CNN Dem Debates

[escarzamd]

And to counter the doubts about the quality of care you receive in the ER, consider this. Emergenct Medicine is a red-hot choice for residency and is more competetive than Gen Surgery, OB/Gyn, and every other specialty save CT surg, Neurosurg, and Ortho.

You can guarantee that a board-certified, EM trained physician was in the top quartile of his class at the worst. You can also guarantee that he went thru an old-school, merit-based style training regimen of 100 hr work weeks and intensive academic programming. My class would scoff at regulation of resident hours. You just can't be ready to do the job on 60hrs/wk of training and academics. The book stuff is easy, but you cannot replace the experience of patient encounter after patient encounter; most problems that kill are not that common, and w/o the volume, you may never see them in real-time practice. The trick, in some cases, is to see so many "normal" patients, that when someone shows up looking different, the light-bulb goes off.

We're not monkeys. The weak ones get weeded out damn quick, and the ones that survive are typically part of a small, incestuous, regional group of people where everyone knows everyone, and if you sneak thru residency as a sub-par doc, you will be found out soon enough if you're not getting it done appropriately on the wire w/o a net.

 

[Chadman]

escarzamd: I gather you are a doctor. Question for you...what is the logic behind having health care professionals work such long hours/shifts? Is it a man/womanpower issue? Is it to give you more time off in some way?I guess I've never understood the logic in having a doctor or nurse work long hours when they have such an important role to play in saving lives? Naive question, I'm sure, but I honestly have never heard why it works the way it does.

Would love to hear your take on this...thanks a lot.

 

[escarzamd]

I was speaking of residency in the last post. Training physicians are not the last last line of defense. They are supervised by attendings, who bear ultimate responsibility.

The logic is that the more you see while training, the better off you will be when you graduate. Partially an ego thing, partially done for practical purposes.

I now work 14-15 10hr shifts/month. Much better mentally. Tough to keep your brain on much longer.

Nurses typically work 3 12hr shifts/wk full-time. There just are not enough of them to keep up w/the workload at times.

Under the gun here. glad to get into it more later.

 

[djv]

Strange then why we here the stories of ambulances sent down the street to the county hospital. No need to try and drop off at a private one. No one is denied but some place are just so busy.

 

[StevieD]

Fresh out of school my daughter works making $10 an hour. The medical insurance her company offers cost her $50 a week.

People without insurance tend not to go to a doctor until they are too sick and end up in Emergecy. Emergency also full of kids with colds and the flu. This is all costing us a lot of money.

Health Care in this country is a disgrace. The Republicans had 4 6 years to do anything they wanted to it and they did nothing except make it worse.

Another disgrace.

 

[AR182]

Fresh out of school my daughter works making $10 an hour. The medical insurance her company offers cost her $50 a week.

People without insurance tend not to go to a doctor until they are too sick and end up in Emergecy. Emergency also full of kids with colds and the flu. This is all costing us a lot of money.

Health Care in this country is a disgrace. The Republicans had 4 6 years to do anything they wanted to it and they did nothing except make it worse.

Another disgrace.

what do you propose ?

 

[escarzamd]

Bounce this one around.......

The current care delivery model is centered around acute care: stabilization, diagnosis, treatment, and recovery in a perfect world.
80% of our health-care costs center around the care of chronic health problems....... multiple hospitalizations, costly procedures, ever more expensive pharmaceuticals to name just the top 3 reasons. People are living longer, and now health-care cost and delivery is a victim of its own success, in a way.

My thought is to raise the retirement age and age where Medicare A kicks in. Currently at 65 for both, SS is tentativelt scheduled to raise the age to 67 and then 70 by 2050. Medicare should be concomitantly raised as well. The trade off is the "young elderly" gap from 60ish to the age where Medicare/SS take over.

The rub is that over the last 20yrs, the percent of these near retirement individuals w/o coverage has hovered steadily around 12-14%, and this will rise soon. If the age is raised, covering this gap becomes difficult. Most will just have to work longer to keep covered and to insure that they continue to pay into the system. Those not covered will allegedly be offered a way to buy the coverage at a cost.....and not a small one (say $300/mo) and this still won't make this a zero-sum change. Costs will still rise faster than payments (most likely) and the indigent will have to either be paid for outright thru higher premiums to those that can afford this ticket, or by expanding state MedicAid coverage.

I know its not appealing to people that they will have to work into the sunset years, but its a necessary evil.......the trade-off for the advances in medicine in the 20th Century. This idea might work, if it wasn't such a piece of political plutonium in Florida specifically. has to be done , imo. We have limited resources to shuffle around between benefits and health care coverage for the elderly. These programs were designed to cover only the indigent and disabled, and have morphed into coverage for everyone, ostensibly a subsidy for earlier and longer retirements. We just cannot afford the cost of the system as it is right now. Benefits will have to frozen or even cut, and premiums will likely have to rise if we stay the course, because the boomers (and maybe the illegals) are coming.

Just some talking points, here. Solution is multi-factorial, of course, but it breaks down to 3 main things: access to, quality of, and cost of care. This idea addresses none of those things, so its basically duct-tape, but its a place to start from.

Ultimately, a market-driven model will be the early move, but a great deal of the onus for how the dollars will be spent will depend on informed decisions by the patient. You have a finite amount to spend on you and your family, but you have to take some responsibilty for how thats spent. You can choose where and from whom you get care. Hopefully that improves quality as the competition for patients heats up, but you can't just have every test under the sun. You get informed of the reasons and make your own decision. Here's the cost, but here's what we may be missing and the attendant morbidity related to this potential diagnosis. Now you choose, do I need this test??More power to the consumer = more responsibilty taken on by the consumer. Scary, but that's how it will have to go. Fundamentally changes the doctor-patient relationship. Lots of people in my business hate this idea because we assume patients are stupid and can't be trusted to make an informed decision. It also would require all of us (health pros) to be more savvy regarding individual patients specific coverage so that we can help them navigate the minefield and spend their finite dollars efficiently. Liability will creep in here, and that needs to be addressed before a system where the patient and doctor partner up to make the decisions can start rolling.

That's where I see it going, though. If a system like that fails, the next step is socialized medicine, which nobody will like. Reminds me of an old saying in the business.......no idea who gets the credit ............."If you think health care is expensive now, wait 'til its free."

Like to hear some thoughts on the new #2 hot-button political issue this coming election cycle. Have a day.....D:SIB C

 

[smurphy]

I think one easy step would be to allow competition in the pharmaceutical industry. It's quite the double standard the way the GOP says they are for free market, but protect the drug companies - allowing them to overcharge exponentially. Let other companies compete and import the exact same meds and the consumer will benefit greatly. It would save healthcare costs across the board. this can be achieved with a stroke of a pen.

 

[escarzamd]

I like it. We don't get any good perks from the companies anymore anyway!!! JK

 

[escarzamd]

Quick aside t letting market efficiency dictate drug prices.......I have to look it up, but I heard some rumblings about the FDA requiring more stringent (and therefore requiring more time) human trials prior to approval.

Two thoughts.......1) Drugs get more expensive initially, because of less exclusive time under the patent, but get to generic status quicker, hopefully lowering the cost to the patient.........2) Fewer and fewer companies can remain solvent and adsorb the cost of the research, which can lead to a monopolization of the biz, and possibly less and less in the way of evolution of the science.

I have to check out if this is really going to happen.

 

[djv]

It's already been shown by Steve Forbes how easy it is to fix S/S. First no early retirement to age 65. If taken then you get only 68% of full amount. New 100% pay age goes from 67 to 68 years old.
Lift tax rate from $97.000 to $115.000.
Al this other jumping around and 1000 word programs are not needed. Above makes it a go for over 85 years.
Remember S/S first put in when life span average was like 63/65. It's now 74 for men and 78 for woman.

 

[DOGS THAT BARK]

Fresh out of school my daughter works making $10 an hour. The medical insurance her company offers cost her $50 a week.

People without insurance tend not to go to a doctor until they are too sick and end up in Emergecy. Emergency also full of kids with colds and the flu. This is all costing us a lot of money.

Health Care in this country is a disgrace. The Republicans had 4 6 years to do anything they wanted to it and they did nothing except make it worse.

Another disgrace.

Hate to tell you Stevie but your paying the price for your conviction's.

Just checked price of top of line plan for female age 24 in Ky including Dr co-pays and ** card and entire premium is $119.89 a month.

You want to live in liberal aids friendly state--pay the price and quit whining

P.S. Appears Mass and San Fran have similiar complaiants--who would have ever imagined--
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/04/27/BUGP8IFROR1.DTL

 

[djv]

I believe you just said doc co pay is yours.$20 per visit. And that $119.00 plan has 1000 deductible or is it 1500. But you note Steve said her company is charging $$$. So maybe some one is sticking it in pocket and it don't need to be.
One state to another on health care should not be that far a part. Or a heavy tobacco states like Kentucky.Tenn.Virgina would be out of site.

 

[The Sponge]

http://www.youtube.com/watch?v=Icor2ILQtLw&mode=related&search=

 

[DOGS THAT BARK]

$500 Ded
$25 Dr co-pay
Drugs Generic $15 co-pay Name Brand $30
Cal year out of pocket max $2,500 including ded
lifetime max $5,000,000
age 24 female nonsmoker $119.89

Wonder what the average cost of cable or cell phone bills are in U.S.

 

[THE KOD]

I watched a repeat of the Democratic debates and thought that Obama stood up uncomfortably talking for a long time and making almost no sense whatsoever. He sure looked like he was sweating making a mistake.

And what was that green thing around Hillarys neck ?

Hillary has all the right answers. She is scary

 

[djv]

Scott I think you may have seen a get together of just three. Ed,O, and Hill. Some questions only about faith were asked. If that was it. Yes O talked to much.
DTB. I think a 24year old gal should be able to get 119 a month insurance. But if in any year she get hits with all those extras. Well then all can add up to over 300 a month. And every year she grows older that 119 is going up.
There is no cheep insurance. I agree every thing goes up. It should stay close to inflation. Most these jumps last 8 years are at rates of over 7/8% a year.

 

[djv]

I see they have another case in L A where they let a woman bleed to death in emergence waiting room. In fact people trying to help her called 911 to see if they would come and take her to different hospital.