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Donald Miller
Byrne Robotics Member
Joined: 03 February 2005
Location: United States
Posts: 3601
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| Posted: 15 September 2008 at 2:30pm | IP Logged | 1
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I would not say that they are holding back any cures...That sounds a little too conspiracy theory for even me....
I am saying that they are not looking for cures...they are looking for stop gaps, that they can charge for.
Don
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Jeff Alan Hays
Byrne Robotics Member
Joined: 20 January 2007
Posts: 133
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| Posted: 15 September 2008 at 3:37pm | IP Logged | 2
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Two things have changed the course of medicine greatly in the last 25 years or so, or longer if Medicare is considered.
The first is the managed care constructs, private entities such as HMO's, PPO's, POS's, etc., and government programs such as Medicare and Medicaid. These organizations probably had different agendas at their creation, but they seem to operate under the same principles: provide the the greatest amount of health care at the lowest price.
The complexities of working under this paradigm are many. Medicare originated the concept of diagnosis codes, diagnosis modifiers, coding levels, complexity of visits, etc. to give standardization in payment. Unfortunately, these processes have developed to a high level of inefficiency, where individuals at private or government based insurers routinely, and frequently intentionally, deny services, payment, testing or medication in a yearly effort to lower cost.
Coding standards change constantly as do "allowable" tests and medications. The time lost in a office, clinic or hospital setting generating paperwork for billing purposes or to justify treatment is enormous. Nurses, for instance, spend a substantial portion of a working shift doing paperwork as opposed to attending to patient needs. The actual cost of these processes may range from tens of thousands of dollars a year for a private practice to millions for a hospital.
Because of this, hospitals now use less well-trained personnel for health care- PA's, nurse practioners, etc. Unknown to many, this level of care is substandard or negligent a frightening amount of time.
At the office level, phycians may have to limit visits to a calculated time- 10 or 15 minutes to meet the cost of seeing patients. This is not conducive to proper medical care.
On the other hand, it's almost impossible to sustain an office enviroment with a high percentage of Medicare or Medicaid patients. In the state I live in, Medicaid funds have traditionally run out by the end of summer. After this, physicians are not reimbursed for seeing this population.
The second major issue is the escalation of malpractice cases. Most physicians pay between $20,000 ( a bargain) to $150,000 a year in malpractice premiums, even if there is no history of malpractice. This is a huge hurtle to surmount on a yearly basis. Costs are not always predicated on a few high dollar cases (though they are damaging) but also on the number of lower level payouts made simply to avoid a court case, even if the MD-defendants are not at fault. In my state, the leading malpractice insurer paid out close to $500,000,000 (500 mil) last year in malpractice awards. Attorneys (not all) may take a large percentage of any such pay out.
The result here is that a significant number of physicians will stop practicing "high risk" medicine or will retire. In my state and the adjoining state, there are large areas where no neurosurgeon is available for a radius of several hundred miles. This puts patients with emergent neurosurgical trauma at excessively high risk.
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Donald Miller
Byrne Robotics Member
Joined: 03 February 2005
Location: United States
Posts: 3601
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| Posted: 15 September 2008 at 3:43pm | IP Logged | 3
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And now they are protesting Mortal and Zombie marraiges.
..
Don
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Jeff Alan Hays
Byrne Robotics Member
Joined: 20 January 2007
Posts: 133
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| Posted: 15 September 2008 at 3:49pm | IP Logged | 4
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One thing worth remembering about pharmaceutical companies is that they did not change substantially. Payment constructs changed. While capitalistic, U.S. drug companies have always produced fantastic new drugs. Typically, the cost of these meds goes down significantly over time with greater use.
30 years ago, hospital formularies had most major drugs on site and available for inpatient use. This is no longer true. For reasons relating to deals brokered between hospitals and managed care organizations, many drugs are left off formulary in place of a chosen competitor. The problem here is that drugs of similar classes, or even in the same class, differ and this leads to alternate medication regimens for inpatients that may not be beneficial. The cost here comes as pharm co.'s are left out of various markets. This raises the price which they attempt to make up elsewhere.
Malpractice is another huge issue as millions or billions of dollars are at stake if a drug fails in early trials or is pulled off the market at a later time. Some drugs are pulled while other drugs such as Coumadin survive (as it should).
The U.S. is still a leader in new medication development- where certain countries with socialized medicine are not, ao there are benefits to the profit-driven sysem of drug companies.
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Michael Myers
Byrne Robotics Member
Joined: 28 December 2004
Posts: 831
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| Posted: 15 September 2008 at 4:13pm | IP Logged | 5
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"I'm sorry, but this statement proves to me that you've been drinking
the Kool-Aid..."
'Got it, Joe.
Edited by Michael Myers on 15 September 2008 at 4:24pm
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Scott Richards
Byrne Robotics Member
Joined: 22 September 2005
Posts: 1258
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| Posted: 15 September 2008 at 4:15pm | IP Logged | 6
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Well, good news for the Zombies. We are on the right path.
http://www.youtube.com/watch?v=ZEhG5DKmkHQ
http://www.youtube.com/watch?v=u2d--x8uc9s
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Michael Retour
Byrne Robotics Member
Joined: 27 May 2006
Posts: 932
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| Posted: 15 September 2008 at 5:43pm | IP Logged | 7
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Today was a day that will go down in history.
The Fed pumped liquidity into the financial system three times today (I believe the total was $96 billion but some reports say $70 billion). The European Central Bank, the Bank of England and the Swiss National Bank added roughly $55-$60 billion into the panicked, desperate banks.
Institutions that withstood the Great Depression are no more. The so-called assets evaporated and will continue to do so. Housing prices will stop falling? That is a joke. They won't. No action needed has been taken to halt the fall of housing. There is no confidence in this administration anywhere.
Washington Mutual has been cut to junk status by S&P.
Bank of America shares are sinking down down down to Davey Jones territory.
Is AIG the next domino to fall? It dropped something like 60% today.
This is a strong economy? This is prosperity?
“I do not understand how we got into this situation,” said New Jersey
Gov. Jon Corzine, a former chief executive of Goldman Sachs.
“I don't think anybody has a handle on it,” said Corzine. "I have a
feeling that people do not know all of the exposures they have to the
entities that are troubled, and therefore causing additional problems
that have to be adjusted, requiring even more capital and even greater
shrinkage of balance sheets and other risk exposures.” At least Corzine is showing some truthfulness in stating no one knows the counterparty risks.
Chicken little is running around the yard screaming the sky is falling but Merrill fell, Lehman fell and the FDIC is "on watch" to see what the impact is on other banks (because they don't know seeing as Alan "Bubbles" Greenspan didn't want these derivative products on the books or regulated). Why a late rent check in Brooklyn could set off a chain-reaction collapse! Smiling.
Bush, in his way, said no more bailouts but clearly was lying as the Fed intervention into the "free market" is a bailout and a desperate one at that. The Fed and Bush's team are trying to arrange a bailout of AIG right now through various ways: Goldman Sachs, JP Morgan.
See, if AIG is downgraded (as is the rumor around the water cooler) then its credit default swaps (a derivative) will go South (as they have been doing) taking Lord knows what with them. AIG is having a fire-sale of assets.
One wonders how the banks are getting away with listing all the junk on their books as assets (the homes sitting there, values eroding daily).
“I’m playing the hand that was dealt me,” Paulson said sounding more like a card shark than a Treasury Secretary. He should resign today. He's a disgrace.
Now, Wall St. is on its knees praying the Fed will cut rates. Let's have some hyperinflation folks!!
No crystal ball is needed, Michael.
But we don't really know the situation do we? We don't know the name of the next corpse to arrive at the morgue will be do we?
You went a lot farther than simply saying the "sky was falling" and
that the situation was "unsolvable". Do I even need take the time to
post the quotes? As it is, I appreciate the current tone...even I am
slow to adopt it myself.
No, you don't need to go back and dig up my old quotes.
I believe the financial system has already collapsed with much more debris to float ashore. I believe the financial system is bankrupt and that rearranging of deck chairs on the Titanic (the bailouts) aren't going to help matters at all. I believe these bailouts will worsen the crisis.
You don't believe the financial crisis is of that severity or you might not even believe that there is a financial crisis. I don't recall whether or not you said you believed one existed or not. I do seem to recall you saying we had some "problems" but can't remember exactly what you thought they were.
Michael, we have discussed it, and I asked you what solution you
offered in place of the derivatives market. You never responded.
Maybe fifteen years ago I would have said regulate and tax them (as a way of drying them out so we would not have gotten to this point) but I think it is too late for that. At things stand now I think perhaps a general bankruptcy reorganization of the economy (and not just the USA's either) is in order.
The Italian government (among others) have been calling for this sort of action for years, recognizing the systemic threat.
It isn't just a US problem. It is international and will only be solved with international action and I don't mean wars.
Only the US, acting in concert with the other great powers of the world, could solve this. I am talking about Russia, China, Europe, etc. Maybe a new monetary conference akin to the Bretton Woods conference? Former Italian Finance Minister Giulio Tremonti called for such actions back in March of 2008. Some Russian government officials backed his call. I also believe the Chinese government had a positive response to this call for a new monetary conference.
I tend to believe that most European governments (including Russia, which is a European nation), China and India would welcome such a measure. I believe most of the world would rejoice at such a conference to bring under control an out of control worldwide financial crisis.
I don't know if you read the international press. You might. If you do you know as well as I do this "banking" crisis, or "housing" crisis, or "economic" crisis isn't confined to the US. This needs to be repeated over and over. You've pointed it out when you mentioned the fictional values on real estate in other nations being worse than ours.
Short of potent action, taken by governments in concert, matters will get worse and accelerate.
That's my answer to "derivatives" but the system is the problem and derivatives are just a feature of the system. Greenspan, as you know, fought tooth and nail to keep derivatives OBS during his tenure as Fed chair. He fought to keep them unregulated and now everyone is going to pay the price for his "hollow victory" in the matter.
To an extent. In real terms, we're so far looking at the ubiquitous,
generic approximation of $100-$150 billion for both institutions. We
won't really know until the auctions in October. Keep it in mind
though, such an 'event' automatically effects what you're thinking of
as outstanding possible debt. As I mentioned to Joe, 98% of borrowers
are on time and, technically, the former GSEs assets are solid, if
overvalued. By and large, the market has reacted favorably.
The market is reacting favorably? The market today is more of a con-game than a real gauge of how American companies are doing. How many more accounting scandals do we need to see that?
No, it can't be termed a simple bailout for
overseas institutions as the collateral is mostly domestic. Overseas
institutions do benefit, just not in the direct method to which i
gather you refer. The benefit is the same as to everyone else, and to
a lesser degree than domestic concerns when ripple effects are
considered.
You misunderstood me. I didn't mean to imply it was a "simple bailout for overseas institutions" but did mean to imply the ripple effects are worldwide. Just Lehman's bankruptcy, the fourth largest investment bank, rattled bourses around the world Mike and you know that (this was before the other "body count" numbers for the day came in). The folks dying from starvation worldwide are dying due to a systemic worldwide economic crisis not because they didn't get rain last year.
If it was, indeed, simply a case of the Fed 'starting the ball
rolling', then ALL of the other countries in worse shape than we
regarding market overvaluation, would not, in fact, be in a worse
spot. Now, this isn't the case, is it? Or, at the very least, market
overvaluation would have first evidenced itself in America. Also, not
the case.
I never said the Fed "started" the housing bubble did I?
I agree the housing values are worse in some places but there are no worse banks than the American ones when it comes to good old derivatives are there? Now, who lit the fuse on this Boris and Natasha bomb going off all over the world? The American financial system did in order to feed the bubble (others had their part but it was mainly to prop up this nation's illusion of prosperity and the delusion people have of the "mighty American economy"). Social Security liquidity flows were attempted to be diverted into the stock market in order to prop up the system. That failed. Housing came in next. Popular shows like "Flip This House" or whatever it is called came on (they might have named it "I've Flipped My Lid"). Does anyone actually believe you can base your economy on selling each other homes? On speculation? A nation of speculators? What about production of durable goods? Industry? Agriculture? Rebuilding of infrastructure? The last four items I mentioned would make a nation strong and justify a strong market, a strong dollar, etc. but I am not in charge of matters like that am I?
Mike wars are won by logistics and the Iraq fiasco points out just how low we've sunk as a nation once able to provide the in depth capabilities for emergencies like a war. Katrina pointed it out too. The collapse of the bridge in Minnesota did. The Northrigde earthquake did. The rolling brownouts every summer did. The state of water management did. The state of public and private education did. Just because we can talk about comics and how great we think Byrne is doesn't mean we're all rolling in millions of dollars (I'd take some other currency considering the dollar's standing now and where it can drop to very quickly) and prosperous.
What is the plan to keep the dollar's value anyway? Is there one? If there is I haven't seen it.
You know how Europe reacted to this. You know how Asia did.
I believe you're seriously underestimating the magnitude of the crisis.
Either way, both your previous critique and Joe's current critique, as
it relates to any current financial crisis in the sub-prime markets
either originating or being engineered in America, loses out.
I say we're in a global financial collapse with the subprime collapse merely a feature of it. I say we've been in this crisis for roughly thirty years and the strength of our economy (in the US) has been eroding over those thirty years as measured by physical output and infrastructure.
There are ways out of this but, like the alcoholic or addict, people have to admit the problem exists and then take the proper action.
Delusions won't get us anyplace. The current batch of politicians seem to be operating under a series of dangerous delusions that have cost the nation much. It's time for them to step aside. Let someone in who knows what to do.
FDR would have been able to handle this. Hamilton would have. Lincoln too.
I look forward to the naming of the "strong sectors" of the US economy. Or your take on a solution to the mess we are most clearly in.
What a day.
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Monte Gruhlke
Byrne Robotics Member
Joined: 03 May 2004
Location: United States
Posts: 3299
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| Posted: 15 September 2008 at 8:00pm | IP Logged | 8
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I don't understand why he government needs to bail anyone out (people losing jobs and the economy tanking? Please, that reason hasn't bothered anyone for the past 6 years, why would it now?).
Let all the company skeletons fall out of the closet in this mess, and the USA can better use the money they would have spent to get this country on the road out of this recession.
And healthcare HAS turned into sick care. With the crappy premiums to be met, people only go to get help when it's absolutely necessary. Of course it's going to cost more this way, but then there's no profit in preventive care.
edited for spelling
Edited by Monte Gruhlke on 15 September 2008 at 8:02pm
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Steven Myers
Byrne Robotics Member
Joined: 10 June 2004
Location: United States
Posts: 5729
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| Posted: 15 September 2008 at 8:52pm | IP Logged | 9
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Isn't medicare better run and easier to work with than any private insurance company?
Isn't the largest group of uninsured Americans children?
Isn't it true that we have all kinds of treatments and cures that sick people can't afford?
I don't have solutions to these points, but I think we should be doing something!
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Jeff Alan Hays
Byrne Robotics Member
Joined: 20 January 2007
Posts: 133
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| Posted: 15 September 2008 at 9:56pm | IP Logged | 10
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"Isn't medicare better run and easier to work with than any private insurance company?"
Really, not. In fact, Medicare is often farmed out to local insurers who make many of their own rules. For example, in my state, a certain diagnosis code will not allow a certain simple blood test to be ordered. A Medicare resident who lives 15 minutes away across the state line can have the same test done with the mentioned diagnosis code. A federal system, but there is lack of continuity from area to area.
The lack of affordability is a good question. Ironically, though treatment or payment options can often be found for a great many patients, it is hard work. One problem is that private insurers, and certainly state and federal governments, are not terribly accountable for their tendency to practice medicine without a license. When they deny or delay treatment, they rarely face lawsuits as a result. There have been a few federal court decisions protecting insurers in these scenarios.
While our society is far too litigious, these companies should probably share the risk that the general health care community operates under.
It's interesting to think that there was a time, just a few decades ago, when medical insurance was not nearly so hard to come by or to work with. The concept of an insurer saying a patient's hospital time was limited, or denying treatment, was almost unheard of. A free market approach used to work fairly well for that industry, but government protection and use of such entities has altered the playing field.
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Jodi Moisan
Byrne Robotics Member
Joined: 19 February 2008
Location: United States
Posts: 6808
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| Posted: 16 September 2008 at 12:57am | IP Logged | 11
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I believe hell just froze over.
http://www.youtube.com/watch?v=OviYjJWIYbY
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Joe Zhang
Byrne Robotics Member
Joined: 16 April 2004
Location: United States
Posts: 12843
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| Posted: 16 September 2008 at 6:09am | IP Logged | 12
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Are we on the "right" channel ?
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Topic Closed)
