Miscellaneous And Off Topic Subjects

[entropy]

btw.. I don't think Dr's pushed for preventative care. They were paid on a FFS. Keeping patients out of the doctors office wasn't the ultimate reward. Yes, they were not making them sick and yes they were giving them meds for treatment. But if people don't take the meds, don't exercise, etc.. just another FFS treatment. For years readmissions were repaid (and things like falls are no longer reimbursed as easily either.. some start to a pure FFS). How many tests are given because insurance will pay vs what the patient needs? Human nature is you respond to how you are rewarded.

If your Health System only received $X per patient regardless of their conditions, I bet you the current behaviors would not be replicated going forward.

[iam416]

I remember when AA used to be top shelf. Occasionally insightful, not dreadfully unfunny. He had it all. Now...woof...

AA=Anand Viswanathan
Talent=Magnus Carlsen

[AlabamAlum]

I remember when AA used to be top shelf. Occasionally insightful, not dreadfully unfunny. He had it all. Now...woof...

AA=Anand Viswanathan
Talent=Magnus Carlsen

At least you avoided calling yourself Morphy.

[AlabamAlum]

btw.. I don't think Dr's pushed for preventative care. They were paid on a FFS. Keeping patients out of the doctors office wasn't the ultimate reward. Yes, they were not making them sick and yes they were giving them meds for treatment. But if people don't take the meds, don't exercise, etc.. just another FFS treatment. For years readmissions were repaid (and things like falls are no longer reimbursed as easily either.. some start to a pure FFS). How many tests are given because insurance will pay vs what the patient needs? Human nature is you respond to how you are rewarded.

If your Health System only received $X per patient regardless of their conditions, I bet you the current behaviors would not be replicated going forward.

I think there is good evidence that most did via simple recs like diet, exercise, avoidance of ETOH, and the like.

[Jeff Buchanan]

Yeah, public health took a nose dive during the Reagan years (??) and even before when, to save money, the emphasis in that government sector changed from delivering basic care to educating the public who, by-in-large, promptly ignored it.

The clinic framework was there, it's gone now and would be costly to rebuild it but I definately share your view of the ER. It has become the access point for basic health care for those underinsured/uninsured. Talk about expensive.

Re R&D.........federal research grants with accompanying fast track FDA approval to market. This stuff also took big cuts so we could afford billion dollar aircraft carriers and stealthy fighters. Priorites. There can be a reasonable balance based on reasonable congressional debate minus the lobbyists but that is not likely to happen in our lifetimes if at all. Need some more brilliant incremantalism here and on this particular issue we're not likely to get it with PAH.

[Hannibal]

I'd be interested in knowing when health care insurance became a common benefit provided by employers (thanks to being a deductible expense vs. you paying tax on it as income). You can probably trace the spiraling-out-of-control costs back to that point

[entropy]

AA... I think recommending something is different than making sure it happens or incentivizing people to ensure it happens.

I view that as needed. As long as the consumer is absent from the choices or consequences most won't change


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[Hannibal]

If food was run like health care...

You would get "food insurance" as a benefit through your employer and your premiums would be deducted from your paycheck. You would go to the grocery store and there would be no prices on anything. You would fill up your cart, check out, and pay nothing as you left, but instead you would fill out a mountain of paperwork. A month later, you would get a statement saying that your grocieries cost $9,000, but since insurance covers $8,000 of it, you owe $1,000. You would go to the grocery store again next month, but this time you would decide that you want a box of Corn Flakes. But Corn Flakes might not be covered, so you would spend a half hour on the phone with "John" (who speaks with an Indian accent) to find out whether Corn Flakes are on your plan. It's an absolutely horrible system and I don't think I have heard any solutions that don't involve just rearranging the deck chairs on the Titanic.

[Wild Hoss]

Its cute that Jeff thinks we can get an aircraft carrier for a billion dollars.

[froot loops]

It became an employer benefit during WWII due to wage ceilings. It was deployed by employers to get workers because it wasn't considered a wage, therefore it was a way to entice workers.

[AlabamAlum]

AA... I think recommending something is different than making sure it happens or incentivizing people to ensure it happens.

I view that as needed. As long as the consumer is absent from the choices or consequences most won't change


Sent from my iPhone using Tapatalk

No one makes sure something happens now.

As far as incentive: concern, care, reputation, avoidance of lawsuits, and keeping a regular patient on your roster, paying you (i.e., alive and not seeking a new doc) were all incentives. The thought that the nominal reimbursement that docs get for preventative now are great motivators has been shown to be greatly overstated.

[Hannibal]

Its cute that Jeff thinks we can get an aircraft carrier for a billion dollars.

We can't even get a health care web site for a billion dollars!

[Wild Hoss]

If food was run like health care...

You would get "food insurance" as a benefit through your employer and your premiums would be deducted from your paycheck. You would go to the grocery store and there would be no prices on anything. You would fill up your cart, check out, and pay nothing as you left, but instead you would fill out a mountain of paperwork. A month later, you would get a statement saying that your grocieries cost $9,000, but since insurance covers $8,000 of it, you owe $1,000. You would go to the grocery store again next month, but this time you would decide that you want a box of Corn Flakes. But Corn Flakes might not be covered, so you would spend a half hour on the phone with "John" (who speaks with an Indian accent) to find out whether Corn Flakes are on your plan.

LOL.

...and you'd only be able to shop at certain grocery stores. And sometimes you wouldn't know if the checker was on your approved list, so you might get a $3,500.00 bill instead of $1,000.00.

[Wild Hoss]

We can't even get a health care web site for a billion dollars!

...don't get me started on CGI.

If the failures of privatized federal contracting had an acronym, it'd be CGI.

[Hannibal]

Trump changing his tone....

http://www.realclearpolitics.com/video/2016/08/18/donald_trump_apologizes_for_offensive_statements_i_speak_the_truth_for_everyone_who_doesnt_have_a_voice.html

Heh. I wonder if it will have any effect. Or if he will revert back to Republican Primaries Trump within a couple of days.