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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 6:03 pm 
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Here's a general idea of what military members cannot do with regard to politics and campaigns:

-Use official authority or influence to interfere with an election, to affect its course or outcome, to
solicit votes for a particular candidate or issue, or to require or solicit political contributions from others.
-Be a candidate for, or hold civil office, except as authorized in paragraphs 5. and 6.
-Participate in partisan political management, campaigns, or conventions, or make public
speeches in the course of such activity.
-Allow, or cause to be published, partisan political articles signed or authorized by the member for
soliciting votes for or against a partisan political party or candidate.
-Serve in any official capacity or be listed as a sponsor of a partisan political club.
-Speak before a partisan political gathering of any kind for promoting a partisan political party or
candidate.
-Participate in any radio, television, or other program or group discussion as an advocate of a partisan
political party or candidate.
-Conduct a political opinion survey under the auspices of a partisan political group, or distribute
partisan political literature.
-Perform clerical or other duties for a partisan political committee during a campaign or on election
day.
-Solicit or otherwise engage in fund-raising activities in federal offices or facilities, including
military reservations, for a partisan political cause or candidate.
-March or ride in a partisan political parade.
-Participate in any organized effort to provide voters with transportation to the polls, if the effort
is organized by or associated with a partisan political party or candidate.
-Attend, as an official representative of the Armed Forces, partisan political events, even without
actively participating.
-Engage in the public or organized recruitment of others to become partisan candidates for nomination
or election to a civil office.
-Make campaign contributions to a partisan political candidate.
-Make campaign contributions to another member of the Armed Forces or an officer or
employee of the federal government for promoting a political objective or cause.
-Solicit or receive a campaign contribution from another member of the Armed Forces or from a
civilian officer or employee of the United States for promoting a political objective or cause.
-Use contemptuous words against the office holders described in Title 10, United States Code,
Section 888.
-Display a large political sign, banner, or poster on the top or side of a member's private vehicle
(as distinguished from a political sticker).
-Sell tickets for, or otherwise actively promote, political dinners and other such fund-raising
events.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 6:56 pm 
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the FDA, SEC, OSHA, EPA, NRDC, SCC, IRS, FBI, CIA, DHS, USPTO...

My, you ARE on your way to being a lawyer... :lol:

ZM

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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 7:01 pm 
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ZelieMike wrote:
Quote:
the FDA, SEC, OSHA, EPA, NRDC, SCC, IRS, FBI, CIA, DHS, USPTO...

My, you ARE on your way to being a lawyer... :lol:

ZM

I'm taking Administrative Law this semester. Needless to say, it's fresh in my head. :D

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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 8:59 pm 
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Willton wrote:
Bob in Boston wrote:
And, yeah, Willton, I have read Hannity and Coulter, and both of them do hit hard. But so far, at least, I haven't seen anything remotely close to the stupefyingly ugly, bitter, and deranged lashing out by the Left.

Really? Perhaps you've forgotten this little gem:
Quote:
"I was going to have a few comments on the other Democratic presidential candidate, John Edwards, but it turns out that you have to go into rehab if you use the word 'faggot,' so I'm - so, kind of at an impasse, can't really talk about Edwards, so I think I'll just conclude here and take your questions," said Coulter, whose comment was followed by applause.

http://www.cnn.com/2007/POLITICS/03/04/ ... index.html

Yes, I'm sure that the above quote cannot be considered a "stupefyingly ugly, bitter, and deranged lashing out" by Ms. Coulter.


You know, in hindsight, I imagine Ann Coulter, too, wishes she had given further thought to her choice of words to describe John Edwards . . . until after the world learned that he'd fathered a baby out of wedlock by a campaign assistant. And then hid in an LA hotel men's room and used his cellphone to call for help when reporters tried to question him about it. This, after his wife -- the mother of their children -- had been diagnosed with a recurrence of cancer and was waiting for him at their home back in North Carolina.

"Faggot" just doesn't seem appropriate in that circumstance.

And, anyway, Coulter ought to hang her head in shame at how poorly she compares to performance artist Sandra Bernhard:

http://www.youtube.com/watch?v=CN6TDGOd3Y8

That would be the same Sandra Bernhard who has warned Gov. Palin not to make a scheduled campaign appearance in Manhattan, or she'd be gang-raped by some "big, black brothers."

The URL, from the theater's own blog:
http://theaterjblogs.wordpress.com/2008/09/13/first-footage-of-sandra-live-on-stage-at-theater-j/

Ugliness, I guess, is in the eye of the beholder.

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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 10:03 pm 
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Bob you always do the nasty, don't you?

BF13--
In terms of health care, I cannot site the exact details of either candidate's position. However, my general feeling is that McCain wants to do some tax incentives to make it more affordable. Whereas, Obama wants to have government play a bigger role in paying for some of the cost.

First,let me say that I don't think we Americans have all the right answers. That does not make me unpatriotic. I cry during those same moments of emotional pride that you do. I love my country too. I just have always believed that the love it or leave it attitude of the hardhats during the Vietnam mess was wrong. We need to have the right as loyal Americans to question our government. Without that, we will never improve ourselves. That is Patriotic not the converse. It is somewhat unpatriotic to blindly drink the Kool-Aide.
Ah, but I digress...

So, let me ask why not look at the way the rest of the world does health care? Why are we right and they are all wrong. Doesn't that make us stubborn and short sighted? Yes, they all have government as the provider of health care. Are there flaws? sure. Are there ways we Americans with our creative minds can solve the problems? Why do we reject it out of hand?

No employer can afford to continue to offer health insurance. Most already lay off much of the cost to employees and others simply reduce employee numbers. They then force workers to work overtime so as to lower their health care costs of the sacrificed workers. This tendency is growing and will continue to grow. It high cost makes employers less competitive with others in the same industries in other countries.

We the consumers of health care are losing our standard of living as the insurance cost increase at high rates, as out of pocket costs and co-pays continue to increase. We Americans are losing our middle class status more each year. And as more Americans can't pay for insurance or the charge of the provider, the rest of us are assessed even more. This is not going to solve itself. It is only going to worsen.

Doctors fees, hospital charges, and (maybe the worst) pharmical drug charges are out of control and result in Americans paying a much higher percentage of our GDP then the rest of the world for health care.

Government is the only organization that can solve this problem. So, whoever is moving in that direction is the better candidat IMO. Obama is the guy moving more toward the solution so he gets my support. What good is a tax break of even $50.00 a month do, when your health care costs go up $50-$60 a month every year. The working poor will lose not even break even. That leaves even more pressure on all others rates for insurance. No, we need to have government be the provider and work out the problems as best we can. The simply is no other answer for us.

Now I know that some of you will think me a socialist or a communist. Label me any way you must, but understand that we have no choice if we want to keep a middle class.
BTW, do any of you see these Billions of handouts for the finance industry and ownership of much of it by government as not socialism? Communism?

That's just one reason why I will vote for Obama. More later...

_________________
2011 Will Be Our Year -- well make that 2012 (just saying) So it looks like 2013 now - how long must this go on!
THIS IS IT-- NO MORE STREAK!!! *** Finally*** Time to win it in 2014


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 Post subject: Re: Liberalism's finest hour
PostPosted: Fri Sep 19, 2008 11:25 pm 
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Regarding healthcare in America, there is no doubt in my mind that the system is broken. It is not hopelessly broken, but it is close and getting closer every day. It is broken due to very specific causes, and nationalization not only will not solve many of the problems, it is certain to set our medical system back, and opens up whole new cans of worms. Further, as any cynic will point out, the government has done such a bang-up job with education, transportation, social security, welfare, providing for our troops on the front line, etc………..why in the world would we trust the management of our healthcare system to this same entity?

The first point that is crucial to understand is…why is healthcare so expensive? The answer to that question is…because healthcare IS expensive. We are blessed to live in a country that has made great strides in developing new technologies for use in the medical field. But the truth of the matter is that new technologies cost a lot of money. MRI machines are expensive. CT machines are expensive. Equipment and reagents to run even some of the simplest blood tests are expensive. Technicians to run the tests and equipment are expensive. Nurses to draw the blood are expensive. Even the candy stripers who wheel you down to radiology for an X ray cost the hospital money. If you want to truly cut healthcare costs, then let’s go back to the days of a doctor showing up with a black bag containing a stethoscope, reflex hammer, and blood pressure cuff.

Even the much-maligned pharmaceutical companies are not the evil entity that they are made out to be. Without actually crunching numbers (because it’s a Friday night and its not worth it), suffice it to say that the development of even one single drug- from screening small molecules for their chemical properties all the way through Phase I, II, and III clinical trials- is an extremely expensive process (of course, if we cut a lot of the clinical trials it would be much cheaper…but also much more dangerous). Now, consider the fact that a very small percentage of drugs that go through this development process ever pass all of the stringent FDA guidelines and make it to market. Further, consider the fact that some drugs that DO make it to market are only for a very small patient population. While different sources use different numbers, I’ll err on the conservative side and say that only one out of every six drugs that are studied ever crosses your pharmacy counter (I’ve heard as few as 1:20 depending on what you consider “studied”, I suppose). Keeping all of that in mind, every drug that makes it to market has to recoup the costs spend developing it and the other 5-19 that failed. And, as our friends who are on the legal side of the ledger will tell us, patents don’t last forever. Every drug that makes it to market essentially has 6 years to generate the millions (billions) spent in the R&D of that drug and those that failed. Therefore, those drugs have to be priced high until generics are available in order for these companies to remain profitable. And when you read about how these companies have such “high” profits, ask yourself what would happen if just one or two of those successful drugs hadn’t worked out, or one or two fewer drugs in the future year do not pan out. (And those working for drug companies are therefore vulnerable to layoffs and re-hirings, depending on the successes and failures of drugs…it is hardly a secure industry).

So I hope that you will agree with me that healthcare is expensive. Are there excesses? Absolutely, and I will openly address those in a bit. But even if we completely cut out any wasteful spending and mandated that hospitals, pharmaceutical companies, and health insurance providers not collect any profit, healthcare would STILL be ridiculously expensive. Most middle class citizens simply cannot afford to pay for it, and that is indeed a problem.

So what if the government takes over? Would MRI’s suddenly become cheaper? The price of a mass spectrometry machine (used in many blood and urine tests , especially toxicology) suddenly goes down? Of course not. Healthcare is going to be just as expensive. And while the cynic will say there is no limit to how deep Uncle Sam would reach into our pockets to pay for it, the fact is that there is a limit. So how does the government balance their healthcare book? Well, they tell the doctor to not order as many MRI’s. They tell the hospital to get by with just one CT scanner instead of 3. It flies in the face of evidence-based medicine, and will lower the quality of care that each of us receives. With only one CT, you may have to wait an extra month (or 6, as many of my Canadian friends will attest to) to get scanned…not so bad if you have a torn rotator cuff, of course, but pretty damn costly if it’s a tumor growing in your brain.

Additionally, I hate to bring this up because it is misinterpreted to read that doctors are greedy, but government reimbursements, if kept at levels comparable to what Medicare and Medicaid offer now, will drive many doctors and small private hospitals out of business. As it is, many doctors currently try to avoid Medicare/Medicaid patients because they represent negative income. If every patient was reimbursed at these levels, many doctors would be driven to bankruptcy, and more worrisome, you would probably see a huge shift to concierge medicine (doctors are paid a “retainer fee”…in the thousands of dollars, to be available as a private physician to a smaller patient base) that would only be accessible to the incredibly wealthy. This would further destroy the quality of care that most patients would experience, as we would have a severe shortage of doctors.

Also, a point that is often overlooked is how much the development of new technologies would be stymied. If hospitals aren’t able to invest in adopting new technologies, there will be less advancement in the field. It would be very difficult to imagine a pace of new discoveries equivalent to what we have experienced in the past few decades under a nationalized healthcare system. There are so many cures that we would never find, so many new screenings that would never be used. Taking into account all that I have said thus far, it should be apparent that while *everyone* would have healthcare coverage, we would be sacrificing a great deal of quality in the process, and while I’m not going to argue this point this evening, it very likely will end up costing us more, as every government program does. Obviously this is a contentious point that could be the subject of its own thread, so I’m going to leave it for now.

Finally, let me pose a philosophical question to you. Let’s imagine a nationalized healthcare system, just for a minute. The government- or better put, the taxpayers- are paying for everyone’s healthcare. Why should I have to pay for the treatment of lung cancer in a guy that smokes two packs a day? Would you deny him care instead (obviously you can’t)? Or perhaps you have to make cigarettes illegal (fine with me, btw). Oh, but you know, what about the treatment of cirrhosis in a chronic alcoholic (or injuries from a drunk driving accident). Perhaps we need to return to prohibition. And you know, I’ll be damned that I’m going to pay for the diabetes care of a guy who can’t put the Twinkies away, or the woman who eats at McDonalds 5 nights a week. Better make those illegal too, right?

Now, obviously using the “slippery slope” argument is a weak tactic in making my point. But my question that I would ask is that if the government is paying for our healthcare, do they then not have an interest in ensuring that we don’t harm our own health, thereby costing them more money? And if they do now have an interest in how we handle our own health, how much can they (or the better question- will they) do to legislate that we take care of ourselves? Are we opening a door for more government intervention into our own private lives?

Now obviously it’s easy to criticize nationalized medicine. But I want to follow this up with a (hopefully shorter) post detailing what I see as REAL solutions to our healthcare problem. It’s going to have to wait until tomorrow though as my laptop battery has died. But I promise that there are better (in my opinion) though tougher solutions to solving our healthcare crisis.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 12:29 am 
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Quote:
the government has done such a bang-up job with education, transportation, social security, welfare, providing for our troops on the front line


Don't forget to mention the housing market.

BBF, you were able to intelligently describe what I was fumbling with in my explaination of the proposed healthcare system. Healthcare is expensive and somebody has to pay for it. Nice post, its certainly a confusing topic, one that gets muddled by soundbites from both candidates.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 8:30 am 
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BBF, that was a spectacular post! Looking forward to the next one.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 11:21 am 
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BBF -- it is clear that you have a dog in this hunt. But even we people who aren't in your industry have issues worth considering. I'll be waiting your solution ideas. It is a very involved issue, but others not directly employed by the industry have legitimate concerns as well. We as a people can no longer walk down this path of self-destruction. Whatever your ideas, they must include the wealfare of all Americans. My guess is that you will suggest limiting delivery of care for some because of age or degree of servivability for a reasonable period of time. Those are ugly options but need to be on the table for everyone.
If you suggest as many in the industry do, that lawyers are the problem, let me now suggest that people who are injured by the delivery of the cure absolutely must have the right to damages and the system needs a way to dismiss those who are not able to perform at a minimum level. So, to lay this at the feet of outside forces is a cop-out in my mind.

But there is one over-riding question for me that needs answered.

Is health care a right or a privledge?

And there are clear implications for all of us if it is a right. The solution if not single payer, then what?

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2011 Will Be Our Year -- well make that 2012 (just saying) So it looks like 2013 now - how long must this go on!
THIS IS IT-- NO MORE STREAK!!! *** Finally*** Time to win it in 2014


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 11:39 am 
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If I may tell you my story to help everyone understand the problem a little better.

I had Postrate cancer. Through the outstanding doctors who cared for me it was detected very early and successfully treated. I am today free of it but will always have some side effects to live with.

Most public issue is that I have that going problem. I use Flo-max for help regulating my bladder. It is a fairly expensive drug that my insurance will not cover because it is a name brand and there is no generic. The charge at the local store is $147.00 for a month's supply.
I discovered through my own research that I can and do get a generic not availible in the U.S. for much less. I pay only $72.00 for a three months supply now, and my insurance pays nothing. If I chose the brand name it was still only $91.00 for 3 months.

Well, you can tell me all you want about research costs, we Americans are paying for them and the world is not. Why should we be penalized?
How's that a reasonable thing to have happen? Then read about our FDA telling Americans that they can't do that because it may not be safe. Are you kidding me! The name brand comes in exactly the same packaging.

That's just one issue I have with our industry.There are more. BROKEN SYSTEM.

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2011 Will Be Our Year -- well make that 2012 (just saying) So it looks like 2013 now - how long must this go on!
THIS IS IT-- NO MORE STREAK!!! *** Finally*** Time to win it in 2014


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 11:49 am 
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BTW, I don't hear anyone yelling that they have screwed up Social Secrity, Medicade, or Medicare. Those are health related and are government controlled.

One other thought- These bailouts that we are going to pay represent tremendous spending by government for another industry in our country. As you know we now will own the insurance industry. Why is it ok to bail them out but not medical care? Isn't that socialism too? Sounds like Marxism at it's finest to me! But that's ok and maybe a good thing? Well, it's necessary for the good of all.-- Right?

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2011 Will Be Our Year -- well make that 2012 (just saying) So it looks like 2013 now - how long must this go on!
THIS IS IT-- NO MORE STREAK!!! *** Finally*** Time to win it in 2014


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 12:04 pm 
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Substitute2 wrote:

Well, you can tell me all you want about research costs, we Americans are paying for them and the world is not. Why should we be penalized?
How's that a reasonable thing to have happen? Then read about our FDA telling Americans that they can't do that because it may not be safe. Are you kidding me! The name brand comes in exactly the same packaging.

That's just one issue I have with our industry.There are more. BROKEN SYSTEM.


Your frustration, Sub, is shared by nearly every American on prescription drugs, from young women paying for birth control to old men with 15 different medications for 15 different chronic illnesses. The reason we Americans pay for the drugs and other countries don't is because those drugs have patents in the US that are not enforceable in other countries. That means that the makers of Flowmax have to compete in other markets with generic drug makers, and therefore prices are cheaper. Has nothing to do with the FDA.

One solution that is touted by some would be to prevent drug companies from being able to exclusively patent their drugs. I concur that that would clearly and definitively bring down drug costs in the US. I can also tell you that it would prevent many drug companies from staying in business, as they need to make a lot of money off of each drug that hits the market to continue funding future drugs. Had we gone to this solution 15 years ago, it is likely drug companies would have not had the money to continue to develop new drugs, and Flomax may not be available today.

It comes down to a simple decision. Do we want to have state-of-the-art medical care? That includes drugs, diagnostic tests and screenings, and non-pharmacological treatments (not to mention state-of-the-art training for physicians and future physicians, nurses, technicians, etc). If the answer is yes, we have to acknowledge that state-of-the-art medical care is expensive. The solution is not to have a single payer system, but rather to make our health care system as efficient as possible and to cut all wasteful spending (again, I will outline my thoughts on that next), something that our esteemed government is not exactly known for.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 12:06 pm 
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Substitute2 wrote:
BTW, I don't hear anyone yelling that they have screwed up Social Secrity, Medicade, or Medicare. Those are health related and are government controlled.



Not to be snarky, but if that's the case, then you just aren't listening. You do know that Social Security is on its way to bankruptcy in the very near future, right? And that Medicare and Medicaid reimbursements have fallen so low that many recipients are being denied care. So yes, those programs are screwed up.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 2:01 pm 
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Ok, I promised solutions, so allow me to climb on my soapbox once again…

Consider all that is forthcoming in the following framework. I believe that everyone is entitled to state-of-the-art care, whether they can pay for it or not, regardless of age, race, sex, or socioeconomic status. I also believe that there is some role for government spending in healthcare and some degree of oversight in the industry. In general, I support minimal government oversight (not just in healthcare, but across the board), but I recognize someone has to ensure that the best interests of the decision-makers are aligned with the best interests of the general public. Nothing more, nothing less.

As I stated before, nothing is going to make an MRI machine cost less. Nothing will allow hospitals to pay nurses, doctors, and technicians less. So if we want to have the latest and greatest technologies be a part of our medical care, we have to recognize that it is expensive and that we have to find ways to pay for it. This means that we as a society have to find ways to efficiently spend every single healthcare dollar. And as I have already said, the United States government is NOT the model for efficient spending. So if the technologies and cost of delivering medicine is not changeable, how can we reduce healthcare costs?

1. Public health. This is the single biggest difference we can make in reducing the cost of healthcare to the American consumer. The amount of money we spend taking care of diseases that are largely preventable is staggering, and probably makes up the biggest chunk of healthcare spending. High cholesterol, high blood pressure, obesity, smoking, type 2 diabetes, etc, etc. I doubt many can imagine how much is spent managing these conditions and treating the resulting cardiovascular disease that inevitably follows. In fact, I would suggest that if we could cut 90% of the use of statins (cholesterol) and beta-blockers, ARB’s, ACE inhibitors (all for blood pressure), health insurers would be able to pick up the tab for almost all of the rest of America’s medications without raising rates a dime (perhaps stretching it, but you get the picture). And we COULD cut the usage of those drugs if we could trim the obesity rate, the smoking rate, etc. Public health efforts aimed at stopping smoking and living a healthy lifestyle WOULD make a huge difference in our healthcare costs, a difference that most Americans would undoubtedly underestimate by at least 10fold. And here is the best part…this is something that the healthcare industry is strongly in favor of. Docs don’t want to have to prescribe 15 different pills to keep you from having a heart attack, they would much rather see you have a healthy diet, hit the gym, and lose weight. Even better, the health insurers ALSO are strongly in favor of this because it reduces their costs. In fact, many insurers offer things like free gym memberships, or reductions in rates for leading a healthy lifestyle. Unfortunately, the hang up is that the government does not fund public health nearly enough. And why is that? Well, lets imagine two candidates running for office. Candidate A says “I understand you can’t afford healthcare. I want to give you free healthcare through the government!”. Candidate B says “I know healthcare is too expensive for most people. I want to take your tax dollars and spend it to hire people to go out and get you to get off your ass and go to the gym!”. Who wins that election?

This sort of goes back to my previous post about the government making smoking, drinking, and McDonald’s illegal. If the government is paying for all of our healthcare, and the easiest way to cut costs is to stop people from smoking, drinking, and being obese, won’t it follow that they would have an interest in convincing (or forcing) us to do just that? So wouldn’t the more logical solution be to invest in public health programs NOW, before it came to that?

2. Academic research. I’ll spill the beans…the drug industry is NOT interested in curing disease. Why? If you cure a person of a disease, they no longer need to use your drug. They are interested in TREATING disease. They want you to have to take a drug that manages your cholesterol for the rest of your life, as opposed to taking a drug that eliminates your high cholesterol after one month. The reasons, of course, are obvious. As a result, drug companies aren’t very good at developing cures, or even things like vaccines (I’ll come back to that one). Instead, that falls to academic labs who are not doing for-profit research. These labs are funded through grants both from private organizations (American Cancer Society, American Heart Association, etc) as well as government grants through the National Institute of Health and National Science Foundation. Believe me when I tell you that our academic research community is as underfunded right now as has been at any point in the history of the discipline. Labs that have published very high-impact work in leading journals (some even considered for Nobel Prizes) are being boarded up, as they can’t afford to carry out their research any longer. Even worse, I can tell you that right now, there isn’t even enough money available to enough labs to train graduate students. People enrolled in graduate school cannot find labs with enough money available to train them, which means that we will have a shortage of investigators in the future if something is not done soon. If the government wants to spend money to fix healthcare, right after public health spending, they need to increase research spending. The faster we can find CURES for diseases (as opposed to TREATMENTS), the faster we can lower our medical costs. Or, if one were to try to summarize these first two points, we should be spending our tax dollars on preventing diseases that we can, and curing those that we can’t…instead of muddling along the course we currently are following.

3. Vaccines. Any idea of how many diseases could be prevented by vaccines? Nearly every infectious disease, cancer, and possibly even many autoimmune diseases could be prevented by vaccines. There are 3 hurdles to overcome though. First, people are ignoring vaccines that we do have, sometimes because they don’t have access to care, sometimes because they believe a lot of the hogwash on the internet about supposed risks of vaccines (again a debate for a whole different thread on a whole different day). Second, drug companies aren’t developing new vaccines because they have no interest in CURING disease (see point 2). And third, even vaccines that are developed by the research community are not necessarily brought to market here in the US. Look at the flu shots as an example. We get a large percentage of them from companies outside of the US? Why? Vaccines represent a huge risk to drug companies. Let’s say I am producing a new vaccine for SARS. A SARS epidemic breaks out in China, and now nearly everyone in the US gets vaccinated. I end up vaccinating 150 million people. Now, taking 150 million people at random, how many of them will die within a 24 hour period? (That is being generous, as we probably aren’t vaccinating “random” people, but instead “at risk” people such as the elderly and people with significant comorbidities). And how many of those people who die within a day (week, month…) of getting the vaccine are going to blame the vaccine and sue me (I’m not anti-lawyer, I promise. I’ll address malpractice soon)? Not to mention that vaccines are 99.9% effective, but in 150 million people, that means 150,000 people are still not protected, still get SARS, and still sue me. No thanks, I’ll stick to producing Lipitor.

4. Litigation. I’ll get this out of the way now, since I know this will be the least popular point and will make me look as if I am anti-lawyer. Yes, people who are harmed by a doctor or medical institution should be compensated. Yes, doctors who do not do their job properly should be reprimanded and perhaps even weeded out. But because mistakes happen, every doctor and every medical facility must carry malpractice insurance. And if you think health insurance premiums are ridiculous, you should see malpractice insurance premiums. I’ll use as an example a small private practice I know of in the South Hills. Private practices are generally viewed as one of the most profitable careers (aside from plastics, orthopedics, neurosurgery, etc). This practice has 3 physicians and 1 nurse practitioner. It has existed for about 12 years, and has not had one single suit filed against them. The one physician who I know in this practice took home just over $60,000 last year after malpractice insurance payments. Now, let me ask you how many people you know who would be willing to graduate from high school and spend a minimum of 8 years (depending on your degrees, as many as 15 years) in post-secondary education, graduate with an AVERAGE of over $200,000 in student loan debt, all to earn $60,000 a year, even as a good doctor who has never had a suit filed against them? We are facing a physician shortage in the future as it is, but high risk fields where malpractice insurance is even higher is driving away ALL qualified physicians, because the field isn’t profitable. Of course I am not arguing that doctors are in it just for the money, or even that money is the biggest factor for many of us. But it is a factor. As mentioned above, its also a factor for vaccine makers. The one solution that is often mentioned is capping pain and suffering awards. In other words, patients are compensated for all costs, lost wages, additional medical care, etc. But there is a limit to the amount they receive for pain and suffering. I don’t know if that would have a trickle down effect in lowering malpractice insurance premiums, but proponents suggest that the lower the awards are, the less the malpractice insurance companies have to pay, and the less they will charge in premiums. Now, I’m not suggesting we limit pain and suffering to $100 or anything. But a $1 mil or $5 mil cap sounds entirely reasonable. And, the logic goes, if a physician and/or hospital is paying less in malpractice insurance, that is less cost that they must pass on to a healthcare consumer. Note that I don’t think this is nearly as important as my earlier points, but I do think it is a key to a reformed healthcare system.

5. A focus on evidence-based medicine. I can’t stress this enough. So much of our healthcare money is spent on unnecessary expenses. Doctors order unnecessary tests and drugs for many reasons. One is fear. If someone comes in complaining of headaches that sound precisely like migraines, you probably want to treat them for migraines. However there is always a chance, maybe ever-so-small, that it’s a brain tumor. And we all know what happens if you miss that diagnosis, both to the patient and to the physician. So the doc goes ahead and orders a CT, even though it isn’t really called for, just to be sure. Or perhaps a doc has a patient who saw an add on TV for the latest blood pressure drug. Evidence suggests that the drug is no better than some of the diuretics that we have used for decades and cost only pennies, but the patient WANTS the newest drug. So what does the doctor do? He prescribes the more expensive drug because he knows that if the patient were on the cheaper diuretic and had a heart attack by chance, he would be hearing from the patient’s lawyer. If the patient is on the more expensive drug and has a heart attack, well, it isn’t the doctor’s fault. Forget the fact that both drugs are equally effective, docs are pressured by patients. I can personally vouch for the fact that this happens in every doctors office every day. And who fields the cost for the more expensive drugs? The insurance companies who then pass the cost on to the consumer. I don’t know how to force a return to evidence based medicine. Perhaps ban direct-to-consumer advertising of drugs? I don’t know. But without changing this, healthcare will remain wasteful and expensive.

6. Electronic patient records. This will reduce medical errors and lower medical costs in many ways. It will definitely make healthcare more efficient. I don’t have much else to say about it, aside from the fact that healthcare providers are already pushing for and instituting this. The hold up is not the system, but privacy advocates and groups like the ACLU. Once privacy concerns are addressed, I think people will be surprised at how fast electronic charts are instituted. The technology is there, and the desire to adopt the technology is there.

7. Infection control. The difference in cost between an inpatient who does not pick up an infection and one who does is astronomical. Bugs like MRSA and C. difficile are the scourge of infection control specialists nationwide (worldwide). This is something that the medical system MUST fix, and CAN fix. It is costly.

8. Profits. Many hospitals and health insurance providers exist as non-profit institutions, yet collect “profits” in the hundreds of millions of dollars. UPMC and Blue Cross are great examples. So they must “invest” all of this money back into the organization. Of course, that can include millions of dollars in bonuses for the CEO, etc. While I hate government intervention in private enterprise, you have to wonder if there shouldn’t be some stricter rules in what defines “non-profit”. Perhaps if there were requirements for how much of the “profit” has to be reinvested in charity healthcare to those who can’t afford it, subsidized prescription medication, etc. would help. I’m not a business-oriented person, and I don’t know much about tax law or anything like that, so I’ll leave debate of this point to those who are much smarter than I.

Ok, I think that’s a good start. I think the overriding theme is that we can take steps to REDUCE medical costs (drastically), as opposed to shifting the costs from employers and individuals to all taxpayers. And there is no reason to deny anyone medical care for any reason. Sub, it won’t make your Flomax any cheaper, but by reducing healthcare costs across the board, health insurers are able to cover more of your costs, and you pay less out of pocket. In contrast, a nationalized healthcare system does nothing to reduce costs, and wouldn’t help with any of the solutions I’ve listed above. Your Flomax still wouldn’t be any cheaper, we would all be paying for it (and probably paying MORE for it) in taxes. That doesn’t sound like a sustainable solution to me.


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 Post subject: Re: Liberalism's finest hour
PostPosted: Sat Sep 20, 2008 7:07 pm 
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Thanks BBF for taking the time for this. It is truly impressive and shows that you have given a great deal of thought to the entire issue as it relates to health care providers and institutions. There is a wealth of information to digest. Certainly much of it makes perfect sense.

I need some time to re-read and think about your thoughts but knowing me, I'll most probably have some comments for you. Maybe we can start to work on some of these things together or as a group. Again, need some time to think it over in my limited way.

But thanks again.

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 Post subject: Re: Liberalism's finest hour
PostPosted: Mon Sep 22, 2008 2:05 pm 
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Just read in the latest issue of The Economist about a Republican lobbyist who set up an organization designed to defeat Hilary Clinton's run for the presidency. The organization was called Citizens United Not Timid. The acronym for the organization was clearly not unintented. C'mon Bob. The ugliness is on both sides. We can all come up with examples of outrageous conduct. It is the attempt to portray the outrageous conduct as "mainstream" for a political party that is particularly objectionable.

As for comparisons . . . Sandra Bernhard to Ann Coulter? The parallels are lacking . . .

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 Post subject: Re: Liberalism's finest hour
PostPosted: Mon Sep 22, 2008 2:25 pm 
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BBF wrote:
I4. Litigation. I’ll get this out of the way now, since I know this will be the least popular point and will make me look as if I am anti-lawyer. Yes, people who are harmed by a doctor or medical institution should be compensated. Yes, doctors who do not do their job properly should be reprimanded and perhaps even weeded out. But because mistakes happen, every doctor and every medical facility must carry malpractice insurance. And if you think health insurance premiums are ridiculous, you should see malpractice insurance premiums. I’ll use as an example a small private practice I know of in the South Hills. Private practices are generally viewed as one of the most profitable careers (aside from plastics, orthopedics, neurosurgery, etc). This practice has 3 physicians and 1 nurse practitioner. It has existed for about 12 years, and has not had one single suit filed against them. The one physician who I know in this practice took home just over $60,000 last year after malpractice insurance payments. Now, let me ask you how many people you know who would be willing to graduate from high school and spend a minimum of 8 years (depending on your degrees, as many as 15 years) in post-secondary education, graduate with an AVERAGE of over $200,000 in student loan debt, all to earn $60,000 a year, even as a good doctor who has never had a suit filed against them? We are facing a physician shortage in the future as it is, but high risk fields where malpractice insurance is even higher is driving away ALL qualified physicians, because the field isn’t profitable. Of course I am not arguing that doctors are in it just for the money, or even that money is the biggest factor for many of us. But it is a factor. As mentioned above, its also a factor for vaccine makers. The one solution that is often mentioned is capping pain and suffering awards. In other words, patients are compensated for all costs, lost wages, additional medical care, etc. But there is a limit to the amount they receive for pain and suffering. I don’t know if that would have a trickle down effect in lowering malpractice insurance premiums, but proponents suggest that the lower the awards are, the less the malpractice insurance companies have to pay, and the less they will charge in premiums. Now, I’m not suggesting we limit pain and suffering to $100 or anything. But a $1 mil or $5 mil cap sounds entirely reasonable. And, the logic goes, if a physician and/or hospital is paying less in malpractice insurance, that is less cost that they must pass on to a healthcare consumer. Note that I don’t think this is nearly as important as my earlier points, but I do think it is a key to a reformed healthcare system.


BBF -
Our firm does a lot of medical malpractice defense work. I admittedly have handled only a handful of cases over the years. However, I have done a fair amount of reading on the subject as Tort Reform is interesting to me. If you look at the studies done over the last 10 - 15 years, the number of jury verdicts against doctors has gone down markedly, the number of cases filed against doctors has gone down markedly, the amounts paid for verdicts against doctors have gone down and the total amounts paid in settlement for doctors have gone down. The only rising costs involve the hourly rate charged by the attorneys over those 10-15 years. So . . . a fair question to ask is this: With decreasing costs overall, why are premiums going up? Who is pocketing the difference? And, once you reach the answer to this question, I think it is fair to ask: Who owns the medical insurance companies?
From a philosphophical point-of-view, I have no problem with caps on non-economic damages.
However, there is more to the picture than just verdicts and claims.
I can also tell you this. From my experience, the average billable rate for a med mal defense lawyer is at least 50% less than a corporate transactional lawyer and the amount of money that is spent on attorneys for corporations for ridiciulous disputes (costs which are ultimately borne by the consumer) is far more appalling than costs for defending a physician.
While the litigation system may not be perfect, I'm not sure that it is broken to the extent that the medical insurers want everyone to believe.
As for a physician's take home pay . . . I have a fair number of physician friends and am privy to the methods for setting up a medical practice and how the corporation can be structured. Yeah, they may be showing $60,000 to the IRS but I can assure you that they are not living $60,000 lifestyles. A very good physician friend of mine in Denver, CO claims take home of about $50,000. She has a full time nanny, drives a very expensive car, lives in a home worth more than $750,000 and has taken vacations to Europe, New York and San Diego since January 1.

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 Post subject: Re: Liberalism's finest hour
PostPosted: Mon Sep 22, 2008 3:57 pm 
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No. 9 wrote:
Just read in the latest issue of The Economist about a Republican lobbyist who set up an organization designed to defeat Hilary Clinton's run for the presidency. The organization was called Citizens United Not Timid. The acronym for the organization was clearly not unintented. C'mon Bob. The ugliness is on both sides. We can all come up with examples of outrageous conduct. It is the attempt to portray the outrageous conduct as "mainstream" for a political party that is particularly objectionable.

As for comparisons . . . Sandra Bernhard to Ann Coulter? The parallels are lacking . . .



No, No. 9., the Economist did not say the lobbyist who set up that anti-Hillary group was a Republican. That would have been a curious waste of time and effort, given that she got off to a poor start in the Democratic primaries and was mathematically out of contention with a couple of months left.

Now, perhaps the lobbyist was a Republican; I don't know. Clearly, you remember it that way. But here, word-for-word, is how the relevant paragraph from the Sept. 11 issue reads:

Quote:
But it was Mrs Clinton who got the whipping. She not only lost an unlosable primary race. She was dissed and denounced in the process. Chris Matthews of MSNBC said that she owed her Senate seat to her husband’s infidelity. One lobbyist created an anti-Hillary pressure group called Citizens United Not Timid. A couple of young men ordered her to “iron my shirt”. Mr McCain, whom she regards as a good friend, looked on benignly when a Republican asked him “How do we beat the bitch?”


Meanwhile, Charlie Rangel calls Governor Palin "disabled." Try as I might, I can't get the idea out of my head that Charlie Rangel isn't mainstream. Same goes for Carol Fowler, the chairwoman of the South Carolina state Democratic Committee, who said Palin's only qualification to be McCain's running-mate is that she hasn't had an abortion.

Yet, it's the Left that bleats about how low the level of political discourse has sunk.

Hmmmm.

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 Post subject: Re: Liberalism's finest hour
PostPosted: Mon Sep 22, 2008 4:21 pm 
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No. 9 wrote:
..As for comparisons . . . Sandra Bernhard to Ann Coulter? The parallels are lacking . . .


Yeah, Coulter is a hell of a lot funnier! :o :lol: :lol: :lol:

ZM

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 Post subject: Re: Liberalism's finest hour
PostPosted: Mon Sep 22, 2008 5:35 pm 
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No. 9 wrote:
Just read in the latest issue of The Economist about a Republican lobbyist who set up an organization designed to defeat Hilary Clinton's run for the presidency. The organization was called Citizens United Not Timid. The acronym for the organization was clearly not unintented. C'mon Bob. The ugliness is on both sides. We can all come up with examples of outrageous conduct. It is the attempt to portray the outrageous conduct as "mainstream" for a political party that is particularly objectionable.

As for comparisons . . . Sandra Bernhard to Ann Coulter? The parallels are lacking . . .

Indeed. One is a comic; the other is a lawyer. One tends to have different expectations from the latter than from the former.

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