Unless they plan to be union lifers, what's in an Obama vote for young Americans?

  • Posted by a hidden member.
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    Jun 12, 2012 5:34 AM GMT
    nanidesukedo said
    riddler78 said
    nanidesukedo said
    riddler78 said
    Timbales saidWhy vote for Obama? He's not Romney.


    Because that's worked out so well for the US... icon_rolleyes.gif


    Yep, it did, actually. He inherited a horrible economic downturn/depression, and since he took office, things have been getting better - albeit slowly.

    He introduced sweeping healthcare reform.
    He supports gay marriage.
    He got rid of DADT...

    The list goes on. Progress..Not regression, which is what fundamental conservatives want.


    You'd be in the minority if you believe that the economic rebound is anything but dismal. The economy was forecast to be flying - even the Obama Administration thought it would be - the only problem is that they spent their money on things that didn't work including projects conveniently pushed by their financial backers.

    Yes, we're further on the gay rights issues. But again, as I've noted repeatedly you suffer gay or straight from bad economic times - unless of course you work for the government.

    And as for the "sweeping healthcare reform" the one that's despised by a majority of the US? Well count that in the plus column if you want, but by doing so, and accepting how horribly written it was for the benefit of lobbyists in the insurance industry and for certain other major corporations, you're showing your colors as a partisan - and not even an ideologue who puts values in ideas over party.


    Nope, wrong-o, my support of the healthcare reform is as an actual doctor, as a healthcare provider. It's not perfect, but it's a major step in the right direction and helps close a lot of huge holes in the current healthcare system - ones that I deal with every day with my patients.



    And there are many doctors who would disagree with you. I'm curious though - did you say that you are employed by a hospital or do you have your own practice?
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 5:36 AM GMT
    I'm employed by a hospital - as such, my patients are often the indigent population.
  • Posted by a hidden member.
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    Jun 12, 2012 5:44 AM GMT
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.
  • musclmed

    Posts: 3591

    Jun 12, 2012 5:48 AM GMT
    once you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 5:49 AM GMT
    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.


    I know very few people who are actually happy with their plan? Do you know how often very basic, general medicine and treatments (especially preventative care) is refused by insurance companies?

    Also, good preventative care will prevent ER visits, hospital and MRICU stays - it'll save so much money if implemented correctly. Making the ER a place where people can't be refused has become a major safety net that is ineffective and costs way too much when simple preventative care, if covered, would be far cheaper (cool studies on the usage of social workers and patient centered medical home model in this regard).

    When people can't afford $4 or $10 medication and simple pcp visits and then get sick because of that and require hospital stays that can cost 10,000-500,000+, you are definitely saving money - also, you are preventing all the negative outcomes that come to not only the individual, but also their loved ones, when someone is sick (missed time from work, stress, etc).

    Unfortunately, these savings in money are not immediate - an investment must first be made if there are to be future dividends.
  • Posted by a hidden member.
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    Jun 12, 2012 5:53 AM GMT
    nanidesukedo said
    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.


    I know very few people who are actually happy with their plan? Do you know how often very basic, general medicine and treatments (especially preventative care) is refused by insurance companies?

    Also, good preventative care will prevent ER visits, hospital and MRICU stays - it'll save so much money if implemented correctly. Making the ER a place where people can't be refused has become a major safety net that is ineffective and costs way too much when simple preventative care, if covered, would be far cheaper.

    When people can't afford $4 or $10 medication and simple pcp visits and then get sick because of that and require hospital stays that can cost 10,000-500,000+, you are definitely saving money - also, you are preventing all the negative outcomes that come to not only the individual, but also their loved ones, when someone is sick (missed time from work, stress, etc).


    1. The polling suggests with compared to the alternative, people are happy with their plans - a significant majority.

    2. The biggest insurer that declines the most treatments is... medicare. This is probably the best reason against giving government agencies more control. More money is spent on medicare on a per capita basis in the US than what's spent per capita for healthcare in Canada. The question shouldn't be whether or not the US should have a healthcare system that is structured more like Canada, but why the US doesn't spend its healthcare dollars as effectively as Canada or elsewhere (though as Canadian doctors will tell you the spending in Canada is unsustainably low).

    3. So inconveniently for advocates of preventative care are now the panels that are coming out against preventative testing for any number of diseases...
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 5:54 AM GMT
    musclmed saidonce you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.


    Yea - colonoscopies aren't going anywhere. It's one of the most proven screening methods. Hell, it's one of the few that they know save lives. Stop the fear mongering. You know this.

    Mammogram age is controversial and the age is being highly debated - probably will be for the next 100+ years.

    Also, there are times that medically treating an appendicitis is definitely more appropriate than surgical treatment.

    Stop the fear mongering.
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 5:56 AM GMT
    riddler78 said
    nanidesukedo said
    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.


    I know very few people who are actually happy with their plan? Do you know how often very basic, general medicine and treatments (especially preventative care) is refused by insurance companies?

    Also, good preventative care will prevent ER visits, hospital and MRICU stays - it'll save so much money if implemented correctly. Making the ER a place where people can't be refused has become a major safety net that is ineffective and costs way too much when simple preventative care, if covered, would be far cheaper.

    When people can't afford $4 or $10 medication and simple pcp visits and then get sick because of that and require hospital stays that can cost 10,000-500,000+, you are definitely saving money - also, you are preventing all the negative outcomes that come to not only the individual, but also their loved ones, when someone is sick (missed time from work, stress, etc).


    1. The polling suggests with compared to the alternative, people are happy with their plans - a significant majority.

    2. The biggest insurer that declines the most treatments is... medicare. This is probably the best reason against giving government agencies more control. More money is spent on medicare on a per capita basis in the US than what's spent per capita for healthcare in Canada. The question shouldn't be whether or not the US should have a healthcare system that is structured more like Canada, but why the US doesn't spend its healthcare dollars as effectively as Canada or elsewhere (though as Canadian doctors will tell you the spending in Canada is unsustainably low).

    3. So inconveniently for advocates of preventative care are now the panels that are coming out against preventative testing for any number of diseases...


    That's how it should be with preventative testing - if it's not effective and doesn't save lives - you shouldn't do it. If you are dealing with a test that either isn't effective or doesn't alter the course of illness (which many screening tests are - IE why we don't screen for lung cancer with x-rays), they shouldn't be done.
  • Posted by a hidden member.
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    Jun 12, 2012 7:30 AM GMT
    nanidesukedo saidNope, wrong-o, my support of the healthcare reform is as an actual doctor, as a healthcare provider. It's not perfect, but it's a major step in the right direction and helps close a lot of huge holes in the current healthcare system - ones that I deal with every day with my patients.

    Every doctor and dentist I know who are in private practice disagree with you in the strongest of terms.

    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    That explains your position.

    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.

    Exactly. Explains why nanidesukedo thinks the law is good. It helps the small minority of people he treats and the expense of the bigger picture and the overall economy.

    musclmed saidonce you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.

    Amen.
  • Tiran

    Posts: 227

    Jun 12, 2012 8:01 AM GMT
    Have I mentioned that to an outsider who pays any attention to American politics you people appear to be BugFuck Insane? Your inability to look at a ANY idea on its actual merits rather than on partisan grounds being the number one reason.
    And speaking as a Canadian, we don't understand why you don't have a similar health care system (actually we do understand, you have the best government money can buy).
    Yes we spend more on healthcare per capita, but we don't have families going bankrupt over appendicitis, much less cancer.
    And while you might occasionally hear about our conservatives (whom you would call liberals) mutter about changing our healthcare system, you will notice that no conservative government (and we have had quite a few, federally and provincially) will do more than finagle the edges of the system. They know that if they did it would be the LAST thing they EVER did and their party's future would be razed and sown with salt.
    And lets not forget our banking system, the one that includes 3 of the 5 strongest banks in the world, thanks to our more CONSERVATIVE finance laws.

    As an outsider, I would say as Obama's plan seems to be modelled at least somewhat on the Canadian system, your youth would be foolish NOT to vote for him.
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    Jun 12, 2012 8:08 AM GMT
    Tiran saidHave I mentioned that to an outsider who pays any attention to American politics you people appear to be BugFuck Insane? Your inability to look at a ANY idea on its actual merits rather than on partisan grounds being the number one reason.
    And speaking as a Canadian, we don't understand why you don't have a similar health care system (actually we do understand, you have the best government money can buy).
    Yes we spend more on healthcare per capita, but we don't have families going bankrupt over appendicitis, much less cancer.
    And while you might occasionally hear about our conservatives (whom you would call liberals) mutter about changing our healthcare system, you will notice that no conservative government (and we have had quite a few, federally and provincially) will do more than finagle the edges of the system. They know that if they did it would be the LAST thing they EVER did and their party's future would be razed and sown with salt.
    And lets not forget our banking system, the one that includes 3 of the 5 strongest banks in the world, thanks to our more CONSERVATIVE finance laws.

    As an outsider, I would say as Obama's plan seems to be modelled at least somewhat on the Canadian system, your youth would be foolish NOT to vote for him.


    It's sad how ignorant you are of our healthcare system. You do realize that it's very much unsustainable? What you don't seem to understand is that the Americans have the worst government money can buy. No, the Americans spend far more on healthcare per capita but still as you point out have families going bankrupt. You'd think that Americans would first try to fix medicare before throwing more resources into it.

    And the reality is that there is change coming to the Canadian healthcare system because it is unsustainable - especially given that our baby boom generation is far more pronounced than the American one - which will put a greater burden on our healthcare system because we are also living longer. Further, you do realize that our healthcare is effectively subsidized by the pricing policy of big pharma? I'm not complaining but it's also hardly sustainable.

    As for our banking system - yes, it's more conservative but here's the problem - have you paid attention to the developing bubble and the increased consumer borrowings? Further, I don't suppose you've noticed that Canada never had the same restrictions as Glass Steagall and yet they didn't suffer like the Americans did and yet there are many Americans who ignorantly point to the repeal of Glass Steagall as the cause of the financial crisis?

    As an outsider you seem remarkably ignorant of both Obamacare and the Canadian healthcare systems.
  • Timbales

    Posts: 13999

    Jun 12, 2012 11:31 AM GMT
    riddler78 said
    Timbales saidWhy vote for Obama? He's not Romney.


    Because that's worked out so well for the US... icon_rolleyes.gif


    When there is a system in place that only allows for the choice between two parties that are only interested in maintaining their own power base and fucking over the other party, one can either abstain, vote for a third party with no hope of winning or for the lesser of two evils based on their own values.
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    Jun 12, 2012 11:43 AM GMT
    Tiran saidAs an outsider, I would say as Obama's plan seems to be modelled at least somewhat on the Canadian system, your youth would be foolish NOT to vote for him.

    I know of many Canadians and have spoken with a few who have come to the US for surgeries because they felt the delay in Canada would have jeopardized their lives. More of the youth in the US are without jobs and seeing his policies as bankrupting their future. Fortunately the number of those who think as you do are getting fewer in number as they see the facts and wise up.
  • musclmed

    Posts: 3591

    Jun 12, 2012 2:05 PM GMT
    nanidesukedo said
    riddler78 said
    nanidesukedo said
    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.


    I know very few people who are actually happy with their plan? Do you know how often very basic, general medicine and treatments (especially preventative care) is refused by insurance companies?

    Also, good preventative care will prevent ER visits, hospital and MRICU stays - it'll save so much money if implemented correctly. Making the ER a place where people can't be refused has become a major safety net that is ineffective and costs way too much when simple preventative care, if covered, would be far cheaper.

    When people can't afford $4 or $10 medication and simple pcp visits and then get sick because of that and require hospital stays that can cost 10,000-500,000+, you are definitely saving money - also, you are preventing all the negative outcomes that come to not only the individual, but also their loved ones, when someone is sick (missed time from work, stress, etc).


    1. The polling suggests with compared to the alternative, people are happy with their plans - a significant majority.

    2. The biggest insurer that declines the most treatments is... medicare. This is probably the best reason against giving government agencies more control. More money is spent on medicare on a per capita basis in the US than what's spent per capita for healthcare in Canada. The question shouldn't be whether or not the US should have a healthcare system that is structured more like Canada, but why the US doesn't spend its healthcare dollars as effectively as Canada or elsewhere (though as Canadian doctors will tell you the spending in Canada is unsustainably low).

    3. So inconveniently for advocates of preventative care are now the panels that are coming out against preventative testing for any number of diseases...


    That's how it should be with preventative testing - if it's not effective and doesn't save lives - you shouldn't do it. If you are dealing with a test that either isn't effective or doesn't alter the course of illness (which many screening tests are - IE why we don't screen for lung cancer with x-rays), they shouldn't be done.




    I think experience taught me this lesson. It hit me when I heard from a bureaucrat at the V.A. that they wanted to have as a goal for everyone patient hypertension to be prescribed a thiazide diuretic.

    Mind you that hypertension treatment and control is usually tailored to the patients individual profile.

    The reason for doing this was as a measure to show that the VA could treat hypertension for under 10 dollars a year.

    When I mentioned that medical research requires informed consent the Washington bureaucrat said that "Well the federal gov doesn't have to worry about silly rules"

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.

    The point is , to balance the books they will do or say anything to make the politicians in power look good.
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 3:50 PM GMT
    socalfitness said
    nanidesukedo saidNope, wrong-o, my support of the healthcare reform is as an actual doctor, as a healthcare provider. It's not perfect, but it's a major step in the right direction and helps close a lot of huge holes in the current healthcare system - ones that I deal with every day with my patients.

    Every doctor and dentist I know who are in private practice disagree with you in the strongest of terms.

    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    That explains your position.

    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.

    Exactly. Explains why nanidesukedo thinks the law is good. It helps the small minority of people he treats and the expense of the bigger picture and the overall economy.

    musclmed saidonce you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.

    Amen.


    A. I know more doctors than you ever will and this is not the case.

    B. Working at a hospital does not make my patients the small minority - if you think only a small minority of people ever end up at a hospital, you are severely delusional (hospitals consist of both inpatient and outpatient care).

    C. The fact that you support musclmed when he sits there and talks about colonoscopies going away, further shows that y'all have no friggin clue what the hell you are talking about.
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 3:53 PM GMT
    musclmed said
    nanidesukedo said
    riddler78 said
    nanidesukedo said
    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.


    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.


    I know very few people who are actually happy with their plan? Do you know how often very basic, general medicine and treatments (especially preventative care) is refused by insurance companies?

    Also, good preventative care will prevent ER visits, hospital and MRICU stays - it'll save so much money if implemented correctly. Making the ER a place where people can't be refused has become a major safety net that is ineffective and costs way too much when simple preventative care, if covered, would be far cheaper.

    When people can't afford $4 or $10 medication and simple pcp visits and then get sick because of that and require hospital stays that can cost 10,000-500,000+, you are definitely saving money - also, you are preventing all the negative outcomes that come to not only the individual, but also their loved ones, when someone is sick (missed time from work, stress, etc).


    1. The polling suggests with compared to the alternative, people are happy with their plans - a significant majority.

    2. The biggest insurer that declines the most treatments is... medicare. This is probably the best reason against giving government agencies more control. More money is spent on medicare on a per capita basis in the US than what's spent per capita for healthcare in Canada. The question shouldn't be whether or not the US should have a healthcare system that is structured more like Canada, but why the US doesn't spend its healthcare dollars as effectively as Canada or elsewhere (though as Canadian doctors will tell you the spending in Canada is unsustainably low).

    3. So inconveniently for advocates of preventative care are now the panels that are coming out against preventative testing for any number of diseases...


    That's how it should be with preventative testing - if it's not effective and doesn't save lives - you shouldn't do it. If you are dealing with a test that either isn't effective or doesn't alter the course of illness (which many screening tests are - IE why we don't screen for lung cancer with x-rays), they shouldn't be done.




    I think experience taught me this lesson. It hit me when I heard from a bureaucrat at the V.A. that they wanted to have as a goal for everyone patient hypertension to be prescribed a thiazide diuretic.

    Mind you that hypertension treatment and control is usually tailored to the patients individual profile.

    The reason for doing this was as a measure to show that the VA could treat hypertension for under 10 dollars a year.

    When I mentioned that medical research requires informed consent the Washington bureaucrat said that "Well the federal gov doesn't have to worry about silly rules"

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.

    The point is , to balance the books they will do or say anything to make the politicians in power look good.


    I'm not sure I understand why HCTZ would be a cost saving mechanism, when, like you said 0 HTN mediciation is tailored to the individual...especially when most meds (except the ARBs and a few other less commonly used ones) are on the $4/$10 list and cost almost nearly the same.

    Though, with simple hypertension without an other risk factors (Diabetes, etc), a diuretic is the first line therapy (may be changing as more are found out about the benefits of ACE-Is) and is actually reasonable as a first attempt at medication if there were no other risk factors/contra-indications.
  • Posted by a hidden member.
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    Jun 12, 2012 4:19 PM GMT
    nanidesukedo said
    socalfitness said
    nanidesukedo saidNope, wrong-o, my support of the healthcare reform is as an actual doctor, as a healthcare provider. It's not perfect, but it's a major step in the right direction and helps close a lot of huge holes in the current healthcare system - ones that I deal with every day with my patients.

    Every doctor and dentist I know who are in private practice disagree with you in the strongest of terms.

    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    That explains your position.

    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.

    Exactly. Explains why nanidesukedo thinks the law is good. It helps the small minority of people he treats and the expense of the bigger picture and the overall economy.

    musclmed saidonce you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.

    Amen.


    A. I know more doctors than you ever will and this is not the case.

    B. Working at a hospital does not make my patients the small minority - if you think only a small minority of people ever end up at a hospital, you are severely delusional (hospitals consist of both inpatient and outpatient care).

    C. The fact that you support musclmed when he sits there and talks about colonoscopies going away, further shows that y'all have no friggin clue what the hell you are talking about.

    I don't know why you needed to get nasty. You don't know how many doctors I know but that is not the point. The ones I do know are quite aware of the national and economic issues involving healthcare and see things 1000% different from you. Maybe you don't have all the answere and a bit of humility might be in order instead of an attitude very likely rooted in defensiveness.
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 4:36 PM GMT
    socalfitness said
    nanidesukedo said
    socalfitness said
    nanidesukedo saidNope, wrong-o, my support of the healthcare reform is as an actual doctor, as a healthcare provider. It's not perfect, but it's a major step in the right direction and helps close a lot of huge holes in the current healthcare system - ones that I deal with every day with my patients.

    Every doctor and dentist I know who are in private practice disagree with you in the strongest of terms.

    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    That explains your position.

    riddler78 said
    nanidesukedo saidI'm employed by a hospital - as such, my patients are often the indigent population.

    So here's my question - I don't doubt that we as a society should help provide for the least fortunate. But does this mean that everyone else's healthcare plans should be forced to change when most people are generally happy with their plans? I should also state that I have been on the record as saying that I believe strongly that the US healthcare system desperately needs reform, but what was written is not only moving in the wrong direction but is resulting in unnecessary costs and additional bureaucracy and entitlement spending when there are alternatives.

    That's why I imagine people in the US generally hate the bill - sure there may be some good accomplished at the margins, but there's been a significant cost to it.

    Exactly. Explains why nanidesukedo thinks the law is good. It helps the small minority of people he treats and the expense of the bigger picture and the overall economy.

    musclmed saidonce you get government involved you get fact finding government bodies that look to cut costs.

    Like eliminate mammograms under 50 years old. Rationalize away screening colonoscopies.

    And yes propose and re-propose to medically treat Appendicitis versus surgical treatment.

    Fortunate thing is that the Supreme court will rule soon and November will be here shortly.

    Amen.


    A. I know more doctors than you ever will and this is not the case.

    B. Working at a hospital does not make my patients the small minority - if you think only a small minority of people ever end up at a hospital, you are severely delusional (hospitals consist of both inpatient and outpatient care).

    C. The fact that you support musclmed when he sits there and talks about colonoscopies going away, further shows that y'all have no friggin clue what the hell you are talking about.

    I don't know why you needed to get nasty. You don't know how many doctors I know but that is not the point. The ones I do know are quite aware of the national and economic issues involving healthcare and see things 1000% different from you. Maybe you don't have all the answere and a bit of humility might be in order instead of an attitude very likely rooted in defensiveness.


    You're one to lecture on humility...my response is not rooted in defensiveness - it's rooted in correcting your dismissal of my patients as a "small minority" because you are trying to explain away beliefs of those that are opposite to you.

    The fact stands: Almost every doctor I know, even if they don't agree 100% with the bill, think that it's a huge step forward in the right direction - even moreso have I seen this on hospital ethics committees.
  • musclmed

    Posts: 3591

    Jun 12, 2012 6:50 PM GMT
    nanidesukedo said

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.

    The point is , to balance the books they will do or say anything to make the politicians in power look good.


    I'm not sure I understand why HCTZ would be a cost saving mechanism, when, like you said 0 HTN mediciation is tailored to the individual...especially when most meds (except the ARBs and a few other less commonly used ones) are on the $4/$10 list and cost almost nearly the same.

    Though, with simple hypertension without an other risk factors (Diabetes, etc), a diuretic is the first line therapy (may be changing as more are found out about the benefits of ACE-Is) and is actually reasonable as a first attempt at medication if there were no other risk factors/contra-indications.



    I will elaborate.

    A V.A. beaurocrat decided to put as a CLINICAL REMINDER to doctors that all hypertensive patients should be on a thiazide.

    They were measuring this parameter, and putting a negative and positive incentinve on MD'S ,NP's and PA.s for the percentage of patients with the diagnosis of hypertension on a thiazide. Independant of whether they were controlled or not.

    Simply HCTZ is cheap and by FIAT they wanted to try to cut costs and put everyone on a diuretic.


    This is the future with electronic medical records and meaningful use.

    The health care law will likely fall but do not misunderstand the intent of governement to define what the standard of care is.


    I am assuming at 25 you are either in medical school or residency. Come back to me when you are treating a patient and want to order a study and have to jump through 100 hoops and hear 100 opinions on why it is not indicated.

    Medicare by coding guidelines is the single most powerful arbitrator of what studies are performed and how medicine is practice.


    I am confident your attitude will change with time. Goverenment is not a friend to MD's at all.


    PS HCTZ pills are about 2-3 cents a pill
  • nanidesukedo

    Posts: 1036

    Jun 12, 2012 7:36 PM GMT
    musclmed said
    nanidesukedo said

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.

    The point is , to balance the books they will do or say anything to make the politicians in power look good.


    I'm not sure I understand why HCTZ would be a cost saving mechanism, when, like you said 0 HTN mediciation is tailored to the individual...especially when most meds (except the ARBs and a few other less commonly used ones) are on the $4/$10 list and cost almost nearly the same.

    Though, with simple hypertension without an other risk factors (Diabetes, etc), a diuretic is the first line therapy (may be changing as more are found out about the benefits of ACE-Is) and is actually reasonable as a first attempt at medication if there were no other risk factors/contra-indications.



    I will elaborate.

    A V.A. beaurocrat decided to put as a CLINICAL REMINDER to doctors that all hypertensive patients should be on a thiazide.

    They were measuring this parameter, and putting a negative and positive incentinve on MD'S ,NP's and PA.s for the percentage of patients with the diagnosis of hypertension on a thiazide. Independant of whether they were controlled or not.

    Simply HCTZ is cheap and by FIAT they wanted to try to cut costs and put everyone on a diuretic.


    This is the future with electronic medical records and meaningful use.

    The health care law will likely fall but do not misunderstand the intent of governement to define what the standard of care is.


    I am assuming at 25 you are either in medical school or residency. Come back to me when you are treating a patient and want to order a study and have to jump through 100 hoops and hear 100 opinions on why it is not indicated.

    Medicare by coding guidelines is the single most powerful arbitrator of what studies are performed and how medicine is practice.


    I am confident your attitude will change with time. Goverenment is not a friend to MD's at all.


    PS HCTZ pills are about 2-3 cents a pill


    In this case, I think the government is right in setting standards - the government is in line with AHA guidelines and JNC 7:

    http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

    I think if the government wants to set standards that ensure quality control, they should. When scientific data supports the usage of thiazide diuretics as first line therapies and that it's considered (technically) impossible to consider HTN resistant until you've tried them on a diuretic...it's in line with the scientifically measured gold standard of care.

    This happens at hospitals all the time - Pts automatically receive vaccines, there are "protocols" that define how things are to be treated per hospital.

    In the case of diseases that are universally prominent, such as diabetes and HTN, where there are overlying research boards (like the AHA) who have set forth guidelines defining the best medical treatment..If the government wants to step in (in government funded institutions, like the VA, mind you) and state that the institution should be following the best medical practice - they should.

    This isn't like they are stepping out of medical line and stating that everyone gets an ARB or automatically put on a Beta blocker like metoprolol..They are following the guidelines set forth by the AHA and JNC 7.

    Also, as a resident, I do treat patients - I do jump through hoops....Maybe you don't remember residency at your age, but the residents are the ones who are doing 95+% of the ordering of medicines and testing.
  • Posted by a hidden member.
    Log in to view his profile

    Jun 12, 2012 8:44 PM GMT
    nanidesukedo said
    musclmed said
    nanidesukedo said

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.

    The point is , to balance the books they will do or say anything to make the politicians in power look good.


    I'm not sure I understand why HCTZ would be a cost saving mechanism, when, like you said 0 HTN mediciation is tailored to the individual...especially when most meds (except the ARBs and a few other less commonly used ones) are on the $4/$10 list and cost almost nearly the same.

    Though, with simple hypertension without an other risk factors (Diabetes, etc), a diuretic is the first line therapy (may be changing as more are found out about the benefits of ACE-Is) and is actually reasonable as a first attempt at medication if there were no other risk factors/contra-indications.



    I will elaborate.

    A V.A. beaurocrat decided to put as a CLINICAL REMINDER to doctors that all hypertensive patients should be on a thiazide.

    They were measuring this parameter, and putting a negative and positive incentinve on MD'S ,NP's and PA.s for the percentage of patients with the diagnosis of hypertension on a thiazide. Independant of whether they were controlled or not.

    Simply HCTZ is cheap and by FIAT they wanted to try to cut costs and put everyone on a diuretic.


    This is the future with electronic medical records and meaningful use.

    The health care law will likely fall but do not misunderstand the intent of governement to define what the standard of care is.


    I am assuming at 25 you are either in medical school or residency. Come back to me when you are treating a patient and want to order a study and have to jump through 100 hoops and hear 100 opinions on why it is not indicated.

    Medicare by coding guidelines is the single most powerful arbitrator of what studies are performed and how medicine is practice.


    I am confident your attitude will change with time. Goverenment is not a friend to MD's at all.


    PS HCTZ pills are about 2-3 cents a pill


    In this case, I think the government is right in setting standards - the government is in line with AHA guidelines and JNC 7:

    http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

    I think if the government wants to set standards that ensure quality control, they should. When scientific data supports the usage of thiazide diuretics as first line therapies and that it's considered (technically) impossible to consider HTN resistant until you've tried them on a diuretic...it's in line with the scientifically measured gold standard of care.

    This happens at hospitals all the time - Pts automatically receive vaccines, there are "protocols" that define how things are to be treated per hospital.

    In the case of diseases that are universally prominent, such as diabetes and HTN, where there are overlying research boards (like the AHA) who have set forth guidelines defining the best medical treatment..If the government wants to step in (in government funded institutions, like the VA, mind you) and state that the institution should be following the best medical practice - they should.

    This isn't like they are stepping out of medical line and stating that everyone gets an ARB or automatically put on a Beta blocker like metoprolol..They are following the guidelines set forth by the AHA and JNC 7.

    Also, as a resident, I do treat patients - I do jump through hoops....Maybe you don't remember residency at your age, but the residents are the ones who are doing 95+% of the ordering of medicines and testing.


    icon_lol.gif Good point. I am thoroughly enjoying reading your commentary!
  • nanidesukedo

    Posts: 1036

    Jun 13, 2012 12:44 AM GMT
    Thanks, Catfish. It's always important to point out that often times, when protocols are instituted in university hospitals, government institutions, etc...in regards to various illnesses and treatments, it's because they are trying to ensure that, amongst a large group of physicians that have different training and lengths of practice, that best standard of care is followed.

    These protocols are not a negative thing, but are in place to ensure that evidence based medicine is practiced so that patients may have the best outcome.

    Hell, the ER basically runs off protocols and algorithms with a little bit of creativity and personal experience tossed in.
  • musclmed

    Posts: 3591

    Jun 13, 2012 1:41 AM GMT
    nanidesukedo said
    musclmed said
    nanidesukedo said

    Trust me . The Govt" doesnt care about people , medical licenses or ethics.
    ll


    In this case, I think the government is right in setting standards - the government is in line with AHA guidelines and JNC 7:

    http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

    I think if the government wants to set standards that ensure quality control, they should. When scientific data supports the usage of thiazide diuretics as first line therapies and that it's considered (technically) impossible to consider HTN resistant until you've tried them on a diuretic...it's in line with the scientifically measured gold standard of care.

    This happens at hospitals all the time - Pts automatically receive vaccines, there are "protocols" that define how things are to be treated per hospital.

    In the case of diseases that are universally prominent, such as diabetes and HTN, where there are overlying research boards (like the AHA) who have set forth guidelines defining the best medical treatment..If the government wants to step in (in government funded institutions, like the VA, mind you) and state that the institution should be following the best medical practice - they should.

    This isn't like they are stepping out of medical line and stating that everyone gets an ARB or automatically put on a Beta blocker like metoprolol..They are following the guidelines set forth by the AHA and JNC 7.

    Also, as a resident, I do treat patients - I do jump through hoops....Maybe you don't remember residency at your age, but the residents are the ones who are doing 95+% of the ordering of medicines and testing.


    My age? hmm kinda a snide comment you think?

    JNC7 makes sense when you start someone off on a medicine. It is no reason to change someones regimen.

    I would say the comment about the 95% is just not true. Maybe in an academic setting and in a hospital setting.

    Have you ever called an insurance company to get an approval for an MRI or a test?
    In a hospital for the most part everything is pre-authorized. So you have tons to look forward to after residency. Trust me residency is a cakewalk compared to private practice.

    Back to the VA ? which is a microcosm of the bigger health care debate.
    Medical decisions are vested with the Doctor in consultation with the patient.

    Often times as Nephrologist, Thiazides make sense. But not for everyone. But to have a bureaucrat change everyone's regimen just because it saves some money is unethical.

    Last is informed consent. You rationalized the HCTZ change, but I doubt that the average person understands that the future of Obamacare could have that exact sort of fiat change as a standard operating procedure.

    The JNC7 data you presented are about 8 years old published in DEC 2003.
    Its HARDLY THE STANDARD OF CARE.

    FYI Thiazides worsen diabetes. Since the majority of the patients I see are obese and pre diabetic. How well should i be judged ? In the "Hypertension community " most believe the JNC7 is OUTDATED and wrong. Geared for an international audience and lacks the nuance of treatment in the U.S
    You sort of site AHA, but AHA directly contradicts Jnc7, in that it clearly states thiazide can be first line but the therapy must be tailored to the patient and the individual risks.


    HCTZ has no evidence that it prevents strokes or heart attackes. However the VA didnt care.
    http://tinyurl.com/7xotwku


    Remember when you order a medicine the standing order is not the prescriber. You are. You have a ethical obligation to the patient. Not the government or some other institution.

    We are not talking about standing orders to switch Nexium to Protonix in the hospital. Changes medications regimens that are working just to prove a point or save a dime is just wrong.

    The VA example just shows what would happen in a public system. I agree something needed to be done. But disagree with the way and unconstitutional way it was done.
    And I would say with the AMA example of record drop in membership that most physicians have a pessismistic view of the future.
    http://www.doctorsandpatients.org/oh-doc-survey-results



  • Posted by a hidden member.
    Log in to view his profile

    Jun 13, 2012 2:27 AM GMT
    Wayyyyy off topic, but JNC 8 is probably still going to emphasize thiazide diuretics as first line, just not HCTZ (but rather chlorthalidone and indapamide).

  • nanidesukedo

    Posts: 1036

    Jun 13, 2012 2:46 AM GMT
    Chlorthalidone = sweet. Longer acting and more potent.

    And please see above - I already mentioned the whole thing about HCTZ only being standard of care when there weren't other issues - like diabetes and it was simple, uncomplicated HTN...so, that whole rant was pointless, musclmed.

    Also, switching medications is appropriate if the standard of care is the one with the most Evidence backing patient outcomes. For example, if I had a patient come into my clinic with diabetes and hypertension and they were on a bunch of different meds, but none of them were an ACE-I/ARB - you better damn well believe I'm gonna alter their medication to the scientifically proven care and do whatever the hell I can (even if I have to replace a med) to get them on an ACE-I/ARB