Originally Posted by The Rani

Um ... did you even read what I wrote?

Option 1 = keeping the person longer in the first place = increased cost
Option 2 = refuse to readmit = decreased level of care

I don't know how I can make it simpler than that.

i did pick option one, if it only came down to those two choices. however, i'm not really sure it's that "simple."

it's not as if these people are going to be discharged with no follow-up. in fact, if you go back and read the article that playwrite linked to, it sounded like there would be follow-up either in people's homes or in clinics, both of which *are* less expensive than hospital care. if people get decent follow-up care, they probably would not have to go back to the hospital.

sounds like a slam dunk to me.

There was no snark in that message. It really is a good time to be healthy.
If that's what Romney is saying, he's absolutely correct.
And if that rubs people the wrong way, I seriously don't give a shit.

good health is wonderful at any time and at any age.

the problem with romney is that he has been so privileged all his life that he says crazy stuff implying that emergency rooms can and should be used for primary care.

so why does he get a pass, while obamacare gets the "piece of crap" label?

is this even really about health care at all, or just about sniping at obama?

Originally Posted by JohnMc82

Sigh, back to the magic ad-hom. I'm sure tearing down two dimensional characters is useful on stage, but it doesn't teach you economics. Assuming you did pay attention in Macro 101 you'd know that lower interest rates are generally considered to be stimulating via Keynesian interpretations of the Great Depression.

Good start, I'm sure you can follow along this far. Except it is different this time. See, the 1930s was the last time all commodity classes hit a low trough in the supercycle. Grain was so cheap that a lot of product rotted because it wasn't worth taking to market.

This time, commodity classes are approaching relative peaks of a commodity super cycle. The last time that happened in the U.S. was during the Civil War. Prices got so high the red states thought they could walk off with all the cotton and grain and let the cities starve. Then, of course, a bunch of Union soldiers stomping through all the farms didn't exactly help prices come back down right away either.



Are there a lot of bad investments? Yeah! Do they need to be unwound? Uh... yeah! I'm not saying this is going to happen someday, I'm saying it already did. The Fed recognizes that and they're working to clean 'em up and get the system back in order. There's nothing particularly controversial about this...

The problem is that the Federal Reserve's actions aren't living up to the textbook model's expectations. Hell, Bernanke wrote the damn textbook with his research.

He wrote it in 1982, when we had about 10 years worth of data on free-floating fiat currencies. Based on that limited data-set, you get a lot of weird results like commodity price assymetry - where the decrease of energy prices doesn't increase economic gains proportionately to the losses of energy price increases. The new research that looks at the whole forty year floating currency period finds that symmetry again and a macro incentive to drop commodity prices.

So the Federal Reserve is actually going the wrong way, because that is exactly what the textbooks say they should do.

Congress is going the wrong way too, but that has something to do with the idiots we keep electing thanks to a seriously limited spectrum of choice and a loud chorus of paid fools claiming they're opposite extremists.



Yes, and almost all of the deleveraging is in the mortgage sector, correlating to the rapid rise in defaults and foreclosures. Student loan debt is at record highs while credit, auto, and other revolving debt levels are average for the ten year period.

Maybe some malinvestment being wiped clean?

1930s Even back then, Keynes talked about "pushing on a string." Do you think our monetary system is anything like it was in the late 1920s-1930s? You do know what Nixon did in 1971, right? Why would you think the "string" has become stronger? Viagra?

FED I don't think your grasping what I'm telling you. You are the one attributing great and wonderful power to the man behind th curtain. I'm saying they're impotent going either way. The only thing they can tangible do is keep the carrying costs of existing debt down. Yes, they can get you all to get into your hysteria mode (actually, most of you don't have any other mode) and jack up asset prices and feel validated by any cost-push inflation that comes along and ignore any decline in prices as "not important."

Again, some believe it's the FED game to manipulate you hyperinflationisties into some asset inflation and get a wealth effect. I don't believe that. The FED knows the Saudis have more to do with oil prices that either the FEDs actions or your inflation-is-just-around-the-corner. The FED knows that whatever collateral damage is caused by the hysteria will be short-lived in a demand-starved economy. You said it yourself; gas prices will choke off the economy. Have you ever stop to ask yourself why that is so easy to do TODAY when our economy has cut GDP dependence on a barrel of oil down about 70% since the 1970s? It's because of a fundamental lack of demand. Nobody is sufficiently spending in the domestic economy.

The one entity that could deficit spend without any REAL costs has it hands tied by t-bagging idiots. Everyone NOW sees how a drop in federal deficit spending will take us over the fiscal cliff, but nobody is bright enough to ask what would happen if there was actually MORE federal deficit spending. Oh, no can't have that because some numbskulls named Reinhart & Rogoff looked at countries that owed their debt in foreign currency or gold and got into trouble – a situation that don't exist and will never exist in the US. And it sells because 48% of the country has bought into the 3T movement conservative bullshit that the govt is the problem.

We're in a world of hurt because we live in magic pony land, but at least we can have our freedom fries – if we can still afford them.

Originally Posted by The Rani

...Maybe this is a better way of explaining it ...

...don't even go looking for any data; just deduce your conclusion from your own personal experience.

You would make a fine Austrian economist.

Too bad the big old real world doesn't work that way.

Originally Posted by The Rani

So here's the horrible and callous comment that started the firestorm:

Can anyone provide a reasonable argument why hospitals would NOT do either or both of the things that I describe in the first sentence?
No, of course not.

So instead, let's all pick on The Rani. Yeah, that's a great idea. It will make her feel bad, so she'll shut the hell up.
And really she's only saying that stuff because she is Ayn Rand reincarnated.
Phew! That explains it. Now we can all believe in Obamacare again and sleep well at night.

If that's really what you guys want to believe, wonderful. Good luck with that.

The problem with the healthcare, as opposed to the health insurance, industry is the metrics used to measure success by the providers.

• First, maintain control of the situation. Any need to comply with externals is immediately pooh-poohed as affecting heathcare quality.
• Second, maintain autonomy. This assures that the previous point is achievable.

That's about it.

Now the health insurance industry wants to achieve the same first goal, but wishes to destroy autonomy as a means to acquire control. Otherwise, health care and health insurance tend to play together to an extent, needing each other to survive as they do.

So how is great care actually achieved? Since it already is ...

• Find an example, or even better, many examples of great results at lower cost.
• Emulate it/them

That's about it.

SO what's the next step? There are so many atrocious practices in US medicine, it should be easy to make real progress.

• From France, all health records are carried by the patient on a smart card, which is updated during each encounter. All providers have access to the full history of every patient, and one that's searchable on a computer ... among other excellent practices.
• From the Mayo Clinic, operate in teams and treat the whole patient ... among many excellent practices.
• From the Cleveland Clinic, use only outcome based medicine ... among many excellent practices there.

All these are good ideas, but how to pay for them is another thing altogether. One thing we know, fee for service isn't it. Moving to something else risks cost overruns as the methods are refined. Show me a CEO or a politician who wants to raise his/her hand to assume that risk.

So, good luck with that.

Originally Posted by The Rani

In medicine, the Real World consists of doctors and patients, not statistics.
As I've said, I'm not interested in a boxing match. I'm sharing my opinion, and yes it's based on direct experiences with these issues.
People can choose to...

For some reason, I feel like a trend-setter...

~Chas'88

Originally Posted by The Rani

Good luck with what? None of this has anything to do with my comment.

By the way, have you ever considered what other forum members say about YOU behind your back?
"Just so you know" ... you're certainly in no position to throw stones.

i don't need to hide it.

i like marx & lennon. his posts are well thought out.

and as a long-timer on the site, he's certainly been in a position to observe quite a bit.

Study: Romney health care plan to leave 72M uninsured.

all joking and snarking aside, there is a real choice to be made here. from where i'm sitting, the affordable care act is a better deal for the united states.

and not just massachusetts.

Originally Posted by The Rani

Good luck with what? None of this has anything to do with my comment.

By the way, have you ever considered what other forum members say about YOU behind your back?
"Just so you know" ... you're certainly in no position to throw stones.

I doubt any of us has a large cheering section. We're opinonated and diverse. Why expect other results?

FWIW, I avoid the entire PM side of this forum. I enjoy the public side, and stay there. YMMV.

Originally Posted by princeofcats67

Rani, the next time you guys decide to do an impromptu presentation of the movie Aliens on the MB, would you be so kind to give me a jingle before all the choice roles are taken?

Hmmm. Let's see what's left.

Ripley-taken.
Carter Burke-taken.
Alien Queen-taken.
[Note: I haven't determined who M&L is just yet; Maybe Lt. Gorman].

I would probably pick Hicks or Bishop, maybe Newt.

Prince

What an honor - to be the only truly clueless member of the cast. Gee, thanks!

Originally Posted by Marx & Lennon

What an honor - to be the only truly clueless member of the cast. Gee, thanks!

aliens has nothing to do with health care.

i believe the snarkers are losing the argument, so they are trying to change the subject.

big shiny logo and all -- and the logo has nothing to do with the movie anyway.

rani:

you haven't made an answer to playwrite's earlier request for data to back up your claims about the affordable care act.

instead you decide to re-cast aliens and make yet another personal attack on a fellow poster.

can you understand why people would find that annoying?

Originally Posted by The Rani

In medicine, the Real World consists of doctors and patients, not statistics.

Wow, that is a pretty amazing statement from someone in the medical field; well, except if you are a witchdoctor.

Do you do your own clinical trails as well?

Originally Posted by The Rani

Hey guess what, I don't care what you find annoying.
Moreover, if you don't want to make it about personalities, you might want to stop making it about personalities
You reap what you sow, and you can stop annoying yourself any time you choose.

i see then.

your philosophy appears to be "do as i say, not as i do."

and the "douchebag" post is still up.

so, to continue the run of cliches, i'll just say "you, rani, like to talk the talk, but you don't walk the walk."

why should you be privileged to make personal attacks, while then crying when others complain about it?

Originally Posted by princeofcats67

Rani, the next time you guys decide to do an impromptu presentation of the movie Aliens on the MB, would you be so kind to give me a jingle before all the choice roles are taken?

Hmmm. Let's see what's left.

Ripley-taken.
Carter Burke-taken.
Alien Queen-taken.
[Note: I haven't determined who M&L is just yet; Maybe Lt. Gorman].

I would probably pick Hicks or Bishop, maybe Newt.

Prince

I think you need to get out of the house more. Those kitty box fumes may be taking a toll - could be irreversible, if you don't get some fresh air.

Originally Posted by The Rani

I didn't tell you to do anything, dude (or dudette,) and if you think I'm crying about anything you're as clueless as M&L.

then why the "douchebag" post?

Originally Posted by The Rani

... P.S. M&L being Gorman is right on topic.

No, I'm under no obligation to debate on your terms, nor you on mine. I write what I wish. I don't see you being constrained in any way either.

On your snide "clueless" reference, I have a problem with a system that is designed to be opaque for the benefit of those inside the system. You see this as an assault on your profession. Maybe it is. Your profession has acted in its own interest, and so has the insurance industry. Eventually patients will act in theirs, though not yet apparently. In the mean time, we have an emerging mess that will replace a current mess. I don't consider that a net good ... or bad. Its a waste of time and resources for minimal gain.

Its not as if this is some new and unaddressed issue. We have models of excellence - I mentined a few of them. Your profession is doing its utmost to avoid incorporating them. The insurance industry, likewise. Keep this in mind: medical care, as currently financed, is 17% of GDP. The ACA won't reverse that. In fact, it will continue to expand. It is approaching the size of all non-health related governement spending at all levels of governement, combined ... including Social Security. It will be changed one way or another. If your profession is interested in helping the cause, then weigh-in. But remember, the solution can't be spend more, or even as much as we are now. Any soution that ignores that isn't a solution.

For reference, you may want to look at the the Japanese system, not that we are likley to adopt it. It's the one system where the insurance industry won (mostly) and yours didn't. The care is excellent there, btw.

Originally Posted by The Rani

Nah, I leave the clinical trials to the drug companies who profit from the results. That makes the most sense.

As you know, such trails are not just limited to drugs but to all treatments even head shrinking therapys. What you may not know is statistical analysis in such trails is pretty typical.

Setting aside the snark, I think we can all agree that the current American health care system is seriously flawed, perhaps even broken. What we have is a debate on whether the ACA helps improve the current system or makes it worse. I see Playwrite, Marx and Lennon, and the Bouncer as saying that it helps and Rani, Deb, and Justin '77 saying that it doesn't and that we need to start over with something new. There are good arguments on either side; why can't people make them without getting personal and touchy?

Originally Posted by the bouncer

i see then.

your philosophy appears to be "do as i say, not as i do."

and the "douchebag" post is still up.

so, to continue the run of cliches, i'll just say "you, rani, like to talk the talk, but you don't walk the walk."

why should you be privileged to make personal attacks, while then crying when others complain about it?

Careful bouncer, your type is too big.

Originally Posted by Eric the Green

Careful bouncer, your type is too big.

Yes, bouncer was using the default font size, and that was too small. In fact, Garamond even looks too small at size 4, which should be large. I think that font is not forum friendly, for reasons unknown. Most of us are using Verdana at size 2.

Originally Posted by Marx & Lennon

I doubt any of us has a large cheering section. We're opinonated and diverse. Why expect other results?

FWIW, I avoid the entire PM side of this forum. I enjoy the public side, and stay there. YMMV.

The only problem with second paragraph is that often on the PM side you are more likely to get a response. Despite all the valid points I make on this forum, I find that only a select few ever generate a response. Posted a real thoughtful one on this issue a couple of days back. I believe I said that there still is probably not enough support among the populace at large for all-inclusive national healthcare. I expect it will happen eventually but I proably won't be around to see it.

Originally Posted by princeofcats67

I don't believe Gorman was truly clueless, and I did say maybe in your case, M&L. I guess you're not Gorman. Too bad, really.

There's absolutely NO way you could be Vasquez, so I guess you're relegated to a "grunt" or some "drone" alien.

Prince

PS: Gorman went down with: Honor.

Yeah, clueless to dead in one step. What an honor.

Originally Posted by Brian Beecher

The only problem with second paragraph is that often on the PM side you are more likely to get a response. Despite all the valid points I make on this forum, I find that only a select few ever generate a response.

I'm certainly guilty of that. I'll post for a while, then stay away for a while. I rarely read everything posted in the interim, so I miss a lot of responses to my own posts, to say nothing of posts that should interest me.

Originally Posted by Brian Beecher ...

Posted a real thoughtful one on this issue a couple of days back. I believe I said that there still is probably not enough support among the populace at large for all-inclusive national healthcare. I expect it will happen eventually but I proably won't be around to see it.

Actually, Medicare is already close, for those of us of a certain age. The ACA may add a public option in the future, which could be a start down that path.

FWIW, I don't expect to see a full implementation in my lifetime either. We're close in age, if I remember correctly.

Originally Posted by Eric the Green

Careful bouncer, your type is too big.

well, someone complained that it was too small when i used size 4.

and i like garamond. the forum offers a variety of fonts. why not use them?

Originally Posted by princeofcats67

I was the one who chose to re-cast Aliens, not Rani. I suppose some might find that annoying. Then again, some might find it rather annoying that some might attempt to discuss Healthcare on an MB that is primarily designed for discussions concerning Generational Dynamics.

this thread is almost five years old. clearly there's an interest in discussing the topic.

and if you're going to have a thread devoted to snark, it's not going to break anyone's balls to talk about health care.]

Besides, from my POV, Rani's the only member here who has some semblance of experience i/r/t Healthcare from the perspective of a medical doctor.

but that is not the only perspective that needs to be taken into account here.

Ultimately, I have no desire to gain entrance into the "Hypocrisy Room" at "Club Certainty". So, I guess as long as you're having fun, why criticize others for attempting to have some fun as well? Are my actions interrupting your serious discussion on Healthcare matters?


Prince

PS: And there's always the precious ignore-feature, for those so inclined.

i am not so inclined.