kbordson

Apparently in your haste to whine you missed this part of the Constitution: Section 8 - Powers of Congress The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States; Apparently in your haste to whine....

Happy Birthday!! Enjoy the warm weather!!

When Pinky and I finally rule the world. but.... where are you going to find rubber pants our size?

Who said I was? Here.... this is my belief - I even reference YOU in that statement. I haven't flipped. Some controls are good. But "which" controls? And why SHOULD I trust the govenrment?

Why? Because I am disgusted by the pandering and condescending "tone." Because if you want to discuss and debate like adults then "yes, dear" shouldn't be in the conversation. Because if you don't believe it.... don't lie

I personally find your sarcasm insulting. But... if you feel that you must be a snot and intentionally say things that are against your actual beliefs (I think some people call that lying)... go for it.

Well I stand corrected. Please refer to item #43. He said.."I have a newer bridge other than the bridge I sold ya in the middle of the desert, and it doesn't have water either. Oh and while you're at it work harder!" Item #43 was President #43. The difference between the two bridges is that one of them will be built here in the US, with our own workers, who will (after taxes) spend their paychecks in our own stores. The other was a bridge in the desert of another country, that we paid a premium price for (plus expenses and nearly tax free), that was either never built or is was so poorly constructed that it has already fallen apart. Ummm.... re-read that speech. He NEVER says nutin about not working on that bridge over in the desert, he just ADDS new ones like everyone goes to college if they do some community service and everybody gets new and efficient power and everybody gets electronic medical records that will "reduce error, bring down cost, ensure privacy and save lives." (He said it... it must be true)

Well ... he did say one true thing

"Get over it." What a dumb statement that truly is. As if it's something to get OVER - instead of a deep darkness that you don't even have the strength to reach up from.

Are you talking about wearing them at home? Or for daily wear? Don't know if I would want my gyn to be wearing those (under the standard gloves, I'm assuming)

Yes, but no. Yes - I feel, as you stated, that there are MANY that feel "entitled" to multiple government provided services. Many of those expect to take from taxes, but really have no desire to pay in or contribute to the society. If there was a form of civil service that was mandatory starting at age 18-22 (or even 18-20... or once done with college, 22-24) then I think people would have more respect for they they are "owed" by the government. By working for something, you better understand it's worth. No - Personally, I don't want the whiners in the military. It might "make them better people" but it would tear up the morale. Civil service - have them work in Nursing homes, Hospitals, road clean up, painting over vandalism/graffiti, work in food banks/ homeless shelters, orphanages/ foster care (admin jobs... not take those lil children home). Help them see that so many have worse off situations and that maybe their life isn't really as bad as they think it is. Jobs that help the community but not necessarily in the military. Those that WANT to do their service in the military can but not forced military service.

so everyone should take that attitude? Trust me... I'm all for desiring to "escape the system." But the reality is that LIFE with modern conveniences and "entitlements" comes with cost. If you break your leg - a nice compound fracture. You want someone there to XRay it, set it and cast. Some pain meds would be nice. And... if it doesn't heal just like new, you want the right to sue him/her for not having a perfect outcome. a dollar a month.... $120/decade?! How long is anyone going to support you before the system collapses? Doctors decide that it's not worth the risk. Nurses get frustrated that they can't feed their families. Buildings go into disrepair. For you to take that "break the system" attitude, you should be willing to completely care for yourself without imposing at ALL on others. And... you don't have to pay to stay healthy. Many people HAVE insurance but are NOT healthy. It costs nothing to walk and exercise. Or to bypass McDonalds. Or meditate.

I truly hope this is sarcasm. So... you want the care. But don't want to pay for it - AT ALL. Not on a personal level nor with taxes. Lets look at other costs of health care. Physician expenses: Direct - Medical School. Books/Equipment (stethoscope, speculum). Board Certification. Conferences for continuing education. ACLS. Pager/phone. Malpractice Insurance (as an OB/Gyn?!). Electronic Medical Records (in my practice that is $500/month per physician) Indirect - Food (even ramen costs money), vehicle to get to the hospital (I drive a Hyundai), housing, clothes Nurses expenses: Direct - Nursing School. Books/Equipment. Certification. ACLS. (malpractice for some fields is becoming an issue) Indirect - food, vehicle, housing, chothes Clinic/Outpatient expenses: Office manager. Receptionist. Billing/coding. Office rental/lease, electricity/power, heat/air conditioning, water, furniture (waiting room chairs/tables, front desk supplies/computers/photocopier/fax, exam room tables) Patient gowns (laundering) Gloves. culture swabs. needles. measuring tapes. sterile / non-sterile gel. Hospital expenses: the building itself (including architecture specific for the ER or the OR suite or Labor and Delivery or ICU or CCU or lab ....) over head paging ("code blue....") electricity/power, heat/air conditioning, water, furniture (beds for ER, for OR, for patient rooms; waiting room chairs/tables; check in/admitting supplies; nurses station supplies) medical records (paper or electronic charts, dictation) radiology (XRay, CT, MRI, ultrasound - and people capable of operating them) pharmacy (medicines, IV solutions, Pharmacists and assists) lab (vials, needles, swabs, machines, culture media and people working in that department) physical therapy, supply/ sterile supply, transport, dietary, janitorial services, linen services, grounds keeping (snow removal to even get to the door), security, parking (and probably LOTS, LOTS more) So... you want all this but make "someone else" pay for it. Who?

Personal choice. interesting segway here. Getting cancer as a personal choice. Of course no one would ever say "not doing anything with the rest of my life, lets get some cancer thing." But... your risk activities do greatly influence certain cancer types. My dad had lung cancer; my mom has COPD (second hand injury from my dads smoking). My sister smokes close to a pack a day. That's her choice. If she gets lung cancer.... it is due to choices that she made. I have enjoyed a nice cigar every once in a while to relax/celebrate. If I get lung cancer, it it do to choices I made? Should I pay more as one would pay more to drive a hummer? Should it be even a further tax on tobacco? But... some people CAN smoke all their life and NOT get cancer. Look at George Burns (RIP) Lets look at another cancer with "choices." Cervical cancer. (Now personally I HATE this cancer. I hate the way it grows, I hate the way it smells, I hate the way it kills) But... lets look at choice. We (medicine) currently believe that the changes that progress to squamous cell carcinoma of the cervix are induced by the virus HPV. This is a sexually transmitted virus. She might not have chosen to get cancer. Nor did she choose to get a STD. But.... in most cases (excluding rape and those situations) she DID choose to sleep with "him." So do we tax sexy lingerie .... or "untax" condoms? (note: condoms do not protect completely from viruses) But again... there appears to be a genetic predisposition here again.... so can some people sleep with multiple partners and not pay extra or does everyone PERSONAL CHOICE comes with PERSONAL RESPONSIBILITY.

So you're saying an "n" of one is "proof"? Doesn't meet giudelines for appropriate research.

My point was it was a VOLUNTEER service. The firefighters weren't on the gov't payroll. Should it have been? Would it have changed the results? I don't really think so to either question. In some communities, people want everything provided for them by the governement. In other communities, the people are more self reliant and don't expect or demand that other people moneys make their life easier.

In rural South Dakota, you might NOT get a nice paved road. Hard packed gravel might be what you have to pay for to get from the county road to your house and depending on how far away it is from that road... might be a mile or more. Entitled to fire protection? A lot of communities still have volunteer fire departments. A friend lost his house when it burned down during a bilzzard and the fire truck got stuck. Was he "entitled" to better? Entitled to police "protection"? They are not there to "protect" you. They enforce the law. But... the law has to be broken first (or a distinct threat against a law) You can't just call them up and say "need a body guard here cuz .... I can't take care of myself." Entitled to "public schools"? Although I personally think that public school are better or equal to many of the private ones (having been to both).... I have several friends that home school because they are disappointed in either option. Are they "entitled? Nope, they are just relying on personal responsibility to educate their children. Other questions? Are you entitled to drive? Are you entitled to weight 350#? Are you entitled to skydive? What some consider "rights" should really be looked at as personal responsibility.

Prenatal vitamins are not prescription only. They are at every walmart, grocery store, and corner pharmacy. They cost approx $15 for 240tabs. AND... women SHOULD be taking it PRIOR to getting pregnant to fully decrease risk of neural tube defects. A good (ish) argument... but not the best. A better one would be offering free vaccinations.... but even though that is provided through several sources, it's still underutilized. But then you get the argument that vaccinations are bad and cause problems.... and the lawsuits..... and those aren't cheap either. Maybe people just have to understand that LIFE is expensive. LIFE has risks. In life, you're not always ENTITLED to an easy answer. You're entitled to life.... but not necessarily at the expense of others. And the next question would be determining what is socially acceptable care for "society"? Basic emergency care? Motor vehicle accident? MVA where he/she wasn't wearing a seatbelt? Skydiving with a miscalculated swoop? Anybody filming a Jackass video? Preventative and primary care? Depression and counseling? Prenatal care? In vitro fertilization? IVF for a 32year old that has been trying for 8years and can't get pregnant? IVF for a 23 year old with two children already? Care of a 23w near viable infant in the NICU for months and months and months? Care of your 89yo grandmother that has ovarian cancer? Care of a type 1 Diabetic 7 year old? Care of a type 2 diabetic 39 year old weighing 345lbs? Chronic obstructive pulmonary disease? In someone exposed to second hand smoke? in a 2 pack per day smoker? Liver failure in a person that over dosed on tylenol with chronic pain issues? in a person with Hepatitis C that caught it from a blood transfusion in the 80's? Hep C from IV drug use? HIV antiretroviral suppression? Antiretrovirals in a patient that will take them occasionally and then build up a resistance to those meds? As a culture in the USA, we are tending to move away from personal responsibility for individual health. Our diets SUCK. Our health habits are horrid. Exercise? But we blame our job. Our children. OUR choices.... it's our choice to take this poor care of our bodies.... We need to change OUR perception. We are entitled to exercise. We are entitled to eat well (not crappy McDonalds) We are entitled to meditate. Not to say that those will save a person with a ruptured appendix.... but it might decrease the hypertension, the diabetes, the anxiety issues..... the chronic stuffs that eats most people up.

Actually, you are not correct. It is school dependant, and I have looked up several here in the Kansas City Area. MD Schools: KU requires source UMKC does not (as noted in my initial post, it is one of the 6yr programs) D.O. Schools KC-UMB does not (however it does state that "The baccalaureate degree is preferred and preference is given to those candidates who will have earned the degree prior to matriculation in the medical school program.") source Chiropractic Schools Cleveland Chiropractic College's does not source But... the reason that I even initially posted any referece was due to the fact that one posted knowledge based on some students she knew that it was "extremely intense." Lots of fields take "extremely intense" course loads and I was just trying to better clarify as I TRULY have experience in this field. I have since been called "arrogant" in pm's for wanting to correct this but namecalling aside, there are different levels of care. I NEVER specified that anyone is "just" or "only" a anything. I have respect for ALL the healthcare providers. But you should know what you are getting and from whom. WHICH WAS MY ONLY REASON FOR CORRECTING THAT And... if you look at my posts, I also commented on how manual medicine (whether from a chiropractor OR a DO) can be very helpful in wellness. Now... if some of you wish to continue a pissing contest about who is smartest or better or whatever you feel that you might be proving, go for it. But I'm backing out of it.

You might want to look at that study closer. What drugs did they look at (specifically - antibiotics? hormones? anticoagulation? psychiatry?), what were the outcomes (knowing what they used as a bench mark for the "no real advantage" is important) , what was the cost savings? (truly... not just "millions of Euros.") There are only TWO medicines that I would not write generic for - those are Coumadin and Synthroid. I generally don't write for coumadin because it's contraindicated in pregnancy (I use heparin in those cases). The reason that I prefer trade in those cases is that generic allows a broader variance of the actual dosage administered. Most of the time that variance isn't truly that big of a deal, but if I'm worried about hypothyroidism in pregnancy or blood clots in high risk patients post surgery... the cost of the trade FAR outweighs the issues of complications. BUT the bottom line is ... is it truly for the govenment to tell you "ahhhh... it's ok if you get a pulmonary embolus... we saved so much with warfarin." (like a Geico commercial) (oh. and ... some neurologist write for trade on their anti-epileptics because serum levels are important with that too)

Right. cuz right now all doctors want to do is do ineffective things that just spend money for the sake of pulling the last lonely dollar out of the poor patients hand. It's not like I've never given a prescription for someone CONVINCED that she NEEDS antibiotics for the viral illness that she has. It's not like I've ever taken the time to try to explain how evidence shows that the antibiotics won't help her and might lead to more problems with drug resistance. It's not like the PATIENTS demand ineffective things DESPITE being told what evidence based medicine would recommend. And trust me, patients NEVER threaten the physician. Lets just blame the doctors that want to provide "ineffective" treatment. So, lets go to the next step... what are the penalties going to be to the physicians that do cave to the pressures of what the patient wants? Especially if what the patient wants is contrary to what the government decrees? How will the government go about "influencing" change to follow recommendations?

So you honestly believe that the government will add non-biased and objective results to those already in existence. No interference by lobbies or politicians with a desired spin. No manipulation of results or misrepresentation.... There are MANY current thoughts against drug company interference with research. With good reason! Disclosure of conflicts of interest and financial bias is a big thing in research. Science should be science. Data should stand on its own. Health care should be evidence based but individualized to specific patients needs.... not reflect a political agenda. I would be very suspicious of any doctor that just uses the results of this kind of study. The motives behind it are NOT science based.

There are already NON-government directed studies that publish results of evidence based medicine. I would prefer to get my data from the green journal, the gray journal and

Tell me. What is the next step to this federal program?

A new take on "Evidence Based Medicine" - What your doctor can and cannot recommend as directed by your Government New York Times 2/16/09 U.S. to Compare Medical Treatments By ROBERT PEAR Published: February 15, 2009 WASHINGTON — The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness. Under the legislation, researchers will receive $1.1 billion to compare drugs, medical devices, surgery and other ways of treating specific conditions. The bill creates a council of up to 15 federal employees to coordinate the research and to advise President Obama and Congress on how to spend the money. The program responds to a growing concern that doctors have little or no solid evidence of the value of many treatments. Supporters of the research hope it will eventually save money by discouraging the use of costly, ineffective treatments. The soaring cost of health care is widely seen as a problem for the economy. Spending on health care totaled $2.2 trillion, or 16 percent of the nation’s gross domestic product, in 2007, and the Congressional Budget Office estimates that, without any changes in federal law, it will rise to 25 percent of the G.D.P. in 2025. Dr. Elliott S. Fisher of Dartmouth Medical School said the federal effort would help researchers try to answer questions like these: Is it better to treat severe neck pain with surgery or a combination of physical therapy, exercise and medications? What is the best combination of “talk therapy” and prescription drugs to treat mild depression? How do drugs and “watchful waiting” compare with surgery as a treatment for leg pain that results from blockage of the arteries in the lower legs? Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight? For nearly a decade, economists and health policy experts have been debating the merits of research that directly tackles such questions. Britain, France and other countries have bodies that assess health technologies and compare the effectiveness, and sometimes the cost, of different treatments. Hillary Rodham Clinton, as a senator, was an early champion of “comparative effectiveness research.” Mr. Obama, who is expected to sign the stimulus bill Tuesday, endorsed the idea in his campaign for the White House. As Congress translated the idea into legislation, it became a lightning rod for pharmaceutical and medical-device lobbyists, who fear the findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care. In addition, Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols. The money will be immediately available to the Health and Human Services Department but can be spent over several years. Some money will be used for systematic reviews of published scientific studies, and some will be used for clinical trials making head-to-head comparisons of different treatments. For many years, the government has regulated drugs and devices and supported biomedical research, but the goal was usually to establish if a particular treatment was safe and effective, not if it was better than the alternatives. Consumer groups, labor unions, large employers and pharmacy benefit managers supported the new initiative, saying it would fill gaps in the evidence available to doctors and patients. “The new research will eventually save money and lives,” said Representative Pete Stark, Democrat of California. The United States spends more than $2 trillion a year on health care, but “we have little information about which treatments work best for which patients,” said Mr. Stark, who is the chairman of the Ways and Means Subcommittee on Health. In the absence of information on what works, Mr. Stark said, patients are put at risk, and billions of dollars are spent each year on ineffective or unnecessary treatments. Steven D. Findlay, a health policy analyst at Consumers Union, said the action by Congress was “a terrific step on the road to improving the quality of care and making it more efficient.” But critics say the legislation could put the government in the middle of the doctor-patient relationship. Bureaucrats “will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost-effective,” Betsy McCaughey, a former lieutenant governor of New York, wrote on Bloomberg.com. Rush Limbaugh broadcast the charges to millions who listen to his radio talk show. Lawmakers and lobbyists agree that researchers should compare the clinical merits of different treatments. Whether they should also consider cost is hotly debated. Representative Charles Boustany Jr., a Louisiana Republican who is a heart surgeon, said he worried that “federal bureaucrats will misuse this research to ration care, to deny life-saving treatments to seniors and disabled people.” The House Appropriations Committee inadvertently stoked such concerns in a report accompanying its version of the economic recovery bill. It said that research comparing different treatments could “yield significant payoffs” because less effective, more expensive treatments “will no longer be prescribed.” A similar proposal was included in a recent book by Tom Daschle, who had been Mr. Obama’s nominee for health secretary, and Jeanne M. Lambrew, who is the deputy director of the Office of Health Reform in the Obama White House. Women and members of minority groups expressed concern about that approach. Drugs and other treatments can affect different patients in different ways, they said, but researchers often overlook the differences because their studies do not include enough women, blacks or Hispanics. “Some drugs appear to be more effective in women than in men, while other medicines are more likely to cause serious complications in women,” said Phyllis E. Greenberger, the president of the Society for Women’s Health Research. “It’s important to look for these sex-based differences.” In a letter to House leaders, the Congressional Black Caucus said, “We are concerned that comparative effectiveness research will be based on broad population averages that ignore the differences between patients.” House and Senate negotiators tried to address these concerns. The final bill says that the research financed by the federal government shall include women and members of minority groups. Moreover, in a report filed with the bill, the negotiators said they did not intend for the research money to be used to “mandate coverage, reimbursement or other policies for any public or private payer.” Congress did not say exactly how the findings should be used. Private insurers can use the data in deciding whether to cover new drugs and medical procedures, but it is unclear how Medicare will use the information. Under existing law, Medicare generally covers any treatment that is “reasonable and necessary for the diagnosis or treatment of illness or injury,” and the agency does not have clear legal authority to take costs into account when deciding whether to cover a particular treatment. Andrew Witty, the chief executive of the pharmaceutical company GlaxoSmithKline, said European officials often considered the costs as well as the clinical benefits of new drugs — with mixed results. “Comparative effectiveness is a useful tool in the tool kit, but it’s not the answer to anything,” Mr. Witty said in an interview. “Other countries have fallen in love with the concept, then spent years figuring out how on earth to make it work.”