RufRTs Obama Windup

[nimic]

I always shunned the phamaceutical reps that showed up at the hospital to advocate their drugs (most of them are hot though )...especially when docs were being taken to lunch/dinner and plied with bribes essentially, in order to prescribe specific drugs being flogged. I felt it was unethical and unsavoury. Big pharma costs would be easy to cut.... free market competition in this sector would be excellent (a very republican idea )

Look at the level of individual taxation going on in the UK and Canada.....are you really getting "free healthcare" ?

Isn't it a fact that the taxes in the US aren't so much lower than "the rest", though?

 

[MikeUpNorth]

Look at the level of individual taxation going on in the UK and Canada.....are you really getting "free healthcare" ?

No one has claimed we get "free healthcare". What we do have is a healthcare system which strains our economy a lot less and provides a better service (The World Health Organization's ranking of the world's health systems). Also, and this is the big point, it covers every citizen regardless of their wealth. It is free at the point of service.

I know Americans like to think they're world leaders in most things, and a lot of the time they are, but when it comes to healthcare their system is a disgrace.

 

[Team Brian GB]

Isn't it a fact that the taxes in the US aren't so much lower than "the rest", though?

One of the things I noted was that at least in the state of New York, parents have to pay an additional tax if they have children in school.

 

[Mockney]

He he, the power of the caf, even the WUMs end up talking sense in the end.

I was fairly sure the power of the caf was that even sensible posters end up talking nonsense in the end?

Excellent, excellent article.

Read this in its entirety.

I did, here's a better one

"Left-of-centre parties the world over might learn from this electoral disaster. They might start to understand why conservatism has an inbuilt advantage in all advanced democracies and why the near-collapse of the capitalist system has apparently done conservative parties no harm. Progressive parties can hope to overcome this only by ruthless unity and a narrow focus on limited goals.

The conservatives’ advantage is simple: they know exactly what they are trying to achieve. They seek to preserve, as far as possible, existing structures of economic privilege, power and social traditions. That means, of course, the preservation of the capitalist system. The more that it appears in danger, the greater will be the fear of change among the natural majority in any reasonably affluent society, and their main priority will always be to keep the privileges and lifestyles they enjoy. To achieve this, conservative politicians and voters are willing to bury all minor ideological differences and use every conceivable mechanism to keep power.

Progressives, by contrast, are united only by what they are against. They do not like the status quo, which they consider unjust. But once they gain power, as shown by the Democrats’ internecine struggles over healthcare, they are riven by conflicts. Because progressives are fighting for an infinite range of possible reforms, it is much harder to unite behind any specific programme.

The only way for progressive parties to win and keep power in modern democracies is to show great discipline in uniting around a clear and narrow agenda and to behave extremely aggressively towards their conservative opponents.

The Democrats’ failure to capitalise on the post-Lehman economic crisis could serve as an object lesson in how not to do this. Instead of heaping all the blame on the Bush Administration and the extreme free-market ideology of the congressional Republicans, the Democrats tried to pursue a bipartisan approach in Washington, while directing their political fire against bankers on Wall Street. The Republicans were delighted to join the rhetorical attacks on bankers, as it distracted from their own primary responsibility for the disaster.

The Democrats could have argued, quite justly, that what turned a relatively normal boom-bust cycle in housing into the greatest financial disaster in history was the Bush Administration’s incompetence and its ideological refusal to intervene in the mortgage markets and the banking system much earlier.

Instead, Mr Obama effectively exonerated the Bush Administration by accepting personal responsibility for the crisis from the moment of his inauguration. This was brave but foolhardy. As a result, voters now blame the Democrats, not the Republicans, for unemployment. Polls show that the Democrats’ $800 billion jobs and stimulus programme, which is partly responsible for pulling the economy out of recession, is widely confused with the hated $780 billion bank bailout package introduced by the Republicans under President Bush.

Contrast this with how Republicans handled the deeper economic crisis that confronted President Reagan in 1981. Democrats take some comfort that Reagan lost popularity during his first year just as quickly as Mr Obama, but went on to win a landslide victory in 1984.

The key difference, as noted by E. J. Dionne, the Washington Post political commentator, before this week’s Massachusetts debacle, was that Reagan refused to take responsibility for the economic crisis. Instead, he devoted the first two years of his presidency to convincing voters that this economic disaster was entirely the responsibility of Jimmy Carter and the liberal progressive elite. By the time that the economy started improving, voters were so convinced by this that the credit went entirely to Reaganomics.

The economic pattern of the early 1980s may well be repeated. The US economy is likely to start to recover strongly, with a growth rate of more than 5 per cent expected this month.

But it looks increasingly doubtful that Mr Obama and the Democrats will enjoy the benefits. Having won Massachusetts, the Republicans will have no compunction in claiming that what saved the US economy was the conservative backlash. If the Democrats fail to challenge them, this is the version of reality that American voters will start to believe."

 

[Team Brian GB]

I know Americans like to think they're world leaders in most things, and a lot of the time they are, but when it comes to healthcare their system is a disgrace.

One of the most ridiculous parts of it is that ambulances are not covered by many insurance schemes, one of my British friends feared he broke his ankle playing football but he called and waited for a taxi to the hospital because he was told an ambulance would cost him out of his pocket $500.

 

[Team Brian GB]

The Republicans were delighted to join the rhetorical attacks on bankers, as it distracted from their own primary responsibility for the disaster.

The Democrats could have argued, quite justly, that what turned a relatively normal boom-bust cycle in housing into the greatest financial disaster in history was the Bush Administration’s incompetence and its ideological refusal to intervene in the mortgage markets and the banking system much earlier.

The irony is in Britain it was the supposedly social democratic party that was responsible for the likewise boom in spending and lending, though unlike the American electorate, the British people hold Gordon Brown at least partially responsible.

 

[RufRT]

Here is a quick comparison of effective tax rates for developed countries. Add to this gasoline taxes/provincial tax/Goods and Services tax (canada) or VAT in the UK and you get the picture....nothing comes for free.

 

[RufRT]

"The Democrats could have argued, quite justly, that what turned a relatively normal boom-bust cycle in housing into the greatest financial disaster in history was the Bush Administration’s incompetence and its ideological refusal to intervene in the mortgage markets and the banking system much earlier"



Hmmm, this argument nicely ignores Barney Frank and Bill Clintons central role in deregulating mortgages so that Acorn/Fannie Mae could flog subprime mortgages to those that could never repay.

Spin goes both ways Mockney.

 

[Team Brian GB]

Here is a quick comparison of effective tax rates for developed countries. Add to this gasoline taxes/provincial tax/Goods and Services tax or VAT in the UK and you get the picture.

The United Kingdom isn't included.

 

[RufRT]

The United Kingdom isn't included.

probably better you don't see it Brian

 

[MikeUpNorth]

Here is a quick comparison of effective tax rates for developed countries. Add to this gasoline taxes/provincial tax/Goods and Services tax or VAT in the UK and you get the picture.

How about we add in college fees and insurance as well. And adjust for the fact that Americans get far fewer holidays a year.

 

[Pogue Mahone]

I always shunned the phamaceutical reps that showed up at the hospital to advocate their drugs (most of them are hot though )...especially when docs were being taken to lunch/dinner and plied with bribes essentially, in order to prescribe specific drugs being flogged. I felt it was unethical and unsavoury. Big pharma costs would be easy to cut.... free market competition in this sector would be excellent (a very republican idea )

Look at the level of individual taxation going on in the UK and Canada.....are you really getting "free healthcare" ?

There already is free market competition in this sector. It's the marketing budget that's paying for the reps you shun.

Besides, as we've established, it's the insane amount of spending on unnecesary investigations that's fecking up the US health service, not the spending on pharmaceutical treatments.

The NHS spends about 12% of it's total budget on drugs. I would imagine this figure is even lower in the US, where getting pissed, falling over and bumping your head is usually enough to warrant skull and c-spine x-rays, CT brain and full biochem work-up in a US A&E Dept. In the NHS the same patient would have a brief history/examination then given a couple of paracetamol and told to feck off home; with an identical clinical outcome.

 

[RufRT]

How about we add in college fees and insurance as well. And adjust for the fact that Americans get far fewer holidays a year.

Hmmm, I distinctly remember being charged more for car and housing insurance in Canada...essentially twice more.

I'll grant you college, although state universities are not outrageous.

How much does McGill charge per year ? You might be surprised Mike.

 

[RufRT]

There already is free market competition in this sector. It's the marketing budget that's paying for the reps you shun.

Besides, as we've established, it's the insane amount of spending on unnecesary investigations that's fecking up the US health service, not the spending on pharmaceutical treatments.

The NHS spends about 12% of it's total budget on drugs. I would imagine this figure is even lower in the US, where getting pissed, falling over and bumping your head is usually enough to warrant skull and c-spine x-rays, CT brain and full biochem work-up in a US A&E Dept. In the NHS the same patient would have a brief history/examination then given a couple of paracetamol and told to feck off home; with an identical clinical outcome.

Excellent point...so what is driving this Pogue ? You got it, LITIGATION out of control. We are back to Tort Reform

 

[Team Brian GB]

probably better you don't see it Brian

Oh I know how the figures would turn out, but the actual figures with regard to the National Health Service are pretty low as a figure of total government spending - about £110billion which is about 12% of government spending, as opposed to most estimates of the costs of QUANGOS coming in around £90-100billion and social welfare costing last year £165billion.

Education incidentally is about £80billion and defence £42billion.

 

[Pogue Mahone]

Excellent point...so what is driving this Pogue ? You got it, LITIGATION out of control. We are back to Tort Reform

Which is where you lose me, I'm afraid.

Is litigation really all that much worse in the US than everywhere else?

If so, why? And how would Tort Reform prevent this? (I can just about grasp what a Tort is but I don't know what type of reform you're talking about)

 

[MikeUpNorth]

All I know RufRT is that, from talking to my colleagues in the New York office, my standard of living is significantly higher than theirs for the equivalent role. For a start I get 26 days holiday a year (plus a load of public holidays), whereas I think they get 10-12 days a year. Also, their income is hemorrhaged by health care.

 

[RufRT]

All I know RufRT is that, from talking to my colleagues in the New York office, my standard of living is significantly higher than theirs for the equivalent role. For a start I get 26 days holiday a year (plus a load of public holidays), whereas I think they get 10-12 days a year. Also, their income is hemorrhaged by health care.

Don't compare anyone to someone living in NY...costs and taxes are ridiculous there.

 

[Team Brian GB]

How about we add in college fees and insurance as well. And adjust for the fact that Americans get far fewer holidays a year.

That is a very big shout, public universities that charge similar figures for their own state residents as British universities cost our nationals very barely figure in the top 100 rankings in the US, whilst our top universities are at the very top of the world rankings and give very generous loans that the Americans do not provide.

 

[Mockney]

Hmmm, this argument nicely ignores Barney Frank and Bill Clintons central role in deregulating mortgages so that Acorn/Fannie Mae could flog subprime mortgages to those that could never repay.

Spin goes both ways Mockney.

It does. Except the right are far better at viciously propagating it. After fecking up the world for 8 years, it's now all apparently the fault of the bloke who's been in charge for a year, and the bloke who was in charge 9 years ago...Brilliant.

 

[Team Brian GB]

Which is where you lose me, I'm afraid.

Is litigation really all that much worse in the US than everywhere else?

If so, why? And how would Tort Reform prevent this? (I can just about grasp what a Tort is but I don't know what type of reform you're talking about)

I found figures yesterday from the National Health Service Litigation Authority, that 1000 cases are investigated a year and total payouts for 2008/2009 were £805,000.

 

[MikeUpNorth]

Don't compare anyone to someone living in NY...costs and taxes are ridiculous there.

I live in London. Like for like.

 

[RufRT]

Which is where you lose me, I'm afraid.

Is litigation really all that much worse in the US than everywhere else?

If so, why? And how would Tort Reform prevent this? (I can just about grasp what a Tort is but I don't know what type of reform you're talking about)

I believe it most definitely is Pogue. In this country, a women was awarded $1 million dollars because she spilled a cup of McDonalds coffee in her lap and it was deemed by the Jury to be "too hot"...

I can tell you that docs in this country are under a constant spectre of lawsuit and do tailor their practice to order more testing. The common scenario described in court is as follows :

Plaintiffs Attorney : So doctor, when Mrs X came to your office, did you have test Z available at your disposal ?

Doc : Yes

Plaintiffs Attorney : Is test Z easy to perform

Doc : Yes

Plaintiffs Attorney : Would test Z have shown xyz ?

Doc : Yes, but the test wasn't indicated by the exam

Plaintiffs Attorney : Just answer the question doc, would Test Z have shown xyz ?

Doc : Yes

Plaintiffs Attorney : I rest your honour


Now, the point is Pogue that even if you take into account patient risk factors for a specific disease and the physical exam, you get crucified for a bad outcome even if you did everything correctly. A malpractice attorney simply has to convince a lay Jury of twelve that a test existed that could have saved Mrs X. For this reason alone, docs cover their arses by ordering more tests. If there was sensible Tort Reform, there would be limits placed on malpractice payouts and the number of frivolous lawsuits brought to trial. This would cut costs by billions of dollars. When an insurance company pays out, insurance premiums to docs go up. When doc premiums go up, they charge more and so on and so on.

 

[RufRT]

I live in London. Like for like.

Ummm, I don't know where you live in London, but I don't think there is a cheap area anywhere there ! Do you live in Brixton ?

 

[RufRT]

I found figures yesterday from the National Health Service Litigation Authority, that 1000 cases are investigated a year and total payouts for 2008/2009 were £805,000.

This is miniscule. In Ontario, last time I checked docs pay a 2k premium through the Royal College of Surgeons for malpractice insurance costs. Compare this to 80k for OB GYNs in the US or even higher for anesthesiologists/neurosurgeons.

Maybe Dr Dwayne can clarify the cost of malpractice insurance in Canada.

We're getting off topic here, this thread is supposed to be about demonstrating what a shite president Obama turned out to be

 

[RufRT]

gotta sleep, be back later to school you chumps

 

[MikeUpNorth]

I believe it most definitely is Pogue. In this country, a women was awarded $1 million dollars because she spilled a cup of McDonalds coffee in her lap and it was deemed by the Jury to be "too hot"...

I can tell you that docs in this country are under a constant spectre of lawsuit and do tailor their practice to order more testing. The common scenario described in court is as follows :

Plaintiffs Attorney : So doctor, when Mrs X came to your office, did you have test Z available at your disposal ?

Doc : Yes

Plaintiffs Attorney : Is test Z easy to perform

Doc : Yes

Plaintiffs Attorney : Would test Z have shown xyz ?

Doc : Yes, but the test wasn't indicated by the exam

Plaintiffs Attorney : Just answer the question doc, would Test Z have shown xyz ?

Doc : Yes

Plaintiffs Attorney : I rest your honour


Now, the point is Pogue that even if you take into account patient risk factors for a specific disease and the physical exam, you get crucified for a bad outcome even if you did everything correctly. A malpractice attorney simply has to convince a lay Jury of twelve that a test existed that could have saved Mrs X. For this reason alone, docs cover their arses by ordering more tests. If there was sensible Tort Reform, there would be limits placed on malpractice payouts and the number of frivolous lawsuits brought to trial. This would cut costs by billions of dollars. When an insurance company pays out, insurance premiums to docs go up. When doc premiums go up, they charge more and so on and so on.

That's not the way it should work. The way it should work is that an expert witness (another experienced doctor) is asked "Did the doctor act appropriately and in the best interests of the patient?" If the answer is yes, then there is no case to answer regardless of the outcome.

 

[MikeUpNorth]

Ummm, I don't know where you live in London, but I don't think there is a cheap area anywhere there ! Do you live in Brixton ?

I live in West London (borough of Ealing) and work in Kensington. It's not considered a particularly cheap area.

 

[Twisted_Woody]

This isn't going to help anything:

Supreme Court rolls back campaign cash limits - Supreme Court- msnbc.com


Might as well become USA Inc.

 

[Pogue Mahone]

This is miniscule. In Ontario, last time I checked docs pay a 2k premium through the Royal College of Surgeons for malpractice insurance costs. Compare this to 80k for OB GYNs in the US or even higher for anesthesiologists/neurosurgeons.

Maybe Dr Dwayne can clarify the cost of malpractice insurance in Canada.

We're getting off topic here, this thread is supposed to be about demonstrating what a shite president Obama turned out to be

That's very much in line with what we pay in the UK/Ireland. A friend of mine is an obstetrician who pays £110kStg as her annual premium

Which brings me back to my point of whether or not the threat of litigation in the US is more perceived than real, for whatever reason?

 

[Pogue Mahone]

I live in West London (borough of Ealing) and work in Kensington. It's not considered a particularly cheap area.

That's my 'hood, that is.

Cheap it ain't.

 

[RufRT]

That's not the way it should work. The way it should work is that an expert witness (another experienced doctor) is asked "Did the doctor act appropriately and in the best interests of the patient?" If the answer is yes, then there is no case to answer regardless of the outcome.

Right, and this is one aspect of Tort Reform..medical expert panels that decide the validity of a case before it goes to trial.

Trial Lawyers want no part of it...it doesn't matter to them whether the case has merit or not, only if it can be won

 

[RufRT]

This isn't going to help anything:

Supreme Court rolls back campaign cash limits - Supreme Court- msnbc.com


Might as well become USA Inc.

yep, not a big fan of buying elections

 

[McLovin]

Hmmm, I distinctly remember being charged more for car and housing insurance in Canada...essentially twice more.

I'll grant you college, although state universities are not outrageous.

How much does McGill charge per year ? You might be surprised Mike.

Around $17,000 a year for International students, which is considerably less than what top american universities charge. (I pay $3,000/year as a Canadian)

 

[RufRT]

That's very much in line with what we pay in the UK/Ireland. A friend of mine is an obstetrician who pays £110kStg as her annual premium

Which brings me back to my point of whether or not the threat of litigation in the US is more perceived than real, for whatever reason?

Well, part of it is the process of a lawsuit. Docs go through months of depositions, cases are backlogged and it might take 4-6 yrs to go to trial. In the meantime, you have to practice as though nothing happened....the pyschological stress of a malpractice lawsuit is no small matter.

Then, there is always the prospect of the insurance company deciding to settle before the case right before it goes to trial, in most cases out of sheer "bean counting" It is better to pay X dollars now instead of XXX dollars later (even if the case has no merit...)

If the case does go to trial, you have the prospect of your professional judgement beiing called into questioned and judged by 12 lay persons who may not understand the complexities/issues of the case at hand, but decide that Mrs X deserves "something". Malpractice attorneys don't care if the case has merit, they just want to win. 40% of 1-5 million bucks is a nice paycheck for 5 days in court.

I think this scenario is hammered into docs from the get go....and their practice is tailored to avoid the scenario, with resultant increase in test costs and test driven practices. My Mrs is a radiologist....she laughs at some of the reasons and thought processes behind ordered CT/MRI's...its ridiculous and solely CYA (Cover your Arse)

 

[RufRT]

Around $17,000 a year for International students, which is considerably less than what top american universities charge.

Top schools will always be market driven as well. Most people wouldn't balk at paying 30k yearly to attend an Ivy League School....it gets paid back in the end through better employment (or at least, thats the theory

See, free market economics are good for everyone

 

[Pogue Mahone]

Well, part of it is the process of a lawsuit. Docs go through months of depositions, cases are backlogged and it might take 4-6 yrs to go to trial. In the meantime, you have to practice as though nothing happened....the pyschological stress of a malpractice lawsuit is no small matter.

Then, there is always the prospect of the insurance company deciding to settle before the case right before it goes to trial, in most cases out of sheer "bean counting" It is better to pay X dollars now instead of XXX dollars later (even if the case has no merit...)

If the case does go to trial, you have the prospect of your professional judgement beiing called into questioned and judged by 12 lay persons who may not understand the complexities/issues of the case at hand, but decide that Mrs X deserves "something". Malpractice attorneys don't care if the case has merit, they just want to win. 40% of 1-5 million bucks is a nice paycheck for 5 days in court.

I think this scenario is hammered into docs from the get go....and their practice is tailored to avoid the scenario, with resultant increase in test costs and test driven practices. My Mrs is a radiologist....she laughs at some of the reasons and thought processes behind ordered CT/MRI's...its ridiculous and solely CYA (Cover your Arse)

The thing is, docs over here go through an almost identical process (as well as the potential horrors of the GMC raking through your affairs) but manage patients very differently (and considerably more economically)

I guess part of the reason is that if we started ordering loads of unnecesary tests we'd get push-back from the radiology department and our seniors, who hold the budget for the department and are aware that we're working in a system with finite resources. We all work to peer-reviewed, evidence based clinical guide-lines, which often factor in the economic impact of taking a particular course of action (Welcome to the National Institute for Health and Clinical Excellence) At the end of the day, if you adhere to these (rational and cost-effective) guidelines you are almost impervious to litigation, whether or not you investigate the bejasus out of each and every patient.

Maybe the defensive medicine practised in the US is part and parcel of working in a private system, where whatever test you want to do will be paid for by the insurers (and hence the poor cnuts paying private health insurance) almost without question? It all seems incredibly inefficient to me.

 

[hungrywing]

The thing is, docs over here go through an almost identical process (as well as the potential horrors of the GMC raking through your affairs) but manage patients very differently (and considerably more economically)

I guess part of the reason is that if we started ordering loads of unnecesary tests we'd get push-back from the radiology department and our seniors, who hold the budget for the department and are aware that we're working in a system with finite resources. We all work to peer-reviewed, evidence based clinical guide-lines, which often factor in the economic impact of taking a particular course of action (Welcome to the National Institute for Health and Clinical Excellence) At the end of the day, if you adhere to these (rational and cost-effective) guidelines you are almost impervious to litigation, whether or not you investigate the bejasus out of each and every patient.

Maybe the defensive medicine practised in the US is part and parcel of working in a private system, where whatever test you want to do will be paid for by the insurers (and hence the poor cnuts paying private health insurance) almost without question? It all seems incredibly inefficient to me.

But you don't have great American physicians like House - or those docs on ER, or Gray's Anatomy - to live up to. The American people demand healthcare comparable to that which is advertised on TV. If you don't solve the case within a maximum of two episodes, your ass is getting sued.

 

[RufRT]

The thing is, docs over here go through an almost identical process (as well as the potential horrors of the GMC raking through your affairs) but manage patients very differently (and considerably more economically)

I guess part of the reason is that if we started ordering loads of unnecesary tests we'd get push-back from the radiology department and our seniors, who hold the budget for the department and are aware that we're working in a system with finite resources. We all work to peer-reviewed, evidence based clinical guide-lines, which often factor in the economic impact of taking a particular course of action (Welcome to the National Institute for Health and Clinical Excellence) At the end of the day, if you adhere to these (rational and cost-effective) guidelines you are almost impervious to litigation, whether or not you investigate the bejasus out of each and every patient.

Maybe the defensive medicine practised in the US is part and parcel of working in a private system, where whatever test you want to do will be paid for by the insurers (and hence the poor cnuts paying private health insurance) almost without question? It all seems incredibly inefficient to me.

It is, but it can and should be streamlined. We are peer reviewed and guideline driven as well...except those guidelines typically take into consideration legal aspects as well as the right practice algorithm. I am convinced that you will only modify entrenched physician practice behaviours in the USA once the threat of malpractice is pared to reason.

 

[RufRT]

But you don't have great American physicians like House - or those docs on ER, or Gray's Anatomy - to live up to. The American people demand healthcare comparable to that which is advertised on TV. If you don't solve the case within a maximum of two episodes, your ass is getting sued.

too true