It isn't Free.....The Democrats Lied

Discussion in 'Politics' started by Buffalo Roam, Sep 10, 2010.

  1. joepistole Deacon Blues Valued Senior Member

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    22,910
    You are going to need to support this statement. Healthcare expenses in this country have been growing at twice the income growth. That is just not sustainable over the long term.

    Electronic record keeping is a part of this healthcare reform law. Private industry (exception being healthcare) implemented electronic record keeping several decades ago.

    Additinally the new law makes payments based on outcome not on number of services provided. Information sharing will go a long way in improving outcomes.

    The bill also provides for increasing the numbers of healthcare practioners. If you had read and understood the link previously provided you would have understood that fact.
    Did you miss the part that everyone needs to be covered so that every one who benefits can pay a portion of the nations healthcare expense?
    Again, just because you refuse to acknowledge something does not mean it does not exist. Shutting your eyes and refusing to acknowledge the boogieman will not send him away.
    The nations healthcare expenses will be borne by a larger number of payers. Today, individuals do get healthcare at emergency rooms instead of physician offices...that is expensive healthcare. Keeping patients out of hospitals generally keeps healthcare costs down. Hospitalization is the most expensive form of heatlhcare.

    LOL. Are you suggesting that we let a portion of the ill people die off in order to balance the situation?

    As pointed out to you previously, those 33 million are getting healthcare today the only place they can get it...in the nations emergency rooms. The supply of physicians has for too long been kept artificially low in order to keep physician reimbursements high.

    Other industrial countries manage to treat 100 percent of their populations and produce better outcomes for about half of what it costs us here in The United States. If you don't think that is a problem...then I think you need to rethink your positions.

    The nation is going to need more healthcare providers regardless of the healthcare reform law. Until just last year, the nation had not added not one single seat to American medical schools.

    The nations population has grown something like 30 percent since a seat was last added to American medical schools. And as you pointed out in addition to growing the population of the country, its citizens are getting older and more in need of medical care.

    The solution to the nations medical problems is not more of the same.
    Where does it come form now? In the area where I live they continue to build new hospitals and care facilities. When there is a profit to be made, private industry will get the capital. And there certianly is a lot of capital in the healthcare industry.

    What you don't seem to understand is that when these large capital investments are made, the costs are recovered not in one year, not in two years but in decades.
    What you premise lacks is the recognition that those 33 million or so people are today getting heatlhcare in the nations emergency rooms and hospitals. And under the healthcare reform law those people will be paying what they can afford to pay for their healthcare versus nothing today.
    Oh I have me people with signficiant medical problems. But their income and medical coverage never allowed them to benefit from that deduction. The only people who benefit from this deduction are those who are under insured and low income.

    And then when they qualify, only get to deduct a portion of their expenses. So all in all, it is not a signficant financial benefit.

    Yes, Bill Gates should pay the same FICA that everyone else pays on all his earned income...should he decide to work. Bill is retired these days and pays zero FICA.
     
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  3. adoucette Caca Occurs Valued Senior Member

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    What link?

    So how are they going to increase healthcare professionals?
    And assuming they do so, isn't the cost of training them and their annual salaries going to raise the cost of medical care?

    Why of course it will.

    The Emergency room buggaboo. I knew that would come out. No, it's not more expensive to treat that way, it's just the pits for the patients because of the LONG waits. The cost of a shot of pennicillin is the same however.

    The issue of the medical costs for the 30+ million new insured is really focused on how you are going to deliver preventative medicine, and that's an entirely new cost. Ultimately doing so may save you money in the long run, but to provide these there are substantial UP FRONT costs to the system.

    Can't get around it.

    Source?
    You think that's true of Nurses as well?

    Yeah. How does this plan do that?

    Produce better outcomes?
    Really?
    Source?

    Theoretically they don't get it now, that's one of the reasons savings are projected. If you provide care to them before they get real sick you will OVER TIME reduce the total cost. It's a long range strategy, but its up front costs are pretty high. Not saying that's a bad thing, just saying people need to be upfront about the cost structure.

    What BS, someone who makes 1 million a year should not pay $75,000 to FICA, luckily the gov agrees with me and stops FICA at $106,800 (income).

    BS, I am not low income and I have an excellent medical plan but my wife's initial week hospital stay, MRIs, Biopsies, consults etc was over $40,000 and the brain surgery was over $60,000. At 80% coverage, that was $20k to me and that was one week after diagnosis. 30 rounds of Radiation therapy using a machine that delivered it to a precise point, over $1,000 per treatment, my cost was about $200 per, or $6,000. MRIs nearly every month for two years at $2,000 per, my cost varied, but was usually about $500, or $6,000 per year. The medicines she was taking were outrageous, forget the anti-cancer medicines (the last one she took was experimental at $20,000 a friggin dose and the insurance company paid half), her anti-nausea pill was $50 a pop, took them once or twice a day for nearly two years. Insurance paid 50%.
    You know NOT of what you speak.

    http://www.suite101.com/content/medical-bankruptcy-epidemic-a73393

    Finally, you seem to miss my point once again. You're a real black or white kinda guy. No grey in your world apparently.
    I think Health care is a serious problem in the US, particularly due to inherent problems in our Tort system (seems no one has mentioned how the unique problem in the US of our Medical Malpractice suits and the fear of it that drives our medical costs to be so high).
    I just don't think that the Obama plan is going to solve it but I don't think it's all bad either, its got a lot I agree with.
    What I think is not well understood is how this substantial increase in people being provided health care is going to initially increase costs.

    Arthur
     
    Last edited: Oct 6, 2010
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  5. joepistole Deacon Blues Valued Senior Member

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    22,910
    Ya think? I bet if you looked at some federal government contracts or laws you would find a few that required a vendor to get and maintain insurance of one sort or another...prehaps a surety bond.

    Are you saying states have more authority than the the Federal government?
     
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  7. adoucette Caca Occurs Valued Senior Member

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    Again, this requirement would NOT be based on the Commerce Clause.

    Did you read that link (I can't copy paste from it)
    Read secs 15, 16, 17 and 18

    Of course they do.
    Over their residents.
    I don't need a FEDERAL drivers licence do I?

    Arthur
     
    Last edited: Oct 6, 2010
  8. Cowboy My Aim Is True Valued Senior Member

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    3,707
    We'd have to eliminate government interference to find out...
     
  9. spidergoat pubic diorama Valued Senior Member

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    54,036
    Ever read Dickens?
     
  10. Cowboy My Aim Is True Valued Senior Member

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    3,707
    Or Ayn Rand?
     
  11. spidergoat pubic diorama Valued Senior Member

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    54,036
    Not yet, but I heard her fictional free market icons were sciency geniuses, not tea party goons.
     
  12. joepistole Deacon Blues Valued Senior Member

    Messages:
    22,910
    The cost of not training them is going to cost even more. Either way, it is going to cost money. The ony question we need to answer now is wither we want to pay a lot more or a litlte more.

    And if you bothered to read the previously provided link, you would not be asking what link.
    .
    Patients do have long waits in emergency rooms now. But that is not the issue. The issue is that uninsured people are getting treatement today throught the emergency rooms. And that cost is being paid by those who do have healthcare insurance.

    And let me remind you what the issue was here. The issue was that there were not enough physicians and faciities to treat 33 million more people. You yourself have acknowledged that those people are today receiving treatment in emergency rooms.

    You are attempting to errect a strawman here. I never said preventative medicine was a cost lowering exercise. Let me repeat myself. They way the new healthcare law will lower costs

    1) spreading the heatlhcare costs over a larger payer base (more people contributing about 33 million more people contributing towards the heatlhcare cost in the nation)
    2) implementing a system of metrics and rewards based on outcome rather than sheer numbers of services provided.
    3) automation of record keeping (something other businesses have done decades ago and if heatlhcare markets were competitive, this industry would have done so decades ago as well). But healthcare markets in the US are not open and not competitive...keeping prices high.

    http://www.allcountries.org/ranks/preventable_deaths_country_ranks_1997-1998_2002-2003_2008.html

    There are upfront costs. That is why Obamacare is projected to save more money over the second ten years than the first ten years. But it all boils now is how much more do you want to pay? With healthcare costs consistently doubling the growth of income, that is just not a sustainable model and the problem will continue to get worse unless dramatic changes are made to the system.

    So you believe that only the middle and lower incomes in this nation should pay for the Social Security System. If benefits were commensurate with contributions, I might agree with you. But that is no the case.

    I guess you and I have differences of opinion on income and what is a good healthcare insurance policy. My healthcare policies have always been capped at a maximum of 5k in out of pocket expenses in any given year. So in your personal case, the maximum expense you would have been liable for is 5k in a given year.

    If you made 100k per year, then your max out of pocket would never allow you to qualify for the tax deduction you have been referencing because you need 7.5k (2009 and earlier threshold) just to get to the point where you can deduct medical expenses. A good health insurance plan will make sure you never get close to meeting that
    7.5k out of expense requirement so that you can start deducting expenses greater than 7.5k from your income.

    Additionally, if you have money in a healthcare spending account, that money is used to directly reduce/offset your allowable healhcare expenses for this deduction...further limiting the usefulness of the deduction.

    So back to my original statement. You only qualify for the deduction if you have poorer insurance (higher deductables, caps, etc.) and are lower on the income scale.

    Yeah I am a real stickler for facts and reason. But that does not mean I don't see the forrest for the trees...a fact confirmed by by Briggs-Myers personality type.

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    Yes the heatlhcare situtation in The United States has lots of problems. But it is not because of the tort system. The highest estimates including actual tort costs and "preventative mediciine" claims has never exceeded 5 percent of total healthcare costs per the CBO.

    If someone on the Republican side could make a convincing arguement I would be all ears. But they have never been able to explain and show how this is or would significantly change the healthcare cost system in this country.

    I think a lot of people share your concern and don't understand how insuring everyone is going to cause healthcare expenses to be reduced. I too have some issues with what is being called Obamacare. I don't think it goes far enough to make the industry more competitive and therefore more price competitive. But it is a start. A single payer system would be the most efficient and the most cost competitve....that is the system used by other industrial nations. That does not mean socialization as often portrayed by the healthcare industry....that means single payer which shifts the cost curve in favor of the consumer versus the supplier as is the case today.
     
    Last edited: Oct 7, 2010
  13. adoucette Caca Occurs Valued Senior Member

    Messages:
    7,829
    Thanks for nothing.

    1) Right, so for 33 million people their costs will go up. That's what I've been saying from the beginning. The FACT though is the vast majority of these people are YOUNG AND HEALTHY, so they will be paying the costs for the elderly. Sure, EVENTUALY they will benefit, but that won't happen for most of them for many decades.

    2) I've now read the proposals and that's ALL theoretical. All they have now in plan is to pay for DATA, not outcome. The fact of the matter is even at the end of the day, they are saying they will INCENT people to do better, but that's really not the same as saying pay based on outcome, because there is absolutely no discussion of not paying if someone doesn't do well.

    3) Actually they are doing this quite rapidly in the hospitals NOW as computers and automated record keeping are rapidly being deployed. The record keeping they are talking about is FAR MORE INTRUSIVE, and is related to #2 above and there is no actual evidence that this will create the immense savings you think it will.

    As far as open and competitive, no system you have linked to is 'open and competitive'

    As far as that link about Outcome, that has to do with overall outcome of people and had to do with people NOT being treated, not outcome of TREATMENT. Big difference.
    BS, 5% is friggin huge, but its over 5 and nearer 10%.
    http://en.wikipedia.org/wiki/Medical_malpractice

    No, and luckily the gov agrees with me, FICA is capped at 106k of income.
    Get over it.


    As to insurance:

    Get really sick and you will probably find out your out of pocket caps are not for ALL things you pay for.
    Mine read: This limit does not apply to balance-billed charges from out of network health care providers or services that are not covered by the plan.
    It's that last one that opened it wide open because of the nature of the disease we elected to have the treatment done at a Neurosurgery center that specialized in the treatment of Glioblastoma Multiforma, of course it was out of network, that and the fact drug charges which are also not under the cap. Avastin, a new bio-engineered drug being used for cancer treatment costs about 60K per year.

    In any case, we could go on and on, but to no purpose, there will be no way to know what this is going to do to medical care and costs for decades.


    Arthur
     
    Last edited: Oct 7, 2010
  14. joepistole Deacon Blues Valued Senior Member

    Messages:
    22,910
    How do you know the majority of these people are young and healthy? Where is your proof? Two, if you are insured today, you are paying for the healthcare costs of these individuals. It is not like they don't have healthcare expenses.

    In an earlier response, you acknowledged that these people were filling emergency rooms.

    Do you understand incentive pay? Apparently not, it is used extensively in private industry because if set up correctly, it works.
    And what is the basis for this claim? Yes in some areas they are implementing electronic record keeping but not all. As I said earlier, private industry (less healthcare) went this way decades ago.

    I have personally been involved in several projects with in large companies that automated records and workflow yeilding hundreds of millions in cost reductions. It does not take a rocket scientist to figure this one out.

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    I don't understand what the hell you are talking about here. The issue is control of the supply and demand curve. A competitive market keeps supply and demand in balance. That is not what we have in the US and Obamacare attempts to make our system more competitive by treating the healthcare industry like a utility. I preferr the single payer system as previously mentioned. It shifts the power from the supplier to the purchaser...a reverse of what exists in the US healthcare system today.

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    I guess you like being the sap.

    Like I said a good health insurance policy will have an annual out of pocket maximum of around 5k. And the threshold to take the medical deductable is currently 7.5 percent before you can start deducting healthcare expenses in 2009 and prior years.
     
  15. adoucette Caca Occurs Valued Senior Member

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    7,829
    Well because Medicare/Medicade does a good job of taking care of the other end of the spectrum. It's the YOUNG and HEALTHY and POOR who are the largest group without insurance. So by and large you can't pass on much of the cost to these people, but you ARE going to be providing much more initial medical care to them then they actually pay for.

    They don't go to Emergency rooms for CHECK UPS, and that's how extending medical care to them is supposed to eventually reduce costs. Oh and they don't just go to emergency rooms, many of them go to "doc in a box" and other "urgent care" outlets.

    Sure, for PIECE work, not so much for MEDICAL CARE. Of course one can theorize anything, but there is no solid proof that this will substantially cut costs. Again, my wife was a nurse, there is no friggin incentive system in the world that could have got her to give better care, because she always gave over 100%.
    It's obvious that you think the people providing our heatlh care are lazy and sittiing around with their thumbs up their butts, and that if you just provided an incentive to do better friggin MIRACLES will occur, but my experience is quite the opposite. Doctors work hard and nurses are almost always over worked. Too many patients, not enough time.

    The issue is how much money will it save. My wife was a nurse, I helped the doctor she worked with automate some of his practice, but the reality is it couldn't be done effectively because of the MASSIVE amount of patient data compared to the low percent of hits. One of the big things you are missing is that a vast amount of data exists in paper today in private practices all across the country and Obamacare is not going to get that mountain of paper into digital form. Hospitals are much better for this, as they don't really need to worry that much about history, and so they are the ones that are well on the way and aren't waiting for Obamacare to tell them to do it.

    How the heck do you intend to make the Medical field a competititve market?
    Are we going to see doctors advertising their success rates?
    Boy, that will SUCK, as doctors won't take referrals of cases they don't think they can cure.

    I guess I feel it isn't fare to taking far more of someones income for medical insurance when it is far more than they should realistically pay. I guess you like stealing.

    Arthur
     
  16. joepistole Deacon Blues Valued Senior Member

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    22,910
    You are forgetting the principal of insurance again....remember it is not about actual costs. It is about mitigation of risk....potential costs. And you have failed to prove your contention that the uninsured in this nation are the young and healthy.

    One if 10 of the nations children are uninsured. Whereas 1 in five adults under age 65 are insured. That kind of puts a plug in your premise.

    http://www.iom.edu/Reports/2009/Ame...-Consequences-for-Health-and-Health-Care.aspx

    http://www.pbs.org/newshour/bb/health/jan-june09/healthcare_01-05.html
    Do you have any evidence to support this premise? I suspect not. Urgent Care outlets are not required to provide medical care to the uninsured. And I have yet to find one who does. Emergency rooms on the other hand have no choice. They are bound by law to treat anyone for anything that comes through their doors.
    You keep ignoring the Congressional Budget Office projections in addition to any other evidence that runs contrary to your preconcieved notions.

    A nurse is not a physician. A nurse does not prescribe medical care. A nurse implements and supervises medical care prescribed by a physician. Thus incentive pay is not and would not be targeted at nurses. Incentive pay is for decision makers...the physcians and hospital administrators...not nurses, not respiratory therapy techs, not X-ray techs etc.

    Now how do come to that conclusion? I worked in a hospital. I was a corpsman in the Navy and a paramedic in large urban area while I went to college. So I know very well what happens in the medical system.

    Incentive pay as previously stated has nothing to do with worker bees. Like with anything else, there are hard working follks and there are slackards. But in general I think nurses are over worked. Established physicians, may or may not be over worked...it is their choice.

    Incentive pay rewards insitutions for better outcomes...not worker bees.
    You nor Obamacare is going to transfer all of the existing paper data into electronic format because as you point out that would be a huge burden and the benefit would be very minmal.

    You pick a date in the sand and from that date everything is electronic. That is how we do it in industry.

    And maybe that is a good thing. What Obamacare does bring about is a more coordinated system of care. Under the present system of healthcare the physican is the centerpoint...the locus of attention and not the patient. A patient should not be so dependent on an individual for good quality heatlhcare. The healthcare system should routinely produce good healthcare just like the auto factory produces good quality cars time and time again.

    A system of metrics and processes will not only streamline heatlhcare but improve quality as well. Under the present system, may God help you if you have a bad physician.

    In a competitve market physicans compete for patients versus looking for reasons to discard them after taking their money.

    Are you on Medicare or Social Security Arthur? If you are you are getting benefits far in excess of your contributions into the system. So are you stealing if you accept Medicare and Social Security benefits?

    That is my point. Social Security and Medicare programs are welfare programs - benefits are not commensurate with contributions. And as long as that is the case then the burden should be spread equally on all earned income earners...not just the poor working slobs on the lower end of the income ladder.
     
  17. Mr MacGillivray Banned Banned

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    527

    Then I agree completely with you, because Obama sought the compromise. And compromises are always more costly then the right decision.
     
  18. Gypsi Registered Senior Member

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    I never cease to be amazed by the irony - how in order to have the satisfaction of defining themselves as "free" (from government interference) people are prepared to be financially ruined, to lose all they've worked for, to be burdened by crippling inescapable debt - or die because they'd rather not, or can't. How "free" is that, really?
     
  19. adoucette Caca Occurs Valued Senior Member

    Messages:
    7,829
    Well the "Standard" care was available and the costs would have been capped by my insurance plan.

    But, when faced with a diagnosis of 50% mortality at 14 months, and 98% at 36 months then one considers the options that are available to you, even if they are "out of network" and non-standard.

    And a lot of the medicines are covered by the clinical studies themselves, but the other aspects of treatment are not, but because you have to go to their site for surgery and treatment you won't be "in network" and if you read your policy, there is a good chance that this type of treatment is not covered under your cap (because the costs can be so very high).

    About 60,000 people per year get Glioblastoma Multiforma per year and there are maybe about 6,000 openings in these advanced clinical trials and since they aren't the "standard of care", luck and money pretty much decides who gets in them. You have to fly to their facility, stay in their hospitals, take their treatments. etc.

    In our particular case we participated in three separate trials, in three different locations, with the medication in the last trial costing $20k per dose.

    The question I have is how do you think this system, which continually pushes the envelope of medicine, but often at substantial cost to the participants, will work in a system dedicated to reducing costs?

    http://clinicaltrials.gov/ct2/results?term=Glioblastoma&recr=Open

    My wife survived 18 months after diagnosis.

    Arthur
     
  20. adoucette Caca Occurs Valued Senior Member

    Messages:
    7,829
    How so? Are children not YOUNG?
    Why, yes they are.
    Are children not in general healthy?
    Why, yes they are.

    Medical costs go up as people age. Easy to find the data, but basically over about 40 your costs go up to ~3 times average and over 60 or so its about ~5 times the average. The cheapest age is the first two decades of your working life, so young workers are paying for insurance which predominately pays for the medical care of older people and other people's kids.

    The uninsured aren't necessarily poor, there are plenty of young workers who aren't insured and get treated via these outlets.

    No, I'm just relying on other data. Your claim that these changes will save all this money is speculation. Not that it can't be right, but its not carved in stone. Or are you going to tell me that the CBO is always right?

    Right, so now you are saying that doctors are the problem and have low incentive to cure you.
    What planet are you from again?
    LOL


    Doesn't work that way, patients have HISTORY, you can't draw a line in the sand. At the doctor's office that I helped that was our initial plan, but the reality was that patients typically had a LOT of history, and you just couldn't afford to get that data into a USABLE format that would make the doctor's work easier. Computer professionals have been working for YEARS on this problem and there is no magic wand in Obama care that will solve it.

    Again, WHAT PLANET ARE YOU FROM?
    Repeat, there is NO SHORTAGE of Sick People. There is a growing shortage of Doctors and Nurses. You have said so yourself, in that that is a problem that you think Obamacare is going to also magically solve.

    Nope, been paying in my whole life though, the max each year but for my first few when I was a teenager.

    Oh BS.
    From my most recent mailing from the SSA, I and my employer have paid in a total of $240,000 to SS and $82,000 into Medicare, going back to the late 60s, and taken nothing out, so given reasonable interest rate compounding on these investments, then considering my estimated future life expectancy, there is little likelihood of my breaking even.

    BUT, if there hadn't been a cap on SS and Medicare earnings that were taxable, then that amount would be more than double and then there would be no possible way I'd recover what I put in.

    Arthur
     
  21. joepistole Deacon Blues Valued Senior Member

    Messages:
    22,910
    You have not proven your claim. Per my previous post there are far more uninusured who are not children than those who are children. It is typical of you to grasp only that piece of information you think supports your cause and ignore the rest.
    As a group, yes the older folks are the more medical are they will need. But you still have not proven your claim that the bulk of the uninsured are younger folks. By definition, we know that there are almost no uninsured folks over 65 because they are provided medical insurance courtesy of the federal government.
    Yeah, I am telling you that budgets and projections are created and used every day in industry...just like an architectural plan. Do things occasionally not go as planned, yes. But that is no reason not to do a project. Hell if everyone adopted your kind of logic we would still be living in the stone age. And finaly you cannot poke holes in the projections and estimates. If you can provide some sound arguement as to why the CBO numbers might be wrong that is one thing. But the bottom line is you cannot.

    I think you naivety is showing. Private industry does not use incentive based pay because is does not work. And two, no one is saying (other than you) that physicians have a low incentive to cure people. What is being said is that with metrics and incentive based pay people are rewarded and incented to make sure the do the things that benefit the patient (e.g. keeping down readmissions). I will give you a personal example, I was discharged from a hospital a while back. But because I was not given the appropriate medication on discharge, I was rehospitalized within days of being discharged. That is a flat out mistake...a costly mistake. Things like that happen all the time. If hospitals and physicians are not compensated equally as well for the second time, there is no financial incentive to make sure that upon discharge I was given the appropriate medication. Things like that happen all the time.

    Let me give you another example, let's suppose a drug company rewards doctor X for prescribing their drug versus other drugs although another competitive drug would do just as well which drug do you think the physican will prescribe more?

    Sure patients have history. But here is the rub and what you are not getting...it is not all relevant to the current health of the patient. The relevant material in a patients record needs to be part of the patients medical record, but not all of the record needs to be there.

    I picked up and moved across the country. My medical records did not move, but still I am being well treated without all of my previous medical records. If you know anything about medical records, you know that they can be voluminous. Do you think a physician reads all of it when seeing a patient? NO, they don't. Even if they wanted too it would take too much time and be of too little value.

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    NO DUH. Do you have a point here? Who said Obamacare was going to magically solve anything? Oh yes, the extreme right.

    So, is there a point here? Everyone in the US pays into it. It is the law.

    You know, that is just what my aunt says. She is 85, she has been on the system for 28 years now. I think if you do a serious look at the numbers and a serious estimate of the costs, you will find otherwise. Delusion is such a wonderful thing my friend except with reality comes calling. And again, Social Security benefits are not substancially commensurate with contributions. If it were then what you contributed would actually have a signficant impact on your benefits. And that is not the case today. Social Security and Medicare is an entitlement burden that should be borne equally by all earned income contributors.
     
  22. adoucette Caca Occurs Valued Senior Member

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    7,829
    LOL

    Stop it.

    It hurts when I laugh this hard.

    Arthur
     
  23. joepistole Deacon Blues Valued Senior Member

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    22,910
    Well good, I am glad you got a laugh because that is all you have. You have not been able to support your claims. And you have not been able to refute any of the points and rebuttals I made.

    So in the end all you have is your baseless notions and opinions.
     

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