Miscellaneous And Off Topic Subjects

[Jeff Buchanan]

Starting with the premise that the provision of healthcare services in the US is inefficient, and I don't think you'll find a lot of disagreement on that from MDs, a smaller physician work force is entirely doable.

Studies have found that clinics delivering care can do so with far fewer MDs than are typically found within them. For example, the Mayo Clinic in Minneapolis in one study did the same amount of work that the Cedar-Sinai in LA did with 50.

This BS call from some quarters in education for more docs is more about getting young people to fork out the $250k (or take on the debt) it takes, sometimes way more, to get that MD degree. Medical education is big business and one of the most lucrative revenue streams in any institution providing that kind of training.

[iam416]

There was a time when insurance was catastrophic. Now it's comprehensive. The result (coupled with a number of other factors including the rise in malpractice costs) is a massive uptick in consumption of health services, many of which are unneeded. Physicians are incentivized through various mechanisms to recommend treatments -- whether it's drug company pushing a new drug or an overly cautious screening to guard against malpractice.

In any event, the US remains at the forefront in medical advances so it's not all bad. But, when I was in private practice and more or less paying the cost of my insurance plan, I very much wanted a low cost catastrophic option. At the time I think the value calculation was 3 years w/o a catastrophic event and it the premium differences paid for themselves.

[iam416]

The only way to make health care cheaper in the US without rationing it is to get employers out of the health insurance business, eliminate coverage mandates, and turn health insurance into actual insurance, not the socialized payment plans that they are now. Health care insurance shouldn't be used for anything but unforseen emergencies.

Heh. Hanni beat me to it. EFZ.

[entropy]

Large companies could be self insured. There is no reason they need to pay a markup for Insurance. In fact, I think in the ideal world, the role of insurance in healthcare would be greatly reduced.

Also, as talent pointed out... insurance has evolved. Now we want insurance to cover my cold. When it was first designed, it was for life threatening events. The model really hasn't changed other than charging more and negotiating with providers more...

Another issue is litigation. I don't blame people for suing when there are avoidable deaths (and there are more than we think)... But in college (back in the early 90's) my friends dad was a Kidney specialist in Buffalo NY. He paid 90K per year in malpractice insurance. And he had no claims according to his son...

[Ghengis Jon]

Not surprising. My wife has been in practice since 1991. Her malpractice insurance has rapidly increased over the last 15 years. The insurance company explains that across all specialties, the average doctor gets sued once every 8 point something years. With no suits in 25 years, she's 'overdue'. Yep. Insurance companies can/will use the law of averages instead of track history for premium rates.

The French have an interesting concept going. They cap the amounts you can sue for beyond actual damages in medical cases. You slip on your neighbor's sidewalk and sue? Actual damages, $50 pain and suffering, $100 punitive damage, legal fees. Thats it, although there are different amounts for different types of case. Amounts rise for malpractice cases, but P&S and punatives are all capped. France doesn't have the medical litigation problem we have in the US.

And yes, Obamacare is driving her out of business. Just the electronic input requirements force her hire an additional person for no benefit other than being able to receive reduced payouts. She's waiting for the economy to pick up a bit more and then she's selling the practice. She is so done with that shit.

[hack]

We disagree. IMO, materially altering the C/B calculus materially alters the outcome. But, that requires a belief in the rationality of humans. Crazy talk, I'm sure.

As an upside, we'd also see foreigners from countries with "more advanced" healthcare systems stop coming to the US for life-saving procedures and treatments and such.

fucking foreigners

We do disagree. It's very common to assume that a policy change will lead to the exodus of some group, and not just in the US. I think it's better to consider policy in context rather than out of it. I agree it has to be a costs/benefits anaysis. Not just benefits.

[Da Geezer]

Talent said:

There was a time when insurance was catastrophic. Now it's comprehensive. The result (coupled with a number of other factors including the rise in malpractice costs) is a massive uptick in consumption of health services, many of which are unneeded.

Correct. When something of value is free there will be a sharp increase in demand for it. I remember during the Reagan years, the Government decided to give away their stored cheese. Perfectly well-to-do folks would line up for the cheese when the "cheese truck" arrived. It was certainly better for the Government not to store the stuff and better for citizens. But the folks who lined up knew it was good cheese and it was free. I doubt if they would have paid even a minimal cost.

As Jon says, malpractice claims are exorbitant. The simple solution is to make a list of the maximum amount to be paid for any malpractice or negligence claim. For example, start with death being worth $ 1 million, and try to come up with a comprehensive listing and a "not to exceed" amount for each. Of course, you run into one of the most powerful interest group, the trial lawyers, and that kills the idea.

[Da Geezer]

This morning, I heard that Chairman Xi Jaoping of China was caught up in the Panama Papers. Pretty interesting since he has been routinely executing Chinese citizens for doing the same thing.

[Jeff Buchanan]

Thanks Doc Hodgeman for your comprehensive views on the myriad complex and interrelated problems in the US health care system. I remember your paper of a few years ago.

[Dr. Strangelove]

Big number of polls out today.

IBD ran all candidates against each other in a general election...Clinton easily beat Trump, solidly beat Cruz, but lost to Kasich. Sanders beats all three.

Nearly all the polls show Cruz and Sanders with good leads in Wisconsin but some group called ARG (?) has Clinton and Trump ahead. Their poll appears to be a significant outlier compared with others at RCP

http://www.realclearpolitics.com/epolls/latest_polls/

[Dr. Strangelove]

There was also a significant SC Decision yesterday that preserved the 'one person, one vote" principle in a unanimous decision...although Thomas apparently went along because he never dares question a state government.

http://www.theatlantic.com/politics/archive/2016/04/evenwel-ruling-supreme-court/470280/

[Hannibal]

Big number of polls out today.

IBD ran all candidates against each other in a general election...Clinton easily beat Trump, solidly beat Cruz, but lost to Kasich. Sanders beats all three.

Nearly all the polls show Cruz and Sanders with good leads in Wisconsin but some group called ARG (?) has Clinton and Trump ahead. Their poll appears to be a significant outlier compared with others at RCP

http://www.realclearpolitics.com/epolls/latest_polls/

The only head-to-head poll with any significance is Hillary vs. Trump, which is obviously troubling for Trump. Sanders, Cruz, and Kasich all are largely unknown and any general election poll that involves those guys is meaningless since a generic nameless candidate always has an advantage over a defined one.

[Wild Hoss]

Dont know how one can make the case that Ted Cruz is "largely unknown". He's plenty well known...as an extremist dickhead who most people reject in favor of Hillary Clinton.

You can make that case for Kaisch imo.

Sent from my SM-G900P using Tapatalk

[Hannibal]

Dont know how one can make the case that Ted Cruz is "largely unknown". He's plenty well known...as an extremist dickhead who most people reject in favor of Hillary Clinton.

You can make that case for Kaisch imo.

Sent from my SM-G900P using Tapatalk

Most people still don't know that about Cruz yet. He is benefitting tremendously right now from the "Stop Trump" movement. His poll numbers would plummet below where they are now if he got the nomination.

[iam416]

The only head-to-head poll with any significance is Hillary vs. Trump, which is obviously troubling for Trump. Sanders, Cruz, and Kasich all are largely unknown and any general election poll that involves those guys is meaningless since a generic nameless candidate always has an advantage over a defined one.

I'm troubled by how frequently I agree with Hanni. It used to be once a year but now it's more like once a week. I may have to re-examine by principles, beliefs and general existence.

But, yes, the Trump-Clinton poll is death. Those two awful candidates are almost entirely known by the electorate. The true undecideds in that matchup are small. Making up 10 points in that situation requires a colossal fuck up by your opponent. And of the two, I know which one I think is more likely to somehow add to the negative numbers.

Kasich's numbers are probably the least reliable. No one really knows him nationally. That said, his campaign style/persona would probably play well in the general (it's obviously a persona....he ain't an "aw shucks" nice guy...heh). And he can push a brand of pragmatic conservatisim that can win.

Cruz is the smartest of the bunch, and I think he's pretty good on the stump. But he's definitely pushing an ideology (like Sanders), and I'm fairly confident he doesn't have enough political charisma to get that ideology past the general electorate.

Unless, of course, he runs against Sanders. Then it's not even a candidate choice -- it's an ideological choice. And there is SOOOOOOO much to blister Sanders with to make it unequivocal that he's Vermont's Jeremy fucking Corbin. Hillary has treated him with kid gloves because she knows she has it in the bag and she knows she needs his supporters on board. Of course, Sanders is NOT a Democrat, so I wouldn't expect much help from him.

If I had to guess, I'd call it like this:

Hillary +12 over Trump
Hillary +5 over Cruz
Kasich +4 over Hillary
Kasich +8 over Sanders
Cruz +2 over Sanders (I think Adam Smith still beats Karl Marx in American elections)
Sanders +4 over Trump (I think massive negatives nix Adam Smith)

So, IMO, Hillary is still the Ds strong candidate, by far, despite the polling. And I think Kasich would actually be the Rs best bet.

The one thing I'm not factoring into Kasich/Cruz running is that Trump voters will be alienated and won't vote. If you factor that in, I'm not sure any R can win in November.