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

  • musclmed

    Posts: 3591

    Jun 13, 2012 3:03 AM GMT
    nanidesukedo saidChlorthalidone = 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


    Ok lets say the patient had very mild hypertension and was diabetic. The VA wanted you to start with HCTZ first, no matter what. And it was put as a negative mark for every patient for each MD who didn't follow that.

    Not chlorthalidone, HCTZ.

    The "rant" was , you are talking to someone who is boarded in Hypertension
    Its great you practice evidence based medicine. And I am glad you have not had the experience of a non MD somewhere in Washington suggesting a therapy that is detrimental.

    As far as Screening colonoscopy the VA pushed guiac cards and still do.
    Do not think for a second some government body will try to rationalize not doing them. It happens in Canada.

    The "owned comment was just immature"

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    Jun 13, 2012 10:50 PM GMT
    musclmed said
    nanidesukedo saidChlorthalidone = 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


    Ok lets say the patient had very mild hypertension and was diabetic. The VA wanted you to start with HCTZ first, no matter what. And it was put as a negative mark for every patient for each MD who didn't follow that.

    Not chlorthalidone, HCTZ.

    The "rant" was , you are talking to someone who is boarded in Hypertension
    Its great you practice evidence based medicine. And I am glad you have not had the experience of a non MD somewhere in Washington suggesting a therapy that is detrimental.

    As far as Screening colonoscopy the VA pushed guiac cards and still do.
    Do not think for a second some government body will try to rationalize not doing them. It happens in Canada.

    The "owned comment was just immature"



    And yet you still practise in academic medicine with a VA appointment, no? Change it from within. When the new guidelines come out, I'm sure chlorthalidone will be put in place instead of HCTZ.

    As I understand it, in CPRS there is a place to put down a reason why you didn't choose a first-line medicine to start with. I used to clear quite a number of them as a fellow when renal input was necessary to get an ARB or carvedilol.

    And it's not just guaiac cards, it's them + sigmoidoscopy which is equivalent to colonoscopy for screening. Cheaper and AFAIK statistically equivalent in picking up colon cancer.
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    Jun 13, 2012 11:11 PM GMT
    musclmed said

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


    Interesting.. The VA "didnt care" huh? Please show us the text where that is stated.

    musclmed said

    Ok lets say the patient had very mild hypertension and was diabetic. The VA wanted you to start with HCTZ first, no matter what. And it was put as a negative mark for every patient for each MD who didn't follow that.

    Not chlorthalidone, HCTZ.


    I'm going to put in my 2 cents as a long term VA patient. Your statement is FALSE. Sorry, but I'm walking proof.icon_wink.gif
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    Jun 14, 2012 4:51 PM GMT
    Given the other threads about the difficulties in the job market for new college graduates and how some RJ members are having a rough time, I think this thread needs more exposure.
  • GQjock

    Posts: 11649

    Jun 14, 2012 4:58 PM GMT
    Yeah Like exposure on how the republican party wants to double the interest rates on college loans?
    Or how about exposure on how Romney himself stated when a student needs cash for school they should say ....Start a business or ask Mom and dad for money

    LOL ........ This thread is a JOKE

    Young people are democrats FOR A REASON
    and that reason is self interest
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    Jun 14, 2012 5:08 PM GMT
    GQjock saidYeah Like exposure on how the republican party wants to double the interest rates on college loans?
    Or how about exposure on how Romney himself stated when a student needs cash for school they should say ....Start a business or ask Mom and dad for money

    LOL ........ This thread is a JOKE

    Young people are democrats FOR A REASON
    and that reason is self interest


    Really? so how the fuck is what you spewed out of your mind helping young graduates NOW?? Nothing was said about Romney or the future. What is in a vote for O-blame-a?? HMMM? Hmmm?
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    Jun 14, 2012 7:10 PM GMT
    If you hear the liberal lie that the Republicans are not in favor of keeping student loans low, read this for the facts.
    http://online.wsj.com/article/SB10001424052702303665904577452483587070336.html?KEYWORDS=student+loans

    The Politics of Student Loans By ALLYSIA FINLEY, June 12, 2012

    While visiting the University of Nevada, Las Vegas, last week, President Obama warned that student loan interest rates could double next month if Congress doesn't act fast. There he goes again.

    In 2007 Congress reduced interest rates on subsidized Stafford loans to 3.4% from 6.8%. The lower rates, which were phased in over five years, expire at the end of this month. Mr. Obama wants to extend the below-market rates at an annual cost of $6 billion to taxpayers. Since Republicans don't want to alienate young voters, they've agreed to extend the rates temporarily in return for spending offsets.

    The president, however, has rejected all of the GOP's proposed offsets even though he's suggested many of them in the past. Democrats would rather continue whacking Republicans over the issue until November. So a-whacking they go.

    If the president is intent on blowing up the issue, Republicans would do well to point out that the primary beneficiaries of an extension would be this year's college freshmen and high school seniors—who will be voting in their first presidential election this fall—not those who have already graduated and can't find jobs. In fact, those who graduated in 2009 and 2010 (and borrowed before the ultra-low rates took effect) are paying an average rate of about six percent. So much for "fairness."

    Perhaps the president expects the job market to worsen in the years ahead and wants to cushion the blow for future grads. More likely, he believes that bludgeoning Republicans on an issue that's near and dear to students' pocketbooks will help drive young people to the polls this November. While Republicans understandably don't want to give Democrats any ammo during an election year, there's never a politically opportune time to cut subsidies or entitlements.

    And if Republicans are afraid of addressing a relatively small entitlement like student loans, will they ever muster the courage to tackle Social Security and Medicare, which would pit them against more significant constituency groups?

    http://blogs.wsj.com/washwire/2012/06/08/glimmer-of-hope-for-student-loan-compromise/

    By Janet Hook, June 8, 2012,

    Even as Congress is mired in stalemate on issues from taxes to highway funding, Democrats and Republicans in Congress are quietly edging closer to a compromise on legislation to block an increase in student loan rates.

    Republicans in the Senate are encouraged by a new proposal from Senate Majority Leader Harry Reid (D., Nev.) for covering the cost of the student loan bill – an alternative to an earlier Democratic tax increase that the GOP had rejected out of hand.

    Rep. George Miller (D., Calif.), ranking Democrat on the House Committee on Education and the Workforce, said Friday that he considered the Reid proposal a “serious” effort at compromise that made it more likely the stalemate would be broken before July 1, when student-loan interest rates are scheduled to double to 6.8% if Congress does not act.

    Republicans were low key in their response to the proposal , unveiled by Mr. Reid Thursday, but in the current partisan climate on Capitol Hill the absence of rancor was seen as an encouraging sign of growing trust between the parties.

    At issue is legislation that extends for one year the current 3.4% interest rate on federal student loans. President Barack Obama has campaigned hard for the extension, making it a cornerstone of his appeal to young voters in his reelection bid. GOP presidential candidate Mitt Romney and Republican leaders in Congress have agreed to freeze the loan rate, but the bill to do so has stalled for weeks because the two parties have disagreed over how to cover the $5.9 billion cost of the bill. Republicans proposed to cut spending from part of Mr. Obama’s signature health care law; Democrats proposed closing a loophole that allowed some wealthy individuals to escape paying Medicare and Social Security taxes.

    Republicans offered alternative financing proposals last week in a letter to Mr. Obama, but received no response from the White House or congressional Democrats – until Thursday when Mr. Reid countered with his alternative offset proposal. He dropped the tax-loophole-closer and instead proposed raising the premiums employers pay for insurance provided by the Pension Benefit Guarantee Corp. Mr. Reid also would ease pension-funding requirements for companies, which would raise revenues because companies would then take fewer tax breaks for pension contributions.

    Don Stewart, a spokesman for Senate Minority Leader Mitch McConnell (R., Ky.), would say only that Republicans would review the proposals, but added, “Now that Democrats are willing to take this issue seriously, and not just use students as props, we may be making progress.”

    Said Rep. John Kline (R.,Minn.), chairman of the House Committee on Education and the Workforce, “I am encouraged by Senator Reid’s willingness to offer a new proposal to pay for an extension of the lower rate and look forward to considering it when it has been approved by the Senate.”
  • GQjock

    Posts: 11649

    Jun 14, 2012 7:14 PM GMT
    jock_1 said
    GQjock saidYeah Like exposure on how the republican party wants to double the interest rates on college loans?
    Or how about exposure on how Romney himself stated when a student needs cash for school they should say ....Start a business or ask Mom and dad for money

    LOL ........ This thread is a JOKE

    Young people are democrats FOR A REASON
    and that reason is self interest


    Really? so how the fuck is what you spewed out of your mind helping young graduates NOW?? Nothing was said about Romney or the future. What is in a vote for O-blame-a?? HMMM? Hmmm?


    Hmm? HMMM? LOL ....
    How "The Fuck" does giving incentive to companies to ship jobs over seas
    Stifling Science in the name of religion
    and causing an economic situation round the world that creates a bubble prone boom and bust cycle?
    Now.... if you wanna talk REALITY
    and I know that's hard for you
    there needs to be a jobs bill that Goes thru that Lil ole republican congress that doesn't get lost in committee or get blocked by a Lone wolf republican senator and doesn't get filibustered by the Party of NO

    UNTIL then any young man or woman would be bat shit crazy if they voted republican
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    Jun 14, 2012 7:39 PM GMT
    ummm, cuz he's not Romney?

    think both of them r losers. OUR gr8 nation deserves better candidates. js
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    Jun 15, 2012 2:40 PM GMT
    Voting for Obama is a vote for not going back to the Bush policies which is exactly what is promised by all accounting of Romney's rhetoric, stated policies and etc. No credible authority on economics can place the blame for the start of our current economic problems on anyone but Bush era policies and war expenses.
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    Jun 19, 2012 11:28 PM GMT
    the country had jobs with the Bush economy. This guy O-blame-a is clueless.