beliefs.

I take it, then, that you ignore all FDA regulations and all epidemiological information coming from the CDC. Then you would be making incorrect assumption. A does not equal B here. But, you can read into it what ever you want.

Why not? - private enterprise has had decades and you admit it can't fix the problems in the system it created. THAT is a good question with a simple answer. I do NOT trust the government. I do NOT want to rely on the government. I personally believe in PERSONAL autonomy and responsibility. And I can not reconcile with the government telling me as a physician what is cost effective care, nor telling me as a patient what I amd "entitled" to. I want the right to research my conditions and decide what is the best care FOR me. Whether that might be in the guidelines of the government regulations or not.

Yes. Do YOU understand the Medicaid IS NOT the only model for government provided medicine? Be careful not to throw the baby out with the bath water. Oh right. There's Medicare. I can list problems with that system too. And even Tricare.... which is one of the reasons that I got out of the miiitary. I have said the system is broken. But, I do NOT want the government involved in medical decision making.

OK. It seems that I have to explain basics. Do YOU understand that Medicaid IS government provided medicine? So when I'm complaining about the problems with medicaid, I'm complaining about the problems that are with government provided medicine. I have worked within this system. I don't think it is best. I'm not saying private insurance is best or not... but government controls limit the practice of medicine.

Don't look now, but you're making an argument supporting universal healthcare over private, for profit care. No ... I'm not. I'm saying that I do not WANT to and MANY physicians do NOT fight the decisions by the government. In that situation, the patients will be limited in their options.... and the physicians will have to be the evil ones to tell them "no."

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

The article doesn't lean for or against Paul Krugman's finding. But it does make good points about why most find the study controversial. To me, it seems that this was a fluke. Where are the other studies that show the same results? This is just one instance that job loss didn't happen. When more studies come out similar, then maybe we could put the unemployment effects of increasing minimum wage to bed. We've already put to bed the claim that increasing the minimum wage always results in more unemployment. That myth was easy to disprove. And we put to bed the claim that increasing the minimum wage always leads to prosperity. That myth was easy to disprove

I have NEVER said that it isn't broken or that it doesn't need to be fixed. I try from the inside to help my patients.... which are mostly medicaid by my CHOICE. Currently in Kansas City, there are only a handful of physicians that take pregnant medicaid patients. AND... if you had regular insurance at the beginning of the pregnancy, but lost your job (or he lost his job) and lost the insurance, then many of the ob/gyn groups will drop those patients. I try to offer an alternative to those women other than going to the teaching hospitals (publicly funded and VERY inefficient). BUT.... with some of those women, it IS a challenge to keep them in my caselist. Some have problems that are harder to treat with Medicaid - example: hyperemesis (puking and puking and puking... typically limited to the first trimester) My goal is to limit the dehydration and try to keep her out of the hospital. I use different medications (phenergan, reglan, pepcid, vit B6, unisom) but I can't write a prescription for zofran (which is an EXCELLENT anti-nausea med with very few side effects... I can admit her and give it to her IV, but I cant write a rx for it and have her use it as an outpatient... now honestly, which costs more, a hospital admission and IV medication or a prescription) Or lets talk about dental issues in pregnancy. How many dentist take medicaid for adults? Here in the KC area... only one or two. So finding them care for that part of her health and wellness is quite a challenge. (Note: she could have always gone and paid out of pocket of routine dental care, which would have been A LOT cheaper than having to find someone to do a root canal or extraction during the pregnancy) Another example: Intrauterine Devices (Mirena) This is a VERY good and VERY reliable method of contraception that medicaid had said that they were going to drop. I FOUGHT against that decision. I was PISSED that the government was going to take away this option for a VALID AND RELIABLE contraception because the upfront cost was more than a few pack of pills. The gov'ts argument was that some of the women take them out before 5 yrs and they don't get the monies worth out of it. BAD argument.... so the government is saying that just cuz some women don't tolerate it and want it removed or because some women have changes to their life situations and feel that they are ready for another child before the 5yr mark, they are no longer providing it? But with medicaid, the government CAN AND DOES say that. And doctors have to FIGHT the government. That gets very tiring and not many do. And some of these patients are VERY non-compliant. (generally it's only a handful that fall into this category) But with the system as it stands, I can tell her: "Ms. Smith, you NEED to keep your appointment and your referrals that we schedule for you OR I WILL fire you as a patient and you will need to go to Truman for your care." Why am I so harsh on this? Because if you have a history of drug use, and your pregnant and you complain about intermittent chest pain - I NEED you to be seen and evaluated by cardiology. If you're not having the pain at that moment, you don't need to go to the ER, but you DO NEED to be evaluated!!! To just decide not to and then to have a catastrophic event during labor puts me in SUCH a legal risk!!! And yes... there is some of this that is about me. I don't want to be sued of everything and lose my licence because of non-compliance. In theory could I "win" that case? Maybe. Depends on the lawyer and the jury. If she dies... my malpractice insurance might decide to settle despite whether or not I was "right." If they settle, that looks bad on my record for the rest of my career. So I want to maintain the right to fire her. Other reasons to fire patients: intolerable rudeness. My staff does NOT deserved to be sworn at or work in a hostile environment. I do not deserve to be threatened by an angry father that has an incorrect sense of entitlement (NO, sir. It is NOT your "right" to do that) I deal with this. Do you? Or do you just sit on a computer and whine about those that are trying to fix thing?

What motive have the Dems to restructure? Just 3 months ago they won the WH and Congress, and the GOP is imploding. Wait and see. The "Dems" are going to get themselves into some serious trouble in the next few years. And just because one girl named Tina thinks that they are imploding doesn't mean the party is going away. You can (and obviously DO) agree with her. But I don't.