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The Phlegmatist posted:Some of what goes into that is doctors ordering too many tests, but some of that is also driven by patient expectations being really weird because they don't understand evidence-based medicine. That is more the instinctive human bias for doing something over doing nothing.
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Jun 28, 2017 01:33
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evilweasel posted:That is more the instinctive human bias for doing something over doing nothing. B-12 or PSA's? For screenings, I think it's more how counter-intuitive limiting screenings = better health outcomes is. Also, is this pretty much the way things are with most screenings? I know breast cancer screenings went the same way as well.
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Jun 28, 2017 04:34
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Futuresight posted:Profit is not the only place where insurers cost the public money though. A huge chunk of their expenses (and hospital/doctor expenses) would also go away if the insurance industry went away. Exactly. The multitude of insurance companies means doctors' offices need inflated business offices to handle claims, denials, etc. The loving Primary Care - Network - Referral system bullshit is one aspect of this. I called up my PC and got a referral to an outside clinic. I went to said clinic, who billed my insurance. My insurance gave me a Statement of Benefits claiming they don't have the referral. I spent an hour on the phone in the middle if the workday fixing this myself, speaking to no fewer than 5 different people. Who the gently caress can I bill for that? And does this get counted in GDP?
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Jun 28, 2017 11:25
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BirdOfPlay posted:B-12 or PSA's?
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Jun 28, 2017 11:43
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Forgall posted:Wait, how can a screening be harmful? Sometimes they pick up on things that would have gone away naturally, like very small cancers. So you end up undergoing chemo and surgery for a breast lump that would never have come to anything.
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Jun 28, 2017 12:34
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Lemming posted:Maybe I'm misinformed but to me I only hear single payer and Medicare for all, I'm fine with the second as a rallying cry as well because it seems almost synonymous. I don't hear "public option" almost ever except in the context of how Lieberman hosed us I'm only vaguely familiar with what happened with that, but what was Lieberman's personal motivation to get rid of the public option in drafting the ACA? And why is he such an rear end in a top hat to his own party coalition? Also, we all agree in our DnD thought bubble that the health insurance middlemen companies absolutely need to go, but how do you market to voters the concept of getting rid of companies that have embedded themselves into the fabric of the American healthcare sector? The Republicans could easily howl about Democrats killing American jobs and government takeovers etc while low-information voters conditioned through decades of propaganda to distrust the government would lap it up. That's the part I'm not seeing addressed which is really crucial and practically impossible IMO in our political environment. E: Invalid Validation posted:And you would think a healthy and smart population would be a good financial investment for corporations. But what the gently caress would I know? You would think that, but the donor class is more interested in keeping workers chained to their job and suppressing any movement toward worker empowerment rather than contributing to a more functional or productive workforce. Employer-provided healthcare, right-to-work laws etc are all guided along the same goals of suppressing the power of the working class. Teriyaki Koinku fucked around with this message at 13:55 on Jun 28, 2017 |
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Jun 28, 2017 13:06
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Traditional Medicare is actually much worse than any private insurer when it comes to arcane billing loopholes requiring an army of highly trained staff to navigate in my experience. I know "Medicare for all" sounds like a great cure all to simplify everything and lower inefficiencies, but it isn't quite that simple. There's a reason why Medicare Advantage Plans (where people pay a private insurer extra for a plan that offers at minimum everything Traditional Medicare covers) are so popular and have higher patient satisfaction rates. All Medicare Part D Drug Plans are also administered by private insurers. Traditional Medicare itself is a swamp of red tape, weird rules, and bizarre policies that have needed updating for 20 years. So saying "Medicare for All" is quite a different can of worms than "Single Payer". Medicare itself is a highly blended and confusing private/public plan.
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Jun 28, 2017 13:49
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Teriyaki Koinku posted:Also, we all agree in our DnD thought bubble that the health insurance middlemen companies absolutely need to go, but how do you market to voters the concept of getting rid of companies that have embedded themselves into the fabric of the American healthcare sector? Do they absolutely need to go though? Germany manages to have a pretty good health care system while keeping health insurance companies around. Medicare-for-all (or public option) and heavily regulated private health insurance companies continuing to exist to provide supplemental plans for the gaps seems like a much better way to utilize the existing insurance infrastructure than to dismantle everything and rebuild it as a single payer system.
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Jun 28, 2017 13:49
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BarbarianElephant posted:Sometimes they pick up on things that would have gone away naturally, like very small cancers. So you end up undergoing chemo and surgery for a breast lump that would never have come to anything. Seems like a pretty insignifant negative compared to "most people never die of neglected cancer again"
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Jun 28, 2017 13:57
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Subvisual Haze posted:Traditional Medicare is actually much worse than any private insurer when it comes to arcane billing loopholes requiring an army of highly trained staff to navigate in my experience. I know "Medicare for all" sounds like a great cure all to simplify everything and lower inefficiencies, but it isn't quite that simple. There's a reason why Medicare Advantage Plans (where people pay a private insurer extra for a plan that offers at minimum everything Traditional Medicare covers) are so popular and have higher patient satisfaction rates. All Medicare Part D Drug Plans are also administered by private insurers. Traditional Medicare itself is a swamp of red tape, weird rules, and bizarre policies that have needed updating for 20 years. I am going to assume that the any Medicare for All plan would also have the votes to update the system and make needed reforms. If you have the votes for that kind of expansion of the welfare class, you would have the votes to make it more efficient too.
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Jun 28, 2017 13:59
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Teriyaki Koinku posted:
Health Insurance lawyers provided retraining as public defense attorneys, accountants shifted towards resource management for hospitals, CEO's and managers eat a bag of dicks.
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Jun 28, 2017 14:00
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Neurolimal posted:Seems like a pretty insignifant negative compared to "most people never die of neglected cancer again" the ancillary part is that it doesn't really pick up cancer all that well, so sure you catch some cancers but you have a much higher rate of unnecessary surgeries that, overall, lead to reduced health outcomes on average Teriyaki Koinku posted:I'm only vaguely familiar with what happened with that, but what was Lieberman's personal motivation to get rid of the public option in drafting the ACA? And why is he such an rear end in a top hat to his own party coalition? a lot of insurance companies were based in his state, he was an rear end in a top hat because he got primaried and lost and won as an independent so his pre-existing assholishness got turned to 11
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Jun 28, 2017 14:00
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BirdOfPlay posted:B-12 or PSA's? The screening bit. There's other cases of surgeries where you've got poor health outcomes to begin with and the surgeries really only make things worse, but people want it anyway.
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Jun 28, 2017 14:03
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Ancillary Character posted:Do they absolutely need to go though? Germany manages to have a pretty good health care system while keeping health insurance companies around. Medicare-for-all (or public option) and heavily regulated private health insurance companies continuing to exist to provide supplemental plans for the gaps seems like a much better way to utilize the existing insurance infrastructure than to dismantle everything and rebuild it as a single payer system. This makes sense, yes, given the reality of American healthcare as it exists today. Does the political will exist, though? The Republicans here are completely anathema to a public option, so when is the soonest we can get to Democratic control of the House and Senate again? It'd be hilarious if Trump signed off on a public option should the Democrats retake control of Congress. E: Lieberman question answered above, sorry I have a slow Internet connection at the moment.
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Jun 28, 2017 14:04
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Teriyaki Koinku posted:Also, as per my original question: why did Lieberman kill the public option? Seems like a regrettable backtracking to make up for lost time because of one rear end in a top hat screwing it up for everybody. Lieberman is well beyond one rear end in a top hat. His spite is now legendary. I remember hearing he once killed a plan that would lower the age requirement for Medicare to 55 just to spite the staffer whose idea it was.
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Jun 28, 2017 14:06
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Rygar201 posted:I am going to assume that the any Medicare for All plan would also have the votes to update the system and make needed reforms. If you have the votes for that kind of expansion of the welfare class, you would have the votes to make it more efficient too. Needed reforms to "End Medicare As We Know It?". How many votes do you think that has?
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Jun 28, 2017 14:07
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Teriyaki Koinku posted:This makes sense, yes, given the reality of American healthcare as it exists today. He didn't really kill the public option; dems had enough votes for cloture, it just didn't happen because of one of two reasons (either that Obama was interested in a bipartisan government and wanted both parties on board, or that Lieberman was an already hated scapegoat that could cleanly tie their hands WRT Public Option) The public will exists, but it's going to take a while to move that into new political will, considering states with rock-solid democrat supermajorities are vetoing healthcare reform.
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Jun 28, 2017 14:08
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Knowing Trump, what are the chances the Democrats could hypothetically manipulate him into signing a public option healthcare law as long as he gets to put his name on the legislation so he gets to claim responsibility for a legislative accomplishment and smile and dance like a big boy over it? Jangling the proverbial key chain, if you will.  I know it's completely hypothetical, but it amuses me to think about. Teriyaki Koinku fucked around with this message at 14:13 on Jun 28, 2017 |
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Jun 28, 2017 14:10
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karthun posted:Needed reforms to "End Medicare As We Know It?". How many votes do you think that has? I still can't believe Politifact really named that one the Lie of the Year. You missed the point though. People were saying that expanding Medicare to everyone would also include a lot of Medicare's problems. I'm just pointing out that in a hypothetical where Congress has the votes to expand Medicare to every man, woman, and child in America the notion that they wouldn't have the votes to make the process easier on the patient seemed a bit of a reach. ^^^ Trumpcare, the GREATEST HEALTHCARE IN THE WORLD! (Bill introduced by Liz Warren and Bernie Sanders)
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Jun 28, 2017 14:11
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Neurolimal posted:He didn't really kill the public option; dems had enough votes for cloture, it just didn't happen because of one of two reasons (either that Obama was interested in a bipartisan government and wanted both parties on board, or that Lieberman was an already hated scapegoat that could cleanly tie their hands WRT Public Option) this is a stupid nonsense belief that idiots have been spouting for eight years who need a ~grand conspiracy~ instead of "there were exactly 60 democrats so any one democrat had a veto over any part they didn't like" they didn't have the votes for cloture, because one of those necessary votes was liberman, and he wouldn't vote for cloture with a public option. liberman also killed the medicare buy-in for 55-65.
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Jun 28, 2017 14:13
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evilweasel posted:this is a stupid nonsense belief that idiots have been spouting for eight years who need a ~grand conspiracy~ instead of "there were exactly 60 democrats so any one democrat had a veto over any part they didn't like" I lost track of how many times you and Willa had this argument. Surely the response is ingrained in the muscle memory of your hands by this point. I don't know how McConnel is going to square the circle on BCRA though. Heller and Collins need very different things from the bill than Lee and Paul. Do we think he might just drop it alltogether and move on
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Jun 28, 2017 14:18
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Rygar201 posted:Trumpcare, the GREATEST HEALTHCARE IN THE WORLD! (Bill introduced by Liz Warren and Bernie Sanders) I am completely in favor of manipulating our idiot President in the most cynical, Machiavellian ways possible if it means signing a public option into law. Ideologically pure by typical leftist standards? Probably not; but if it works, it works! 
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Jun 28, 2017 14:19
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Rygar201 posted:I don't know how McConnel is going to square the circle on BCRA though. Heller and Collins need very different things from the bill than Lee and Paul. Do we think he might just drop it alltogether and move on I think his avenue to getting it passed is buy off all the other moderates, then give Paul/Lee/Cruz what they want. Heller and Collins have made it pretty hard to get bought off but it's always possible he could pick Collins off instead of Paul. His problem though is Paul has been thought of as unreachable for a while and has been very open he's willing to vote down obamacare repeal for this year until he gets a much bigger repeal.
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Jun 28, 2017 14:22
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evilweasel posted:this is a stupid nonsense belief that idiots have been spouting for eight years who need a ~grand conspiracy~ instead of "there were exactly 60 democrats so any one democrat had a veto over any part they didn't like" I don't know enough about congressional procedings to argue back (only that I recall a compelling argument that it was possible). I'l go ahead and accept what you're saying unless said argument resurfaces: My Bad. Teriyaki Koinku posted:I am completely in favor of manipulating our idiot President in the most cynical, Machiavellian ways possible if it means signing a public option into law. I don't know if its really manipulating; it's no secret that Trump's entire presidential bid was to spite Obama, and that he doesn't give a poo poo about networking with politicians to further jack-poo poo beyond "I'm the president, more money for me, more people know of and like me than before this". He's....not exactly been hands-on with the bill beyond "GET IT DONE". His early arguments in the primary at least show that he's well aware that UHC/PO/NHS ultimately benefits him and other billionaires not dependent on hopding healthcare over workers' heads. Even if he's not interested in putting any effort into making it happen. All this to say: if democrats somehow got majorities in congress during his presidency, republican leaders have nothing to make Trump toe the line so long as the bill benefits/doesnt harm him and he can rubberstamp his name on it. Neurolimal fucked around with this message at 14:32 on Jun 28, 2017 |
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Jun 28, 2017 14:29
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I'd absolutely love to see Paul Ryan poo poo his pants over a Republican President signing a Medicare-for-All/public option Democratic bill. The Republican outrage would be heard from outer space.  Republicans might shield Trump from charges of Russian collusion, but imagine their reaction to Trump colluding with Democrats. It's a pipe dream, absolutely no denying that, but it's a glorious pipe dream. Teriyaki Koinku fucked around with this message at 14:48 on Jun 28, 2017 |
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Jun 28, 2017 14:43
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Teriyaki Koinku posted:I'd absolutely love to see Paul Ryan poo poo his pants over a Republican President signing a Medicare-for-All/public option Democratic bill. Absolutely not. The republicans would embrace it because it would be extremely good for Trump and the party in 2020. They would campaign on the democrats in congress jacking their taxes up and how successful Trump has been as a republican president.
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Jun 28, 2017 14:51
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Mr. Nice! posted:Absolutely not. The republicans would embrace it because it would be extremely good for Trump and the party in 2020. They would campaign on the democrats in congress jacking their taxes up and how successful Trump has been as a republican president. So you think it's better for the Democrats to completely stonewall Trump and the Republicans like the latter did with Obama? Am I reading that right? These are all hypotheticals, not trying to get a burn on you or anything. The Republicans only wanted to obstruct Obama at all costs, even if it meant foregoing easy 'wins' in their favor (eg Chained-CPI) if said wins involved cooperating with Obama. E: if Democrats were even halfway competent at politicking, I could see them eating the Republicans' lunch with regard to healthcare legislation. Teriyaki Koinku fucked around with this message at 15:09 on Jun 28, 2017 |
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Jun 28, 2017 14:58
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Teriyaki Koinku posted:So you think it's better for the Democrats to completely stonewall Trump and the Republicans like the latter did with Obama? Am I reading that right? Absolutely not and I hope to see universal healthcare sooner rather than later. I'm just saying that it's trivial to turn it into a republican talking point for 2020.
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Jun 28, 2017 15:06
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Forgall posted:Wait, how can a screening be harmful? The PSA screen is just a blood test, so it's not harmful in and of itself. What will happen though is that a patient will want to follow up a positive PSA screen with a prostate biopsy to actually check for the presence of cancer. 75% of the time it isn't actually a sign of prostate cancer, and prostate biopsies, like any invasive surgery, can sometimes cause infection. Sometimes swelling after surgery causes patients to require urethral catheterization as well, and that's a common source of UTIs which are no joke in older patients. So from a patient perspective you'd always be concerned about the 25% it's actually cancer and can be caught early, but when you're setting public policy and care recommendations you have to take into account the risk of complications due to unnecessary biopsies, costs of routine screening, whether or not cheaper methods do the job just as well, etc.
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Jun 28, 2017 16:18
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https://twitter.com/jessicataylor/status/880036208176504832 In a non-plutocratic state this would be the final nail in the coffin.
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Jun 28, 2017 16:20
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Rhesus Pieces posted:https://twitter.com/jessicataylor/status/880036208176504832 the bill as 12% support in another poll
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Jun 28, 2017 16:34
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The Phlegmatist posted:The PSA screen is just a blood test, so it's not harmful in and of itself. This is the reason why a lot of preventive services have a minimum age before they are covered. Start too early and the true positive rate is so low that the financial and human cost of false positives is out of proportion to the benefits There's like a whole political conversation about the age at which to begin mammogram screening
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Jun 28, 2017 16:41
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There's a cool bonus where a positive result on some of these screens will increase your premiums forever. Happened to a friend of mine with a false positive pap smear.
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Jun 28, 2017 16:55
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Doc Hawkins posted:There's a cool bonus where a positive result on some of these screens will increase your premiums forever. Happened to a friend of mine with a false positive pap smear. Good news thats not allowed under the ACA! Bad news: that's being repealed
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Jun 28, 2017 16:58
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evilweasel posted:the bill as 12% support in another poll Found it: https://twitter.com/gideonresnick/status/880082529683943425 Under normal circumstances a bill this unpopular would never have made it this far and continuing to support it would be political suicide.
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Jun 28, 2017 17:06
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Neurolimal posted:Seems like a pretty insignifant negative compared to "most people never die of neglected cancer again" Atul Gawande is my favorite author on all things healthcare. I can't recommend his article on the dangers of over-testing and over-treatment enough http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande quote:H. Gilbert Welch, a Dartmouth Medical School professor, is an expert on overdiagnosis, and in his excellent new book, “Less Medicine, More Health,” he explains the phenomenon this way: we’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference. No test is perfect. Overtesting leads to false-positive diagnoses, which lead to unnecessary treatment, which can cause real damages to the body.
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Jun 28, 2017 17:50
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I'm pretty sure that's the definition of a concern troll, right? Someone who hears "everyone should have access to healthcare" and responds with "but if they did, more tests would be administered, therefore more unneeded procedures would be performed, therefore people shouldn't have easy access to healthcare"?
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Jun 28, 2017 18:00
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call to action posted:I'm pretty sure that's the definition of a concern troll, right? Someone who hears "everyone should have access to healthcare" and responds with "but if they did, more tests would be administered, therefore more unneeded procedures would be performed, therefore people shouldn't have easy access to healthcare"? This is an issue entirely separate from the health care debate and was something someone mentioned and people were interested in so people are discussing it because it is counter-intuitive and interesting. Nobody is using it as an argument about Obamacare/Trumpcare.
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Jun 28, 2017 18:02
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call to action posted:I'm pretty sure that's the definition of a concern troll, right? Someone who hears "everyone should have access to healthcare" and responds with "but if they did, more tests would be administered, therefore more unneeded procedures would be performed, therefore people shouldn't have easy access to healthcare"? Real universal health care systems do have checks and balances in place to prevent lots of unnecessary treatments being ordered. It's a real problem. It's quite solvable in methods that don't have to be "poor people don't get healthcare." Even rich people aren't all that enthusiastic about being jabbed, prodded and colonoscopied if it isn't necessary. Healthcare isn't a fairground ride.
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Jun 28, 2017 18:02
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Subvisual Haze posted:Atul Gawande is my favorite author on all things healthcare. I can't recommend his article on the dangers of over-testing and over-treatment enough http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande I'll plug a book I read on this again, as it was really insightful. Written by the chief medical officer of the American Cancer Society he talks about two dichotomies: the woman he treated in his private clinic who had a positive mamogram but ultimately didn't have cancer and insisted on expensive and unnecessary treamtment and the woman who came into the public clinic he works at whose breast had fallen off from cancer  https://www.amazon.com/How-We-Do-Harm-America/dp/1250015766 Misallocation of resources under our private model is one of the biggest problems around. BarbarianElephant posted:Real universal health care systems do have checks and balances in place to prevent lots of unnecessary treatments being ordered. It's a real problem. It's quite solvable in methods that don't have to be "poor people don't get healthcare." Even rich people aren't all that enthusiastic about being jabbed, prodded and colonoscopied if it isn't necessary. Healthcare isn't a fairground ride. A huge problem is American patients almost demand some form of treatment when they see the doctor. I went to my ENT (ear/nose/throat) doctor a few months ago as I was convinced I had a sinus infection. Doctor takes a look and says "nah you're good" and immediately jumped into explaining why he wouldn't be ordering any follow-up tests or prescribing medicine or anything of the sort, despite my repeated insistance that I know "no sign of infection = no drugs". They have to reflexively explain like this because people can and will doctor shop for someone who gives them pills or a CT scan or whatever else because people cannot cope with "yes you are ill, no there is no recommended treatment at this time." Honestly, we should just start giving people true placebo prescriptions because it seems to be the only way to placate them. For a sadder example of this, look at pain management. You have some doctors giving out pills like candy and getting folks who don't need pain meds addicted, and at the same time there are folks who legimately need pain medication to function and are denied because they're "drug seeking." axeil fucked around with this message at 18:18 on Jun 28, 2017 |
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Jun 28, 2017 18:05
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