Knights & Knaves Alehouse

Foster, regardless on how you (or anyone) comes down on this, the fact is this centralized medical admin. was included in the stimulas package (which by the way has nothing to do with stimulas). And it does mention medical providers checking in with a centralized govt. adminstration. What, if any, suspicions you have is of course up to you. Personally, I wouldn't trust so blindly (any party). When it involves the govt. its always best to hope for the best, of course, but assume the worst. I find it odd you don't question more.

As far as that Bloomberg piece being discredited, it wasn't. That was an opinion piece, you can't discredit opinion (only present a counter opinion). In the end only time can tell which (if either) is correct. Personally I think its a matter of putting 2+2 together (as many things are). And I'm not even bringing up the expansion of medicare for people out of work till 2011 (regardless of income or means) which is going to cost the American Tax payer what? (ontop of the Stimulas bill).

AxeMental wrote:For Werral: "Nationalization, also spelled nationalisation, is the act of taking an industry or assets into the public ownership of a national government or state, often by force, against the will of the previous owner".


"Socialism refers to a broad set of economic theories of social organization advocating public or state ownership and administration of the means of production and distribution of goods, and a society characterized by equal opportunities for all individuals, with a fair or egalitarian method of compensation."

I'd say they are pretty much the same, wouldn' t you Werral?

Absoultely! My point was just that words have certain rings to them. There was a seurvey somewhere on one of the more left-wing Democratic candidates (I forget his name, he was eliminated pretty early in the primaries). A survey that presented his poliicies without any loaded words like "socialism" or variants did pretty well with the Americans surveyed. But the same policy with words lilke "socialism" used was universally rejected.

In terms of content it makes no difference.

AxeMental wrote: Thats the beauty of it, there's no need to ban private healthcare as long as the government can control what decisions your doctor makes in your behalf (what tests will you get, what perscriptions, and how long must you wait). It's a rather brilliant plan actually, no messy public debate like we saw with Clinton, just attach it to the stimulas bill with your supermajority.

That happens anyway in the US with medical protocols set up to protect doctors from litigation. The UK follows the American model (with protocols), Italy doesn't - each doctor decides what treatment to give based on their diagnosis and medical first principles.

The protocol system protects you from bad doctors and protects medical practioners from litigation. The downside is as you said - the Govenrment (or hospital trust or managers or insurance companites -but not actually doctors) sets up a rather mechanical "if patient x has y then give z dose of medicine b".

The Italian system is great if you have a good doctor, terrible if you have a bad one. Still I essentially think that it is better for medical decisions to lie with doctors, education with teachers etc...

Basically the US/UK system is like D20 and the Italian system like OD&D.

This is cuts across the private/public spectrum and has more to do with the fact that it's almost impossible to sue in Italy and as easy as buying a packet of fries in the US.

Werral: "Absoultely! My point was just that words have certain rings to them."

Hey Werral, I give this politician credit for having the balls to be honest. If a person believes in socialism there's no need to hide it. Call it what it is and defend what you believe in. Using "new code" to hide what your doing isn't cool in my book (almost as bad as sneaking crap into the stimulas bill).

Concerning what you call protocal, the difference is with this system a doctor (presumably) is going to be pressed to not go beyond the base line protocal (say to order extra tests, or put a patient on an medication he's heard about that might cost a little more but some beaurocrat disapproves of).

Actually, it is those little experminents made by practitioners everyday in the real world that help evolve our medical science. For instance, doctors in their practises started noticing that depressed patients (who happened to suffer from migrains) put on anti-depressents started reporting fewer migrains. So docs started perscribing anti-depressents for any of their patients with migraines and walla (its become a bedrock in the treatment of migrains for neurologists)!!!

I actually think protocal is a good idea (as a base line) but the doctor should have the freedom to do as he wishes beyond that.

In any event, this speculation isn't yet reality (as Foster would point out), but anyone with a right mind should be questioning just what is intended (even those that might support socialized medicine) (in the same way they questioned Bushes anti-terrorism legislation (used on Americans).

Remember kids, events are often used to force feed unpopular govt. control (with Bush it was 911, this time its a recession). Look how it turned out in Cuba, or Russia, or China. You want that here?

"Saskatoon is pleasant in the springtime" is an opinion.

"Saskatoon is on the Côte d'Azur" is a (false, or contra-) factual claim, whether presented in an "opinion piece" or elsewhere.

Likewise, the claim that the bill establishes that

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.

is factually false.

That's just one example of the falsehood that makes Betsy McCaughey an "expert" by the standards prevailing in certain quarters.

AxeMental wrote:The difference is with this system a doctor is going to be pressed to not go beyond the base line protocal (say to order extra tests, or put a patient on an medication he's heard about that might cost a little more).

It's not even just that. My common-law wife is a doctor and has worked in the UK and Italy. In the UK she prescribed x dose of a medicine (based n most leading medical textbooks and her own experience) only to have the nurse give the patient a different dose based on a leaflet the health-trust had (based on one survey).

AxeMental wrote: Actually, it is those little experminents made by practitioners in the real world that help evolve our medical science. For instance, doctors in the real world started noticing that patients put on anti-depressents started having fewer migrains. So docs started perscribing anti-depressents for migrains and walla!!! I actually think protocal is a good idea, and reflects equal training.

Yes. I guess I'm unique here in that I believe strongly in public medicine yet still see your concerns as real. None of these problems are caused by healthcare being public. They could happen if hospitals are badly run.

I believe the best system is a largely "hands-off" public system that is not micro-managed from central government (the British NHS ran for most of its existence in this way, but the present government is obssessed with micro-managing everything).

AxeMental wrote: This isn't yet a reality, but anyone with a right mind should be questioning just what is intended (just as anyone with a right mind should have questioned what was up with Bushes anti-terrorism legislation (used on Americans). Events are always used to force feed unpopular govt. control onto people (in that case it was 911, this time its a recession).

Yes. But a concern over whether something is going to be done RIGHT is not the same as saying it should not be done at all.

Werral: "In the UK she prescribed x dose of a medicine (based n most leading medical textbooks and her own experience) only to have the nurse give the patient a different dose based on a leaflet the health-trust had (based on one survey). "

Holly crap! Did your wife chew her out? Man, if that happened here she'd loose her job most likely. American doctors wouldn't put up with crap like that (at the moment).

I hope you read this Foster and Dw, this is the medical care your socialist party is planning for us. That could be your nurse one day in the not so distant future (and if it can happen there it can happen here).

PS the people I've talked to in the real world that supported Obama pre-election seem to be in a bit of a shock. Several have already said they hope he'll only be a one term president. So, it seems reality is making a wakeup call.

[quote="Dwayanu
Likewise, the claim that the bill establishes that

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective.

is factually false.

That's just one example of the falsehood that makes Betsy McCaughey an "expert" by the standards prevailing in certain quarters.[/quote]

How is that false Dwayanu? What specifically do you disagree with in that statement? That it wll be used to hold down costs? That is the only thing speculative in it, the rest is written in the bill. Also, anyone that reads this article realizes those sorts of points are opinion (extrapulated largely from Daschels book), it has to be, the bill hasn't been signed into law yet, no one knows for a fact what will happen. She doesn't have to say "in my opinion" because that is obvious and would thus be redundant. Just as a lib doesn't have to say "carry laws will, in my opinion, cause mass gun fights in the street" I realize thats an opinion so it could be written as if it were factual "carry laws will cause mass gun fights in the street".

So, out of curiosity, if she is 100% correct in her predictions, would either you disapprove? Aren't you guys for this sort of govt. control and cost cutting? I don't mean that in an inflamatory way, just curious. If it were me (feeling the way you guys do) I'd be saying "yeah, she's probably right and it'll be great if it happens, its just the kind of thing we need".

-So just for the record, you guys (Dw, Joe B, Foster, etc.) would be against the government limiting what your doctor could order to cut costs? For example if a doctor wanted to order an MRI and the National Coordinator of Health Information Technology said no (in effect second guessing the docto), you would be outraged (like I would be)? Or no, you'd think it was appropriate (if the case was reviewed and the test deemed unneeded)? I'm just trying to get a feel for how you guys stand on this particular issue. Your thoughts.

AxeMental wrote:Werral: "In the UK she prescribed x dose of a medicine (based n most leading medical textbooks and her own experience) only to have the nurse give the patient a different dose based on a leaflet the health-trust had (based on one survey). "

Holly crap! Did your wife chew her out? Man, if that happened here she'd loose her job most likely. American doctors wouldn't put up with crap like that (at the moment).

Well she also had the problem of being new and having language/cultural issues. Maybe a British doctor wouldn't have taken that shit either (and she wouldn't if an Italian nurse tried it here).

I want to point out that:

a) this does not happen in Italy's public healthcare system (which has its own problems.

b) this did not happen in the British NHS until the present system of health-trusts (actually designed to inject more "free-market principles") was introduced.

c) It would not happen to a doctor trained WITHIN THAT SYSTEM, since they are trained to follow the protocols.

An American doctor would not prescribe anything outside the protocols in the first place "(Unless they were Dr House) - it would simply be outside their training.

British docotrs are now trained to operate within the protocols (though they vary from Health-trust to health-trust, so a doctor moving hospitals may follow "the wrong" protocols.

d) the protocol system exists in America and is in fact refered to as "the American system".

Basically public healtchare is good as long as its a healthcare "of the people by the people for the people" but not if it's an autocratic system lacking transparency.

It's sad to me that so many Americans (and Europeans for that matter) seem to regard "Governement" as "Them" rather than "Us" (which is what it should be in a democracy)

The government shouldnb't be something alien. The Government should be US.

So, if your wife in Italy wants to order an extra test (say an MRI) sooner then is standard (or protocol), would she be free to do so? Or would this be prevented somehow? I know HMOs in this country routinely prevent doctors (who work for them) from ordering more then a certain number of tests (per type) within an alloted amount of time (say 3 months). If they order more tests they get in trouble (in some cases the doctor gets payed less) and I have heard some HMOs actually give a bonus for those that order less. This practise is a cost cutting measure utilized by the HMOs (PPOs aren't under that restriction, its up to the doctor and the insurance company).

Werral, the American people have great respect for some parts of the govt. less for others (also depends on who you ask, libs or conservatives). Our govt. is probably run different then yours (each department has to spend its entire budget or loose it the following year, leading to massive waste; also the more people employed under a department head the more money they make, so the system is encouraged to create make believe jobs (pushing paper around that doesn't need to exist) and inefficiency with workers (just the opposite of private business) to maximize employment opportunites. This of course is a huge burden on the tax payer (but doesn't effect those who pay none). I have, on several occasions heard about this govt inefficiency from those on the "inside" who know first hand. Unfortunately it is a secret to most outside of govt. (and those within it aren't about to let that cat out of the bag) .

http://www.hhs.gov/healthit/onc/background/
http://www.hhs.gov/healthit/onc/mission/
http://www.rules.house.gov/111/LegText/111_hr1_text.pdf

But the bill goes further. One new bureaucracy ...

By a plain reading, that's not speculation about possible future events; it's a statement about the bill.

For a start, how is an office established by executive order of a Republican president five years ago suddenly "new" when a Democrat is in the White House?

"Socialist" in the US is a dirty word and once mentioned many will simply stop listening. I don't think that's really rational. Whatever works works.

I'm in favour of socialism for a lot of infrastructure - British Rail, British Telecom and British Steel all did better as State owned entities and this infrastructure ctually helped small businesses operate:cheap nationalised railways made it easier for a business to find staff.

With private rail commuting 20 MINUTES to London for minimum wage you would spend your daily wage on your commute (possibly more). So the person who could have found work in London now is on the dole.

Better to spend money on trains and infrastructure than welfare IMO (you need some welfare but better to have someone commute on a cheap train to work in the next town).

AxeMental wrote:So, if your wife in Italy wants to order an extra test (say an MRI) sooner then is standard (or protocol), would she be free to do so? Or would this be prevented somehow? I know HMOs in this country routinely prevent doctors (who work for them) from ordering more then a certain number of tests (per type) within an alloted amount of time (say 3 months). If they order more tests they get in trouble (in some cases the doctor gets payed less) and I have heard some HMOs actually give a bonus for those that order less. This practise is a cost cutting measure utilized by the HMOs (PPOs aren't under that restriction, its up to the doctor and the insurance company).

Often protocols actually FORCE doctors to prescribe more tests. For example a CT scan that she didn't want to run on pregnatnt woman (because the patient was low-risk of cancer, and a CT scan is high-risk to the unborn). The protocol REQUIRED a CT scan (because if she had cancer she could sue).

In Italy a doctorcan request as much or as little as you wish with no view to cost, but there is limited availability due to budget cuts (so there may be a wait. This is exasperated by corruption (people with connections don't wait).

Insurance companies also give bonuses to doctors who don't give costly treatment. They will do anything to avoid paying - I know from experience that insuracnce companies can find ways to avoid paying out on expensive treatments.

As I say I'm pro-public healthcare (I'm a socialist to that extent) but anti micro-management. Think of the military. The government sets a budget but it is the military that spends it - politicians don't decide which guns the soldiers use (or they shouldn't). Same with the fire-dept and the police.

Actually the injection of private enterprise into the US military hardly improved efficiency did it?

AxeMental wrote: Werral, the American people have great respect for some parts of the govt. less for others (also depends on who you ask, libs or conservatives). Our govt. is probably run different then yours (each department has to spend its entire budget or loose it the following year, leading to massive waste; also the more people employed under a department head the more money they make, so the system is encouraged to create make believe jobs (pushing paper around that doesn't need to exist) and inefficiency with workers (just the opposite of private business) to maximize employment opportunites..

All government has problems. But the weird budget rule you describe seems to be a big one - why not focus ON THAT. I mean write to your Senator and agitate on that issue. Fight for more transparency in government and more public involvement.

Really, warts and all public healthcare is a boon, some countries do it better than others, but it's almost invariably better than private healthcare alone.

In any case you feel that socialised healthcare is inevitable - in that case do your best to ensure that it is GOOD socialised healthcare and not bad socialised healthcare (it is false to assume that it is innevitably either good or bad).

T. Foster wrote:

PapersAndPaychecks wrote:Axe, I live near two major pharmaceuticals research laboratories belonging to Glaxo Smithkline. It's not like drugs companies can't make a profit in the UK. In fact, considering the recession they're doing bloody well.

Because a national health service doesn't stop people creating new drugs, just like it doesn't stop self-employed doctors making six-figure salaries in every town in the country.

Ah, but you're neglecting the "fact" that in the U.S any sort of private healthcare or medical practice will be banned, as part of the Democratic party's Stalinist agenda

This is exactly what Hillary's aborted plan was aiming at 15 years ago. Of course, any future plan doesn't need to go in that direction, but yeah, it's a concern that needs to be addressed in any new plan. IMO, of course.

What the @#$, Axe???

If a doctor wanted to order an MRI and the Baseball Commissioner "said no (in effect second guessing the docto)," would I be outraged? No! I just wouldn't give a flying fig!

The National Coordinator of Health Information Technology is there to help implement data sharing so the doctor can look at the MRI that's already been done, so it doesn't need to be done again. For which wasted effort a decent physician has too little time to spare. For which needless expense a private insurer would doubtless refuse to pay. For which I would have more money in my own pocket to pay, if we cut down costs as has been done elsewhere ...

What the @#$, Axe???

Does anyone have a link to the actual bill text (pgs 442-446 or so). All I can find are snippits from both sides.

Does anyone have a link to the actual bill text

Dwayanu wrote:http://www.hhs.gov/healthit/onc/background/
http://www.hhs.gov/healthit/onc/mission/

vVv AXE, HERE IT IS vVv
http://www.rules.house.gov/111/LegText/111_hr1_text.pdf

But the bill goes further. One new bureaucracy ...

By a plain reading, that's not speculation about possible future events; it's a statement about the bill.

For a start, how is an office established by executive order of a Republican president five years ago suddenly "new" when a Democrat is in the White House?