How am I qualified to judge the effectiveness of my oncologist. It’s not like I can go on a test drive and any stats are going to be unclear to the layman at best.

And, aren’t you just talking about rationing?

Bleeds Blue on December 2, 2009 at 12:45 PM

No silly, you don’t need to know everything, you just need to have friends- you ask around! You do research on the Internet. We needed an autism doc. We could go local and so so or drive to Florida, pay thru the nose, and get the best in the country. Autism is another good example of this- regular insurance doesn’t cover the treatments that work, so families decide how much treatment they want for their kids. We chose the spendy, Floirda doc and got superb treatment. Others choose to do nothing. It is up to the individual to choose.

There are a lot of good ideas for reforming health care. Nancy Pelosi has none of them.

Now, if a millionaire decides to have hip replacement surgery and gets it, while you’re old granny who worked hard all her life can’t get it, because she’s on a fixed income and might need the thirty grand, that’s the market at work.

But if we socialize medicine, the millionaire gets his hip replacement, and granny gets her hip replacement but has to wait six months, you call that “rationing.”

What’s the effective difference (except that in once case granny actually gets her hip)?

Bleeds Blue on December 2, 2009 at 1:18 PM

That’s the trouble with a hypothetical question. It’s divorced from reality. In socialized medicine, granny is a lot less likely to get her hip replacement, 6 month wait or not. Under the current system, there are other ways to work it.

I could just as easily say that granny gets her hip replacement because a doctor agrees to write off the rest of her bill after health insurance pays. It’s no less likely than granny waiting 6 months for a hip replacement under socialized medicine.

So, I’m going to take my non-existent medical training and evaluate my oncologist based on price? “This guy’s survival rate is 5% higher, but he costs 40% more, so I’m going to go with the other guy.” I don’t think so.

I’m not a mechanic, far from it. I haven’t a clue. Or a veterinarian, or a lawyer, or a contractor. But I certainly am able to do a little research to find one that suits my needs. I’m guessing you’re smart enough to do that too.

When dealing with the human body, averages and percentages mean little when it comes down to you personally. A doctor’s stats don’t mean anything because your body is not going to necessarily react predictably to treatment. And to be honest? Most ailments don’t even need a doctor to administer them because there is well-defined standard protocol for–well, for most everything–that almost all doctors follow as best practice. Even a caveman could do it. It’s what everyone does first no matter how they practice. The head-scratching might come in later, but with a little bit of practice, most diagnoses aren’t rocket science.

I believe the Mayo Clinic is putting doctors on salaries to good effect.

Kaiser does too, as well as taking care if the whole malpractice issue–which is huge.

I belong to Kaiser and am presently undergoing cancer treatment for the second time in two years. Last time, the hospital nearest me didn’t have the sort of nuclear medicine facilities that I needed, so I went to a hospital across town. I had a choice of going up to Sacramento or out to Roseville, I chose the closest one. This time there’s a nuke med department at the hospital nearest me, so I’m going there–but I could have gone back up to Sacramento, out to Roseville, or even down to Stockton if I wasn’t happy with my other choices. If Kaiser didn’t do this type of treatment at all, they would have sent me out of system without any additional cost to me. I’ve always had plenty of choice in my health care decisions, so it’s a good model for making things simpler and less expensive.

With that said, many people do not like Kaiser–fine. They should be able to shop around for the type of health care they do like and can afford. But they should be able to choose, not a government bureaucrat. If they want to be treated by a doc at the Mayo Clinic who is salaried, great. If they want to be treated by an NP, that’s great too. One size definitely does NOT fit all.

What’s the effective difference (except that in once case granny actually gets her hip)?

Bleeds Blue on December 2, 2009 at 1:18 PM

Actually rationing would be, after calculating granny’s QALY it’s determined not to be cost effective to give her a hip replacement. Maybe she only has a few months to live, or a few years, or she is just too old then no hip replacement for her.

That’s healthcare rationing.

Bleeds Blue on December 2, 2009 at 1:18 PM

Except in the future, there will be a whole lot less millionaires to pay for any of your utopian social programs. People will do without in what looks to me to be a very dark future if the world keeps on this track.

Are we thinking here that oncologists and cardiologists will start taking out newspaper ads and bidding against each other?

Perhaps not the newspaper ads, but otherwise, indeed yes. If you shop around to find the the cost of the same treatment is considerably less from one doctor over the other, which will you choose? Despite the seriousness of their profession, doctors are service-providers like any other–no different from the guy who cuts my grass or the ladies that clean my floors, a plumber, a lawyer, whatever. I shop around for the features I want at the price I want to pay, and I hire that person for the job. Why should medicine be any different?

Also, am I talking about rationing? Not in the least. I’m just pointing out that Obama blames elective (unessesary as he calls it) surgery for the cost of healthcare increases. This thread is arguing that lasik offers a model for controlling the price of elective surgery.

Not I believe this debate has anything to do with actually lowering the cost of healthcare as evidenced by the Obamacare bill’s failure to include any real strategy to lower the cost of healthcare.

jhffmn on December 2, 2009 at 1:02 P

“Unnecessary” surgery and “elective” surgery are entirely different animals. “Unnecessary” is when a doctor takes out your tonsils when they’re inflamed not because they won’t clear up on their own but because he’s padding his bill, he’s covering his butt, or he decided that it was easier than listening to you whine.

But, on the rationing.

The only way to make people shop for medical services is to increase the cost to them. We all agree on this, right?

Now, if a millionaire decides to have hip replacement surgery and gets it, while you’re old granny who worked hard all her life can’t get it, because she’s on a fixed income and might need the thirty grand, that’s the market at work.

But if we socialize medicine, the millionaire gets his hip replacement, and granny gets her hip replacement but has to wait six months, you call that “rationing.”

What’s the effective difference (except that in once case granny actually gets her hip)?

Instead of showing eyeballs, Nick could have been showing — well

Nick wanted you to remember something about the topic:
“I saw this great Reason video about healthcare. It said…um…uh…something…

Great video though.”

I had lasik and now need a redo. Great while it lasted, though.

ROCnPhilly on December 2, 2009 at 11:17 AM

I did too, and I also needed a redo. Which is why I paid a little bit more per eye for the lifetime warranty. If I ever need an adjustment I just set the appointment and get it done free of charge.(so to speak)

So, I’m going to take my non-existent medical training and evaluate my oncologist based on price? “This guy’s survival rate is 5% higher, but he costs 40% more, so I’m going to go with the other guy.” I don’t think so.

How am I qualified to judge the effectiveness of my oncologist. It’s not like I can go on a test drive and any stats are going to be unclear to the layman at best.

And, aren’t you just talking about rationing?

Bleeds Blue on December 2, 2009 at 12:45 PM

Do you have anyway to evaluate your oncologist now?

Also, am I talking about rationing? Not in the least. I’m just pointing out that Obama blames elective (unessesary as he calls it) surgery for the cost of healthcare increases. This thread is arguing that lasik offers a model for controlling the price of elective surgery.

Not I believe this debate has anything to do with actually lowering the cost of healthcare as evidenced by the Obamacare bill’s failure to include any real strategy to lower the cost of healthcare.

And, aren’t you just talking about rationing?

Bleeds Blue on December 2, 2009 at 12:45 PM

No, rationing is the government telling you you can’t have it and that’s that.

This is your wallet telling you that you can’t have it right now but you can in the future if you can afford it, so you go shopping and find some way to afford it.

Go make that silly dishonest conflation somewhere else, like, ummmmm, I don’t know, an economics class.

The politicians support Obamacare because it gives them more power. The people who support those politicians support them because they want someone else to pay for their care and would rather spend their money on a new TV. To either group, it’s not about lowering costs.

Why wouldn’t you shop around for oncology or cardiology treatment? Your emergency care example with a gunshot wound is has nothing to to with either of those.

I know often people are limited by which carecenter can offer the treatment, we ran into that ourselves last year with heart surgery. But baring that, why not? I would.

Also, much of what Obama rails against is elective surgery such as the total hip replacement story he tells.

jhffmn on December 2, 2009 at 12:36 PM

So, I’m going to take my non-existent medical training and evaluate my oncologist based on price? “This guy’s survival rate is 5% higher, but he costs 40% more, so I’m going to go with the other guy.” I don’t think so.

How am I qualified to judge the effectiveness of my oncologist. It’s not like I can go on a test drive and any stats are going to be unclear to the layman at best.

And, aren’t you just talking about rationing?

Instead of showing eyeballs, Nick could have been showing — well, you can use your imagination.

Boobs, Ed? Why would we want to see more Democrats…I don’t get it.

I think another big problem is fee for service. Were there a way — as some hospitals and medical systems are exploring — to basically put doctors on (an appropriately high) salary rather than paying them for piecework, you’d derive some of the same benefits that tort reform is expected to deliver.

As a side note, I think that if McConnell told Reid: OK, you’re going to get this bill through anyway, I’ll give you four RINOs for political cover if you give me tort reform” Reid (and Obama) would take the deal in a minute.

Bleeds Blue on December 2, 2009 at 12:13 PM

I believe the Mayo Clinic is putting doctors on salaries to good effect.

Regardless, this “public option” thing continues to be a sticking point. It’s just a bad idea.

Are we thinking here that oncologists and cardiologists will start taking out newspaper ads and bidding against each other? “Buy one round of chemo, get the second round free”?

Lasik and boob jobs are optional surgery where people have all the time in the world to shop around. The most costly portions of medical care are not and so the market is very different.

“Wait Mr. EMT! Don’t take me to Providence Hospital! I hear they’re having a special on gunshot wounds at GW!”

Bleeds Blue on December 2, 2009 at 11:44 AM

Why wouldn’t you shop around for oncology or cardiology treatment? Your emergency care example with a gunshot wound is has nothing to to with either of those.

I know often people are limited by which carecenter can offer the treatment, we ran into that ourselves last year with heart surgery. But baring that, why not? I would.

Also, much of what Obama rails against is elective surgery such as the total hip replacement story he tells.