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Post by doctork on Jul 24, 2009 8:45:17 GMT -5
Of course you're right, BB. Most other industrialized nations have access for all, high quality health care and cost control. At some point, the American prototype of the "rugged individualist" who is self-responsible will merge with the evident need for all citizens to have access to reasonable cost healthcare.
It's been accepted for the over-65 Medicare population (despite the "government boogeyman" threat), and now that it is affecting middle class and affluent, maybe we will see Congressional action for the rest of us.
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Post by BoatBabe on Jul 24, 2009 22:54:33 GMT -5
Thanks, Doc. I always appreciate your insight and know that you are clever enought to recognize a conversation of the topic instead of seeing a personal slight.
It will be interesting to see how this plays out this time.
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Post by BoatBabe on Jul 27, 2009 20:59:20 GMT -5
Tonight we see by the news that the killer of the young man who worked the night shift at the gas station/food mart here in Ballard, has been caught. So, may I pass this on to robbers: Just take the money and leave. After you have the money, what point is there to beat up and then kill the victim? Look better on your resume? I'm sure every robber out there reading this will change their M.O.
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Post by doctork on Aug 2, 2009 21:00:54 GMT -5
Those all night jobs in convenience store are very dangerous for just the type of thing you cite. What a tragedy.
I've been struck by all the continuing coverage of the Harvard professor Henry Gates and the police officer. It seems to me pretty obvious that it was a race/class profiling thing with both men failing to keep cooler heads.
But not many commentators have mentioned what concerns me most: once Mr. Gates was in his own home and had proven his identity, what gives the cop the right to demand Gates to come out of his house? Isn't it the fourth amendment that makes us secure in our own homes? And while Gates would have been wise to be polite, it is not against the law to be rude to a police officer (free speech, 1st amendment), or to refuse to answer questions (fifth amendment). A little more attention to the Constitution please!
PS - I'm inclined to believe profiling was a motivator based on my own experiences as a female physician, since when I began in medicine, we were only about 10 - 12% of doctors, similar to the percentage of African-Americans in the population at the time. Thousands of times in the hospital, or in a social setting where I was introduced as "doctor," many people still assumed I must be a nurse since I am female. "Pattern recognition" prevails, but not always to our benefit. And for all the assumptions that I had to be a nurse, most people still thought that was a good thing and didn't hold "being a nurse" against me; those who profile based on race usually have a presumption about criminal activity or other negatives motivating them.
And I have quit wearing my Afghan shalwar chameez attire on the airplane, even though it's attractive and very comfortable. Even being obviously WASP-y, if I wear clothes that look "A-rab," I must be one of them terrr-wrists, right. The third degree every flight (20 minute search of carry-on and laptop, very intimate pat-downs) got old in a hurry. And I have a US passport for ID, whitebread white skin, and speak English like the local that I am. Imagine if I didn't...
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Post by sailor on Aug 2, 2009 21:33:56 GMT -5
What amazes me most about Gates-gate is that President Obama was naive enough to speak off the cuff and then have the whole thing blow-up into the media frenzy it became. Then he tries to defuse it with the folksy beer at the white house get-together and that didn't really pan out per plan either. The fact that I'm even commenting on this proves that this has gotten totally out of hand.
My opinion: Gates screwed up, the Cop screwed up, the President screwed up, and, I don't think this is a racial issue, I think it's a dumb ass issue. However, I see that Gates is thankful to the neighbor that called in the perceived break-in; he sent her flowers and a thank you note.
Moral of the story; just because you make a stupid mistake there's no reason why you should forget your manners.
Yes, I know, as a moral to a story its pretty lame.
Mike
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Tom
Bashful Member
Posts: 4
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Post by Tom on Aug 3, 2009 7:35:51 GMT -5
Seems like a worthy moral to me. Good manners are important.
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Post by BoatBabe on Aug 3, 2009 9:34:50 GMT -5
Welcome, Tom. Yes, there is something to be said for remaining civil.
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Post by doctork on Aug 3, 2009 11:06:32 GMT -5
I regularly lament the death of civility. It seems to be a long-lost practice.
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Post by sailor on Aug 3, 2009 17:19:12 GMT -5
I love good manners, it's what is supposed to be what separates us from the animals. I'm not to sure about that now; I've seen many well behaved animals and to few well behaved humans.
I remember a quote I read in some military leadership book that went something like this: When killing your fellow man, it doesn't cost a penny more to be polite about it.
And, on an unrelated note... my currant favorite quote (that I have on my desk at work) is:
Success is the ability to go from one failure to another with no loss of enthusiasm. -- Sir Winston Churchill
All the best, Mike
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Post by BoatBabe on Aug 3, 2009 20:45:52 GMT -5
Great quote, Mike. I may have to steal that. Wait! May I please steal that?
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Post by gailkate on Aug 10, 2009 14:04:09 GMT -5
There wasan excellent story this am on Canada's healthcare system. It debunks most of the scare stories being spread around some of our rightwing media - but it also truthfully covers where some of those stories came from. It seems to me that if we get the plan that is most likely here, we'll have the best of the Canadian system with some extras. At this point, they canNOT buy private insurance except for dental and outpatient drugs. (I'm not sure what that means - weren't people here going up there for cheaper drugs?) Read or listen here: www.npr.org/templates/story/story.php?storyId=111721651&ft=1&f=3
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Post by doctork on Aug 10, 2009 15:29:05 GMT -5
Since the citations are mostly from British Columbia, 20 miles over the border from my old house and where my son got care when he was at UBC, I have to say that this seems to be an accurate and fair portrayal of Health Canada. I've heard rumblings that other provinces have more trouble than BC, but overall, I think Canadians get what they need, when they need it, with only rare serious delays, which are minimal in comparison the the 20,000 - 44,000 who die each year in the US due to lack of insurance (non-partisan Institute of Medicine report). I believe there was a Canadian Supreme Court case having to do with the right to buy private health insurance a couple years ago, but it may have pertained only to Ontario.
It's true pharmaceuticals aren't covered, but they are much cheaper in Canada to begin with, and the really pricey ones (injectables for auto-immune diseases and HIV and cancer drugs) seem to be covered separately. Or maybe they have a cap on total out-of-pocket costs - or maybe that is Australia, can't remember.
I don't think we'll be getting anything near as generous as the Canadian system under whatever comes through legislation this year (if it does). Too many disparate parts and powerful constituencies (financial, insurance, pharma) for 100% overhaul.
But there are currently at least 5 different plans on the table in DC and nothing final, so who knows. I think the NPR remark about "social insurance" (large risk pool as in US Medicare or the Federal Employees Health benefit Plan) vs "socialized medicine" is accurate. Canadian healthcare is delivered privately, though there is a public budget set by each province. Government there does not employ doctors, and I do not see that in the US future either, except for the physicians already employed by the military (where there is true socialized medicine since DoD owns the docs, the facilities and the patients) or the VA.
The scare stories are really reprehensible - "killing grandmas" and all the rest. It's just silly lies. I often saw vacationing Canadian patients at the walk-in clinic where I worked. They all bought traveler's health insurance policies for the vacation in the US, even though it was just 20 - 50 miles from home, as they'd heard about the $5,000 ER visit for a simple broken arm.
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Post by gailkate on Aug 11, 2009 9:35:34 GMT -5
We're so lucky having our own doc to help us through the maze! I realize I sounded overly optimistic, as it looks to me as if the scaremongers are determined to kill any plan, simply to block Obama. We all suffer for it.
Terrorizing older people with threats of "Soylent Green" is to my mind criminal. Literally, I wish those liars could be prosecuted. I've said that I think people who are afraid to die should take out extra insurance to cover extraordinay measures. I stand by that, but the real costs from end of life care come mostly from people who don't understand what really happens. Once you've watched a beloved parent hang on for days, even weeks, suspended between life and death by a breathing machine and feeding tubes, you know that's not healthcare. It's cruel to everyone concerned. Docs must have to just steel themselves as they make their perfunctory rounds. It reminds me of that horrible movie Coma, when bodies were deliberately kept "alive" till their organs could be sold to the highest bidder.
Most people want to die peacefully and not to subject their loved ones to a long agonizing vigil. They have the right to plan with their doctor what kind of care they choose and then be certain that their wishes will be followed.
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Post by doctork on Aug 11, 2009 10:00:12 GMT -5
My concern is that the to-do about false controversy (don't worry, there will be no soylent green or death panels) takes away from dealing with the real concerns - how do we handle the immediate cost increases (even if there are long-term savings) and do we really need a public plan, and if so, to what purpose? Massachusetts has done their universal coverage/healthcare reform mainly with private companies, and building on the current employer-based system. That system is reasonably efficient, just too costly and it misses a lot of people.
Most other industrialized nations (Japan, Taiwan, Switzerland, Germany, France) have private coverage available for all at much lower cost, with much better results. A single payer public system like UK and Canada is not required. Of note - Germany's 240 private insurers are all non-profit. Some US non-profits like Kaiser and Group Health Cooperative of Puget Sound also have high-quality at lower cost, though they too have difficulty controlling costs in our current environment.
And even the end-of-life care issue - most people want to die peacefully with family around, not alone in the ICU in pain tethered to machines. For those that do want to "try everything," we could easily afford that if we quit doing and paying for the unnecessary and unwanted things.
I think the public discussion this month is very useful, though I don't care for organized disruption by certain groups whose main goal is for Obama to fail, never mind the plight of the uninsured, the unsustainable spiraling costs, and all the needless morbidity and mortality.
I'm sure there are solutions, if we can lay aside the high-pitched political rhetoric.
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Post by gailkate on Aug 11, 2009 17:54:29 GMT -5
//For those that do want to "try everything," we could easily afford that if we quit doing and paying for the unnecessary and unwanted things.// Agreed, but then I think those who want to fly to Switzerland for assisted suicide should also be covered by taxpayer funds. So, whatever your decision, your death is your preference, not the state's or some religion's or some insurance company's. When pigs fly...
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Post by doctork on Aug 12, 2009 9:28:36 GMT -5
I think there is a difference between trying a proven course of treatment in the US, even if it has a low (but not zero) chance of cure, and flying to another country for a procedure that is not medically necessary (medical necessity = treatments of illness, injury or disease, or results thereof). Even in the US where physician-assisted suicide is legal (WA and OR), it is not covered by insurance.
I haven't observed the attitude of "I'll try anything that might help" to be correlated with a religion, or state or insurance preference (except when it is experimental, then most insurers don't pay). The motivation is usually that the patient is willing to endure painful treatments that probably won't help in order to possibly gain more time with their family (or maybe help future patients through research). I have no argument with that, as long as they are well-informed that cure/prolonged survival is possible but is unlikely. That is how we find better therapy and, ultimately, cures.
And the practicalities: there are residency requirements for PAS; I would like to see healthcare reform happen, and adding fuel to the fire of "death panels" and other fabrications does not help the cause.
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Post by doctork on Aug 12, 2009 9:58:37 GMT -5
On last night's news, I noted the passing of Eunice Kennedy Shriver - she certainly did a lot in her 88 years, and left a great legacy in Special Olympics. Does anyone else remember when Down Syndrome kids were either put in institutions shortly after birth, or hidden inside at home? Either way, they didn't live long.
Then there were the clips of Hilary Clinton grousing at that poor student who asked a question that was subject to mistranslation. I know she was jet-lagged, but I thought she was rude. Obviously the question struck a nerve. I'd refer her to our "civility" comments if I thought she would read them. She is a diplomat - it's her job to be diplomatic, even/especially under difficult circumstances. But the 24/7 coverage of the slip was still over the top.
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Post by gailkate on Aug 12, 2009 14:31:54 GMT -5
I think we're talking about 2 different situations, K.
Yes, Hil looked like a witch, and yes it's been replayed ad nauseum.
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Post by doctork on Aug 12, 2009 17:19:45 GMT -5
I think we're talking about 2 different situations, K. So do you mean that the feeling-guilty relatives are at the bedside demanding "everything be done" and they won't let grandma die in peace? That is often a problem, because the "living will" seems never to be on hand when the decision is made to put the patient on a ventilator. Then it is always harder to take the patient off than to not put them on in the first place. The relatives never want to "do everything" if the patient is uninsured, and the bills will be paid from their inheritance... A study I read a while back showed that of patients who have living wills objecting to extreme treatments usually get the treatments anyway. Or are you referring to overly aggressive doctors who push patients to try everything, when maybe it is not really in their best interest, because the hope is so slim, and the treatment so unpleasant? ( the old joke "Why do they nail coffins shut at funerals?" "To keep the oncologists out" comes to mind.) Or something else? I haven't found that many patients who wish to persist in painful, likely futile treatments when they are told how grim the survival is. And if they do persist, it is usually the younger ones (20 and 30-somethings) who wish to make every possible effort to see their kids grow up. That ups the ante quite a bit compared to the way-over-65 crowd. And then you take the active and alert 82 year old beloved great grandpa, never sick a day in his life, who was still farming a month ago and now is found to have advanced cancer. Prognosis is not good, but one aggressive (but not too) round to try and get another pretty good 3 - 6 months instead of just 3 -4 miserable weeks seems reasonable to me. That by the way is a real patient I saw last week. Global waste and reason is easy to see - it's the individual people/patients that are tough. It is the responsibility of a good family doc (or internist or whatever PCP) to step up to the plate and suggest when enough is enough, but you have to know the patient and family well to do that.
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Post by sailor on Aug 12, 2009 17:56:51 GMT -5
The old health care system, the potential new health care system, it’s all so complicated to me.
Taxes are also complicated, and at one time in history there was a great push for a flat tax system. Of course that never went anywhere.
Why can’t we have a simple flat health care system? You get sick, you go to the hospital, and they fix you. You’re done.
I know, I’m a dreamer.
Mike
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Post by doctork on Aug 13, 2009 7:16:53 GMT -5
No dreaming, Mike. That's how every other developed nation does it. Makes sense, huh?
I'd rather have a simple tax system too, but I guess it's the same - too many special interests to make it simple.
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Post by doctork on Aug 13, 2009 15:21:55 GMT -5
This is from a CNN story on new regulations requiring airlines to obtain more information from passengers.
” U.S. airlines on Saturday will begin asking travelers to provide their birth date and sex for the first time under a new aviation security requirement, federal officials said Wednesday.”
Here's a Wonkette response:
"Well, I draw the line at providing the airlines with sex…even it it IS their first time."
I'm with Wonkette; I will not provide airlines, much less TSA employees or that former governor at DHS, with sex. Isn't it bad enough we have to take off our shoes, shrink our toiletries and go through the Virtual Strip Search?
Supposedly this is to enable more accurate matching of would-be passengers with names on the terrorist list. It took DHS many months to realize that Senator Ted Kennedy is not a terrorist, and could be allowed on an airplane. If they have this list of terrorists, why not send the FBI to arrest them, and let the rest of us travel in peace?
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Post by gailkate on Aug 13, 2009 23:33:20 GMT -5
LOL, the wonkette scores! Even if they think they're being hoodwinked by cross-dressing terrorists, what good does it do to ask? "Hey, lady, are you really a man?" And what would they do, ask everybody to go through the virtual strip machine? I suppose with babies they could insist on a diaper check - "Yup, this here Billy is a boy." The more I think about this, the more ludicrous it gets. Say they have a E.M. Kennedy on their list and Ted comes by. How would it help to ask his gender? Like, duh. And if his birthday is different from the E.M. on their list, wouldn't they already know that, since they require a driver license? Or maybe they think the license might be forged but the person they're questioning wouldn't lie? It's late and I'm getting mixed up.
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Post by doctork on Aug 14, 2009 8:51:18 GMT -5
Nah you're not mixed up, you're thinking logically. TSA does not have to think logically, just try to look like they might be. It's silly. Don't ask questions comrade, just move along!
If you go to the "Evolution of Security" blog (which might now be at http://www.tsa.gov) you might find their sorry (Kathryn Windham's definition of sorry: "not fit to carry buzzard guts") attempt at answering your questions.
For gender ambiguity, the TSA suggests booking as the gender documented on your ID, but the Virtual Strip Search will tell them everything they want to know, and maybe more, anyway. They use fudge-language on the initials and nickname business: "For the near future, minor differences will likely not delay your travel." But change your ID to match your booking name "soon."
I'm OK with this for international travel, but I believe it is unconstitutional to require "Papers please" for domestic travel. All the 9/11 miscreants had accurate, valid ID and were not carrying any forbidden items on board the plane.
ID does NOT equal security, how long does it take to figure that out? That's why it is a boondoggle $7 billion workfare program, not a security program. The TSA routinely misses 70 - 80% of weapons in carry-on luggage while they waste time on "explosive shampoo" and now age and gender ambiguity. PLEASE - just keep guns and big knives and bombs off planes, and I won't mind sitting next to a trans-gender or even a terrorist, if he is unarmed.
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Post by gailkate on Aug 14, 2009 9:43:08 GMT -5
How do we know they miss 70-80% of weapons? I've seen some of the staged incidents - is this an extrapolation from those?
About the 3 oz. limit. I've wondered if this means 4 oz. could make an explosive. So a family of 3 could get on with several 3-oz vials in their baggies, take their seats and quietly start passing vials among each other(maybe surreptitiously mixing all in the empty water bottle they brought along). Even a cute 6-yr-old with her own Barbie carry-on could bring some evil potion. Pretty soon they'd have a hefty almost-bomb going. To cause the most damage, the ringleader could wait till the plane was coming in low for a landing and toss in the final 3 oz. - BANG! there goes the plane and a chunk of LAX or Reagan or even the Mpls/St. Paul airport. As you know, K, we live 10 minutes from that airport so Jerry and Gail and the doggies would be cinder-fied too.
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Post by doctork on Aug 14, 2009 11:18:35 GMT -5
We know about the missed weapons because they have regular "red team" testing for it - fake weapons are planted and sent through the X-ray at the checkpoint. Scores are based on how well the job is done at each airport. They do make the test items harder to detect each year, but some evidence suggests that the airport head of TSA may be given advance warning of when the red team will be there.
There is no good science behind the "3 ounce" limit (it may really be 3.4 ounces or 100 ml), but it may be easier to detect the "right amount" through those limits and the freedom baggie requirement.
AFAIK, the feared binary explosives (two different substances mixed onboard the plane) are either 1) too unstable to carry through the airport without exploding, or 2) require several hours of mixing in an ice bath under careful science lab conditions to create them. You can't really do that in an airplane lavatory - passengers and flight attendants would get suspicious when someone was in there for hours and funny odors were coming out. And the one time this was done "successfully" (Bojinka plot involving flights from East Asia to the US in the mid 90's), the explosion caused one death by blowing a small hole in the plane, and forcing an emergency (safe) landing where all others survived.
And no one made any fuss or started the security liquids/shoe carnival back in the 90's when that happened, even though there was an Al Qaeda plot to blow up 12 trans-Pac flights simultaneously. The plan was thwarted through other means (sensible security precautions I guess). The 1993 WTC bombing, as well as the two African embassies and the USS Cole attack and the Riyahd attack, were also ignored until 9/11.
I strongly support efforts at security (no weapons, enforced cockpit doors, non-acquiescence airline strategy), but the TSA's $7 billion could be much better spent on real security instead of theater.
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Post by doctork on Aug 14, 2009 11:21:29 GMT -5
Kudos for this. The witchy faux pas snapping at the student was over-emphasized, but here is an effort of real merit. Full disclosure - IMC is the agency that organized my first trip to Afghanistan; they do great work, and thanks to Secretary Clinton for recognizing it and helping. www.imcworldwide.org/HillaryClinton
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Post by doctork on Aug 20, 2009 9:01:11 GMT -5
RIP Don Hewitt, developer of "60 Minutes." That really was a major change in television. All the news stories of his passing mentioned he was the producer of the very first televised presidential debates between Kennedy and Nixon.
I try to follow the healthcare reform stuff, but it is way too confusing. It does seems most of the talking heads now feel there will be a bill of some sort. At that health policy conference I attended in July, the experts were thinking maybe 50 - 50 chance.
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Post by doctork on Aug 20, 2009 19:10:05 GMT -5
Tonight I watched the Newshour with Jim Lehrer on PBS, where Gwen Ifil interviewed Wendell Potter, formerly the head of Media Communications with Cigna Healthcare. I worked with him quite a bit back in the day, and he was all-corporate all the time back then.
What a surprise to see him severely criticizing the health insurance industry now. But of course those of us who have been in the industry are the most familiar with the problem areas, and often best informed to voice criticism.
Also today I saw a news poll citing that more than 50% of Americans think that the war in Afghanistan isn't worth fighting. I know that many oppose war on any grounds, but Afghanistan is where the 9/11 attacks originated, using Al Qaeda forces trained in Afghan camps. With the Taliban once again rising and increasing in its power, I believe this is where the "real threat" lies (not in explosive shampoo on domestic aircraft or with imaginary WMD in Iraq).
What gives? I happen to think our efforts in Afghanistan may be too little too late (though I hope it's not), but that doesn't seem to underlie the 50+% opposition.
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Post by joew on Aug 23, 2009 12:33:28 GMT -5
It's strange. I've never felt that we should drop out of any of the wars we've been in during my lifetime. But just recently I've begun to think that Afghanistan is unconquerable, and we ought to get out. I'm not sure of that, but I wonder if we can do anything worthwhile through our military efforts.
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