Ok....

Post #312,800 by Another Scott 8/19/09 5:48:48 PM Reply	Ok.... 1) How do you propose to cover more for less? By starting from the realization that we spend a lot more than any other industrial country and do not have better outcomes to show for it. We start to implement things that have been shown, in the US and elsewhere, to provide better care for less money. 2) How do you increase that coverage without expansion of service provision? See above. It's not rocket science. Details have been given, and are easily available. 3) How do you comfort anyone by pointing to a government run system that has been widely touted as broken? It's widely touted that .... That doesn't mean it's true. I would ask these people who say that government systems are broken, therefore we shouldn't let the government mess with it: We've tried tinkering with the health care system, letting the private sector control costs through competition, and cover everyone through competition for workers. It hasn't worked. Health insurance and health care costs are rising much faster than general inflation, outcomes are worse than in countries that spend far less, too many people lose coverage when they need it most, too many people can't get coverage due to unfair policies by the insurance companies. Folks that advocated letting the economy run itself and keeping the government out of health insurance have been running the show for most of the last 30 years. They strangled the middle class, they blew up the federal debt with little to show for it (Where's the bullet trains? Where's the flying cars? Where's the highly educated workforce that isn't saddled with huge debts? Where's the comfortable, secure retirement?) nearly drove the economy off a cliff, they said "No!" to providing health insurance to poor kids, "No!" to raising the minimum wage, "No!" to preventing the US auto industry from imploding over a few weeks, and so forth. They had more than enough time to prove the worth of their ideas. They lost the election. It's time for them to get out of the way and let the country try a new approach - one based on evidence rather than fear and tired old slogans. If you're worried about comforting people who are worried about their health coverage, I would think that you wouldn't help spread talking points of those who will use any lie to try to score political points. My $0.02. Cheers, Scott.
Post #312,808 by boxley 8/19/09 8:30:37 PM Reply	30 years my ass the only time the repo's ran the show exclusively was shrub 2 first term ist 2 years and it was a fucking disaster. Guess what, the dems are running the show exclusively and I predict the same result
Post #312,809 by Another Scott 8/19/09 8:34:13 PM Reply	Ronnie took office in January 1981. HTH.
Post #312,811 by boxley 8/19/09 9:28:01 PM Reply	with a democratic led house and senate which stayed that way except for 2000-2002. legislation is the business of the senate and congress, the executive carries out the legislation so bzzzt, try it again
Post #312,813 by Another Scott 8/19/09 9:46:16 PM Reply	The sea changed when Ronnie came in. It's not just the number of people on each side of the aisle. When Ronnie won, the whole debate changed. He convinced the political establishment that cutting taxes, greatly expanding the military, "getting government out of the way", etc., etc. was the way to go. That mindset continued under Clinton, with only slight modification. It was only when W made a mess of Iraq, of New Orleans, of the budget, etc., and when the economy imploded and all that his party-mates could offer was more of the same, only then did enough of the conventional wisdom change for the foundation for a future not built on Reaganomics to get a toe-hold. Compare major legislation in the 95th Congress (1977-1978) - http://en.wikipedia....Major_legislation - with that from the 109th (2005-2006)- http://en.wikipedia....Major_legislation - to see how much has changed. E.g. Clean Water Act versus Terri Schiavo.... The ship of state turns slowly. But it's turning. Cheers, Scott.
Post #312,815 by boxley 8/20/09 8:32:12 AM Reply	So you are talking in a macro sense where reagan took over from an economy in shambles, a foreign policy that was useless. Turned it around. Clinton tried to carry that forward and bush payed lip service to it then destroyed it. I will agree with that. Lets see what this sea change brings. thanx, bill
Post #312,824 by beepster 8/20/09 11:57:47 AM Reply	On #2 Details given? Models provided? Really? http://www.cnn.com/2...ortage/index.html "The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally." Legitimate concerns. Not being addressed in the D talking points and giving rise to the strength of the argument around rationing. I will choose a path that's clear. I will choose freewill.
Post #312,825 by boxley 8/20/09 12:04:29 PM Reply	dont confuse the issue with facts
Post #312,829 by beepster 8/20/09 12:47:26 PM Reply	Just think there are very many rational people with fairly basic (and rational) concerns that are being portrayed as irrational, misinformed and sometimes worse. I will choose a path that's clear. I will choose freewill.
Post #312,826 by drook 8/20/09 12:30:22 PM Reply	So we don't have enough doctors? Your argument is: 1) We don't have enough doctors now, based on the wait times to get accepted as a patient, plus the number of doctors not taking any new patients. 2) If we enact universal coverage, there will be even more people wanting access to a doctor, so wait times will get even longer. 3) Therefore universal coverage would require rationing the limited physician resources among an expanded customer base. Well sure, I suppose so. But I would argue that by simply denying healthcare altogether, you've already rationed it. Can you point me to the opponents of healthcare reform who are proposing, as an alternative, that we increase the number of available physicians? And a way to pay for them? -- Drew
Post #312,831 by boxley 8/20/09 12:50:16 PM Reply	Sure offer free medical school for a term of public health sevice. Allow PA's RN's to do a lot of primary care. Remove certain drugs from requiring a prescription. Pharmacists are very well trained on councilling effects with patients. Public health entities are a lot better at managing larger patient loads that private single practices with more support. examples http://www.nhchc.org...directory/AK.html http://www.nhchc.org...directory/NC.html http://www.nhchc.org...directory/FL.html some of these organizations also treat under or non insured people I have used the one in NC and AK when I had no health insurance. Professional and skilled folks. We need to increase their funding to accept more patients who are uninsured. They are a public/private partnership that has established a financial model that can be extended to the larger population that have lost their insurance. These folks use a front loaded funding base as well as filing claims to those entities that cover some of their patients. If I had health insurance I would still use them because they are efficient take something that works and grow it instead of pretending that the government can run a health insurance plan thanx, bill
Post #312,832 by beepster 8/20/09 12:51:56 PM Reply	Excuse me, but the point is that these concerns are NOT BEING ADDRESSED. So why do you then go ask me to find people addressing them? They aren't being denied. They are getting care in the more expensive emergency centers. So getting them coverage is supposed to save money. How, if we need to add expense to expand the area of coverage they are not receiving (primary) to offset the coverage they are (urgent care). Where's the savings? I will choose a path that's clear. I will choose freewill.
Post #312,838 by jake123 8/20/09 1:05:27 PM Reply	That's all well and good but somehow Everybody Else does what you're saying won't work, does it for less, and gets better outcomes. What is so esp. incompetent about Americans that they can't do it too?
Post #312,840 by drook 8/20/09 1:16:55 PM Reply	Addressing != asking Opponents of the Democratic plans keep shouting "No!" at the top of their lungs. To hear them talk, when they bother to make a coherent point (which may happen more than half the time, but it doesn't make the news) we have the best possible system in the world. Except, you know, don't let more people into it because there isn't enough of it to go around as it is. My question is, if the current system is already stretched beyond capacity, where were all these screaming people last year? Where were the organized protests against the inadequacies of the system last year? If people are quiet when a Republican proposes something, but scream in protest when a Democrat proposes the same thing, do you see why I might suspect that their concern isn't with the substance of the issue but with party politics? That's why Barney Frank's response was so dead-on. He called the woman out as someone who wasn't experiencing the same reality as him, and who wasn't interested in an honest debate. She, like everyone else who didn't speak up until the Democrats started pushing reform, didn't have any credibility. That's why yes, it does matter who is asking the questions. It's not worth the effort to debate policy with someone who is focused on ideology. -- Drew
Post #312,874 by beepster 8/20/09 9:58:23 PM Reply	So instead its better to just think everyone is that way...and not address any substantive issues. Okee dokee. I will choose a path that's clear. I will choose freewill.
Post #312,828 by Another Scott 8/20/09 12:41:54 PM Reply	I'll play, for a while... #1 - Dr. Pho is a physician in NH, not MA. It's not clear that he has any special insight on MA's system. #2 - He doesn't say where he gets the 36 to 50 days number from, other than it's from the MMA. He doesn't say what it was before MA required everyone to have insurance. He provides no context. In my looking around the MMA site, I see this: http://www.massmed.o...m&ContentID=30997 The Society strongly supported the enactment of the Health Reform Law (Chapter 58 of the Acts of 2006) and its full implementation. If it were a disaster for physicians and patients, I wouldn't think that the MMA would support it. The MA system is a work in progress and is being tweaked over time. IOW, it's being addressed by concrete proposals. Similarly with the federal bills. E.g. the ACP summary of HR3200 (13 page .PDF) - http://www.acponline...ss/hr3200_faq.pdf 10. How will AmericaÂs Affordable Health Choices Act of 2009 (H.R. 3200) help primary care? AmericaÂs Affordable Health Choices Act of 2009 (H.R. 3200) provides for an additional 5 percent increase, beginning in 2011, for designated evaluation and management services by general internists and other primary care physicians. The primary care bonus is increased to 10 percent for designated services in Health Professional Shortage Areas. H.R. 3200 also would increase Medicaid payments for primary care to be equivalent to Medicare. Although ACP continues to believe that a larger primary care bonus is needed-ACP has asked for at least 10 percent in all areas of the country Â 15 percent in health professional shortage areas. Even so, ACP believes that the recognition of the need to increase payments for primary care is an important step forward. The bill has extensive provisions to increase the supply and improve the training of primary care physicians. AmericaÂs Affordable Health Choices Act of 2009 (H.R. 3200) includes the following additional provisions to support primary care: [...] #3 - He links, apparently approvingly, to someone who says they don't have insurance by choice. http://www.kevinmd.c...-want-health.html It makes me suspicious of anything he presents. I don't feel like spending more time on his comments. HTH. Cheers, Scott.

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