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sactowndog

Is agreement on healthcare possible?

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2 minutes ago, Joe from WY said:

Could also push for the establishment of more medical schools too. The AMA has a vested interest in keeping the small number down. Adding to that number would increase the supply of doctors. 

At the cost it is currently, I think you'd have a hard time getting more people interested.  The more people you make spaces for, the less qualified candidates you get as well.  There's more than one reason they keep it competitive to get in.

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26 minutes ago, Jack Bauer said:

That's your breakdown?  I'd say the biggest draw on the overall medical system isn't doctors, drugs, or hospitals.  It's the increasing bunch of muckety mucks that don't produce or do anything besides increase regulatory burden.  We've increased over the 12 years in droves with the suits upstairs.  I wouldn't say they produce any tangible product that justifies their salary, but they sure like to tell us what we need to be doing. 

growth-in-administrators.jpg

This is your problem, which in part is due to the government, due to nonsense and compliance with all of their stupid, regulated programs. 

How are you going to address drug pricing when the rest of the world won't pay their fair share?

This is what happens when you socialize a portion of the economy.  Every step from creating the VA, medicare, Medicaid, ObamaCare ect... creates massive inefficiencies and causes massive increases in costs.

If we were able to reduce federal control and spending on medical care to a tax credit.   This would allow us to return to the efficiencies of 1965 and the capitalist system would find even more ways to save money through competition and innovation that our current socialist system won't allow.

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35 minutes ago, Jack Bauer said:

That's your breakdown?  I'd say the biggest draw on the overall medical system isn't doctors, drugs, or hospitals.  It's the increasing bunch of muckety mucks that don't produce or do anything besides increase regulatory burden.  We've increased over the 12 years in droves with the suits upstairs.  I wouldn't say they produce any tangible product that justifies their salary, but they sure like to tell us what we need to be doing. 

growth-in-administrators.jpg

This is your problem, which in part is due to the government, due to nonsense and compliance with all of their stupid, regulated programs. 

How are you going to address drug pricing when the rest of the world won't pay their fair share?

Holy Jesus. Just that chart alone makes my corporate clinic idea worthwhile

23 minutes ago, Jack Bauer said:

At the cost it is currently, I think you'd have a hard time getting more people interested.  The more people you make spaces for, the less qualified candidates you get as well.  There's more than one reason they keep it competitive to get in.

So is more nurse practitioner/ pa positions an answer?

Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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1 hour ago, sactowndog said:

Patents are offered to inventors as a reward to their innovation.  It's not tied to their regulatory burden.

  

If you don't understand how the regulatory burden creates a high barrier to innovation that requires patent protection to overcome, then you are the one who doesn't understand economics.

1 hour ago, sactowndog said:

Potentially patent protection should be extended for drugs addressing critical functioning or life in depth but only in return for caps in pricing.   

You're killing innovation with price caps. Patented drugs don't just pay for their own development, they foot the cost for the development of future drugs and the failures along the way.

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We’re all sitting in the dugout. Thinking we should pitch. How you gonna throw a shutout when all you do is bitch.

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20 minutes ago, thelawlorfaithful said:

If you don't understand how the regulatory burden creates a high barrier to innovation that requires patent protection to overcome, then you are the one who doesn't understand economics.

You're killing innovation with price caps. Patented drugs don't just pay for their own development, they foot the cost for the development of future drugs and the failures along the way.

I'm saying many products get patents.  Parents are provided regardless the level of regulation.

Again I haven't set a return. Their are lots of ways to calculate acceptable returns.  Multiples of R&D investment is one option which may not be perfect but again I'm open to discussion around a fair and balanced approach for these specific class of drugs.

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2 minutes ago, sactowndog said:

I'm saying many products get patents.  Parents are provided regardless the level of regulation.

Again I haven't set a return. Their are lots of ways to calculate acceptable returns.  Multiples of R&D investment is one option which may not be perfect but again I'm open to discussion around a fair and balanced approach for these specific class of drugs.

You are a complete idiot.   Socialist policies don't work moron.  Refer to the 20th century to educate yourself dumbfuck.

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1 hour ago, bluerules009 said:

You are a complete idiot.   Socialist policies don't work moron.  Refer to the 20th century to educate yourself dumbfuck.

Still waiting on that definition of diminishing utility.  Try google.  Apparently you can use a computer.

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2 hours ago, happycamper said:

Holy Jesus. Just that chart alone makes my corporate clinic idea worthwhile

So is more nurse practitioner/ pa positions an answer?

I think they could be but they will function better with automation to provide preliminary diagnosis.   The medical information system established by Obama could be used here.

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3 hours ago, Joe from WY said:

Could also push for the establishment of more medical schools too. The AMA has a vested interest in keeping the small number down. Adding to that number would increase the supply of doctors. 

The AMA really doesn't have much influence on any graduate education anymore. Several years ago, they put out a statement that they encouraged more medical training programs contradicting the impression that the organization is against more doctors. It's more about the funding since Medicare pays the lions share of graduate medical education. You know they aren't getting any more funding in the current environment. Not only that, many states are requiring doctoral programs for nurse practitioners and nurse anesthetists which seems to defeat the purpose of more readily available practitioners. Might as well go to medical school then. In any case, the supply of medical providers isn't going to keep up no matter if it's the ACA or the new program, which I guess will do more to decrease health costs since fewer will be able to access and use their benefits.

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3 hours ago, happycamper said:

So is more nurse practitioner/ pa positions an answer?

We are cheaper labor that can fill gluts in coverage but it has the same parallel IMO.

Sensible oversight and regulations.  Good luck.

Nothing to really say here.....except GO MWC!!

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4 hours ago, Jack Bauer said:

That's your breakdown?  I'd say the biggest draw on the overall medical system isn't doctors, drugs, or hospitals.  It's the increasing bunch of muckety mucks that don't produce or do anything besides increase regulatory burden.  We've increased over the 12 years in droves with the suits upstairs.  I wouldn't say they produce any tangible product that justifies their salary, but they sure like to tell us what we need to be doing. 

growth-in-administrators.jpg

This is your problem, which in part is due to the government, due to nonsense and compliance with all of their stupid, regulated programs. 

How are you going to address drug pricing when the rest of the world won't pay their fair share?

This is why I yield the floor to Bauer (and despite that he is a Coug, dude is nails in breaking this all down.....and now I'm nauseous).

 

Nothing to really say here.....except GO MWC!!

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1 hour ago, bluerules009 said:

You are like the retard babbling about the shit balls you rolled down the hallway and wondering why no one else thinks they're important.

Man this is a great insult, I might have to steal it for elsewhere. 

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Remember that every argument you have with someone on MWCboard is actually the continuation of a different argument they had with someone else also on MWCboard. 

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7 hours ago, happycamper said:

Holy Jesus. Just that chart alone makes my corporate clinic idea worthwhile

So is more nurse practitioner/ pa positions an answer?

I mean, yes and no.  It's pretty fluid with the amount of people coming and going from year to year.  You can see the curve upward is pretty small for physicians entering the market.  Midlevels (NP/PA's) make care more readily available, but you still run in to the same problems if your clinic isn't taking new patients who have Medicaid/Medicare.  Medicaid of any sort needs to reimburse better so you can get more people interested in taking it.  I get it's for the poor, but you really only see the really new guys taking it, and they get full on it pretty fast.  You can't have over a certain percentage of it, or you'll never meet your overhead burden, which can often be 20-30k per month.  Doctors that are new will take it and hope to God that people get off of it and get commercial insurance eventually so they can turn a profit at some point.  I've said a lot of times, it doesn't matter if people have insurance if those who are providing the care aren't interested in taking that insurance. 

 

4 hours ago, NMpackalum said:

The AMA really doesn't have much influence on any graduate education anymore. Several years ago, they put out a statement that they encouraged more medical training programs contradicting the impression that the organization is against more doctors. It's more about the funding since Medicare pays the lions share of graduate medical education. You know they aren't getting any more funding in the current environment. Not only that, many states are requiring doctoral programs for nurse practitioners and nurse anesthetists which seems to defeat the purpose of more readily available practitioners. Might as well go to medical school then. In any case, the supply of medical providers isn't going to keep up no matter if it's the ACA or the new program, which I guess will do more to decrease health costs since fewer will be able to access and use their benefits.

I have a NP student with me right now, who's been coming a few days a week since January.  He's getting his doctorate, he's a nurse with 5-6 years experience in the ER and in the cardiac ICU.  He does a great job.  Lots of experience, thinks of good differential dx, knows what labs mean, etc.  One of the best students I've had due to his extensive experience.  He's dawdled through school and it's taken him forever.  He should have just become a doc, given how he's been going to school part time forever and working full time.  He's in his 30s.  With how long he's been in school, it's the epitome of taking your time and not getting out fast, and kind of defeats the purpose of a midlevel provider

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13 hours ago, Joe from WY said:

Could also push for the establishment of more medical schools too. The AMA has a vested interest in keeping the small number down. Adding to that number would increase the supply of doctors. 

Interesting fact is Kaiser is starting their own school so they can get more bi-lingual students and they don't have doctors with massive debt.

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5 hours ago, Jack Bauer said:

I mean, yes and no.  It's pretty fluid with the amount of people coming and going from year to year.  You can see the curve upward is pretty small for physicians entering the market.  Midlevels (NP/PA's) make care more readily available, but you still run in to the same problems if your clinic isn't taking new patients who have Medicaid/Medicare.  Medicaid of any sort needs to reimburse better so you can get more people interested in taking it.  I get it's for the poor, but you really only see the really new guys taking it, and they get full on it pretty fast.  You can't have over a certain percentage of it, or you'll never meet your overhead burden, which can often be 20-30k per month.  Doctors that are new will take it and hope to God that people get off of it and get commercial insurance eventually so they can turn a profit at some point.  I've said a lot of times, it doesn't matter if people have insurance if those who are providing the care aren't interested in taking that insurance. 

Do you see what you describe at the larger HMO's?  It may be a urban versus rural distinction and also account for some of your doctor suits numbers.   

In our area , Kaiser has gone after Medi-Care and Medi-Cal and is even working to establish a Med school to train more doctors that can serve under serviced areas.  

https://www.google.com/amp/www.latimes.com/business/la-fi-kaiser-medical-school-20160310-story,amp.html

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14 hours ago, Jack Bauer said:

That's your breakdown?  I'd say the biggest draw on the overall medical system isn't doctors, drugs, or hospitals.  It's the increasing bunch of muckety mucks that don't produce or do anything besides increase regulatory burden.  We've increased over the 12 years in droves with the suits upstairs.  I wouldn't say they produce any tangible product that justifies their salary, but they sure like to tell us what we need to be doing. 

BTW, while I don't disagree you want to cut the level of physicians versus administrators some of that growth is clearly attributable to the growth of HMO's and PPO's. To the extent those suits directly negotiate and reduce the costs it's probably a good thing.  It also likely reflects with HMO's an integration of insurance and healthcare markets to an extent as you see with Kaiser.  So in that case the data maybe misleading.  

Only one segment of healthcare is experiencing significant price inflation: prescription medicine.  Hospital and doctor care has seen increased usage but not significant price growth.   You can't address costs in medicine unless you address prescription medicine costs which are increasing at or near double digits.

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8 hours ago, sactowndog said:

BTW, while I don't disagree you want to cut the level of physicians versus administrators some of that growth is clearly attributable to the growth of HMO's and PPO's. To the extent those suits directly negotiate and reduce the costs it's probably a good thing.  It also likely reflects with HMO's an integration of insurance and healthcare markets to an extent as you see with Kaiser.  So in that case the data maybe misleading.  

Only one segment of healthcare is experiencing significant price inflation: prescription medicine.  Hospital and doctor care has seen increased usage but not significant price growth.   You can't address costs in medicine unless you address prescription medicine costs which are increasing at or near double digits.

I think that's a naive response.  You can treat most conditions inexpensively.  A few groups of drugs are contributing heavily to increasing costs.  Cancer drugs are expensive.  Autoimmune drugs are expensive.  Hepatitis drugs are expensive.  HIV drugs are expensive.  I can treat diabetes, hypertension, cholesterol, and all that stuff for pretty cheap.  Antibiotics are cheap.  Treatment for most ortho conditions is cheap.  

What I'm saying is there's a small group of conditions that are driving up significant cost, niche conditions that only a small portion of the populace experiences.  That doesn't mean they don't deserve treatment, but that's what this whole thread is about.  Where do you draw the line?  The company has billions invested in these medications.  They have several failed medications along the way that didn't make it to market.  They deserve to recoup those costs.  If you truly limit their income by setting prices, then you blunt the innovation and desire for people to invest in this stuff.  

EDIT: Hepatitis is being cured around the world due to the model we have in the US.  That was unimaginable 20 years ago.  I wish the medication was cheaper, but it doesn't even bug me that it's not.  If I had Hepatitis and there was a drug that cost 90k for treatment, I'd give my left nut for that.  I think they are going to cure Type 1 diabetes pretty soon.  Same with cystic fibrosis.  

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9 hours ago, sactowndog said:

If you intend to make insults your primary contribution to the conversation Tools is a great model.   

Every post you have made in the thread is an insult to all our intelligence.

You want to put price controls on drugs for instance.   An across the board fix you think.

So a company is looking at developing a drug for a rare disease that only has 100,000 patients a year is now out of business.  They will focus on something totally different because of our price controls.   Do you think that disease is going to get any research devoted its way under your plan.  Hell no with your plan only drugs with millions of possible customers will get looked at.  So you will encourage more investigation into little blue pills and dry eye drops but no drug will even be looked at to attack pancreatic cancer because they couldn't sell it for enough to make their money back.

This is just one obvious problem with your socialist ignorance.   You don't even have the intelligence or brains to understand the smallest part of the conversation moron.

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