*politics
*debunked
*money

Adding video to channels (Debunked, Money, Politics) - requested by NetRunner.

I wish I could vote for her.

^ Me too, Liz Warren 2012!!!!

Mostly anecdotal babble. Health outcomes are heavily influenced by cultural habits of eating, drinking (alcohol), drug abuse, physical activity, and genetics. The great majority of US citizens with private health insurance are "safe", to use her term, although certain policies may have lifetime caps on certain types of care, like mental health, which is BS in my opinion. The US leads the world in outcomes in many of the most complex diseases, such as hematologic malignancies.
She is right about a few things. The major reason health-care expenditures have greatly outpaced inflation is the rapid advancement of technology. The true health benefit of all this technology is questionable. The life expectancy in Mexico is just short of the US, despite spending about 10% of what the US spends per capita.
National Health care systems control expenditures by making budgets. Budgets = rationing. Ultimately, US citizens will have to come to grips with the fact that health care spending cannot be an open-ended account. Judging by my interactions with patients, that's not going to be anytime soon. Several things that could be done right away that would make a great difference in overall health-care spending are; eliminate coverage for any medical therapy lacking outcome data to support its efficacy, tort law reform, and PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH. Quit smoking, lose weight, and exercise. Bariatric surgery should not have to be a substitute for will power. But, such is the American way.

Yep I got hit with the same thing, the one-two punch. My side, it was sickness (swine flu, no joke), ending with long-term disability (plus surgery). That cost me my 40-50k job, but luckily I have parents that are helping me try to see through this. Otherwise, I would be a bankrupt statistic and most likely dead.

BTW, @snoozedoctor I understand your beef with "PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH", but that is a very interesting position to hold especially concerning what your oath has to say about that. I assume you're a professional in your field; perhaps you should take up that stance with doctors concerning those fields and see what you could flesh out other than: "throw'em under the bus".

Sorry about your plight. Long term disability is a rare thing after recovery from influenza. You obviously ran into some bad luck and I hope that turns around for you. Actually, I don't think advocating personal responsibility is an interesting or unique position for a physician in the least. Promoting health and prevention of disease is part of our oath. With 1 out of 5 Americans still smoking and 1 out of 3 obese, we are clearly losing the battle. Sorry, but it's not my responsibility to hide the Twinkies, or the Camels and drag people to the gym. If citizens want better health outcomes from their health-care system, they should do their part. The quality of what comes out is only as good as what comes in.



>> ^kceaton1:

Yep I got hit with the same thing, the one-two punch. My side, it was sickness (swine flu, no joke), ending with long-term disability (plus surgery). That cost me my 40-50k job, but luckily I have parents that are helping me try to see through this. Otherwise, I would be a bankrupt statistic and most likely dead.
BTW, @snoozedoctor I understand your beef with "PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH", but that is a very interesting position to hold especially concerning what your oath has to say about that. I assume you're a professional in your field; perhaps you should take up that stance with doctors concerning those fields and see what you could flesh out other than: "throw'em under the bus".

@snoozedoctor

personal responsibility is not really the issue. actual access to healthcare is.
yeah, americans are fat, stupid, and lazy, and eat like shit, but the "for profit" status of western medicine and the insurance and pharma scams aren't really helping matters.

one of the big problems with a "for profit" system is that preventative medicine is not nearly as profitable as medicine that bills by procedures.

>> ^snoozedoctor:

Sorry about your plight. Long term disability is a rare thing after recovery from influenza. You obviously ran into some bad luck and I hope that turns around for you. Actually, I don't think advocating personal responsibility is an interesting or unique position for a physician in the least. Promoting health and prevention of disease is part of our oath. With 1 out of 5 Americans still smoking and 1 out of 3 obese, we are clearly losing the battle. Sorry, but it's not my responsibility to hide the Twinkies, or the Camels and drag people to the gym. If citizens want better health outcomes from their health-care system, they should do their part. The quality of what comes out is only as good as what comes in.

>> ^kceaton1:
Yep I got hit with the same thing, the one-two punch. My side, it was sickness (swine flu, no joke), ending with long-term disability (plus surgery). That cost me my 40-50k job, but luckily I have parents that are helping me try to see through this. Otherwise, I would be a bankrupt statistic and most likely dead.
BTW, @snoozedoctor I understand your beef with "PERSONAL RESPONSIBILITY FOR ONE'S OWN HEALTH", but that is a very interesting position to hold especially concerning what your oath has to say about that. I assume you're a professional in your field; perhaps you should take up that stance with doctors concerning those fields and see what you could flesh out other than: "throw'em under the bus".



Would you argue that regular check ups should be apart of your healthy life style? Perhaps a cholesterol check, yearly blood test for organ function and such?

My last blood work before insurance was over 300 dollars. Flu shot was 60 bucks at the doctor's office. Yes, people who don't insurance don't pay what they bill insurance at. Hell most of the time, the people providing these services don't know what they cost.

Now if a simple flu shot costs 60 bucks at the doctor's office, while Im there getting a check up no less. But costs 10 dollars at the drug store.......where's the disconnect?

As for exercising, Im frankly frightened that I might get hurt and it cost me more than a make in a year to get it fixed. Not to mention how long that recovery time would be and losing my job during that. At least doing stuff on the job and getting hurt means you have worker's compensation and you might be able to convince them to hold your job until you recover. But if you break your leg or pull loose a tendon while exercising you have only what you can afford to pay for. Which you don't know what it will cost until after they are done, insurance or not.

I suspect in other countries where healthcare is universal, people don't have to worry about this and they can push themselves a little. And it's in the countries best interest to make sure people exercise properly, stretch, don't over do it etc. So they probably take more care to make sure people are properly instructed on how to go about it and what they can do as they age to change up the routine and still get the needed results. You know, without having to be a professional athlete or hire a personal trainer. It's all too easy for family docs to recommend you to specialists for every last concern you have, plus they get a nice little referral kick back. It's a nice system the US has.......or not.


US workers work more hours than most countries, spend more time on the road commuting and generally have less time to live a health life as well. It's a useful thing to big businesses requiring those long hours that they provide your healthcare, because it'd be a shame if you lost your job due to not working the outrageous hours and lost that healthcare. If you untied health care from employment, people'd see how truly expensive it is and they'd be more inclined to have it reigned in and made universal. The premiums on health insurance alone would cover all of your general yearly checkups and tests and probably most of another person's for single people.

http://www.rollingstone.com/politics/news/how-i-stopped-worrying-and-learned-to-love-the-ows-protests-20111110

Exactly what is preventive medicine? It's basically don't smoke, don't drink too much, eat right, exercise, and wear your seatbelt. Oh, and don't text while you drive. So, most of it is just personal responsibility. Then there are the screening tests, mammograms, PSAs.....most of which are being cut back because of lack of evidence they improve outcomes and because they probably lead to many unnecessary tests. Immunizations are a great example of preventive medicine that works.
The Emergency treatment and active Labor Act of 1986 was an unfunded mandate that required hospitals to provide emergency services and obstetrical care to all patients presenting for emergent care, regardless of their ability to pay or citizenship. So, nobody is denied emergent care in the US health-care system. Of course, the real problem is uninsured patients that have non-emergent health-care problems.
The complexities of the current US system will make it very difficult, if not impossible, to completely convert to a single payer, National Health Care Plan. Perhaps it may evolve as a parallel public system, similar to the VA system. Regardless, the major problems with the current system are not being addressed. The heroic measures to save a few elderly people, without realistic hope for recovery, are consuming resources that could be used to provide health-care for younger citizens with some hope for a good quality of life. The threat of lawsuits are resulting in physicians ordering tests and consultations that are unnecessary and may add up to a full 10% of all health-care costs.
One often overlooked result of a "for profit" system is the investment in medical technology. The US is by far the World's largest exporter of medical devices. We invented and manufactured the MRI and CT scanners, and much of the high tech devices that other countries use in their National Health Care Systems.
>> ^criticalthud:

@snoozedoctor
personal responsibility is not really the issue. actual access to healthcare is.
yeah, americans are fat, stupid, and lazy, and eat like shit, but the "for profit" status of western medicine and the insurance and pharma scams aren't really helping matters.
one of the big problems with a "for profit" system is that preventative medicine is not nearly as profitable as medicine that bills by procedures.

Recognizing, of course, that medical technology manufacturers are funded by their total sales, not just the US system.

I think my biggest problem with solutions to smoking (which have a partial answer, if you slave their addiction to patches), being fat (which CAN be caused by medical problems and medications--obviously that isn't the primary cause), or any other self-abusive scenario which may indeed need psychological help to truly treat them; the problem is that we functionally still do not understand both the on and off switches to their medical woes or the self-inflicted ones. A "cure" is absent. I do however, see ways you can help. As in having a dietitian play a key role in the reversal of patients outcomes, rather than throwing them out of the clinic with no help. Much like the work of social workers; let us not be afraid to create a new job if it's needed. The question I meant to ask earlier is: Do you wish to be your brother's keeper or did you simply lose your hope?

This is for anyone that sees that our system simply need not be there to help everyone, or help someone more than once, twice, and no matter how long. Some can't even find a doctor that can diagnose them until perhaps that fifth or sixth try...

>> ^snoozedoctor:

Exactly what is preventive medicine? It's basically don't smoke, don't drink too much, eat right, exercise, and wear your seatbelt. Oh, and don't text while you drive. So, most of it is just personal responsibility. Then there are the screening tests, mammograms, PSAs.....most of which are being cut back because of lack of evidence they improve outcomes and because they probably lead to many unnecessary tests. Immunizations are a great example of preventive medicine that works.
The Emergency treatment and active Labor Act of 1986 was an unfunded mandate that required hospitals to provide emergency services and obstetrical care to all patients presenting for emergent care, regardless of their ability to pay or citizenship. So, nobody is denied emergent care in the US health-care system. Of course, the real problem is uninsured patients that have non-emergent health-care problems.
The complexities of the current US system will make it very difficult, if not impossible, to completely convert to a single payer, National Health Care Plan. Perhaps it may evolve as a parallel public system, similar to the VA system. Regardless, the major problems with the current system are not being addressed. The heroic measures to save a few elderly people, without realistic hope for recovery, are consuming resources that could be used to provide health-care for younger citizens with some hope for a good quality of life. The threat of lawsuits are resulting in physicians ordering tests and consultations that are unnecessary and may add up to a full 10% of all health-care costs.
One often overlooked result of a "for profit" system is the investment in medical technology. The US is by far the World's largest exporter of medical devices. We invented and manufactured the MRI and CT scanners, and much of the high tech devices that other countries use in their National Health Care Systems.
>> ^criticalthud:
@snoozedoctor
personal responsibility is not really the issue. actual access to healthcare is.
yeah, americans are fat, stupid, and lazy, and eat like shit, but the "for profit" status of western medicine and the insurance and pharma scams aren't really helping matters.
one of the big problems with a "for profit" system is that preventative medicine is not nearly as profitable as medicine that bills by procedures.



well, one really lacking area is in somatic complaints, which make up, i believe, the close to the majority of complaints at hospitals. things like - bad back, bad shoulder...etc. these are all complaints that often have chronic structural issues, for which western medicine is ill-equipped to deal. they often just medicate those issues until they turn into procedural issues, which is often a very incomplete treatment.
instead structural issues are left to mostly the chiro's to muck about with, and while they get some of the theory right, their quick-fix practices are also often based on a profit motive, and rather incomplete.

In my particular specialty, I have no choice but to be my brother's keeper, which is as it should be. I treat with the same diligence the drug dealer shot by the police or the 5 year old child bitten by the family pet. Every physician I work with does the same. No medical decisions are based on anything other than what is in the best medical interest of the patient. My comments on personal responsibility are made from the perspective of my being a tax-paying citizen of a country that struggles under the weight of a medical system that is a bloated bureaucracy servicing a population of consumers with unrealistic expectations.
I totally agree with your comments on addiction. It's poorly understood and hard to treat. If we had a therapy that was effective, I'd be all for paying for it. But we don't. Psychological counseling is of little benefit. A person doesn't stop smoking, or lose weight, until they are ready. Too often it's because they have a debilitating disease caused by same. I have a few friends that smoke. I've tried to get them to quit. I've described the slow death of emphysema, the air hunger, feeling like you're running a race that never ends, although it does when you die. There's not many worse ways to go. But their response is the same, "I'm not ready to quit." Too bad.
One of the great misconceptions US citizens have, is the criticism that physicians are "controlled" or "puppets" of the system, that they receive kickbacks for referrals, etc. These people have never had experience trying to manage physicians, that's for sure. There's not a more fiercely independent group in any work force. They HATE being told what to do and they are the most ethical group of professionals I've ever encountered.

I retract one statement about physicians I work with "no medical decisions are based on anything other than what is in the best medical interest of the patient." Not true. The great majority of the time it's not too little care, but too much care. Judgment is lacking on when to withhold, or stop, heroic measures. It's often from pressure from family members, fear of lawsuits, or just guilt should they not to "everything possible." Just because you "can" doesn't mean you "should."