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Fine by me
Topic Started: Jul 22 2009, 07:05 PM (343 Views)
Jolly
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Geaux Tigers!
http://www.wusa9.com/rss/local_article.aspx?storyid=88729
The main obstacle to a stable and just world order is the United States.- George Soros
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QuirtEvans
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I Owe It All To John D'Oh
Quote:
 
Cardin responded by asking Broadus what would happen if he became sick, broke a bone, had a car accident and ended up in an emergency room.

"You don't pay. You are part of the population that shifts its costs over to a person who does pay, and they're paying for you," Cardin said.

Explaining how hospitals have often to absorb those costs, Cardin said many hospitals would choose simply to leave the community.

"I just think the overriding public interest is to require you and everyone in this country to have health insurance," Cardin said.


Amen.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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Mark
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HOLY CARP!!!
Maybe, but not insurance paid for by the government.
___.___
(_]===*
o 0
When I see an adult on a bicycle, I do not despair for the future of the human race. H.G. Wells
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Mikhailoh
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If you want trouble, find yourself a redhead
The problem is I have to pay. Others will not have to pay. Ergo I am paying for health insurance for those who don't.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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QuirtEvans
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I Owe It All To John D'Oh
Mikhailoh
Jul 23 2009, 03:04 AM
The problem is I have to pay. Others will not have to pay. Ergo I am paying for health insurance for those who don't.
And you're paying for their health care already, whether or not they have insurance ... because they just go to the emergency room.

The Mik Insurance Plan. Millions served.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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Mikhailoh
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If you want trouble, find yourself a redhead
After all these years of poor folks going to the ER, how exactly are you going to change that behavior? I predict they will still do the same thing. It is going to be left to the ERs to tell them to go to primary care. The first time that turns out badly the lawsuits will stack up like firewood in the fall.

I suppose it is possible that, with profit incentive, doc-in-a-boxes will spring up in underserved urban areas, but I doubt it will occur to any great degree. See article on groceries in Detroit.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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QuirtEvans
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I Owe It All To John D'Oh
It depends on a few things, I'd guess.

First of all, why people don't go to the doctor right now. If they would like to see a primary care physician, but don't go because they can't afford it, if you change the affordability, they might go there instead.

Second, the incentives to go. You could create a system that provides some incentive for people to have annual physicals ... say, a small premium reduction. That could change behavior, and get people used to going to the primary care person. If they get used to seeing a primary care doctor, that could change habitual behavior of going to the ER.

Third, the disincentives to go to the ER. These are all ugly, but they could involve co-pays, greater required proof of indigence, or even longer wait times for non-critical conditions that could have been treated better and cheaper if brought to a primary care physician sooner.

There's probably more that I haven't thought of.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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Mikhailoh
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If you want trouble, find yourself a redhead
I think maybe you overestimate the sophistication of the folks who use the ER as the default. They don't go there simply because they can't afford a doctor. They go there in many cases because that is all there is. I do not believe healthcare reform will change that substantially. They won't be paying their own premiums and co-pays anyway. We will. They will have no real financial incentive because they are essentially wards of the state.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Axtremus
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HOLY CARP!!!
Great innovation that I believe is needed and will help: Minute Clinics!

Put nurse practitioners (or general physicians) in drug stores and grocery stores to take care of simple things like mild fever and flu and whatnot... CVS and Walgreen are already doing this, Walmart may follow soon (hopefully).

See www.MinuteClinic.com .
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Mikhailoh
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If you want trouble, find yourself a redhead
See this thread:
No chain groceries in Detroit






Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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big al
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Bull-Carp
Just give 'em free drugs and lock them in a ghetto. (see Brave New World for details. In Ford we trust.)

Big Al
Location: Western PA

"jesu, der simcha fun der man's farlangen."
-bachophile
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Kincaid
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HOLY CARP!!!
I am also a skeptic - people will still go to the ER unless the ER's start turning non-emergency cases away. Even waiting three hours in the ER is faster than setting an appointment days away.

My BIL is a doctor. He is cautiously pessimistic, saying that there is a complete dearth of GP's in practice and in the pipeline. The GP's will just be overwhelmed (they already are).
Kincaid - disgusted Republican Partisan since 2006.
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Jolly
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Geaux Tigers!
You can take more money home at the end of the day by being a PharmD than you can by being a GP.

Six years education vs 8 years education (plus residency). Average cost to educate? Probably about $50K vs $250K. And don't forget, a pharmacist's malpractice is tremendously less than a M.D.'s.

You want GP's? Then address the problem...not create a system that depends on something you ain't got...
The main obstacle to a stable and just world order is the United States.- George Soros
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ivorythumper
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I am so adjective that I verb nouns!
Mikhailoh
Jul 23 2009, 04:02 AM
After all these years of poor folks going to the ER, how exactly are you going to change that behavior? I predict they will still do the same thing. It is going to be left to the ERs to tell them to go to primary care. The first time that turns out badly the lawsuits will stack up like firewood in the fall.

I suppose it is possible that, with profit incentive, doc-in-a-boxes will spring up in underserved urban areas, but I doubt it will occur to any great degree. See article on groceries in Detroit.
It is not in the interest of the medical/insurance system to direct people to primary care. ER is better for business and cash flow. The whole direction of health care, whether insurance company instigated or governmental, will be toward centralization and crisis management. Primary docs will be phased out except for the wealthy -- everyone else will be funneled into triage at the ER. Preventative medicine and diagnostic testing as part of annual physicals are already being deemed too expensive for the benefits -- it is far cheaper in dollars though not human misery to catch a problem later than prevent one, and as soon as health care rationing is implemented (which Peter Singer is already arguing for) folks will be simply told "gosh, sorry, we discovered this too late". Also, not insignificantly, ER often requires an upfront payment that is not reimbursable as a medical benefit.

It does not look good for the future of primary healthcare, under any system -- private practice will be largely phased out.
The dogma lives loudly within me.
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Axtremus
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HOLY CARP!!!
ivorythumper
 
... it is far cheaper in dollars though not human misery to catch a problem later than prevent one ...

Are you sure? What studies/data sources suggest that this is the case? :blink:
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George K
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Finally
Simple thought experiment:

45 year old has breast cancer.

She undergoes biopsy, surgery, chemotherapy and radiation.

vs.

She dies of breast cancer at the age of 48. No treatment of her subsequent heart disease, hypertension, colon cancer, heart *surgery*, and Alzheimers in a nursing home.

Not to mention Social Security, etc.

What's cheaper?

With preventive care you live longer...to die of something more expensive.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Axtremus
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HOLY CARP!!!
Anther thought experiment:

Dr. K found that Mr. X has high cholesterol and told him, "you better change your diet and exercise more, buddy." Mr. X henceforth changes to a healthier diet and exercise more.

vs.

Mr. X continues with his daily lobster feast and tub of ice cream... until the cholesterol builds up and Mr. X has to undergo a quadruple bypass.

The point is that there are cases where preventive care would have been cheaper, and there are cases where it is not. (Of course, it is also trivially true that the cheapest option is to just let people die without any care, without any treatment.)

On aggregate, summed over all cases over a population, which is more expensive? Preventive care of late stage treatment?

If we have data that says "such and such a condition is cheaper to fix later" and "such and such a condition is cheaper to prevent" -- so much the better, we just choose the right model with the appropriate cost-benefit tradeoff. (I think this is what they call "data driven", right?)
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George K
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Finally
Mr. X lowers his cholesterol with Lipitor and Aspirin. He does great (at age 56) and goes on to avoid heart surgery.

And at age 68, as part of a routine colonoscopy, is found to have a colon cancer. He is brought to the OR, where he undergoes a 5 hour operation that involves the removal of his colon and rectum, giving him a permanent colostomy. He continues with radiation and chemotherapy for another 4 years, until, with metastatic disease in his lung, brain and bone, he dies of his colon cancer.

Is this "late stage treatment'? I don't know.

Despite the emotional appeal of "preventive care," the simple fact remains that "preventive care" allows you to live longer - and people who live longer are more expensive than those who die early. That's why I love smokers. They pay taxes, and die early. No Social Security or long term care to worry about.

In the grave by age 59 of your lung cancer.

Who could ask for more?
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Axtremus
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HOLY CARP!!!
No argument with that, George.

I already admitted that "it is [also] trivially true that the cheapest option is to just let people die without any care, without any treatment."

But if I were to dig deeper, this would be the argument:

While a person "costs" so much to keep healthy, a person also "produces" so much while staying healthy.

There is a "economic cost" to keep a person healthy (and that cost may be higher or lower depending on whether it's "preventive care" or "late stage treatment" or somewhere in between).

There is also a "economic benefit" that is the economically productive work that the person does over his life time. Presumably there is more of it if the person lives healthy longer, and less of it if the person is unhealthy and/or not live as long.

So while it's true that you kept the cost lowest by letting the person die as soon as he is born, it is also true that you get zero economic benefit out of him.

The cost to care for that person presumably goes up if he lives longer, but presumably you also get more economic benefit out of him over his longer life (and presumably even more so if he is healthy through most of that lifespan).

So somewhere there is one or more optimal equilibria where you extract the most economic benefit out of a person while expensing the least economic cost to care for him to get that economic benefit.

Now will that optimal equilibria be reached using preventive care, using late stage treatments, or some combination of both depending on condition?

That answer will not be trivial, and submit will hold the key to a population's economic success.
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ivorythumper
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I am so adjective that I verb nouns!
And Mr X winds up dying of something more expensive later.

But your point is based on flawed science. High cholesterol has been found to reduce hemorrhagic strokes (the deadly kind), but increase ischemic strokes (the kind that more frequently debilitate but don't as frequently kill) and atherosclerosis. However ischemic strokes are found to be more prevalent with a low animal protein and fat diet. It seems that reducing total fat intake and shifting from less to more polyunsaturated fats actually increases the risk of dying of stroke. (see here)

So your scenario seems to show rather that statistically it is more likely that Mr X will die sooner if he follows your doctor's recommendation, and is also more susceptible to a debilitating ischemic stroke. You can do the math on the rate of the two forms of stroke vs prevalence (90% ischemic to 10% hemorrhagic) against the anticipate health care costs -- but of course you've already spent the money to determine the cholesterol level as part of a preventative health care program that doesn't really help Mr X.

It seems better to have him contributing to the economy of society by buying lobster tales and Ben and Jerry's Chunky Monkey. And then he'll die of something more expensive later or just stroke out or get hit by a bus.
The dogma lives loudly within me.
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ivorythumper
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I am so adjective that I verb nouns!
Axtremus
Jul 23 2009, 07:39 PM
So somewhere there is one or more optimal equilibria where you extract the most economic benefit out of a person while expensing the least economic cost to care for him to get that economic benefit.

Now will that optimal equilibria be reached using preventive care, using late stage treatments, or some combination of both depending on condition?

That answer will not be trivial, and submit will hold the key to a population's economic success.
And that while not "trivial" is certainly a ghastly basis for consideration, but entirely expected from reducing the human person to an economic unit.
The dogma lives loudly within me.
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