The hospital bailout is coming.

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The hospital bailout is coming.

Postby kiryan » Tue Mar 03, 2009 11:37 pm

We talked about this in the past, but here are some figures that are just the beginning.

http://www.latimes.com/business/la-fi-h ... 2541.story

50% of hospitals are losing money, most expect to cut services in the next couple years. This is happening basically because private pays are declining (people with private insurance like through their employer) because of job losses and delaying "elective" surgeries. If you want to frame it a different way, hospitals in their present form can't survive on the low reimburement of Medicare/Medicaid.

In a 6-12 months, this will be beyond a disaster as unemployed people who have been putting off going to the doctor become chronically/acutely sick and come in for "free" care in the emergency room (because the government requires emergency rooms to do so).

If you need anything done, I advise you get it done sooner than later. The waits are going to go up, the paperwork is going to get longer and more invasive, and the quality of care is going straight into the toilet in the short term.
Last edited by kiryan on Wed Mar 04, 2009 2:27 am, edited 2 times in total.
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Re: The hospital bailout is coming.

Postby Corth » Wed Mar 04, 2009 12:11 am

I've been noticing some hospitals closing in the NYC metropolitan area lately.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth

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Re: The hospital bailout is coming.

Postby Nokar » Mon Mar 09, 2009 1:54 am

Yet some people say "Let the american automotive industry fail." "Let the union worker lose their job or have massive wage cuts!" Yep that's the way to go. Now the trickle down effect happens. Gotta love it.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 09, 2009 9:12 pm

great argument, bail out the unions so they can keep the hospitals going. the problem with the hospitals is not the trickle down, its that they are required by law to treat people in an emergency room regardless of citizenship or ability to pay.

Assuming you have nothing that the hospitals can go after for collections, you can literally go to the emergency room and get free care; all you need is time. Our docs talk about people who come in to get cold/flu medicine, junkies who come in faking pain to get prescription pain killers ect ect ect, day after day after day... There is literally nothing you can do except recommend intervention programs.

Why do you think you read stories about 18 hour trips to the emergency room? Hospitals intentionally understaff their emergency rooms because they just straight lose money left and right. The fewer people you see in your emergency room, the less money you bleed.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 09, 2009 9:28 pm

kiryan wrote:great argument, bail out the unions so they can keep the hospitals going. the problem with the hospitals is not the trickle down, its that they are required by law to treat people in an emergency room regardless of citizenship or ability to pay.

Assuming you have nothing that the hospitals can go after for collections, you can literally go to the emergency room and get free care; all you need is time. Our docs talk about people who come in to get cold/flu medicine, junkies who come in faking pain to get prescription pain killers ect ect ect, day after day after day... There is literally nothing you can do except recommend intervention programs.

Why do you think you read stories about 18 hour trips to the emergency room? Hospitals intentionally understaff their emergency rooms because they just straight lose money left and right. The fewer people you see in your emergency room, the less money you bleed.


They'd save much more money if they just shot everyone who walked in...
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Re: The hospital bailout is coming.

Postby Jhorr » Tue Mar 10, 2009 3:23 am

When an uninsured patient is admitted to a hospital, the hospital can apply to the State government for funds to offset the money lost by treating that patient. It is never enough to cover the cost of the admission, though. A larger problem is that many patients are admitted to the hospital when medically they should remain outpatients, like the drug addicts you mentioned. They are usually admitted because the docs are cautious about getting sued if something was missed in the initial ER assessment. Moreover, these same patients often circulate among neighboring hospitals and due to the lack of centralized medical records (except in the Veterans Admin system), recent test results from other institutions (which might defend a refusal of admission to the hospital) are not conveniently accessed. Therefore, expensive tests are repeated unnecessarily (since it is easier to just repeat them, rather than navigating HIPPA to track down results). The entire system is retarded. I've trained at several inner-city hospitals. Patients like the ones above literally tell us docs what to do, what meds to give, and when. They lie about their medical history, often their name, and their symptoms. They manipulate admissions for chest pain and then they demand that their docs grant permission to go outside to smoke cigarettes. They stay overnight, sleep in a warm bed, and agree to undergo tests the next day and then they either elope from the hospital or demand to leave against medical advice before they are called for their test the next morning. It's crazy. I am told that Medicare is going to begin auditing hospitals for unnecessary admissions this fiscal year which might help a little, but more docs will get sued probably.
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Re: The hospital bailout is coming.

Postby Corth » Tue Mar 10, 2009 3:52 am

That really is absolutely retarded. Time and time again I am amazed at the hidden cost of litigation upon society as a whole. Ashiwi alluded to the tension in her recent thread between compensating victims (and creating a financial incentive to avoid mistakes), verses the hidden costs alluded to in Jhorr's post. As an attorney, I hate to admit it, but the costs are obviously exceeding the benefit in many cases. At some point the lawyers are going to need to suffer a vicious beatdown. Real tort reform, with teeth, is becoming necessary.

Additionally, the cost of litigation affects our health, not just our wallets. I won't go into details on the specifics, but my wife underwent a very painful, and very unnecessary procedure, because her obstetrician wanted to cover his ass. To some extent I can't blame him. They pay well over $100,000 per year in malpractice insurance - even if they don't get sued very often. On the other hand, I almost ripped his fucking head off. If there was some way to waive the right to sue docs for negligence in advance I would sign that paper each time - just so I knew my family and I were getting the correct treatment, not the cover your ass treatment. As far as I know, such a waiver would likely be void as contrary to the public well being.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



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Re: The hospital bailout is coming.

Postby Ashiwi » Tue Mar 10, 2009 4:01 pm

I look at the results of this kind of stuff every day, and I'm just stumped over what should be done about it. The cost of lawsuits and malpractice insurance just gets funneled back into the cost of medical care, which, as everybody knows, is pricing itself out of reach of the majority of the United States. I don't think most people are in tune with what health insurance premiums are running nowadays, especially when it's insurance for small groups with high risk. Can a family of four with parents approaching 50 or above, kids in college, and an economy like this really afford premiums of $1,000.00 or more every month? I'm not talking about the upper echelons, either, but the average working Joe in a blue collar job. In these cases one parent is always working just to pay the cost of insurance. It's past the point of ridiculous.

Massive reform is needed in both the healthcare industry and the management of high-dollar medical lawsuits. As far as I'm concerned, pure privatization just isn't working in this instance. I'm not supportive of a fully government run medical industry, either, but there's got to be some happy middle ground that would get this monster in line, because we're certainly not managing it realistically.
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Re: The hospital bailout is coming.

Postby Ashiwi » Tue Mar 10, 2009 4:09 pm

Oh, and another note... HIPAA is a nightmare. I wish I could sign one form that would give make my medical information from all medical entities available for all medical entities. I know the reasons behind it, but sometimes it just creates more problems than it solves.

And blame the FDA for the reason you can't get Canadian drugs on most health insurance policies here in the states, in spite of reduced costs.
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Re: The hospital bailout is coming.

Postby Sarvis » Tue Mar 10, 2009 4:22 pm

Ashiwi wrote:And blame the FDA for the reason you can't get Canadian drugs on most health insurance policies here in the states, in spite of reduced costs.


I'm sure the drug company lobbyists had nothing to do with it...
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Re: The hospital bailout is coming.

Postby kiryan » Tue Mar 10, 2009 6:46 pm

Oh echo you on that Corth. My wife had a "really bad" headache, so she called the on call doc who in about 30 seconds said, go to the emergency room who basically sent us home with a $75 emergency room visit copay (forget the real cost). Then she went to her doctor and was sent in for an MRI. The MRI show'd some lightness in a certain area that could've been a cyst (as a matter of fact thats what they told us it was) so they sent her in for another MRI before they determined that there was no cyst. The best part is that the nurse sent us to an out of network MRI provider because she wanted to get the scans done fast so we racked up a several thousand dollar bill there before we fought it.

This all goes back to three things.

1) if medical care is free or very low cost, then we will consume it. I was willing to send Laurel to the expensive MRIs because I thought it was covered under my insurance. If I knew it hadn't I would've done the same thing I told her to do last time she had a "really bad headache". Take aspirin, drink water and go to bed. You aren't going to the emergency room again unless you think you are dieing.

2) healthcare institutions are driven by protecting their asses. If the on call doctor had said take two and call me in the morning and she died, I'd be rich off the malpractice suit. If her doctor hadn't ordered an MRI and she was later found to have had a cyst, again I'd be rich. Practicing medicine is imprecise and the courts/society has established a standard of care that is too high and defined negligence/malpractice as far too broad.

3) emergency rooms bleed money, particularly in urban settings. This increases cost of doing business which is why Urgent care (which can refuse patients) is the new hot money maker. People are opening up urgent care facilities as close to crowded emergency rooms as they can and making a killing by sucking off all the high profit private pays.
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Re: The hospital bailout is coming.

Postby Corth » Tue Mar 10, 2009 11:18 pm

Ashiwi wrote:Oh, and another note... HIPAA is a nightmare. I wish I could sign one form that would give make my medical information from all medical entities available for all medical entities. I know the reasons behind it, but sometimes it just creates more problems than it solves.

And blame the FDA for the reason you can't get Canadian drugs on most health insurance policies here in the states, in spite of reduced costs.


Funny story about HIPAA. When it was first enacted I was employed by an attorney that mostly did personal injury cases for plaintiffs. Defense attorneys in those cases always make a demand for authorizations executed by the plaintiff that allow the defense attorney to obtain the plaintiff's medical records. Well, all of a sudden the healthcare providers started to bounce these authorizations because they were not "HIPAA Compliant". The defense attorneys started demanding "HIPAA Compliant" authorizations, but none of us knew what the hell we needed to do to make them HIPAA Compliant, and certainly none of us wanted to actually read the statute and figure it out. So I came up with a solution that worked quite nicely. I changed the title on the top of the piece of paper from "Authorization" to "HIPAA Complaint Authorization" and had no further problems thereafter.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



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Re: The hospital bailout is coming.

Postby kiryan » Tue Mar 10, 2009 11:40 pm

HIPAA is a void and can be whatever you want it to be. Having read through it, you can sum it up like this:

provide security to patient information inline with industry standards

Basically, don't be negligent.

Now to security Nazi's that means 1024 bit encryption, no USB drives, mac address filtering, no wireless at all, 18 character passwords with a cap lower case number and symbol, and change it every 5 days.

To the rest of us it means, don't share accounts, implement a reasonable password policy, don't distribute patient data via http.
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Re: The hospital bailout is coming.

Postby Jhorr » Mon Mar 16, 2009 2:37 am

Medicine is the only industry where the practitioners are held accountable for 100% accuracy and are not paid for what they charge.

Can you imagine what your plumber or electrician would say if you told him, "if you don't get it right I'll sue you, and regardless of the results you won't get 100% of whatever your bill is"?
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 3:03 am

Jhorr wrote:Medicine is the only industry where the practitioners are held accountable for 100% accuracy and are not paid for what they charge.

Can you imagine what your plumber or electrician would say if you told him, "if you don't get it right I'll sue you, and regardless of the results you won't get 100% of whatever your bill is"?


You want to hold your heart surgeon to the same standards you hold your plumber?
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 4:46 am

Can we find somewhere in between Joe the plumber and Jesus?

I mean if you're having heart surgery... its because you're willing to take the chance of dieing to get "better"... and then you want to sue and win because the doctor wasn't perfect?
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 4:49 am

kiryan wrote:Can we find somewhere in between Joe the plumber and Jesus?

I mean if you're having heart surgery... its because you're willing to take the chance of dieing to get "better"... and then you want to sue and win because the doctor wasn't perfect?


The problem here being that if the heart surgeon isn't perfect, the patient is probably dead. If a plumber isn't perfect, you just need a mop.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 5:06 am

The problem is that plumbing is not nearly as complicated as heart surgery. The more complicated something is, usually the more leeway that you are given for mistakes... except in healthcare at the courthouse.

Do you understand the insanely high standard that medicine is held to? If any part of the paper trail is missing, thats basically an automatic lost case. If a nurse turns off a device and forgets to turn it back on until 5 minutes later... even if its only a monitor, you've lost. If a doctor didn't get around to signing a document or a filing clerk put some papers in the worng chart... you lose.

Seriously is this the standard you want million dollar pay outs based on?
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 5:22 am

kiryan wrote:The problem is that plumbing is not nearly as complicated as heart surgery. The more complicated something is, usually the more leeway that you are given for mistakes... except in healthcare at the courthouse.

Do you understand the insanely high standard that medicine is held to? If any part of the paper trail is missing, thats basically an automatic lost case. If a nurse turns off a device and forgets to turn it back on until 5 minutes later... even if its only a monitor, you've lost. If a doctor didn't get around to signing a document or a filing clerk put some papers in the worng chart... you lose.

Seriously is this the standard you want million dollar pay outs based on?


It's the standard I'd want my life depending on.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 5:37 am

Look, you're not getting the point.

The point is that you can't afford heart surgery today without insurance and tomorrow you won't be able to afford the insurance.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 5:45 am

kiryan wrote:Look, you're not getting the point.

The point is that you can't afford heart surgery today without insurance and tomorrow you won't be able to afford the insurance.


You're missing the point too: Lives DEPEND on doctors not making mistakes. Surgery is risky already without the doctor forgetting to do the procedure right.

Look, this is kind of simple. We don't hold plumbers to any real standard because they won't harm anything but property. We even hold McDonald's workers to a higher standard, forcing them to engage in basic hygiene, washing their hands after using the toilet, wearing gloves and hair nets...

The more likely you are to hurt people by doing your job, the higher standards we hold you to.

Maybe we just need a more reasonable solution that greed driven law suits? Maybe letting capitalism drive our healthcare system isn't the smartest idea, because it gives us a choice between escalating costs and safety?
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 6:13 am

The cost of healthcare is being driven up by the insane standards of safety required by government and courts... not by "capitalism". I don't know why you equate making money off lawsuits to capitalism.

I will concede that there is capitalism driven increases through the supply chain, labor and especially in drugs ect ect ect... but I think you need to ask yourself why prices keep going up? A lot of people in the business blame government for the increasing cost of healthcare, and the argument has sevral points.

1. Medicare/medicaid doesn't pay enough, so private pays have to pay more to make ends meet.
2. Medicare/medicaid pay more for acute care than preventive care (and often doesn't cover preventive care at all, at least not by today's definition of preventive care)... so what do you think we see in the office...
3. Medicare/medicaid burecracy is insane, then add a bunch of state burecracy as well. You have no idea how many FTEs basically sit around and do compliance.
4. Lack of malpractice lawsuit limits.

Now imagine a world where capitalism ruled. Most of this overhead disappears, you would personally decide how much quality you are willing to pay for and which drugs instead of being priced out because all healthcare is held to the same unaffordably high cost.

Government and regulation is a big part of the problem.
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Re: The hospital bailout is coming.

Postby Ashiwi » Mon Mar 16, 2009 1:02 pm

Medicare doesn't pay enough for what? If you can get to the heart of what allowable expenses are, you might come closer to the gist of the medical industry's financial plight. Medicare and insurance companies set values on services deemed to be an "allowable charge" for that service. Are these allowables covering the cost of the service, or are they covering the cost of the other financial hemmorhages that financial institutions are spouting? Hospitals have to cover the cost of every non-pay emergency visit that walks through their doors, and they do so by hefting that cost off on to other patients. They have to cover the costs of exceedingly expensive equipment that is used on a very select few patients, patients who will never pay enough to cover the cost of that equipment. They have to cover the costs of new 2.8 million dollar wings in order to name it after somebody who gave 1.2 million to the hospital. They have to cover the costs of procedures that people opt to have that will never be covered by insurance.

Have you looked at the cost of a botched gastric bypass lately? It runs in the millions, easily. The patient will never pay that.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 1:15 pm

<b>Kiryan</b>: You know what's funny? In one thread you're telling me that throwing away an embryo that will never be used anyway is murder, but in this thread you're saying that if a doctor is negligent it's ok for the patient to die.


<b>Ashiwi</b>: It's interesting that Medicare is requiring expensive equipment that Hospitals will never see a return on. Whenever socialized medicine comes up we hear that Capitalism is better because our hospitals have all the latest shiny healthcare equipment. Sounds like without government say-so, we wouldn't!
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Re: The hospital bailout is coming.

Postby Ashiwi » Mon Mar 16, 2009 3:37 pm

Did I actually say that? The note regarding socialized medicine and the defense of Capitalism sounds right on, but the part about Medicare requiring expensive equipment and government say-so... I'm iffy about that context.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 3:57 pm

Ashiwi wrote:Did I actually say that? The note regarding socialized medicine and the defense of Capitalism sounds right on, but the part about Medicare requiring expensive equipment and government say-so... I'm iffy about that context.


Maybe I misread then. You started talking about medicare, then in the same paragraph started listing various expenses hospitals have to deal with... I thought you were attributing all of that to Medicare.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 4:26 pm

The difference sarvis is that in one you are taking an active part in ending the life of a person. In the other, a person dies from a mistake. Why do you think we have manslaughter vs murder; because its different.

5. Hopsital ERs are required to treat all patients, they have to make up that money somewhere. (government regulation)
6. Labor (government regulation. You can't go out and learn how to be a doctor or a nurse, you have to go out and be certified by the government to be a nurse. Between the lack of supply and the artifiicial demand required to maintain the "absolute best possible care" you have a huge shortage)

---

I want to see healthcare that is 90% as good as it can be at 50% of the cost. I think that is 100% achievable, but not in the current environment.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 4:31 pm

kiryan wrote:The difference sarvis is that in one you are taking an active part in ending the life of a person. In the other, a person dies from a mistake. Why do you think we have manslaughter vs murder; because its different.

5. Hopsital ERs are required to treat all patients, they have to make up that money somewhere. (government regulation)
6. Labor (government regulation. You can't go out and learn how to be a doctor or a nurse, you have to go out and be certified by the government to be a nurse. Between the lack of supply and the artifiicial demand required to maintain the "absolute best possible care" you have a huge shortage)

---

I want to see healthcare that is 90% as good as it can be at 50% of the cost. I think that is 100% achievable, but not in the current environment.


So then maybe we should charge a negligent doctor with manslaughter. I'm sure that would do WONDERS for the medical profession.

Look, you can either hold doctors to a higher standard because their actions determine whether someone lives or dies, or you can give up the whole "life is important" angle. You can't have both. Not yours.


We hold doctors to that high standard so they do not kill people. You can talk all you want about it being a mistake, and "mere" manslaughter instead of murder... but the fact is someone will die, and you won't care because insurance companies saved some money.

Frankly, it's the same issue with these embryos that will never see a womb anyway. They could be used to save lives, but you'd rather have them sit frozen forever in order to preserve life. Newsflash: People are dying while those embryos sit there unused, forgotten and possibly unviable. Why aren't THEIR lives important to you?
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 4:59 pm

I don't believe 1 single life has been saved from stem cell research to date, yet that is the oft cited justification to "kill" embryos. Cuz we are going to save lives and there is no alternative other than using embryonic stem cells.

Well there is an alternative, its called Adult stem cells and doesn't involve embryos. Researchers are having more success with Adult stem cells than embryonic stem cells (everywhere, not just in the US). This has been true for I believe 2 years and I see it as partial vindication of Bush's moral limits on embryonic stem cell research. Bush stood up and said this is morally wrong, and we can be better than this.

---

Negligence vs gross negligence vs a mistake. I would charge a doctor with manslaughter if they committed gross negligence. Just like I would charge a hunter with manslaughter if they engaged in "brush fire". Gross negligence is not a mistake. Negligence is not a mistake. Its intentionally disregarding the normal written or unwritten standards of operation without a good reason. A doctor who never washes his hands is negligent because he knows the risk. A doctor who never washes his hands and has been cited a dozen times and reminded specifically before an operation is grossly negligent.

A doctor who walks into a room where a man is literally spurting blood and dives in without washing his hands is not being negligent in my opinion, but that patient could then turn around and sue the doctor and probably win big money if he came down with a serious infection. Thats the problem Sarvis. Doctors and hospitals doing good work are having their ass sued off for unreasonable things.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 5:22 pm

kiryan wrote:I don't believe 1 single life has been saved from stem cell research to date, yet that is the oft cited justification to "kill" embryos.


Not one life has been saved from researching cures for cancer either, should we stop looking into that?

You kind of have to do the research before you can apply it. You know that right? Research itself doesn't cure disease, it leads to products which do. It's not a magic spell.

But we'll never get the product without doing the research.

Cuz we are going to save lives and there is no alternative other than using embryonic stem cells.


Don't think anyone said there are no alternatives. I'm sure there are research groups researching them as well. Stem cells have been promising though, haven't they? They've grown working heart muscles already. Can you point to any other research projects which have done so? Can you even think of another alternative for growing new hearts?

But yeah, lets scrap it all because no one's completed the research yet and you have a moral quandary about something that's going to be thrown in the garbage. Meanwhile, let's hear why we shouldn't hold doctor's to high standards when they kill actual, living, breathing, talking, walking, fucking, loving people.

Well there is an alternative, its called Adult stem cells and doesn't involve embryos. Researchers are having more success with Adult stem cells than embryonic stem cells (everywhere, not just in the US). This has been true for I believe 2 years and I see it as partial vindication of Bush's moral limits on embryonic stem cell research. Bush stood up and said this is morally wrong, and we can be better than this.


Cite.


Negligence vs gross negligence vs a mistake. I would charge a doctor with manslaughter if they committed gross negligence. Just like I would charge a hunter with manslaughter if they engaged in "brush fire". Gross negligence is not a mistake. Negligence is not a mistake. Its intentionally disregarding the normal written or unwritten standards of operation without a good reason. A doctor who never washes his hands is negligent because he knows the risk. A doctor who never washes his hands and has been cited a dozen times and reminded specifically before an operation is grossly negligent.


And a doctor who normally washes his hands, but was interrupted to sign some paperwork one day on the way into the OR will still kill you. OOPS! Boy is his face red!

Of course, I could also find you stories where a clerical error results in someone getting the wrong operation... losing limbs and such. Clearly the hospital shouldn't have any punishment because it was just a simple mistake. Not like it ruined someone's life or anything. Not like he was going to be thrown in the garbage or anything!

A doctor who walks into a room where a man is literally spurting blood and dives in without washing his hands is not being negligent in my opinion, but that patient could then turn around and sue the doctor and probably win big money if he came down with a serious infection.


Cite.

Thats the problem Sarvis. Doctors and hospitals doing good work are having their ass sued off for unreasonable things.


Unreasonable things like causing someone to die?


Kiryan, tough on researchers, tough on patients, easy on manslaughter!
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Re: The hospital bailout is coming.

Postby Delmair Aamoren » Mon Mar 16, 2009 6:15 pm

From someone directly related to the healthcare industry, let me put it this way:

Privitization of healthcare is a GOOD THING. For-profit privitization is LESS OF A GOOD THING. Governmental healthcare is a BAD THING. Currently, in most areas, hospitals are backed by for profit companies. Additionally, pre-hospital services are also primarily privatized by for-profit companies. The move needs to be towards private, not for profit healthcare. Anytime cost is an issue, the good of the patient risks being sacrificed.

Governmental health care will be inefficient, bogged down by red-tape, and will do the bare minimum to come to a diagnosis/treatment modality.

For profit companies will at times even overdiagnose or over examine/research a particular complaint.

The problem of the "system abusers" which are primarily low-income or homeless will continue. Just as the problem with the very wealthy but mentally imbalanced will rage on. Anxiety attacks are an incredibly expensive trip to the hospital when the symptoms mimic cardiovascular or respiratory problems. Differentiating between them can be difficult and costly. Transients will continue to go to the ER for the "3 warms" warm bed, warm food, warm clothes/blankets. This will not change and has been a problem for decades.

What can change, and must change, is how the businesses are run fundamentally. Profiteering on healthcare must be stopped. All medical services should be private, non-profits that are examined very closely by big brother.

Additionally, to clarify something stated above, yes an ER must treat you in an emergency. This includes life-threatening sickness/illness as well as child birth. This care does not have to be all inclusive. This care is for "stabilization" only. For instance, i ran into a transient about a year ago with a DVT. DVT stands for deep vein thrombisis. Basically a clot in the return circuit to your heart. If allowed to resolve naturally, when the clot does break free and travels back to a large blood vessel enroute to the heart, it will become lodged somewhere else. The "somewhere else" it becomes lodged is generally your lungs. This will result in a MASSIVE or multiple MASSIVE pulmonary emboli. This patient will likely immediately develop chest pain, shortness of breath, and asphyxiate as blood is incapable of exchanging gasses in the clotted off portions of his lungs. As a treatment for this patient, a hospital will give him a medication to help prevent further clot formation (aspirin or plavix usually), and an injectible drug to help break the existing clot into smaller clots. The clot will break free eventually, and most likely kill him. For someone with insurance, the medications are similar, but the clot is surgically removed as to prevent the inevitable. The primary reason for this course of action is that surgery that doesn't immediately save a life is considered for the uninsured to be elective. They are not required to provide surgery to fix this patient.

The bottom line is that our society is so money hungry and quick to sue for anything, that these hospitals and doctors must do their best to cover their asses and prevent litigation. That is why each transient with chest pain gets a chest x-ray, labs drawn, etc. Because the one time it gets treated as a fabricated complaint, it could be real and cost over 1000 times the cost of the care in the form of a settlement and attorneys fees.
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Re: The hospital bailout is coming.

Postby Ashiwi » Mon Mar 16, 2009 6:18 pm

No, I believe that the issue Kiryan is referring to, with Medicare not paying enough, is disputable. I'd rather dispute the outright cost of medicine, instead of the low payments Medicare makes. The cost of medicine is a culmination of so many different factors, and to hold Medicare responsible for some of those is unrealistic. Yes, I understand the providers have to offer care to those who will end up not paying for it, but is Medicare supposed to absorb that cost? If they won't pay for cosmetic services, why are they expected to foot the cost of the complications from cosmetic surgery gone wrong? We're all supposed to foot the bill for these people who want a gastric bypass but can't afford the 1.6 million it costs when the bowel is knicked in the process.

The entire system is broken, and it's getting more broken by the day. I'm not for a purely governmental healthcare system, but pure privatization in the healthcare industry is out of control.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 6:26 pm

im not citing shit, go google it yourself if you want. I've read several articles on it over the past year at least.

this is not simply a decision whether or not to pursue research on stem cells. Its a decision whether to allow NEW FEDERAL funding for research on NEW lines of embryonic stem cells (created by destroying embryos). Private funding... and Federal Funding for research on PRE-EXISTING embryonic stem cell lines was and continues to be ok even before Obama's order.

--

How much would it cost to get a plumber if every time a plumber made a "mistake" the courts gave out 30k judgements because of damage to the house and your pain and suffering? I gurantee it wouldn't be the current 80-150 an hour they charge now.

Going further, plumbing is a simple job, but they bill at 75+ an hour now. Why? Because you can't do plumbing for anyone else without a license from the state. If I'd fix your plumbing for you for $40 or 50 bucks an hour, but I can't because I'm not licensed and I'm not willing to go through several years of programs and apprenticeship programs to learn how to do something I can already do. I'm sure there are guys who would do a reasonably good job for $15 an hour.

So tell me what you want to pay for your plumbing. 15 bucks, 50 bucks, 100 bucks or 1500 bucks an hour. Why is it that we are forced to pay $100 instead of being able to choose $50.

You're going to come back and argue but its your life, its not plumbing. I want the same choice as a consumer. If I have a headache, I want to go see the $15 an hour plumber. I'll take the risk to save my $$. If I'm young and I need brain surgery and I can pay for it, I'll go see the $15k an hour plumber. We need different levels of quality at different price points to find out what the market will bare. Currently we have 1 standard and its quite obvious that the market can not bare it much longer and especially not in a universal healthcare environment.

Government has created an impossibly expensive environment. By not limiting litigation driving us towards "perfection", by requiring so much overhead for all their reporting, by requiring emergency rooms to treat everyone including illegal immigrants, by requiring extensive licensure to perform simple clinical tasks. Get rid of these artificial government imposed cost drivers and we could see affordable healthcare again.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 6:37 pm

kiryan wrote:im not citing shit, go google it yourself if you want. I've read several articles on it over the past year at least.


Ok Teffie, I guess we'll just assume everything you say is true because you saw it in some scandal rag. :roll:

this is not simply a decision whether or not to pursue research on stem cells. Its a decision whether to allow NEW FEDERAL funding for research on NEW lines of embryonic stem cells (created by destroying embryos).



Yes, destroying embryos which are going to be thrown out or sit frozen for an eternity.

THROWN OUT.

FROZEN FOR ETERNITY.

You're not doing them any favors.


How much would it cost to get a plumber if every time a plumber made a "mistake" the courts gave out 30k judgements because of damage to the house and your pain and suffering? I gurantee it wouldn't be the current 80-150 an hour they charge now.

Going further, plumbing is a simple job, but they bill at 75+ an hour now. Why? Because you can't do plumbing for anyone else without a license from the state. If I'd fix your plumbing for you for $40 or 50 bucks an hour, but I can't because I'm not licensed and I'm not willing to go through several years of programs and apprenticeship programs to learn how to do something I can already do. I'm sure there are guys who would do a reasonably good job for $15 an hour.

So tell me what you want to pay for your plumbing. 15 bucks, 50 bucks, 100 bucks or 1500 bucks an hour. Why is it that we are forced to pay $100 instead of being able to choose $50.

You're going to come back and argue but its your life, its not plumbing. I want the same choice as a consumer. If I have a headache, I want to go see the $15 an hour plumber. I'll take the risk to save my $$. If I'm young and I need brain surgery and I can pay for it, I'll go see the $15k an hour plumber. We need different levels of quality at different price points to find out what the market will bare. Currently we have 1 standard and its quite obvious that the market can not bare it much longer and especially not in a universal healthcare environment.



You're kidding me right? I'm talking about people DYING when doctors make mistakes, and you want to argue over plumber licensing? All you're showing is that people care even when just their property is damaged, and want plumbers to be licensed. If you didn't want a licensed plumber, you'd call your cousin.


Government has created an impossibly expensive environment. By not limiting litigation driving us towards "perfection", by requiring so much overhead for all their reporting, by requiring emergency rooms to treat everyone including illegal immigrants, by requiring extensive licensure to perform simple clinical tasks. Get rid of these artificial government imposed cost drivers and we could see affordable healthcare again.


Get rid of those and you'll have witch doctors sticking leeches on your arm for $10.

I really love how you seem to think all the legislation just comes out of thin air. Newsflash: It comes in response to things that happen. No one proposes a stop sign at an intersection until too many people get run over, and no one adds regulations on hand washing until people die.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 6:48 pm

Ashiwi. To characterize the current system as "pure privitization" is bold at best. In your job, you should see and understand how invasive government is as the single largest payer and constantly wielding the legislating stick. I don't know whether to blame government 100% or blame the half private half government environment equally.

If the system was purely private and running as it is, I would be up for a change. But government is a big part of the reason that healthcare is unaffordable TODAY. When has government ever done anything efficiently and affordably? Do you really think that with more regulation, more administration and overhead they can do something to fundamentally change the cost of healthcare?

I've spoken with 3 people who travel regularly to DC for healthcare summits. There is an ever growing # of leaders who believe that medicare/medicaid are major drivers of the increase in cost. Organizations do not get reimbursed what procedures cost and as a result do charge everyone else more. Organizations do not get reimbursed for "preventive care" and as such focus on "acute care" because medicaid/medicare pays those claims better.

Now things are changing some, particularly in preventive care, but make no mistake, medicare/medicaid as the single biggest customer to most healthcare organizations dictates policy to these "private" healthcare organizations.
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Re: The hospital bailout is coming.

Postby Ashiwi » Mon Mar 16, 2009 9:15 pm

Which part of the healthcare industry are you referring to as a government entity? I do admit there are tons of regulations that drive prices up, but if you could see what I look at on a daily basis, you'd probably carry your own share of disgust over private sector healthcare providers.

Know the going cost providers expect for blanket warming?

$65.00.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 9:54 pm

I'm looking at it from both the provider and the payer perspective. My company owns 3 hospitals, operates 2 additional ones and owns and operates about 30 additional facilities. We also have our own health plan insurance company.

Yea totally disgusted, but you know why it costs $65? Its because a nurse has to do it, we have to charge medicare/medicaid 3x to get it paid once, we have to have 10 people to get a claim processed, because medicare/medicaid allows $65... and becaues we lose money giving kids vaccinations seeing patients in the office... things that we actually want to do.

I just found out what cobra will cost me if I quit to take a new job that I've been offered.

$1514.96 for medical (thats only 2% more than what my company pays)
$147.89 for dental and vision

Thats probably in addition to my copays and deductibles.

Those of you that work... do you really appreciate the true cost of your healthcare insurance? Imagine what a drag this is on the economy...
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 10:07 pm

and sarvis, this is not a scored academic debate, you aren't going to "win" based on technicalities if I didn't cite my sources properly or at all.

I'm sharing my points of view and information because I think that I am right and so I can get feedback to determine if I need to change my ideas. If something I say is convincing enough to change your world view... if it is true... then I would strongly encourage you to research those particular points yourself so that you can determine if they are true enough to act on.

I hope that you can admit that although I draw some strange conclusions and see liberal socialist conspiracies everywhere, I do not make shit up and pass it off as fact.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 10:10 pm

kiryan wrote:I hope that you can admit that although I draw some strange conclusions and see liberal socialist conspiracies everywhere, I do not make shit up and pass it off as fact.


I really can't tell unless you cite things. That's the point.
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Re: The hospital bailout is coming.

Postby kiryan » Mon Mar 16, 2009 10:15 pm

I cite articles constantly with my thoughts and analysis.

Your loss for discounting truth simply because it wasn't cited.
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Re: The hospital bailout is coming.

Postby Sarvis » Mon Mar 16, 2009 10:47 pm

kiryan wrote:I cite articles constantly with my thoughts and analysis.

Your loss for discounting truth simply because it wasn't cited.


The funny thing with your "truth" is that it was wrong, or at best partially correct. Adult stem cells are not as viable, cannot be used for any kind of tissue and are harder to obtain. The only advantage is their compatibility since they can come from the same person who needs the treatment.

Posting an article to discuss is not the same as citing your argument, either.
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Re: The hospital bailout is coming.

Postby Jhorr » Tue Mar 17, 2009 5:13 am

Doctors are human and they make mistakes. We are not saints or miracle workers. However, a mistake is not necessarily negligence. I believe the courts do a good job in differentiating the two. Most suits are filed because of a bad outcome and poor patient-doctor communication. The docs didn't prepare the family for the gravity of the situation, and then death was a surprise. At the end of the day, patients come to the hospital because they want treatment, doctors don't coerce them to come there. And while every patient is entitled to a standard of practice, the reality is that nobody is entitled to a good outcome. In other words, you can't sue someone because you have bad luck, or bad genes.

Again, if you brought your broken pipe to a plumber and demanded they fix it with 100% accuracy otherwise they'll be sued for an outrageous sum and also said "by the way, you'll get paid what I deem appropriate, not what you charge", they would tell you to take a hike. You can say, well medicine is different because a life is at stake. But, plumbing was one of the most important public health advances of modern times. Without good plumbing you have a cholera outbreak. Yes, the skills and training are different, but the impact on health (both quantity and quality or life) isn't too dissimilar.
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Re: The hospital bailout is coming.

Postby Corth » Tue Mar 17, 2009 5:29 am

As Jhorr points out, doctors are human and they make mistakes.

The question we should consider is why society even allows malpractice lawsuits against doctors in the first place. There are indeed several reasons. The primary one is to to create a financial incentive for doctors to not be negligent. If you make a mistake that rises to the level of negligence, you will get sued, your reputation will be affected, and your insurance premiums will rise. This incentive works very well. Procedures and protocols are often established by doctors and hospitals for the express purpose of preventing malpractice liability, and often indeed they do prevent mistakes from happening.

At some point, however, the cost to society of increased healthcare expenses due to malpractice insurance premiums and unnecessary "cover your ass" procedures, exceeds the benefit of allowing malpractice lawsuits in the first place. It is then incumbent upon society to rebalance the system so that the incentive remains in place while the cost to society is limited. The most obvious way is by capping awards for simple negligence, while perhaps allowing a full recovery in instances where the doctor is grossly negligent or reckless.
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