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07/15/2014 07:35:39 AM · #51 |
Yeah people keep reelecting people like Pelosi....I don't see how that woman functions from day to day
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07/15/2014 07:59:26 AM · #52 |
while congress as a whole has a low approval rating, remember that congress is a collection of people elected to represent each state and district so that theoretically every person has a representation.
the problem isn't indvidual lawmakers, per se. they are competent people... the problem is that when they all get together, lately they never stop playing politics... ever. before they'd only do this shit around the elections, now its tow the party line every single day.
its no wonder stuff never gets accomplished.
Message edited by author 2014-07-15 07:59:49. |
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07/15/2014 02:03:06 PM · #53 |
Originally posted by Mike:
the problem isn't indvidual lawmakers, per se. they are competent people... the problem is that when they all get together, lately they never stop playing politics... ever. before they'd only do this shit around the elections, now its tow the party line every single day. |
That is a big part. Back in the day, Tip O'Neil and Ronald Reagan could have fundamentally different ideas about the direction of the country and how the government should behave, yet they could respect each other and sit down together, share a meal and make deals. Today every member of Congress is running in the next election the moment they take office. Making the slightest concession is seen as a betrayal of moral values, and the government gets less and less done. And some people are very happy with that. |
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07/15/2014 03:08:28 PM · #54 |
we need term limits. i know we essentially have term limits but if these guys knew they only had a few years to fix something they wouldn't keep dragging their feet to extend their stay as long as possible. i think they'd they'd also be more likely to abandon party politics...
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07/15/2014 05:47:19 PM · #55 |
Originally posted by Mike:
we need term limits. i know we essentially have term limits but if these guys knew they only had a few years to fix something they wouldn't keep dragging their feet to extend their stay as long as possible. i think they'd they'd also be more likely to abandon party politics... |
A better way to say that is we need a limit on terms....I agree
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07/15/2014 06:00:36 PM · #56 |
In California we have had term limits since 1990. It did nothing to lessen political partisanship, and many people feel it gave the big money and political parties more power than ever.
What has seemed to worked here is open primaries. Now the top 2 vote getters face off in the general election regardless of party. More liberal districts will have 2 Democrats, conservative areas have 2 Republicans. This has taken some of the power from the parties and given power to the more centrist voter, while the party only primaries tend to appeal to the party extremists. It has also sent a few very long serving congressmen out on their ear. |
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07/15/2014 11:55:10 PM · #57 |
Politicians are easy punching bags, but they're simply products of our demands. They act as they do because that's what keeps them in office. These people are actually justified to undermine progress on their platforms of spite because that is exactly what their constituents have asked of them. The real problem is in our communities, like it or not.
On healthcare, there are plenty of third-world countries where the privileged have become accustomed to having desperate and destitute neighbors living just outside their gates. I think it's in our best interest to not go that route. |
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07/16/2014 12:23:42 AM · #58 |
Here's my opinion and... it's just one of many... Everyone has an opinion.
I've had whelps and blisters from Poison Oak for ten days. I've never been allergic to it... always been able to run in it... nothing happened. Except this time.
But... we have a really high insurance deductible so we can afford the premiums after ObamaCare rules kicked in.
The clincher for me is...
If you're not working... you don't have to worry. Your insurance is "free". No one pays for it. (just kidding, of course!! SOMEONE pays for everything...)
It's how all people eat.
I'll be really ... totally fine... It's just a matter of time before all of the itchies go away. It's just "annoying"... not "life threatening".
It doesn't bother me at all that ... the people with "free healthcare" would be able to go to the doctor and get this fixed a week or so ago...
Ok.
So... I'm lying now.
It really stinks that ... because Hubby and I are working and... pay taxes instead of going "on the government dole"... that we have to go without the medical care that's free to others who don't work... because it's too expensive.
While the people who aren't working... can go get what I should go get (but won't because... it's too expensive...) for "free".
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07/16/2014 01:05:52 AM · #59 |
| You could complain about freeloaders, or you could ask your doctor, insurance company, pharmacy and drug company why it's prohibitively expensive to get a simple lotion to cure a rash. Your anger is misplaced. |
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07/16/2014 01:06:01 AM · #60 |
Originally posted by LydiaToo:
Here's my opinion and... it's just one of many... Everyone has an opinion.
I've had whelps and blisters from Poison Oak for ten days. I've never been allergic to it... always been able to run in it... nothing happened. Except this time.
But... we have a really high insurance deductible so we can afford the premiums after ObamaCare rules kicked in.
The clincher for me is...
If you're not working... you don't have to worry. Your insurance is "free". No one pays for it. (just kidding, of course!! SOMEONE pays for everything...)
It's how all people eat.
I'll be really ... totally fine... It's just a matter of time before all of the itchies go away. It's just "annoying"... not "life threatening".
It doesn't bother me at all that ... the people with "free healthcare" would be able to go to the doctor and get this fixed a week or so ago...
Ok.
So... I'm lying now.
It really stinks that ... because Hubby and I are working and... pay taxes instead of going "on the government dole"... that we have to go without the medical care that's free to others who don't work... because it's too expensive.
While the people who aren't working... can go get what I should go get (but won't because... it's too expensive...) for "free". |
Quite a nice summary of the problem... Well done. (calamine lotion, btw, works wonders)
----
Good news on my end, blood tests came back negative for cancer. I still have a bloody sore throat, but apparently I won't die.
Still not happy, but I'm happy I'll live to be unhappy about the next thing I need to seek medical care for. :D |
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07/16/2014 01:10:01 AM · #61 |
Originally posted by LydiaToo:
the people who aren't working... can go get what I should go get (but won't because... it's too expensive...) for "free". |
This is largely a myth. The vast majority of the poor are either working poor, elderly, disabled or children who cannot work, NOT freeloaders. Over 90% of "entitlements" go to these groups. On top of that, 24 Republican-led states refused to expand Medicaid coverage, and as a result anyone earning less than $11,500 (30+ hours a week at minimum wage) in those areas who doesn't qualify for Medicaid gets NOTHING toward healthcare– not even tax credits. If you're not working in the southeast or midwest... your insurance is likely not "free." You simply don't have any. |
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07/16/2014 07:42:34 AM · #62 |
Originally posted by Cory:
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Good news on my end, blood tests came back negative for cancer. I still have a bloody sore throat, but apparently I won't die.
Still not happy, but I'm happy I'll live to be unhappy about the next thing I need to seek medical care for. :D |
great news.. i went through a similar issue last year. (one of the reasons i took a hiatus from dpc). turns out i had polyps on my voice box that the doctor kept missing after sticking a camera down my throat over and over, much to my discomfort.
i had t removed, it grew back, but now knowing that it wasn't cancer has caused my to stop unconsciously irritating the area and I haven't had a symptom since.
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07/16/2014 04:15:16 PM · #63 |
Originally posted by LydiaToo:
Here's my opinion and... it's just one of many... Everyone has an opinion.
I've had whelps and blisters from Poison Oak for ten days. I've never been allergic to it... always been able to run in it... nothing happened. Except this time.
But... we have a really high insurance deductible so we can afford the premiums after ObamaCare rules kicked in.
The clincher for me is...
If you're not working... you don't have to worry. Your insurance is "free". No one pays for it. (just kidding, of course!! SOMEONE pays for everything...)
It's how all people eat.
I'll be really ... totally fine... It's just a matter of time before all of the itchies go away. It's just "annoying"... not "life threatening".
It doesn't bother me at all that ... the people with "free healthcare" would be able to go to the doctor and get this fixed a week or so ago...
Ok.
So... I'm lying now.
It really stinks that ... because Hubby and I are working and... pay taxes instead of going "on the government dole"... that we have to go without the medical care that's free to others who don't work... because it's too expensive.
While the people who aren't working... can go get what I should go get (but won't because... it's too expensive...) for "free". |
The good news is that even with prednisone, you probaby would have had your poison oak for about 10 days. :)
I think you do have an excellent point, however. "Free" is bad. "Free" causes people to not value what they have. The no-show rate for state medicaid in our practice is much, much higher than traditional insurance? Why? Because psychologically the patient thinks it's not important if they miss their appointment because it "doesn't cost anything". The disconnect between what health care costs is also huge. I have patients who complain about antihistamines being too expensive when a year's worth of generic Zyrtec is $17 at CostCo. They refuse to get it. How can treatment get cheaper than $2/month?!?
In Africa, when you see the doctor, you pay SOMETHING. Even if it is a few dollars, because you then associate a value with what you are receiving. Our system has it wrong on both sides. High deductibles and expensive meds have people with traditional insurance UNDERutilizing preventative care while zero costs have people with state insurance OVERutilizing care. |
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07/16/2014 05:14:32 PM · #64 |
Originally posted by DrAchoo:
The no-show rate for state medicaid in our practice is much, much higher than traditional insurance? Why? Because psychologically the patient thinks it's not important if they miss their appointment because it "doesn't cost anything." |
How do you know that's the reason? A larger proportion of people on Medicaid have limited mobility to get to a doctor, some can't spare the time during doctors' hours whie working to make ends meet, and others are too proud to take a handout. From a "freeloading" perspective, no-cost availability seems like the least likely reason to miss an appointment. It's kinda' hard to reconcile Lydia's claim that people "on the government dole" use healthcare because it's free with your claim that people DON'T use it if it's free.
Message edited by author 2014-07-16 18:29:29. |
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07/16/2014 06:08:14 PM · #65 |
Originally posted by DrAchoo:
In Africa, when you see the doctor, you pay SOMETHING. Even if it is a few dollars, because you then associate a value with what you are receiving. Our system has it wrong on both sides. High deductibles and expensive meds have people with traditional insurance UNDERutilizing preventative care while zero costs have people with state insurance OVERutilizing care. |
Viewed in this perspective one would think that those making use of the "Zero Cost" module would be the healthiest of the financial groups... I wonder if that could be readily demonstrated.
Ray |
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07/16/2014 06:53:20 PM · #66 |
Originally posted by scalvert:
It's kinda' hard to reconcile Lydia's claim that people "on the government dole" use healthcare because it's free with your claim that people DON'T use it if it's free. |
I think his point was they do not value it because they do not bear the cost themselves, not because they under use it.I wonder if Paul's ( GeneralE) experience working at free clinics jibe's with Jason's as far as appointments that carry little cost, being undervalued.
When we make a blanket statement like "free is bad" it overshoots the mark. Public schools are not great, but their flaws do not rest on a lack of tuition. I enjoy basically free, safe drinking water, and when the head of Nestle talks about how precious a recourse drinking water is, far too important to be given away without a private company charging a market rate for it, it scares the snot out of me. Likewise I like my "free" fire and police departments. Of course I may be missing something because I only paid $690 a year for my public university education and they convinced me that sometimes a public good can come out of taxpayers funding a precious commodity that all the people share in and reap the benefits of.
Message edited by author 2014-07-16 18:55:17. |
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07/16/2014 07:30:09 PM · #67 |
Originally posted by BrennanOB:
I think his point was they do not value it because they do not bear the cost themselves, not because they under use it. |
I understand that. Just noting Lydia's comment that people supposedly take advantage of valuable healthcare when it's free next to Jason essentially claiming they don't take advantage when it's free because they don't value it. |
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07/16/2014 07:46:28 PM · #68 |
Originally posted by BrennanOB:
I wonder if Paul's ( GeneralE) experience working at free clinics jibe's with Jason's as far as appointments that carry little cost, being undervalued. |
When I worked at the Berkeley Free Clinic (1970s-80s) the no-show rate was essentially zero.
At the methadone clinic where I now work, as Shannon suggested, the no-shows (for intake appointments) are more often because the clients (often homeless as well) lack the $2 bus fare or alarm clock to get there at 5:30am.
I don't think most people in this country understand how "expensive" it is to be poor, whether working or on "welfare." Someone working full-time (40 hours/week) at the Federal minimum wage grosses under $1250/month -- in the Bay Area you are lucky to find housing under $1000/month; if you do, you are likely to have a 2-hour commute (by bus -- you can't afford a car/gas/insurance/tolls) costing about another $100, leaving you less $150 to pay for utilities, food, childcare ...
Message edited by author 2014-07-16 19:47:01. |
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07/16/2014 08:16:03 PM · #69 |
Originally posted by RayEthier:
Originally posted by DrAchoo:
In Africa, when you see the doctor, you pay SOMETHING. Even if it is a few dollars, because you then associate a value with what you are receiving. Our system has it wrong on both sides. High deductibles and expensive meds have people with traditional insurance UNDERutilizing preventative care while zero costs have people with state insurance OVERutilizing care. |
Viewed in this perspective one would think that those making use of the "Zero Cost" module would be the healthiest of the financial groups... I wonder if that could be readily demonstrated.
Ray |
Actually, it has been demonstrated in a fascinating study in Oregon, but demonstrated to the negative. Free healthcare overutilized expensive services like ER visits more than uninsured controls of equal demographics. No long term health benefits were demonstrated either. I'll have to dig up the link.
Here you go. Abstracts to a number of studies which have come from the "Oregon Health Study".
Message edited by author 2014-07-16 20:24:58. |
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07/16/2014 08:19:32 PM · #70 |
Originally posted by scalvert:
Originally posted by DrAchoo:
The no-show rate for state medicaid in our practice is much, much higher than traditional insurance? Why? Because psychologically the patient thinks it's not important if they miss their appointment because it "doesn't cost anything." |
How do you know that's the reason? A larger proportion of people on Medicaid have limited mobility to get to a doctor, some can't spare the time during doctors' hours whie working to make ends meet, and others are too proud to take a handout. From a "freeloading" perspective, no-cost availability seems like the least likely reason to miss an appointment. It's kinda' hard to reconcile Lydia's claim that people "on the government dole" use healthcare because it's free with your claim that people DON'T use it if it's free. |
You are right. I don't know for sure, but there are things that can help guide my impression. 1) "Trillium" (the name for our state Medicaid) patients more often do not call to reschedule or explain why they didn't show. So they more commonly just vanish than private insurance patients. If you couldn't get off work or couldn't get a ride but still have an interest in coming, I'd think that would not be the case. 2) "Trillium" is now the de facto ACA insurance so there are plenty of people who are not on the fringes of society who have Trillium. 3) Psychological studies have clearly demonstrated the power of "free" on our brains.
EDIT: I think I realized I may be presenting from the side of the coin people are not used to seeing. If a Trillium patient makes five appointments and shows up for two and a traditional insurance patient makes two appointments and shows up for two, the two have utilized the same number of health care dollars, but the Trillium patient has utilized more than twice as much of my time. Since time is a limited commodity, I only have so much to spread around. So, I guess, the reasoning behind the higher no-show rate (be it a lack of caring or a lack of resources) isn't as important. Trillium patients utilize more resources from this point of view than traditional insurance and especially more than non-insured patients (who generally will only come if they NEED to come). I have a high index of suspicion that a good part of this is the lack of perception of the "value" of my time because it is costing them nothing.
Message edited by author 2014-07-16 20:38:24. |
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07/16/2014 09:00:28 PM · #71 |
Originally posted by GeneralE:
I don't think most people in this country understand how "expensive" it is to be poor, whether working or on "welfare." Someone working full-time (40 hours/week) at the Federal minimum wage grosses under $1250/month -- in the Bay Area you are lucky to find housing under $1000/month; if you do, you are likely to have a 2-hour commute (by bus -- you can't afford a car/gas/insurance/tolls) costing about another $100, leaving you less $150 to pay for utilities, food, childcare ... |
I don't think most people in this country understand how "expensive" it is to work. There are the normal bills that everyone has and then, they must also support the ones who don't work (for whatever reason... choice, or inability).
Yet, we still continue to spend more and more and more of these working people's money... without a plan for getting our spending under control.
How much will the working people stand before they join the people whom they are now supporting, and NO ONE is working to support us all?
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07/16/2014 09:06:43 PM · #72 |
Originally posted by Cory:
Good news on my end, blood tests came back negative for cancer. I still have a bloody sore throat, but apparently I won't die.
Still not happy, but I'm happy I'll live to be unhappy about the next thing I need to seek medical care for. :D |
Yay! I love "hearing" this, Cory!
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07/16/2014 09:13:01 PM · #73 |
the government makes and takes in more than enough money to pay for these welfare and social services while wasting it elsewhere. don't get sucked into the political game where your emotions are being tugged.
me helping to cover someone else's premiums isn't the problem we need to be addressing. its the COST of the services themselves... |
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07/16/2014 09:14:56 PM · #74 |
Originally posted by scalvert:
Originally posted by BrennanOB:
I think his point was they do not value it because they do not bear the cost themselves, not because they under use it. |
I understand that. Just noting Lydia's comment that people supposedly take advantage of valuable healthcare when it's free next to Jason essentially claiming they don't take advantage when it's free because they don't value it. |
I didn't say that they take advantage of it... or didn't mean to say that. I thought I said that they COULD go get what I wanted to get... for free (but I wouldn't because it costs too much).
And I don't think that's fair. Why should the people who pay for their own, and other people's, healthcare have to govern themselves according to cost... when deciding whether to go to the doctor (and I think they SHOULD!), when the people for whom they pay healthcare, don't.
I agree with DrAchoo... There is no value for anything you get for free.
This doesn't just apply to money... it's also about effort... or love... or... or... or...
Nobody values anything that's free. One must work for it to value it.
I am excluding, of course, the medically disabled... for a REAL reason... when I express dismay over paying for other people's healthcare. If you CAN work... then ... you SHOULD work. There's plenty to be done. There's trash on the road to my house right now... There are people who need to be taken to doctor's appointments... people who need meals. WHY are we paying people to do that... (with benefits like insurance benefits) when there are able-bodied people who can do it... and they're ALREADY getting healthcare for free because their income is too low (they're NOT WORKING!).
*sigh*
Rant over.
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07/16/2014 09:51:47 PM · #75 |
Originally posted by DrAchoo:
Actually, it has been demonstrated in a fascinating study in Oregon, but demonstrated to the negative. Free healthcare overutilized expensive services like ER visits more than uninsured controls of equal demographics. No long term health benefits were demonstrated either. I'll have to dig up the link. |
You might want to take that with a grain of salt. If someone who hasn't had healthcare suddenly gains access, free or not, would you not expect them to utilize it more (to address longstanding issues or allay fears that regular checkups would have put to rest) than people who've had access all along? Even a modest surge in patients can mean a shortage of doctors with available space, particularly in poor neighborhoods, which leaves the ER as the only option. Futhermore, people with less experience in the healthcatre system might not be as familiar with the difference in cost and care between the ER and a family practice, and therefore more likely to view it as all the same. Obviously there can be other factors at play here, and it's worth noting that all of those studies were by the same authors, which could indicate an agenda. |
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