Presidential address

[DRCOOP2010]

So, let me first say that I'm no politician and I don't know much about the subject. I just wanna know what you all thought about the president's address tonight. With my extremely conservative, republican upbringing I try hard to put my bias aside but I can't help but be concerned.
First, where is the $900,000,000 for this new public insurance option going to come from? He said he's not increasing the national deficit one dime.

Secondly, what 'waste' (SPECIFICALLY!!)is he going to get rid of in today's healthcare system?

Thirdly, how is the fact that he will be reeming the insurance companies with laws going to affect us as providers?

Fourthly, did anyone else see how pissed off most of the republicans looked during that speech? (haha, had to throw that in there)

Lastly, on a more serious note, how do you feel as a PT or future PT in today's uncertain times? What are your concerns?

Try not to throw too many punches, I just want some more educated input.

THANKS!!!

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[DPT ATC]

First, I'd like to state that I dislike politicians from both parties. They are far more worried about remaining in office than actually doing the business that they were elected to do. That being said, I'm at least happy to see that someone (Obama) is actually trying to get something done. I agree that his plan is not perfect, but at least it is a start and hopefully will get something accomplished. I'll answer your questions to the best of my ability, should be interesting to see how everyone interprets his speech based on their own views.

First, where is the $900,000,000 for this new public insurance option going to come from? He said he's not increasing the national deficit one dime.

I thought he answered this clearly. The money will come from the expected savings from money that is already being spent on an inefficient healthcare system. Also, the "public option" he is proposing would still be supported by premiums paid by the covered individuals. The premiums will be cost contained due to competition and controlled costs of operation.

Secondly, what 'waste' (SPECIFICALLY!!)is he going to get rid of in today's healthcare system?

Our current system is full of waste and inefficiency. Every single patient in a SNF is placed into an ultra high RUG to obtain the highest possible reimbursement. There are patients "receiving" 90 minutes of therapy/day when they can only remain awake for 2 minutes at a time. There are also patients getting 90 minutes when they can only participate for 5 minutes at a time due to severely impaired endurance. This is a huge waste and abuse of the system. How much is spent on medical errors because of poor documentation, or illegible handwriting by doctors? How often do patients receive imaging studies when practice guidelines clearly state that they are not needed? I could go on forever with this one!

Thirdly, how is the fact that he will be reeming the insurance companies with laws going to affect us as providers?

Good question. I think only time will tell with this one, but hopefully an increased focus on prevention and wellness would help to further our profession.

Well that's all for now. Like I said before, at least someone is trying to do something. It is much needed.

 

[lee9786]

People say something like "we don't want third party payors making decisions on our healthcare." What lacks in their argument, is that we already have that with the private health insurance industry. The only way to get rid of it is to cut out the third party payor altogether and have the patient pay the doctor directly.

A way to increase the healthcare decisions being made from the provider is to give them the autonomy to make the appropriate healthcare decisions without having to consult the third party. They would simply just do what the patient needed in their skilled judgement. The problem with this though is that in our current model, the financial incentive is there to do more tests regardless of efficacy. The incentive to do more is not just do to fiscal reasons but also liability reasons. Docs do more tests to cover their butt in court when someone tries to sue them for everything they've got. Docs make more money for performing more specialized tests. So obviously to put the decision into the docs hands, you have to take away incentive to do what is unneccesary for delivering effective outcomes.

Now will a public plan drive private insurers out of business and lead to socialized medicine like many seem to fear? I would think no and here's why. First look at what some of the top private health insurance CEOs make as a salary for one year of work (http://sickforprofit.com/ceos/) Second add in the salaries of everyone making over six digits (I don't have the data but based on the CEOs numbers my guess is that there are plenty). After this look at how the insurance model works. It is based on a weighted risk. Basically enough people need to be paying in to make even for what is needed to pay out. The business model states that you maximize revenue and minimize costs. In the private health insurance sector you could translate this as “get money from the healthy and deny the sick.” It only makes sense with the business model to do this and by these standards these folks are doing the right thing. While this may work with say dealing with your car, when you deal with peoples lives an ethical component has to be added. The concept of health insurance should be to help those in need. This is the reason it was implemented in the first place.


Now will a public option drive private health insurers out of business? A public option will set the bar lower for private health insurance business, add competition to the sector, and drive down insurance premiums while increasing value. At any moment should the public option look like it will “take over” the health insurance sector the government should make new regulations for themselves to keep them from doing so. American citizens should put pressure on officials if this should happen and it looks like they aren't taking the appropriate action. If they don't the American people should protest by having everyone in unison not showing up to work until they do. That is the power of democracy. Competition drives down costs and increases service. The public option isn't going to be the most amazing thing under the sun. It won't offer everything and what it might offer might be able to be serviced better by a private-health insurance agency. It won't be all encompassing and there will still be room for private heath insurance. If at any time it does look like the governement is “taking over” the sector then it's time to look at your neighbor and make a stance for democracy.


Everyone thinks they have the answer (including me) without knowing all the details. I have a general understanding but I don't have numbers in front of me. I see the number that this will cost 900 million. I wonder half the time what these numbers really mean and how accurate they are. How much did we predict to spend on the iraq war? Well the cost is currently around 900 billion (http://www.nationalpriorities.org/costofwar_home). We have to look at the opportunity cost of not doing anything. If 900 million is needed to be spent on an infrastructure that is in it's current state headed for collapse, than I would support this as a taxpayor considering it will strengthen this infrastructure. If the President is willing to stand behind his claim that it won't cost a dime than I would certainly give it a shot. After all I wouldn't think he would do this if he didn't believe in it. After all he has to get re-elected doesn't he. How would it look at the polls if he didn't deliver on his promise? It's important to always keep this in perspective.

 

[DRCOOP2010]

DPT ATC, I like alot of what you're saying. The only thing I don't like is your certain speculation about my question regarding the 'waste'. I can point out waste too, but the fact is, people in Washington are going to be determining what waste is to them. I'm just nervous about what they will consider is waste and what is essential. I haven't heard of the president or anyone else outline what exactly they would cut and I was hoping someone had a good source. Not just opinion.

Lee, that was an awesome website! These stinking insurance CEO's and others drive up costs way more than the healthcare system itself. It's ******ed how much they get paid. I'm always nervous about change, but if this is instituted correctly it could be really good.

 

[DRCOOP2010]

PS thanks for the replies. DPT ATC, I hope you're not offended, I wasn't trying to antagonize you. I've seen abuse in SNF's too, but not to the extent that you're talking about. Maybe a couple minutes here and there to bump them up a unit, but nothing like what you said. If you've actually seen this you should be turning those people in. Sorry though, I just wanted a good, reliable source on that question.

 

[Hector82]

I agree with you Dr Coop and your following statement, "I can point out waste too, but the fact is, people in Washington are going to be determining what waste is to them. I'm just nervous about what they will consider is waste and what is essential."

For me it all comes down to personal control and options. I'm just not too keen on the government making my life choices. While we don't have total and absolute control with private health care,we at least have more options and selection power then we would with socialized health care.

Also, there is no competition with socialized health care... . There is no drive to produce better products at lower prices. Competition is the reason why goods and services constantly get better. With out competition there is no drive.

Finally, where is this money coming from? That's an awful lot of money to be spending in a recession.

 

[DRCOOP2010]

For clarification, he isn't proposing a socialist system of healthcare. He's proposing that the government create an entity that provides low-cost health insurance to those who can't afford the normal rates or have been denied for health reasons. He is also trying to get several laws passed to dictate how much insurance companies can charge for premiums and when or if they can drop people from their policies.

 

[Hector82]

Government is still stepping in...Controlling problems that exist because people lack accountability for their own lives. If something is provided to people for free. There is no drive, this plan promotes laziness and personal unaccountability.

Why should one work..when an individual can just be lazy and get HC for free? Yes, I realize that there are many people;kids, elderly, Single mothers that undoubtedly deserve these government benefits. However, I think many will just exploit this new plan much like welfare and other government aid. \

I just see a lot of potential problems down the road with the new plan. I'm a skeptic. I don't like it.

 

[truthseeker]

For clarification, he isn't proposing a socialist system of healthcare. He's proposing that the government create an entity that provides low-cost health insurance to those who can't afford the normal rates or have been denied for health reasons. He is also trying to get several laws passed to dictate how much insurance companies can charge for premiums and when or if they can drop people from their policies.

Coop, he is proposing a government entity to compete with the private industry that doesn't have to turn a profit or even break even like the rest of the industry does.

Society needs to get the consumer closer to the provider. Let the consumer shop for their services. How much does it cost to have a physical with your doctor? No one knows. How much does it cost to have a physical with the doctor across town? Again, no one knows. How much difference is there between the cost of a Chevy and a Lexus? we have a pretty good idea.

The ONLY thing I can see that might be good is to make insurance portable. Currently, the insurance companies have to be confined to a specific state or states. They are bound by the laws of that state, the practice acts etc . . . What a PT can do in South Dakota, they can't necessarily do in Arkansas.

It is socialism.

 

[Hector82]

Agreed. Truthseeker nicely put.

 

[DRCOOP2010]

OK, don't get me wrong, I don't agree with everything he's doing nor do I think it will be carried out just as he said it would. I'm just stating what he said in his address the other night. Your portable insurance idea is good, but there's only one problem. Generally, American people are lazy and aren't going to go online and look for insurance companies all over the country when Joe Blow down the street will give them a rate that's just a little higher than what they might find on the internet. But that's your opinion. My idea of a solution would be to put caps on salaries that CEO's can make, both in insurance and healthcare. Could you imagine if we put a million dollar/year salary cap on CEO's and COO's? That would put millions and probably even billions of dollars back into the industry. I'm busting my hump in school right now and I'm probably going to max out someday at around $100k/year, and I'm perfectly fine with that. I'll be more than happy to have it. They should be able to live on 10x that much with no problem! If I had to guess I would say that administrative greed makes up for alot more of the escalating costs than abuse of the system in healthcare.

 

[tjaze]

OK, don't get me wrong, I don't agree with everything he's doing nor do I think it will be carried out just as he said it would. I'm just stating what he said in his address the other night. Your portable insurance idea is good, but there's only one problem. Generally, American people are lazy and aren't going to go online and look for insurance companies all over the country when Joe Blow down the street will give them a rate that's just a little higher than what they might find on the internet. But that's your opinion. My idea of a solution would be to put caps on salaries that CEO's can make, both in insurance and healthcare. Could you imagine if we put a million dollar/year salary cap on CEO's and COO's? That would put millions and probably even billions of dollars back into the industry. I'm busting my hump in school right now and I'm probably going to max out someday at around $100k/year, and I'm perfectly fine with that. I'll be more than happy to have it. They should be able to live on 10x that much with no problem! If I had to guess I would say that administrative greed makes up for alot more of the escalating costs than abuse of the system in healthcare.

actually, CEO salary will probably only save a billion or two at most. not that they don't deserve to die in a horribly painful way.

but to make my point, the healthcare mess has way too many factors to fix in one bill. a more intelligent approach would be to make small changes, review the consequences, and then decide from there. for example, problems include

1)Culture - fat, lazy, want everything for free - not most people, but enough to bring everyone else down with them. also, america is way more heterogenous and has a larger population than any other developed country out there. what works for the netherlands will never work in america.

2)Defensive Medicine - most doctors don't order more tests for profit, but to make sure their life isn't destroyed by one malicious lawyer/patient combo. tort reform won't IMHO help this because a cap still doesn't prevent a lawsuit. the only solution is removing trial lawyers and juries/judges from the mix. a third-party of experts (and real experts, like doctors) to review cases and decide. that's truly the only way a doctor gets a fair trial because another doctor is way less likely to be swayed by emotional tactics (which was how edwards won his cases)

3) old people - healthcare costs will NEVER decrease until we stop admitting 90+ yr old demented patients for 15 day hospital stays. you either get to keep grandma alive or healthcare costs reasonable. can't have both.

4) Technology - as long as innovations keep happening, there will always be another test we can order to catch one more cancer earlier. and this costs money.

5) Profit - unfortunately, some people have no problem denying claims based on an unreported case of acne to make a couple hundred thousand more.

And the list goes on and on.

People can advocate single-payor forever but it will most likely end up like medicare and ss and spend more than it takes in and will eventually destroy the american economy and leave the U.S. no longer a recognized country. The reason single-payor works so well in other countries is because they their populations are much more similar, much less fat, value similar things, work more, are less greedy, sue less, etc, etc.

just my 2 cents

 

[soccer31]

So it seems to me some people are missing what that really means. You guys are saying that competition needs to occur in a capitalism world in order for things to be competitive and for you, as a consumer, be able to do research and pick what is better for you. I agree 100% with that! However, thats why Obama is creating the public option! By having a non-profit public insurance, the government will be able to provide healthcare at a competing price for those who want it or need it. Key word = want. If you don't want it, them stick with your "private for-profit healthcare 'soulless vampire bastards making money off human pain." (That quote is from Bill Maher but it couln't be more accurate). Now, with public insurance bringing prices down, what is going to happen if private insurance companies want to survive is that they will need to completely revise their costs, premiums, and policies in order to stay in the market. And isn't that what capitalism is about???

 

[lee9786]

The point with the private health insurance CEO's making so much really has more to do with the fact that they will survive an influx of competition. The goal of intervention is to decrease costs and increase service. That is the point of competition. The annual increase in health insurance premiums and the data pointing to the exorbitant salaries of the health insurance CEOs tells me that outside intervention of some type is necessary. Now if hard working, contributing members of society were not denied coverage when they needed it most and resulted to selling their homes to help finance their lifeline than maybe I wouldn't think like this and have sympathy for insurance industries.

The point is healthcare is a public service that has a human element which is driven by ethics. The business model doesn't make decisions based on morale reasoning and is simply designed to maximize revenue. Their is a conflict of interest. The CEO's job isn't the equivalent to a brain surgeon so why pay them like one. Why not use the resources to pay for brain surgery. It will be going to the people that deserve/need it.

If you add up the salaries from all of the private health insurance CEOs you might not be able to pay for healthcare overhaul, but how many lives does 30 million a year save? It at least could be alloted to what people are paying for and not to fund someone's private luxury plane. You could pay someone 200k/year to oversee what these CEOs do and save a tremendous amount of overhead. If the thought process changes from how can we maximize revenue to how can we make this a more cost effective and efficient system than that is good from my perspective.

The goal is to increase competition and not to take over the entire sector. Unless that happens this isn't socialism. If it is socialism than we are already dealing with it with medicare and medicade and need to redefine the term. I don't know if a public option is the answer. I do know that more hard-working citizens need to be able to attain healthcare at a reasonable cost.

 

[DRCOOP2010]

So it seems to me some people are missing what that really means. You guys are saying that competition needs to occur in a capitalism world in order for things to be competitive and for you, as a consumer, be able to do research and pick what is better for you. I agree 100% with that! However, thats why Obama is creating the public option! By having a non-profit public insurance, the government will be able to provide healthcare at a competing price for those who want it or need it. Key word = want. If you don't want it, them stick with your "private for-profit healthcare 'soulless vampire bastards making money off human pain." (That quote is from Bill Maher but it couln't be more accurate). Now, with public insurance bringing prices down, what is going to happen if private insurance companies want to survive is that they will need to completely revise their costs, premiums, and policies in order to stay in the market. And isn't that what capitalism is about???

Bill Maher is a jackass and shouldn't be allowed to be on TV. I wouldn't listen to anything that guy says even if it does sound right.

 

[PharmDan2]

I hate you drcoop. Bill maher is friggin hilarious.

 

[MIDPT2012]

Bill maher is friggin hilarious.

I wish SDN had a like button like facebook does

 

[DRCOOP2010]

Sorry people. I'm a Christian, and Bill Maher belittles people like me. I don't care if people think he is funny. The fact is, he's wrong.

 

[soccer31]

Bill Maher is a jackass and shouldn't be allowed to be on TV. I wouldn't listen to anything that guy says even if it does sound right.

ok maybe he is wrong and God does exist, thats not the point here. You are not going to listen to him because he is not christian or believe in religion at all? And just because of a person's beliefs you will not listen to him/her even if he/she is right??? He is not wrong about everything, is he? insurance companies are just solely after your money and couldn't care less about your health. Thats a fact and you can't deny it. Hopefully you will open up your mind about things....

It feels good to know that others here also like him

 

[PharmDan2]

I guess I like him cuz im an atheist too lol.... Besides the fact that he is friggin hilarious.

 

[DRCOOP2010]

I turn a deaf ear to Bill Maher because he leads millions people (including you guys) astray from reality. He probably throws in alot of intellectual stuff and may even be a pretty smart guy, but the core of what he believes and how he views life couldn't be more wrong. I honestly don't know how you can be a good medical professional and not believe in God. We are responsible for people's lives and well-being. People come to us when they're hurt, scared, and confused and rely on us to provide good, loving care to them in their time of need. Being a Christian and having the Holy Spirit within me gives me the compassion, empathy, and, most importantly, love to deal with people in these situations. You can say 'well I'm a good person. I treat patients well and they get better.' The fact of the matter is patients need physical healing but they usually need mental and spiritual healing as well. That is something that often gets lost in the academia of physical therapy and other professions. I'm fortunate enough to go to a faith-based school where these values are taught.

Don't get me wrong guys, I'm not judging you, looking down on you, or anything like that. I just want you to know that there is more to what you're doing than meets the eye. Food for thought.

 

[Hector82]

Someone should close this thread.

 

[MIDPT2012]

Being a Christian and having the Holy Spirit within me gives me the compassion, empathy, and, most importantly, love to deal with people in these situations.

I wish being a Christian also meant that you didn't refer to people as ******ed in other posts. (see http://forums.studentdoctor.net/showthread.php?t=662891)

I do not practice any religion, yet I have compassion, empathy, and love - and I also know not to judge - or name call.

Ok, I'm off my high horse now.

 

[DRCOOP2010]

OK, apparently this is a sore subject and people are now drudging up my old posts and pointing fingers at me. That's what people do to Christians though. You point fingers to make yourself feel better. We're saved by grace through faith and we're not perfect. Me using the word '******ed' was just me ranting and using a figure of speech. I'M NOT PERFECT and I recognize that. Guess what - you're not either. I wasn't actually referring to people with mental disabilities. I'm sure you've used that term too. Someone should definitely close this post. I could say more but I won't because you guys are ganging up on me. I'm done with this forum.

 

[Cronos]

Calm down and don't take it so personal. No one is perfect and people will make fun of each other, it's a fact of society. You are being just as offensive as the people you are arguing with.

Being Christian can bring nice qualities to the field, but just because someone is not Christian does not mean they lack those exact qualities. People have different beliefs, that's just the way it is.

Anyway it was a good discussion for awhile. I always like gathering different points of view on the healthcare topic and some good information was presented.

 

[soccer31]

I agree that this post should be deleted because it is going into completely other things. I would just like to say however that you DO NOT need to believe in God to be a good medical professional. I am agnostic and I am doing as well as anybody else, regardless of religion. I also apologize if something I wrote previously got distorted and started this whole new debate, I was just pointing out what I think about the healthcare reform.

 

[Cyres]

1) One does not save money by spending money.
2) One does not save money by creating a goverment program.
3) Medicare and Medicaid are pre-existing examples governed health programs, their performance fortells the economic and beurocratic disaster of "Obama care".

 

[truthseeker]

So it seems to me some people are missing what that really means. You guys are saying that competition needs to occur in a capitalism world in order for things to be competitive and for you, as a consumer, be able to do research and pick what is better for you. I agree 100% with that! However, thats why Obama is creating the public option! By having a non-profit public insurance, the government will be able to provide healthcare at a competing price for those who want it or need it. Key word = want. If you don't want it, them stick with your "private for-profit healthcare 'soulless vampire bastards making money off human pain." (That quote is from Bill Maher but it couln't be more accurate). Now, with public insurance bringing prices down, what is going to happen if private insurance companies want to survive is that they will need to completely revise their costs, premiums, and policies in order to stay in the market. And isn't that what capitalism is about???

But soccer, If the government has a plan, the private insurance providers cannot compete because they have to turn a profit. If the government goes overbudget (like they do every year in almost every department) they just tax us more. If blue cross goes overbudget, people lose their jobs or they close offices or they go out of business because they don't have the power to take our money without our consent.

 

[PharmDan2]

I honestly don't know how you can be a good medical professional and not believe in God.

Dude. Please tell me you are kidding. The fact that I believe in scientific theory and not in ancient religious texts means I'm not a kind, caring, compassionate person? If I have to look forward to working with judgemental individuals like yourself then I am definitely not going to enjoy working in the medical profession.

One question though, do you believe in zeus? If not, I guess you wont make a good medical professional.

 

[truthseeker]

I honestly don't know how you can be a good medical professional and not believe in God.

Dude. Please tell me you are kidding. The fact that I believe in scientific theory and not in ancient religious texts means I'm not a kind, caring, compassionate person? If I have to look forward to working with judgemental individuals like yourself then I am definitely not going to enjoy working in the medical profession.

One question though, do you believe in zeus? If not, I guess you wont make a good medical professional.

I think what coop is saying is that the more we know, the more complex the system gets. For those who believe in intelligent design (creation) over straight natural selection, they feel that it supports their point of view. I don't think it had anything to do with a judgment about you or anyone else.

I am not a religious person but it is ironic that those that call the right "intolerant" don't tolerate any opposing viewpoint and try to silence them. (see the post that said -"I think this thread should be closed" ) I could go off on a political rant but I don't have the energy right now.

Lighten up man.

 

[PharmDan2]

ur right truthseeker. I need to lighten up, but its hard to when I hear such idiocy. I guess I just need to laugh in the face of stupidity rather then try to reason with it.

 

[PharmDan2]

I think what coop is saying is that the more we know, the more complex the system gets. For those who believe in intelligent design (creation) over straight natural selection, they feel that it supports their point of view.

I guess it kills me to think I try so hard in school and work so diligently in life to be a PT and someone can so easily discredit that by saying I don't have the basic function of compassion as a PT because my beliefs are different.

Rant over!

P.S. : What do you mean the more we know, the more complex with system gets? This is the opposite of what coop is saying. A belief in god is a simple one which is the opposite of the complexity of science.

 

[truthseeker]

I guess it kills me to think I try so hard in school and work so diligently in life to be a PT and someone can so easily discredit that by saying I don't have the basic function of compassion as a PT because my beliefs are different.

Rant over!

P.S. : What do you mean the more we know, the more complex with system gets? This is the opposite of what coop is saying. A belief in god is a simple one which is the opposite of the complexity of science.

you can move your arm because you chose to. But think of all of the things both macro and micro that have to happen before that actually happens. from the sodiium/potassium flux of an action potential, to the replacement of those ions where they need to be against a gradient, to the neurotransmitter jumping across the synaptic gap to the tropomyosin moving and the ratchet effect of the muscle contraction. This doesn't even consider the actual biomechanics of the joints involved, the concept of "intention" that people with apraxia have problems with. Then you have the people with no physical problems and dementia so there is another entire field of health science that is very poorly understood.

There was a series on HBO years ago called "Tales from the Crypt". One episode a guy somehow got the nine lives of a cat. The mad scientist who gave them to him used him at carnivals. He would kill the guy in spectacular ways, then retrieve him later and make tons of loot. After their 3rd or 4th one, they were in a car travelling to the next event and the guy with the powers said something profound: "isn't it amazing how we can be 99% healthy and still be dead?" or something like that.

My point is that anytime we think we have something figured out, there always seems to be another step. Seemingly infinite detail. Those with religious beliefs would say that science simply tries to explain what we see but the actual evolution of it all was started by a Creator. I am starting to sound like a zealot probably but it is far from the truth. I don't think I have been to church except for a wedding for over a year so take what I say for what it is worth. I don't know what the truth is hence the name "truthseeker" and I have a hard time believing that there is a supreme being guiding my every move/option/decision/circumstance but when you look at the sheer complexity of something as simple as a planarian and how it can actually surrvive and divide and eat and live, let alone something as complex as a human being, it is easy to see why some people believe that it is too complex to have evolved the way Darwin says we did. I really don't know where I stand on that one but I can say that the more I learn, the less gravity Darwin has for an exclusive explanation of why we are the way we are.

I used to believe that Natural Selection was the only factor in determining the "origin of species" but it just seems too complex. Yes I believe that selection occurs, how can you not believe it with people breeding corn plants that can live on the moon or whatever, but I think that there might have been something else working as well.

end of sermon