My old friend Ed

[waterboy]

http://community.livejournal.com/ontd_political/4158824.html

Went to high school and college with this guy. He turned out pretty good. He had a great time with the Tea Partiers in a Maryland demonstration last fall managing to keep his cool and turning the experience around to motivate others. Note the policemen talking to him and shaking his hand. He makes some astute observations about all the parties involved and castigates those who consider him "brave".

A product of Tulsa Public Schools, a state university and an old Tulsa neighborhood. A shame he had to leave the state to find a stage.

[Breadburner]

A fat white Paul Tay......

[waterboy]

I know them both. No similarity. Well, except that they both were born and reared in Tulsa and they both couldn't care less about your opinion of them.

[heironymouspasparagus]

Note the attempted assault by the Tea Bagger at about 1:30...

Sounds about right....

[Gaspar]

He's a bankruptcy lawyer. 

He's probably seen medical expenses push many people into financial ruin.  He obviously feels that a Public Option would end that.   

It would only transfer that debt to the federal government and multiply it. Forcing us down the same path that others are now traveling. 

The healthcare industry is out of control as a result of regulation and market manipulation that grant insurance companies monopolistic power in each state.  These provisions were all part of past socialistic advances.  The answer is not complete Socialism.  The answer is to return the power to the patient and doctor.  Give choice back to the people.

This is easy to do.  Simply force insurance companies to compete on an individual account basis.  Eliminate requirements on corporate insurance plans.  Eliminate the state border limitation to increase patients choices from 2-10 companies to 1,000s.  And finally. . .provide tort limits on medical malpractice. 

Can you imagine what will happen when BCBS realizes that it's 100,000 captive clients will have the ability to go to websites esurance.com and get quotes from hundreds of other companies?

Can you imagine what hospitals will do when patients have the right to say "my doctor sucks, I'm going to go to another doctor at another hospital?"

Can you imagine how the quality of care will increase when doctors, clinics, hospitals, and insurance companies begin to regard patients as customers rather than subject-liabilities.

Medical research has also suffered under the weight of monopolistic control.  Insurance companies dictate what drugs patients can purchase and from what companies based on the cheapest price rather than the best result.  Can you imagine what will happen when as a part of the competitive landscape, patients and doctors can fire an insurance company based on poor formulary performance?  "You don't pay for Arythromycin?  Well then I'm switching to TexiCare."

Socialistic medicine, at best,  will render the same result here that it offers everywhere else.  I anticipate it would render a far worse result.   

[Conan71]

Gaspar, I'm hardly anti-capitalist, but one of the cornerstones of controlling health care costs is reigning in health care sprawl and getting doctors out of the real estate business.  We have yet one more new medical facility close to breaking ground, IIRC, it's a cancer facility less than two miles from another nationally-owned cancer facility.  Facility costs are incredibly high in the medical field.  Perhaps the idea is all these specialty hospitals will provide better care, but I've seen absolutely no evidence that's happened.  All I've seen is the economic health improving of the hospital partners.

This issue is largely overlooked in the health care debate.  Sure it's great for the construction industry and I sometimes benefit from new facilities being built, but as a consumer, it's alarming to see how much my facility fee went up for similar surgeries in a little over a 2 year time span.

[waterboy]

Beware the "easy" button.

I can't imagine what world would have medical procedures as part of an open marketplace. Its a tantalizing idea to have doctors and med centers following the Walmart example of marketing. It was bad enough to see lawyers jockeying with realtors to buy up all the space in phone books and bus seats. The idea of running specials on back surgeries just seems wrong to me. I guess I see medicine the same way I see expressways, part of the (privatized) infrastructure of a healthy nation.  I'm not fully up to speed with the whole process, and I'm sure you guys have spent more time pouring through the arguments than I have. I'm just skeptical that what you described has any chance of being enacted or being successful. We could redesign a car to run on sea water or we could just take existing cars and make them more efficient and flexible in fuel source. That would be my choice.

Its not that Ed had the best idea. It was the way he exercised his rights to a different view, in the midst of a crowd that others were scared of, without violence ensuing that impressed me. Then, to show respect for those different views, to understand his role in the process and to commence opposition, is damn American and I think he did well.

edit: I know that is a wordy sentence. Just tried to clean it up.

[Gaspar]

Gaspar, I'm hardly anti-capitalist, but one of the cornerstones of controlling health care costs is reigning in health care sprawl and getting doctors out of the real estate business.  We have yet one more new medical facility close to breaking ground, IIRC, it's a cancer facility less than two miles from another nationally-owned cancer facility.  Facility costs are incredibly high in the medical field.  Perhaps the idea is all these specialty hospitals will provide better care, but I've seen absolutely no evidence that's happened.  All I've seen is the economic health improving of the hospital partners.

This issue is largely overlooked in the health care debate.  Sure it's great for the construction industry and I sometimes benefit from new facilities being built, but as a consumer, it's alarming to see how much my facility fee went up for similar surgeries in a little over a 2 year time span.

They have been forced to become non-medical entrepreneurs.  I have too many doctor friends to count (the result of growing up in a medical family).  Most have now gone back to school or done another residency to specialize, or have found ways to capture a better market.  Oncology, rheumatology, sports medicine, all offer more attractive financial positions than just practicing medicine.  Family Practice, and Internal Medicine docs used to thrive in great numbers, but have fled their broad fields because they have become forced to be cogs in giant clinics.  These are the most pure and beautiful forms of medicine.  Complete understanding of the patient, their life, and underlying problems from every dimension. They are now an endangered species.

Warren Clinics Internal Medicine docs see a massive number of patients every day, and the healthcare plans have developed quotas for the docs to adhere to.  Don't see enough patients a day, and get dropped from the plan.  The result is exodus.  The escape is to less regulated specializations.

The lowest rung on the ladder is the Family Practice physicians, now forced to operate as little more than hospitalists and clinic docs.

Specialty medicine is blooming because it offers a free market solution to insurance industry control.  The quality of medicine at these clinics is akin to medical care 20 years ago, therefore, the patients view them as outstanding, and are willing to pay higher deductibles and overages to get better care.  This is a side effect of monopoly, and regulation, the development of a medical "class system."

Under socialized medicine, it will be necessary to price control or even outlaw private medicine.  Otherwise those who can afford to go to the good hospital will, and the poor will be relegated to the government clinics.  The evolution can be seen very clearly in Canada and Great Brittan, where they have now licensed private clinics and medical tourism thrives.  Only people who can afford good care get it, the rest get the same thing government always delivers. . .a product stepped on many times.

[Gaspar]

Beware the "easy" button.

I can't imagine what world would have medical procedures as part of an open marketplace. Its a tantalizing idea to have doctors and med centers following the Walmart example of marketing. It was bad enough to see lawyers jockeying with realtors to buy up all the space in phone books and bus seats. The idea of running specials on back surgeries just seems wrong to me. I guess I see medicine the same way I see expressways, part of the (privatized) infrastructure of a healthy nation.  I'm not fully up to speed with the whole process, and I'm sure you guys have spent more time pouring through the arguments than I have. I'm just skeptical that what you described has any chance of being enacted or being successful. We could redesign a car to run on sea water or we could just take existing cars and make them more efficient and flexible in fuel source. That would be my choice.

Its not that Ed has the best idea, it was the way he exercised his rights to a different view in the midst of a crowd that others were scared of without violence ensuing. Then to respect those different views, understand his role in the process and commence opposition. Its damn American and I think he did well.

30 years ago, my dad had a cash register at the receptionists window in office.  He was an Internist.  Most of his patients paid cash.  A physical with lab (CBC, Chem 20, and Sed) and chest X-Ray was about $40.  It took 45mins to an hour because the doctor performed a patient interview because learning about the PERSON was important in diagnosing problems.

Doctors didn't advertise because it was not necessary.  If you heard about a good Cardiologist or Dermatologist, you went to him or her.  No insurance company could stop you.

It was completely unthinkable that an insurance company would ever have the power to regulate what medicine a doctor prescribed or who he referred a patient to.  Laughable!

In the 80s, my father saw his patient population ageing.  Many were now on medicare.  2,000 page plus medical coding books became the norm in his office and each examination, physical and procedure had to be correctly coded and billed.  It was necessary to have his nurse assist with the Medicare billing.  His nurse who used to double as his receptionist now needed an assistant.  He hired a full time receptionist.

In the 90s Lawsuits against doctors made malpractice rates extremely high for docs who had X-Ray machines and performed their own lab work and EKGs.  If he gave up his in-office diagnostic equipment he would have to join one of the clinics to make the use of diagnostics and malpractice affordable.  He joined Warren Clinics, sold his building and moved into their facility.  His 45 minute physicals that included X-Ray and lab work were cut short so that the patient could go across the street to to the lab and radiologist.  He would then get the X-Ray results later that day or the next.  He was not allowed to order a chest X Ray on patients under 50, unless they had a pre-existing condition that necessitated it. 

In the mid 90s he saw the complete takeover by the insurance company.  Warren Clinics was regulated by Community Care, a collaboration designed to give "the patient" more choice.  He could no longer schedule 8 to 10 patients a day and do rounds in the morning or evening.  He had to see twice as many patients to remain "under clinic" at about 15 minutes each. He protested, and was told to hire a PA.

He retired and worked at the VA for a while (because as a veteran he had always planned to give back).

Medicine as a free market enterprise is not a new idea.  The way the medical practice used to work when we were kids is what we need.  This experiment in corporate control has failed.  An experiment in government control cannot possibly offer anything positive. 

[waterboy]

Much of what you say I have found to be accurate for many physicians. You touched on the change in demographics. How do you think we can return to the medicine of my youth, which I agree was preferable, when the baby boomers have so drastically skewed the type of care to match their needs? Its one thing to be a successful family doctor or internist when most of your patients are young adults and children as they were in the 50's and 60's. Its a different set of problems when those giant populations of young children have reached retirement age. Throw in the rapid growth of technology and biochemistry and you have a field that argues against going back to those times.

I abhor what insurance companies have done to our medical system, our entertainment industry and life in general. It seems anything with any risk at all is prohibitive to insure. Thus a world of mediocre medicine and mediocre entertainment. But many of these same doctors willingly invested in these insurance companies and clinics that offered a more steady stream of income didn't they? Now that insurance companies are kings of the country I doubt they will relinquish their hold easily, if at all.