September 10, 2009, 1:45PM
What is irony?
More than half of fighting Joe Wilson's 2nd district in South Carolina abuts the great state of Georgia - these being Barnwell, Allendale, Hampton, Jasper, and Beaufort counties. The frequently uncompensated immigrant healthcare he was protesting about usually lands on the doorsteps of Chatham county, Savannah's
Memorial Health Medical Center. This is the geographic tertiary referral center for the region. The rest goes to Medical College of Georgia in Augusta.
The rep for GA's 1st district R-Jack Kingston and 12th D-John Barrow should pipe up and inform Joe to shut the F#@Kup and take a vacation to reality camp. I'm just saying.
August 14, 2009, 9:36AM
Pardon your protest but you're an idiot.
Yes, I don't like the government running things either. I also hate rations of any sort. Yes, you're grandma is very nice and don't need killin. No I'm not sure you know what socialized anything means or the difference between democratic and republican forms of government. No you're wrong I also like to keep as much of my money as possible. I also don't like taxes. No, I really don't care what you do with your family's uterus.
I suppose your points may be valid in some other context but my friend, you are completely missing the point. You may not have to worry about healthcare soon because there will be no insurance you or your employer can afford. Do you realize that self pay health insurance premiums have risen
over 90% in a generation. Has your salary adjusted up too? Didn't think so. Have you noticed that the problem seems to be
getting worse everywhere.MichiganNevadaFloridaMaineAlaska, Arizona, Arkansas, California, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina and Texas
This looks pretty damn systemic to me. Seems like something individual states cannot solve. Yup, I would almost think that what you need here are broad, sweeping guidelines across state borders to control this insurance tailspin. This even kinda sounds like something that might be suited for the Federal Guvmint to deal with, at least the constitution seems to says so.
You see, your points don't really matter unless you can actually get healthcare. So first things first. Instead of endlessly going on about patriotic fantasies, please solve this REAL problem first. Then we'll be happy to talk about how you would like to meet your maker.
August 11, 2009, 6:20PM
The two great problems facing healthcare in our country are spiraling costs and impeded access. I will admit that my point of view is biased as a specialized physician and as such I do not claim to have a complete perspective on this complicated problem. However, I have made a few observations about the healthcare foodchain or web - whatever descriptor you may prefer.
People want standardized health care access and they don't want to go broke in the process. Insurance companies want to profit by the most efficient means possible and actual patient outcomes are secondary to maximizing the bottom line. Hospitals want to get paid and maximize their reimbursement from insurance companies first and then stick it to the patients for the difference in what the insurance does not cover (not for profit and profit based). The best way for them to do this is to have good outcomes, great patient service, and the latest in technology/services. The latter clearly costs money. Doctor's want to make their patients better and maximize their service fee reimbursement from insurance companies. This physician/surgeon fee is usually a fraction of the total bill for a hospital admission - even with complicated high risk surgery. Further, I can honestly admit that from my perspective these are mutually exclusive, although this is not the case for other Docs. I was formerly in private practice and now I am in academia. I can only speak from my situation but I do appreciate the costs associated with maintaining a practice.
This is clearly a simplistic generalization of the primary factors motivating the key players involved in healthcare. I make it anyway to drawout the simple underlying point that the root problem in this debate is money. Who has it or not, who keeps it, who gets it and who decides where it goes.
There are many things in medicine that are inexact, hence part art and part science. Deciding which treatments are best, what paradigms are no longer beneficial, whether its worthwhile to put grandma through a high risk procedure with potential limited benefit - these are all part of the evolution of the craft and no business plan or government policy will ever sort out the definitive right answer. These issues will never be solved in a townhall debate or on an evening primetime conference. They will always remain a "local" matter between physician and patients, medical societies, and hospital ethics boards. To use these topics as catalyst points for discussion in a public format is disingenuous and only obfuscates the matter.
The PR firms representing the moneyed interests understand this clearly, hence the scare tactics by solicitation of those least informed of us or those perversely politically motivated to harass our representatives in town forums as of late. This is an eleventh hour astroturf measure by the statusquo and it must not succeed.
So to be clear, healthcare - medicine always seeks to reform itself by its very nature. What we seek here is healthcare - money reform, which is primarily controlled by insurance companies. The ultimate purpose of health insurance should be to absorb the costs of these services while pooling the risks of cost for an individual needing catastrophic services. Instead they have mutated into a ponzi scheme of profit making by convenient and systematic denial of payment for services, essentially an open hand on one and a fist on the other. They have overstepped their bounds from what I described and have become gatekeepers/regulators with a misplaced motive of profiteering. Society has suffered the consequences - mass uninsured or underinsured, hospital costs offset to other patients, feedback cycle causing higher premiums, denial of coverage for pre-existing or post-treatment diagnosis, endless administrative paperwork and on and on. Reform of insurance companies would begin to alleviate the access problem and is the first essential step to unravelling labyrinth of healthcare woes.
The other major problem of spiraling costs must also be leveled. The most direct way of accomplishing this task is to set standardized fee schedules for services and placing consumer protection measures. Some of this is being done already via medicare. Unfortunately these measures will not be effective until the parasite that is the health insurance industry is dealt with directly. Obama understands this as evidenced by the change in tone as of late in referring to healthcare reform as "health insurance reform." We must remained focused on accomplishing this task first as this is the true root of the problem. Other measures will be necessary but nothing else will work without this first.
June 13, 2009, 6:42PM
I came across this letter purportedly from opposition
candidate Mousavi to the people of Iran. The media seem to not have taken notice of it in the post election fog. Reports of his house arrest and the virtual national information lockdown seem to be making it difficult to confirm any of this information.
It should be interesting how this evolving situation plays out in the media tomorrow when Bibi makes his highly anticipated speech.
If TPM readers have any better links please post as appropriate.