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Sustainability In Health Care...good take on it...

2K views 18 replies 13 participants last post by  Fatjock 
#1 ·
take a look at this:

http://www.linkedin.com/today/post/arti ... pymf-mpost


I like this part: "Social – America can’t continue to support the consequences of obesity, smoking, non-compliance and self-neglect at the current rate. We just can’t. Preventable conditions like diabetes, heart failure, some cancers and viral diseases are responsible for an estimated 70% of our healthcare costs. Cleveland Clinic has joined with local governments and community groups on weight-loss and smoking cessation initiatives. Our Minority Men’s HealthCenter provides thousands of free screenings and other programs to address disease and outcomes disparities in underserved populations. But it will take more than this. Leaders at all levels of society need to promote the cultural principle that unhealthy habits and lifestyles are no longer acceptable, and that healthy eating, exercise and greater responsibility for our own health are the new norm for the future." Isn't that like buying a nice new car, then running it into the ground by neglecting oil changes and other regular maintenance, and then when faced by a huge bill to fix it, the owner complains to the manufacturer or government about the high cost to fix the neglect of the vehicle?
 
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#2 ·
My brother in-law works in the industry as an accountant. He tells me that 40% of all medicare goes to the last 3 months of life. I told him, I do NOT want to live long enough to wipe out the family assets. Just load me up with happy juice when I'm terminal.
 
#4 ·
So much for freedom.....................

"You're free to live the way we want you to live, if you choose any other way, you'll get punished".

Social engineering by taxation, or legislation, is still the anithesis of freedom.

Freedom means that you have to be able to make bad choices as well as good.

If we wish to be a society, we have to accept that not all members of that society will be of the same mind, body, or capabilities.
When I was in the military we were taught that we could only move as fast as the slowest person. Now that didn't mean that if one person was limiting the group, we just dropped them off the back, it meant that we adjusted the plans to get the best effective group within the operating envelope we had. Sometimes the slow member turned out to be the tactical genius who could re-organize the planning to suit the environment when we arrived at the objective (and on more than one occasion, more than make the time lost in the slower transit to accomodate their physical limitations).

We need to be accepting of the weaker members of our society, for the burden they place on our resources may be more than made up for by the contribution they make to the society.
Strangely enough, when I see documentaries about our prison system, I see a lot of fit young guys working out, and when I see documentaries about charitable works being carried out, I see more than few overweight middle-aged people helping others. Sometimes I wonder who is really the greatest drag on our resources?

There is no "One-size-fits-all" solution when we're looking at exclusion, whether it be from insurance coverage, employment, or even just social acceptability. The only "one-size" solution is inclusion for everyone, accept them for who they are, not what we want them to be.

If we can't do that, than abolish the society, allow Darwinian rules to make the selection.......they can't afford the treatment for their "avoidable" diabetes? , Let 'em die, not my problem. Can't keep up? Leave them! Let the strong subjugate the weak, let the rich exploit the poor, let the young take what they can from the old!!!.....
.....at least everyone will start from an even playing field, and we'll all know where we stand...........................Doesn't sound so appealing? We're not so far from it already, if the truth be known, and propsals such as those mentioned take us futrther down that path.

End of rant.
 
#6 ·
Fatjock is my hero.....
:cheers:
:cheers:
:cheers:

Very eloquently stated.
 
#8 ·
+1 to Fatjock and Jim

The US on a per capita basis spends nearly double the cost per capita of other advanced nations...and has far worse results in mortality and morbidity in nearly any quantifiable metric...What do the other advanced nations have that we lack?

National Health Care...healthcare as a right, not a privilege to the full time employed in larger companies and organizations or those financially able...Over 65 years of age?...you have national health care, disabled?...you have national health care. in the military...you have national health care, go to the VA...you have national health care...poor...you have national heath care

Employed full time and earning just a touch above poverty level, and odds are you have no health care...self employed small business owners...can you say $5,000-$10,000 annual deductible catastrophic coverage?

Nothing is changing as long as the AMA, NHA, Big Parma, ABA etc can spend unlimited funds to lobby the fools on the "hill" to keep the well connected...well. connected to keep our healthcare system continually working to the benefit of the few at the cost of currently approximately 70,000,000 uninsured American citizens

A post in LinkedIn is preaching to the choir...Think of it as Facebook for professionals...Cleveland Clinic is right up there with Mayo Clinic...exceptional organizations...yet I wonder how the salary and other compensations for their CEO compares to the young, single mom who washes dishes in their cafeteria?

My rant over

Bill
 
#9 ·
There is a real conundrum when health care provision is 'free at the point of need' is that free= no value and the system gets abused.


I actually had an American come into our surgery the other day demanding a GP appointment and making a scene in reception - I was called down. in my recalibration briefing I made it clear to him that while we could certainly see him it would not be free and I explained the tariff. he was most upset as he thought the NHS was free and he was staying with a Brit friend and they thought he should get a free Doctor's appointment too. The upshot - he decided he did not need to see a GP right now.

Funny old game.
 
#10 ·
I have been in healthcare for 30yrs. We could debate the problems here for weeks to come. The fact of the matter is the overtesting costs have
been out of control. The MD'S will order unecessary tests to cover their ass, so the lawyers don't sue them. In the early 80's if you went to the ER
a $50 chest x-ray was automatic. Today, a trip to the ER gets you a automatic $2000 cat scan. I encounter countless number of patients that feel
they are entitled to this cat scan simply because they pay a insurance premium. The medicare patients simply say ok because medicare covers the tests.
People have become to believe they are entitled to all and any tests. There is no regard to what the radiation is doing to you while you have that 3rd
cat scan in the last 2 weeks. Radiation is accumalative people. It does not go away. Some of these tests are so valuable they can literally save your life.
Which, here is where the problem comes in. How does a MD not order a test that can give them a definitive diagnosis. Well, the lawyers insist that they do.
Back to my initial statement. We are now paying $2000 vs $50 for a test because of the advances in technology. If you had to pay this difference out of
your pocket, would you have it done? Most would not. This is just one example of medical waste. There are so many more it would make your head spin.
I had to order a garbage can from a hospital approved vendor for $200. The same garbage can could be had at office depot for $45. Make sense to you.
The list could go on and on. Who do you thing is paying for that garbage can at a extra cost of $155. YOU ARE.
This subject makes my head spin. :compress:
BTW, anyone catch the 60 min episode last sunday about HMA putting pressure on ER MD'S to admit medicare patients. CHA CHING.
 
#11 ·
Inyteresting.. My group health plan at work requires that we all get blodd tests for issues like cholesteral and so on.. I'm fat so my BMI is out of line.. so if you don't pass, I have to pay $180 a month more than an employee that does pass... I suspect that this is the justified future... If I sign up for a weight loss program and actually lose weight, the surcharge comes off..
 
#12 ·
Fatjock said:
When I was in the military we were taught that we could only move as fast as the slowest person.
That same military, I'm sure it was the same military I participated it, selected its population so that there was a limit imposed on how slow the slowest person could be and still participate. If they missed that mark, they were, as you put it, left behind. Or discharged.

Can we apply that same philosophy to healthcare? Free healthcare for everyone, as long as you meet some minimum standard for health. Presumably more than a pulse and a body temp above ambient.

I'm all for personal freedom. I'm also for personal responsibility. If you expect care at government expense, shouldn't you also expect control in equal measure? If you want total personal freedom, shouldn't you expect total personal responsibility?

I'm all for helping those that can't help themselves. I would like some voice in the form that help might take. And I'd really like for those that made/make bad choices to accept responsibility for undesirable outcomes from those. I've made some bad decisions that have greatly affected my life. Should I expect you to fix it? Maybe we should all demand to be lottery winners and then we'd all be rich.

/End of rant
 
#14 ·
Insurance is a betting game. They're betting you won't need to use it (much) you're betting you will.

Letting someone with a pre-existing condition in is like going to the roulette wheel knowing the ball won't land on your number. Who'd do that? Rates are different for everyone for a reason.

If we're going to give health care to all, let's just add to our taxes and make it government health care. Period.

When you were born, you weren't guaranteed anything.

Eat right, get a little exercise, don't take unnecessary risk, buy some insurance and hope for the best. Sometimes life screws you. No one owes you anything.

Like others, I'm not fighting in the end. I'm going out gracefully.
 
#15 ·
Chatman128 said:
Fatjock said:
When I was in the military we were taught that we could only move as fast as the slowest person.
That same military, I'm sure it was the same military I participated it, selected its population so that there was a limit imposed on how slow the slowest person could be and still participate. If they missed that mark, they were, as you put it, left behind. Or discharged.

/End of rant
What are the odds of two ex-members of HM RAF living in the Tampa area?

When I was in, selection of the population only took place at time of entry. Once they had spent a lot of money training you, they wanted a return on that investment, before you got out to apply it to making a better living in "civvie street".
If people didn't make the grade, they went for remedial physical training, and if that didn't work in a reasonable time, they would be medically downgraded (therefore no promotion, limited job options, etc), but they served their contract. Their available skills may have been more limited, but were still applied.

Not left behind, not discharged.

Still sure it was the same military?

Chatman128 said:
Can we apply that same philosophy to healthcare? Free healthcare for everyone, as long as you meet some minimum standard for health. Presumably more than a pulse and a body temp above ambient.

I'm all for personal freedom. I'm also for personal responsibility. If you expect care at government expense, shouldn't you also expect control in equal measure? If you want total personal freedom, shouldn't you expect total personal responsibility?

I'm all for helping those that can't help themselves. I would like some voice in the form that help might take. And I'd really like for those that made/make bad choices to accept responsibility for undesirable outcomes from those. I've made some bad decisions that have greatly affected my life. Should I expect you to fix it? Maybe we should all demand to be lottery winners and then we'd all be rich.

/End of rant

I don't dispute most of what you say here, and am very much a strong proponent of "with freedom, comes responsibility".

The question I have is who decides where the line gets drawn? Who decides what decisions are bad, and which are good? There are exceptions to almost every rule, so who decides "that overweight person is a burden, when this one isn't", or "that smoker is going to have major health problems while covered by my company, where this one won't"?

I know nobody died and made me God. So to me the only truly equal way to treat everyone is if the line is drawn so everyone is on the same side of it. Some seem to have no problem putting all smokers, or all overweight people, or whatever group is seen as a "burden" on the other side of the line from themselves, and never see an issue with it, until they are on the wrong side of the line!
If we're all on the same side, and all work together.


I'm not against risk management, but if it's going to be based on the individual, then corrections have to be made the same way. If someone is seen in a "high risk" group, making "bad" decisions to increase potential (such as motorcyclists), by all means load premiums, but if, come renewal time, that loading is found unwarranted, why shouldn't the loading be removed? refunded even? Why must it just go increase the already bloated profits of the carrier?

There is a way to be fair. What is proposed isn't it!
 
#16 ·
So, the answer is to create a system where there are no consequences for actions, because a few people might be caught on the wrong side unjustly? Let everyone in the pool because we can't bear the thought of injustice to those few?

How about the injustice to the folks who do all the right things in their lives, only to have their rates rise when the system is normalized and rates or taxes are baselines? WTF?

My credit score is at the 800 mark. Before the credit reform, I had credit cards that were 3.9%. After credit reform, the bank sent me letters raising my rate. A little at first, and then a little again. The lowest I can get now - with the same credit score - is 7.9%. This is because the banks can't heavily penalize those who aren't responsible with credit.

Similar to health care... I exercise, eat right, floss my teeth, etc. I'm low risk. My health and life insurance rates are low. But they are BOUND to get higher because I will have to share the burden for folks who made poor choices. Great. Thanks. Maybe I should have been eating Big Macs and watching Sunday football instead of hiking/kayaking...

But, unfortunately, that's what my country is quickly becoming - a victim society that takes no personal responsibility. No thank you, sir.
 
#17 ·
rustynail said:
So, the answer is to create a system where there are no consequences for actions, because a few people might be caught on the wrong side unjustly? Let everyone in the pool because we can't bear the thought of injustice to those few?

How about the injustice to the folks who do all the right things in their lives, only to have their rates rise when the system is normalized and rates or taxes are baselines? WTF?

My credit score is at the 800 mark. Before the credit reform, I had credit cards that were 3.9%. After credit reform, the bank sent me letters raising my rate. A little at first, and then a little again. The lowest I can get now - with the same credit score - is 7.9%. This is because the banks can't heavily penalize those who aren't responsible with credit.

Similar to health care... I exercise, eat right, floss my teeth, etc. I'm low risk. My health and life insurance rates are low. But they are BOUND to get higher because I will have to share the burden for folks who made poor choices. Great. Thanks. Maybe I should have been eating Big Macs and watching Sunday football instead of hiking/kayaking...

But, unfortunately, that's what my country is quickly becoming - a victim society that takes no personal responsibility. No thank you, sir.
and part of that responsiblity in my opinion is to take care of your neighbor, those less fortunate than yourself not due to bad choices but due to bad circumstance, govornments cannot do that, they cannot take case by case, they must draw lines, create groups, allow abuses, etc, kyhour local churches and civic groups Can make good choices and individual assessments, as our country did in the beginning, before we became apathetic, lazy , and uncaring, unwilling to get personally involved. and said let us form a huge groaning inefficient system far removed from the source and the need, and shift the burden from our mind to our wallet, pay someone else to care and make choices. I, like sone others have been taught , if there is a problem , before you open your pie hole , first check to see if you are part of that problem, secondly have an idea or a solution to the problem THAT YOU ARE WILLING TO WORK ON (sorry, don't know how to do bold or italics yet ) before adding to the general din and confusion of whiners. My idea, go back to the way it used to be, resources from the community stay in the community and help those in the community , managed in the community and supervised in the community by altruistic trustees who evaluate NEED vs WANT, and take the time to jealously guard the treasure of GOOD WILL against abuse , we have a very small system in place in my neighborhood that does this ,and no we are not a utopia, but if you eat yer wheaties, and don't poop in someone else's , and some fool runs over you with a train, we are quick to help in more ways than just money, spend your time smoking crack and watching porno's with the shades up, and get behind in your electric bill , or have a toothache, we will be quick to refer you to a govornment agency, I personally will drive you to another county to deal with it, but you will have to find your own way back. health care MAY be a right, but rights are paid for by responsiblility fall behind on payments, and your rights get impacted
 
#18 ·
Fatjock said:
What are the odds of two ex-members of HM RAF living in the Tampa area?

When I was in, selection of the population only took place at time of entry. Once they had spent a lot of money training you, they wanted a return on that investment, before you got out to apply it to making a better living in "civvie street".
If people didn't make the grade, they went for remedial physical training, and if that didn't work in a reasonable time, they would be medically downgraded (therefore no promotion, limited job options, etc), but they served their contract. Their available skills may have been more limited, but were still applied.

Not left behind, not discharged.

Still sure it was the same military?
I stand partially corrected. Yet you still suggest that a selection process took place at induction. Not so different after all.

After that, the military had to, as should we all, make the best of a bad choice. And there were repercussions. You just happen to accept them as reasonable.


Fatjock said:
I don't dispute most of what you say here, and am very much a strong proponent of "with freedom, comes responsibility".

The question I have is who decides where the line gets drawn? Who decides what decisions are bad, and which are good? There are exceptions to almost every rule, so who decides "that overweight person is a burden, when this one isn't", or "that smoker is going to have major health problems while covered by my company, where this one won't"?

I know nobody died and made me God. So to me the only truly equal way to treat everyone is if the line is drawn so everyone is on the same side of it. Some seem to have no problem putting all smokers, or all overweight people, or whatever group is seen as a "burden" on the other side of the line from themselves, and never see an issue with it, until they are on the wrong side of the line!
If we're all on the same side, and all work together.


I'm not against risk management, but if it's going to be based on the individual, then corrections have to be made the same way. If someone is seen in a "high risk" group, making "bad" decisions to increase potential (such as motorcyclists), by all means load premiums, but if, come renewal time, that loading is found unwarranted, why shouldn't the loading be removed? refunded even? Why must it just go increase the already bloated profits of the carrier?

There is a way to be fair. What is proposed isn't it!
Unfortunately when you come to me, asking for help, you leave it me to follow my conscience.

And I am likely on the wrong side of the health line. My family has significant medical issues that we have dealt with for years. We have expended a lot of effort to learn ways mitigate them. We have pretty much rejected mainstream medicine as a money machine. People who see us think we look great and comment how lucky we are to have such good health. It isn't an accident and it isn't luck. The first thing anyone asking me for help is going to hear is a menu of alternate choices they can make that will make positive differences. If that is too difficult to understand or implement, then I am sorry I can't help you. If you insist on making what I deem to be bad choices, I'm sorry but I insist that you fund them.

If you demand "equal and fair treatment" I suggest that you also demand that we all win the lottery. I find it grating when I see ads on TV for 'free cellphones' that have more features than what I currently pay for. And they have the temerity to make this sound like a pressing need, a fundemental right. For each example of egregious greed (and insurance companies are certainly a good place to start), I'm sure I can find an equally egregious example of 'gaming the system'. Both are wrong. And I'm not going to fix either of them. So my family and I just choose to make the best choices we can and we muddle along with our half full glass.
 
#19 ·
Chatman128 said:
Fatjock said:
.......Clipped..........
I stand partially corrected. Yet you still suggest that a selection process took place at induction. Not so different after all.

After that, the military had to, as should we all, make the best of a bad choice. And there were repercussions. You just happen to accept them as reasonable.


Fatjock said:
I don't dispute most of what you say here, and am very much a strong proponent of "with freedom, comes responsibility"...................clipped..............There is a way to be fair. What is proposed isn't it!
Unfortunately when you come to me, asking for help, you leave it me to follow my conscience.

And I am likely on the wrong side of the health line. My family has significant medical issues that we have dealt with for years. We have expended a lot of effort to learn ways mitigate them. We have pretty much rejected mainstream medicine as a money machine. People who see us think we look great and comment how lucky we are to have such good health. It isn't an accident and it isn't luck. The first thing anyone asking me for help is going to hear is a menu of alternate choices they can make that will make positive differences. If that is too difficult to understand or implement, then I am sorry I can't help you. If you insist on making what I deem to be bad choices, I'm sorry but I insist that you fund them.

If you demand "equal and fair treatment" I suggest that you also demand that we all win the lottery. I find it grating when I see ads on TV for 'free cellphones' that have more features than what I currently pay for. And they have the temerity to make this sound like a pressing need, a fundemental right. For each example of egregious greed (and insurance companies are certainly a good place to start), I'm sure I can find an equally egregious example of 'gaming the system'. Both are wrong. And I'm not going to fix either of them. So my family and I just choose to make the best choices we can and we muddle along with our half full glass.
Fair points, well made............And I'm totally with you on these cellphone ads.

Your comments also brought to mind something said to me by a colleague once which struck home with me when someone commented how lucky we were with the positions we are in, "it's funny how the harder I work, the luckier I seem to get".
 
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