USCE 2023: Please let them shove a camera up your butt

The Something Awful Forums > Discussion > Debate & Discussion > USCE 2023: Please let them shove a camera up your butt

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FizFashizzle: Mar 30, 2005

the other night i admitted and preop'd fourteen patients for next day ortho surgeries for one surgeon.

He brought on another surgeon in the group to help with but that was just him walking back and forth between two different ORs. He called me at 530a and asked me for the list and that was that.

For those that care

Neuro - long, miserable surgeries and probably the most brutal training. for example, I met a guy once at emory who'd just started his neurosurgery residency. He got his bachelors at souther cal, his masters in electrical engineer at georgia tech, then went straight into med school at emory and into his seven year residency after his core rotations. He's trading away his youth for it. this is meant as a joke but not really.

Ortho - you can just crank out ortho procedures these days; the days of 5 hour knee surgeries with huge postop infection risks are long gone. an ACL repair takes about 45 minutes, shoulders about 75. and these people will operate on anyone. just a reminder that rotator cuff repairs do not respond to surgery better than physical therapy.

Rad/onc - space lasers on a micro scale. this is one of those things that no patients seem to pay for. lots of weird assistant programs that just....take care of things. This is also a field where a lot of insanely smart people from other fields move into when they get bored of doing jet polymer or whatever.

Pain Management - scam artists. all pain management clinics are run by PAs and NPs. churn people out like fast food. during my rotations i was a student under one who I poo poo you not gave all his patients Chick Tracts.

Interventional Cardiology - fancy plumbers. being in the cath lab is pretty badass tho. reminder that top cardiologists are only about 40% correct when listening to murmurs with stethoscopes. they're also the biggest bullshit artists in the world when you hand them an ECG to read. "Transient T Waves of Youth" my rear end get the gently caress out of here with that bullshit

Dermatology - fuuuuuuuuuuck derm. Wet make it dry, dry make it wet. Churning people out, not uncommon for them to do three month followups on medicare patients which is pointless. also these numbers are being driven up by MOHS procedure because the Dermatologist gets to double bill; for the procedure and for the cytology....which they contract out.

Hand Surgery - just not a lot of them, hand is very complex and intricate, again miserable surgeries that take forever, have to know a ton of neuro and vascular as well. And they're on call basically 24/7 because there's never anyone else.

Cardiac Surgery - i mean...the heart is important.

Heme/onc - most expensive drugs that no one can afford but somehow get paid for via mystery programs like above. I prescribed a couple infusions like this in neuro and I have no idea how they ended up being paid. for it's black magic. heme is also just brutal to get good at. some of the smartest people in the hospital in my experience.

ophthalmology - when it comes to shuttling patients through these guys put derm to shame. when it comes to marketing their office or adding retail opportunities they're closer to dentists than anything else. whatever, i guess you need eyes.

# ? Aug 8, 2023 03:27

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# ? May 25, 2024 14:14

Old Kentucky Shark: May 25, 2012; If you think you're gonna get sympathy from the shark, well then, you won't.

Google Jeb Bush posted:

well, you know, i'm not opposed to this being a tradition

It's honestly pretty fun. Trying to do five minutes of stand-up comedy in front of a hostile crowd is one of the weirder but more efficient ways of separating your charismatic retail political monsters from your Matt Gaetzes and Madison Cawthorns.

Also, while everybody gets heckled, I know people who were there, and according to them McConnell's booing was definitely a lot more bipartisan and louder than either of the two gubernatorial candidates.

Old Kentucky Shark fucked around with this message at 03:37 on Aug 8, 2023

# ? Aug 8, 2023 03:32

Ghost Leviathan: Mar 2, 2017; Exploration is ill-advised.

Gyges posted:

I'm always reminded of 2008, when I came out to campaign for Obama. Everyone under 40 was cool and welcoming. Those older gave me poo poo, to the point where I was accused of being a Republican plant come to ruin things.

When Obama blew up his machine, who do you think was still showing up for party meetings? The old people who hated the youths and their stupid enthusiasm. The ones who would yell at a young guy in an Obama shirt, trying to figure out how best to help, that they were actually a spy. People who spent an entire canvasing rally bitching about how slutty/slobby/ghetto all the stupid kids were dressed. That's the FL Democrats. A bunch of hateful old assholes who would rather nobody show up and loose than have to work with someone different.

This explains so much, it goes all the way down to the volunteers and up to the Dems spending a decade making sure their bench is empty. It seems like the party culture genuinely despises young people who might actually want things, with begrudgingly exceptions for the old people freaks who exist to appease boomers exclusively.

Actually, it would make a lot of sense if Florida Democrats in particular and system Dems in general are still really, really pissed off about Nader, even when they've rehabilitated GWB.

Ghost Leviathan fucked around with this message at 04:07 on Aug 8, 2023

# ? Aug 8, 2023 03:37

Main Paineframe: Oct 27, 2010

Fister Roboto posted:

And as we've seen multiple times, impeachment does absolutely gently caress all. It's a worthless check. All I'm seeing is that the system is fundamentally broken. We can't expect it to fix itself.

Impeachment's pretty effective if the president has done something that's widely seen as completely beyond the pale, to the point that even a few members of the president's own party are willing to turn against them.

You're not asking the system to fix itself. You're expecting the system to fix Americans. If Trump wins a presidential election and the Dems don't gain a significant margin in Congress and Republican voters continue to consistently primary out any legislator that dares to defy Trump, then I think it's pretty fair to say there isn't a major political or electoral consensus behind removing Trump.

# ? Aug 8, 2023 03:37

Fart Amplifier: Apr 12, 2003

Fister Roboto posted:

And as we've seen multiple times, impeachment does absolutely gently caress all. It's a worthless check. All I'm seeing is that the system is fundamentally broken. We can't expect it to fix itself.

Well you're stuck with the Constitution.

# ? Aug 8, 2023 03:57

Killer robot: Sep 6, 2010; I was having the most wonderful dream. I think you were in it!; Pillbug

Fister Roboto posted:

Cool, they still should have at least tried. Letting such a gross abuse of power go unchallenged is much worse than challenging it and failing. This is an extremely defeatist attitude.

Fister Roboto posted:

And as we've seen multiple times, impeachment does absolutely gently caress all. It's a worthless check. All I'm seeing is that the system is fundamentally broken. We can't expect it to fix itself.

That's the other side of this. "They should have at least tried", when they try and it fails, easily turns into them having done a worthless nothing. You're obviously applying it to two situations here so I'm not saying you're directly contradicting yourself, to be clear. But I've been through a lot of cases of both (the Democrats trying something symbolic but doomed to failure and them not spending effort on something they know won't change the outcome), and people are always unsatisfied. But it feels like it's because the outcome they did not control is unsatisfactory rather than because of which non-choice they made.

# ? Aug 8, 2023 04:40

Skippy McPants: Mar 19, 2009

FizFashizzle posted:

For those that care

I cared. That was fun, thank you.

# ? Aug 8, 2023 06:01

Discendo Vox: Mar 21, 2013; We don't need to have that dialogue because it's obvious, trivial, and has already been had a thousand times.

I'd love to get further into the current incentive structures applicable to clinicians and potential paths to reform; would we get enough medgoon interest to make an informed thread on the subject possible?

# ? Aug 8, 2023 06:49

Jaxyon: Mar 7, 2016; I’m just saying I would like to see a man beat a woman in a cage. Just to be sure.

^^^ holy poo poo that avatar

Skippy McPants posted:

I cared. That was fun, thank you.

Also that youtuber is fun

# ? Aug 8, 2023 07:18

Liquid Communism: Mar 9, 2004; коммунизм хранится в яичках

Leon Trotsky 2012 posted:

Hillary Clinton is out with a long-form essay that is basically "It Takes a Village 2.0" and it is actually a pretty interesting read.

It is also probably the only article ever written about loneliness that could include this line:

Most of the essay uses the recent announcement by the Surgeon General about the "epidemic of loneliness" in the U.S. and the various health and social problems that arise from it.

The essay covers a lot of interesting questions about how this happened and what (if anything) can be done at the macro level to solve it. "Bowling Alone" and "It Takes a Village" were both published decades ago and seem to have had their theses confirmed from the 2010's to present.

The pandemic greatly exacerbated the effects, but the trend was beginning all the way back in the 1970's and really picked up in 2003.

Even the people studying the phenomenon can't seem to pinpoint exactly why it started happening. The basic things they all agree on are:

- In started sometime in the late 1970's, dramatically expedited around 2003, and surged during the pandemic.

- Technology (especially social media) and economic changes exacerbated the trends, but didn't create them entirely.

- Public social institutions (VFW halls, religious social events, team sports leagues, union halls, civic organizations, PTA/school social events, or hobbyist clubs) gradually started becoming less and less popular until most of them shut down due to lack of interest/funds.

- A decline in marriage seems to have both caused and exacerbated the problem.

- There are significant social, political, economic, and personal health damages caused by loneliness and isolation.

- It impacts both genders significantly, but men have a higher rate of isolation/loneliness than women. 15% of men say they have 0 close relationships and less than half say they have ever made a new friend since leaving high school.

But, nobody is 100% sure what caused the turn or what (if anything) can be done to reverse it.

It's a very long piece, but surprisingly detailed and interesting. I don't know how you would even begin to solve a problem like this. Forcing people into social or religious events seems impossible and difficult once people aren't inclined to attend, the social media genie can't be put back in the bottle, and different groups of people are disconnected or lacking personal relationships for various reasons.

I'd also second the essay's recommendation of reading "Bowling Alone" for more info. It's a little outdated because it was based off of research done in the 90's, but it is a very easy and well-written read that is both depressing and informative.

https://www.theatlantic.com/ideas/archive/2023/08/hillary-clinton-essay-loneliness-epidemic/674921/

Not going to change any time soon, capital demands your labor, not your survival. Who wants to gently caress around with community social hour when they're trying to work around a mortgage that needs two incomes, or working a job that in order to pay well requires 24/7 on-call. Nobody has any loving time or energy, so we either get drunk and/or high to forget the bullshit we put up with, or stare at our chosen method of escapism.

# ? Aug 8, 2023 10:04

Ghost Leviathan: Mar 2, 2017; Exploration is ill-advised.

It's literally just another case of 'Huh, why are all these millions of people independently making suboptimal choices' from people who literally cannot comprehend the concept of material conditions or people for whom working is a requirement, not a choice.

Of course not even getting into how every social space has been shut down, enclosed, declared war on the concept of youth, or merely neglected as hard as it can be. Of course teenagers don't go out when they can't get anywhere without a car and every public space views them as criminal nuisances, and as adults there's nothing to do anyway that doesn't involve spending money, and usually drinking alcohol. You literally can't find a place to sit down or take a poo poo because all the seating and toilets have been removed to spite the homeless. People can't form stable physical world social groups when they're uprooted every few years by the landlord, and people have to move to find any employment that actually allows them to survive.

Worse than useless, because it keeps on pointing to symptoms of a problem they're literally not allowed to acknowledge, and react with frothing rage at anyone who tries.

# ? Aug 8, 2023 11:06

FizFashizzle: Mar 30, 2005

Discendo Vox posted:

I'd love to get further into the current incentive structures applicable to clinicians and potential paths to reform; would we get enough medgoon interest to make an informed thread on the subject possible?

Yeah I�d be happy to go into the various ways I�m getting hosed, even though I�m just a PA-C and not a physician. I�ve been working in the ED for the last six months or so and I can tell horror stories about what HCA is doing.

# ? Aug 8, 2023 11:06

Liquid Communism: Mar 9, 2004; коммунизм хранится в яичках

Ghost Leviathan posted:

It's literally just another case of 'Huh, why are all these millions of people independently making suboptimal choices' from people who literally cannot comprehend the concept of material conditions or people for whom working is a requirement, not a choice.

Of course not even getting into how every social space has been shut down, enclosed, declared war on the concept of youth, or merely neglected as hard as it can be. Of course teenagers don't go out when they can't get anywhere without a car and every public space views them as criminal nuisances, and as adults there's nothing to do anyway that doesn't involve spending money, and usually drinking alcohol. You literally can't find a place to sit down or take a poo poo because all the seating and toilets have been removed to spite the homeless. People can't form stable physical world social groups when they're uprooted every few years by the landlord, and people have to move to find any employment that actually allows them to survive.

Worse than useless, because it keeps on pointing to symptoms of a problem they're literally not allowed to acknowledge, and react with frothing rage at anyone who tries.

Yep. I'm 40ish and have had more than a dozen addresses since high school, across multiple states, chasing work. Even back in the town I grew up in now, I can't so much as schedule a four hour a month D&D game for the old crowd because it's an even split of 'on call for my tech job' or 'still dealing with small children and can't afford a babysitter' and I'm stuck slowly killing myself via 12 hour overnight shifts.

My teenage niece has never really hung out with her friends outside of school. There's nowhere to go. The malls are either closed or as you mention hostile to the existence of teenagers, the school grounds is fenced due to violence concerns so they can't hang out at the playground, the library shut down all its public-facing programs during the pandemic then lost funding for having gay books, and a single ticket to a movie is fifteen loving bucks.

# ? Aug 8, 2023 11:24

Herstory Begins Now: Aug 5, 2003; SOME REALLY TEDIOUS DUMB SHIT THAT SUCKS ASS TO READ ->>

FlamingLiberal posted:

I guess I shouldn't be surprised at all that the WaPo doesn't cite the fact that we have a medical system that incentivizes more expensive doctors, whereas everywhere else they have socialized medicine which means that in general there are more doctors. You also don't have groups like the AMA deliberately capping how many doctors there can be each year thanks to their ability to restrict residencies.

This situation is 100% because we don't regulate this stuff and allow a free market, which means that if there is going to be a deliberately smaller group of doctors allowed in, then the lack of supply is going to keep doctor salaries and patient costs going up indefinitely. Obviously this isn't the main problem with our bullshit system but it's part of it.

Pardon?

# ? Aug 8, 2023 11:47

AtomikKrab: Jul 17, 2010; Keep on GOP rolling rolling rolling rolling.

FizFashizzle posted:

the other night i admitted and preop'd fourteen patients for next day ortho surgeries for one surgeon.

He brought on another surgeon in the group to help with but that was just him walking back and forth between two different ORs. He called me at 530a and asked me for the list and that was that.

Rad/onc - space lasers on a micro scale. this is one of those things that no patients seem to pay for. lots of weird assistant programs that just....take care of things. This is also a field where a lot of insanely smart people from other fields move into when they get bored of doing jet polymer or whatever.

Dermatology - fuuuuuuuuuuck derm. Wet make it dry, dry make it wet. Churning people out, not uncommon for them to do three month followups on medicare patients which is pointless. also these numbers are being driven up by MOHS procedure because the Dermatologist gets to double bill; for the procedure and for the cytology....which they contract out.

Heme/onc - most expensive drugs that no one can afford but somehow get paid for via mystery programs like above. I prescribed a couple infusions like this in neuro and I have no idea how they ended up being paid. for it's black magic. heme is also just brutal to get good at. some of the smartest people in the hospital in my experience.

My wife has to see a dermatologist, but she also has like "This condition requires ridiculously expensive drugs to treat that are just magically paid for at no cost to you, and your insurance will automatically deny the drugs each time it comes up for a new prescription so here are some free samples to cover the gap until they approve coverage like they always do."

# ? Aug 8, 2023 12:02

Mooseontheloose: May 13, 2003

Ghost Leviathan posted:

It's literally just another case of 'Huh, why are all these millions of people independently making suboptimal choices' from people who literally cannot comprehend the concept of material conditions or people for whom working is a requirement, not a choice.

Of course not even getting into how every social space has been shut down, enclosed, declared war on the concept of youth, or merely neglected as hard as it can be. Of course teenagers don't go out when they can't get anywhere without a car and every public space views them as criminal nuisances, and as adults there's nothing to do anyway that doesn't involve spending money, and usually drinking alcohol. You literally can't find a place to sit down or take a poo poo because all the seating and toilets have been removed to spite the homeless. People can't form stable physical world social groups when they're uprooted every few years by the landlord, and people have to move to find any employment that actually allows them to survive.

Worse than useless, because it keeps on pointing to symptoms of a problem they're literally not allowed to acknowledge, and react with frothing rage at anyone who tries.

Isn't that the point of the essay?

# ? Aug 8, 2023 12:05

FizFashizzle: Mar 30, 2005

AtomikKrab posted:

My wife has to see a dermatologist, but she also has like "This condition requires ridiculously expensive drugs to treat that are just magically paid for at no cost to you, and your insurance will automatically deny the drugs each time it comes up for a new prescription so here are some free samples to cover the gap until they approve coverage like they always do."

Yep, -umab drugs are very effective and paid for by Zeus or something.

FizFashizzle fucked around with this message at 12:21 on Aug 8, 2023

# ? Aug 8, 2023 12:05

bird food bathtub: Aug 9, 2003; College Slice

Liquid Communism posted:

Yep. I'm 40ish and have had more than a dozen addresses since high school, across multiple states, chasing work. Even back in the town I grew up in now, I can't so much as schedule a four hour a month D&D game for the old crowd because it's an even split of 'on call for my tech job' or 'still dealing with small children and can't afford a babysitter' and I'm stuck slowly killing myself via 12 hour overnight shifts.

My teenage niece has never really hung out with her friends outside of school. There's nowhere to go. The malls are either closed or as you mention hostile to the existence of teenagers, the school grounds is fenced due to violence concerns so they can't hang out at the playground, the library shut down all its public-facing programs during the pandemic then lost funding for having gay books, and a single ticket to a movie is fifteen loving bucks.

I hear nostalgic talk about being "part of the community" and it just does not apply to my life. What is my "community"? Everybody who lives near me is either new since I moved in or already gone, and I'll have to leave them all behind the next time I want a raise because job hopping is the only way that happens. I've known my cats longer than anybody within 50 miles of me, and that will likely be true until I retire.

Just kidding my retirement plans are dropping dead of a heart attack over a long weekend at work. That doesn't happen anymore either.

# ? Aug 8, 2023 12:12

Owling Howl: Jul 17, 2019

You don't really need local community anymore. You have access to all movies, shows, music, books, games, information and can contact anyone anywhere at any time. You have a very wide array of entertainment options available. Houses are larger and families smaller so homes are less cramped and you have less incentive to go out for a break. More people have cars and generally a lot more money so when they do go out there are more options and it doesn't have to be in the local community.

Before all that you got bored at home and going out for recreation was a necessity. No one needs to care about their neighbors anymore or join groups just to have something to do. There's always something to do even if it is just mindlessly scrolling a feed.

I appreciate that labor conditions are terrible but they used to be worse. We used to work more hours and housework used to be more time consuming. Yet community groups flourished - because there was literally nothing else to do and nowhere else to go.

More entertainment options means former entertainment options have more competition and fewer people will use them. Much like the rise of online shopping meant a lot of brick and mortar stores closed down.

# ? Aug 8, 2023 12:15

Failed Imagineer: Sep 22, 2018

Owling Howl posted:

You don't really need local community anymore. You have access to all movies, shows, music, books, games, information and can contact anyone anywhere at any time. You have a very wide array of entertainment options available. Houses are larger and families smaller so homes are less cramped and you have less incentive to go out for a break. More people have cars and generally a lot more money so when they do go out there are more options and it doesn't have to be in the local community.

Before all that you got bored at home and going out for recreation was a necessity. No one needs to care about their neighbors anymore or join groups just to have something to do. There's always something to do even if it is just mindlessly scrolling a feed.

I appreciate that labor conditions are terrible but they used to be worse. We used to work more hours and housework used to be more time consuming. Yet community groups flourished - because there was literally nothing else to do and nowhere else to go.

More entertainment options means former entertainment options have more competition and fewer people will use them. Much like the rise of online shopping meant a lot of brick and mortar stores closed down.

I hope this is satire but it's extremely grim either way

# ? Aug 8, 2023 12:18

AtomikKrab: Jul 17, 2010; Keep on GOP rolling rolling rolling rolling.

FizFashizzle posted:

Yep, -umab drufs are very effective and paid for by Zeus or something.

Literal magic in the difference between having the medicines or not, and it pisses me off on the fact that insurance companies play games with "denying" the medication the first time it comes across only to just approve it right after so they can up their profit by some percent or something by delaying things since the consequences of that are potentially my wife dying.

# ? Aug 8, 2023 12:21

Blue Footed Booby: Oct 4, 2006; got those happy feet

Owling Howl posted:

You don't really need local community anymore. You have access to all movies, shows, music, books, games, information and can contact anyone anywhere at any time. You have a very wide array of entertainment options available. Houses are larger and families smaller so homes are less cramped and you have less incentive to go out for a break. More people have cars and generally a lot more money so when they do go out there are more options and it doesn't have to be in the local community.

Before all that you got bored at home and going out for recreation was a necessity. No one needs to care about their neighbors anymore or join groups just to have something to do. There's always something to do even if it is just mindlessly scrolling a feed.

I appreciate that labor conditions are terrible but they used to be worse. We used to work more hours and housework used to be more time consuming. Yet community groups flourished - because there was literally nothing else to do and nowhere else to go.

More entertainment options means former entertainment options have more competition and fewer people will use them. Much like the rise of online shopping meant a lot of brick and mortar stores closed down.

I don't know how to explain to you that community and connections to other people isn't about entertainment.

# ? Aug 8, 2023 12:30

Rappaport: Oct 2, 2013

Blue Footed Booby posted:

I don't know how to explain to you that community and connections to other people isn't about entertainment.

O'Brien telling Winston, "if you wish to see an image of the future, imagine a VR set resting on a starving kid's face, forever"

# ? Aug 8, 2023 12:33

FizFashizzle: Mar 30, 2005

AtomikKrab posted:

Literal magic in the difference between having the medicines or not, and it pisses me off on the fact that insurance companies play games with "denying" the medication the first time it comes across only to just approve it right after so they can up their profit by some percent or something by delaying things since the consequences of that are potentially my wife dying.

One of the reasons I miss neuro so much was all the fun tricks I could pull with prescribing and getting things approved.

Oh this male patient with MS needs to fail two other drugs before qualifying for the drug I want to put him on? Well guess what he put his demographic info in wrong and now he�s Pacific Islander and also there�s a suspected family history.

gently caress you genetech; make me deal with Chad again for a prior auth.

FizFashizzle fucked around with this message at 12:51 on Aug 8, 2023

# ? Aug 8, 2023 12:37

Liquid Communism: Mar 9, 2004; коммунизм хранится в яичках

Owling Howl posted:

I appreciate that labor conditions are terrible but they used to be worse. We used to work more hours and housework used to be more time consuming. Yet community groups flourished - because there was literally nothing else to do and nowhere else to go.

I disagree. Hell, my dad was an over the road truck driver and worked less hours a week than I generally do, albeit for way less money, and they were able to cover the bills as a single income family.

# ? Aug 8, 2023 12:52

Panzeh: Nov 27, 2006; "..The high ground"

Blue Footed Booby posted:

I don't know how to explain to you that community and connections to other people isn't about entertainment.

Maybe, but the entertainment aspect has historically been what has gotten people out to do those things.

# ? Aug 8, 2023 13:11

Gyges: Aug 4, 2004; NOW NO ONE
RECOGNIZE HULK

Liquid Communism posted:

I disagree. Hell, my dad was an over the road truck driver and worked less hours a week than I generally do, albeit for way less money, and they were able to cover the bills as a single income family.

I assumed they were talking pre-union won limits like a 5 day, 40 hour work week. We've been losing more and more of what our grandparents had, but we're still ahead of our great grandparents.

# ? Aug 8, 2023 13:24

not joseph stalin: Dec 30, 2008

Regarding -Mabs, the system is just as corrupt as everyone here is guesstimating. Basically, the patients insurer will pay e.g. Abbvie, let�s say 13,000 out of 20,000 for the ANNUAL cost of the drug, excluding copays and deductibles. The 7,000 dollar difference is obviously unaffordable to most patients, especially since it tends to front load at the start of the year. Abbvie (or other big pharma companies) then double dips by donating the drug, let�s say adalimumab, to a shell charity, Abbvie Connects. Abbvie connects then provides as a �charitable� donation, either a debit card usable on the copay, or shops drugs directly to patients. I would suspect this then gets used as a tax write off for Abbvie as the double dip, with a 13,000 dollar payout from insurance and a 7,000 dollar tax deduction. There�s a reason Humira is the most profitable drug in history.

Of course this creates a two tiered system since Medicare guidelines ban rebates as described above, so senior citizens don�t get these medicines. And these medicines are really really effective, generally, and in some conditions absolutely life saving and Without viable P.O. Alternatives.

In other first world countries, these drugs may be 1,500 instead of 20-80,000 for a year. I doubt pharma is selling this to the Netherlands for a loss, so I would assume a 18,000 dollar profit margin on a perhaps 1,000 dollar drug to be extremely plausible.

Source.: prescribes mabs.

not joseph stalin fucked around with this message at 13:50 on Aug 8, 2023

# ? Aug 8, 2023 13:27

Ravenfood: Nov 4, 2011

FlamingLiberal posted:

I guess I shouldn't be surprised at all that the WaPo doesn't cite the fact that we have a medical system that incentivizes more expensive doctors, whereas everywhere else they have socialized medicine which means that in general there are more doctors. You also don't have groups like the AMA deliberately capping how many doctors there can be each year thanks to their ability to restrict residencies.

This situation is 100% because we don't regulate this stuff and allow a free market, which means that if there is going to be a deliberately smaller group of doctors allowed in, then the lack of supply is going to keep doctor salaries and patient costs going up indefinitely. Obviously this isn't the main problem with our bullshit system but it's part of it.

The AMA whining about NPs and PAs expanding practice authority when they have the ability to essentially halt that expansion by massively opening up residency slots and filling the spots APPs currently are in with MDs will never stop simultaneously amusing and irritating me.

# ? Aug 8, 2023 13:28

Gort: Aug 18, 2003; Good day what ho cup of tea

Herstory Begins Now posted:

Pardon?

It's funny seeing Americans (even non-Republicans) talk about "socialized medicine" when here in the UK it's the "National Health Service" and is referred to as nationalised healthcare.

# ? Aug 8, 2023 13:29

AtomikKrab: Jul 17, 2010; Keep on GOP rolling rolling rolling rolling.

not joseph stalin posted:

Regarding -Mabs, the system is just as corrupt as everyone here is guesstimating. Basically, the patients insurer will pay e.g. Amgen, let�s say 13,000 out of 20,000 for the ANNUAL cost of the drug, excluding copays and deductibles. The 7,000 dollar difference is obviously unaffordable to most patients, especially since it tends to front load at the start of the year. Amgen (or other big pharma companies) then double dips by donating the drug, let�s say adalimumab, to a shell charity, Amgen Connects. Amgen connects then provides as a �charitable� donation, either a debit card usable on the copay, or shops drugs directly to patients. I would suspect this then gets used as a tax write off for Amgen as the double dip, with a 13,000 dollar payout from insurance and a 7,000 dollar tax deduction. There�s a reason Humira is the most profitable drug in history.

Of course this creates a two tiered system since Medicare guidelines ban rebates as described above, so senior citizens don�t get these medicines. And these medicines are really really effective, generally, and in some conditions absolutely life saving and Without viable P.O. Alternatives.

In other first world countries, these drugs may be 1,500 instead of 20-80,000 for a year. I doubt pharma is selling this to the Netherlands for a loss, so I would assume a 18,000 dollar profit margin on a perhaps 1,000 dollar drug to be extremely plausible.

Source.: prescribes mabs.

You are exactly correct but like 100k a year if it was out of pocket

# ? Aug 8, 2023 13:33

Liquid Communism: Mar 9, 2004; коммунизм хранится в яичках

Gyges posted:

I assumed they were talking pre-union won limits like a 5 day, 40 hour work week. We've been losing more and more of what our grandparents had, but we're still ahead of our great grandparents.

The 40 hour work week's a joke any way. The concept of 'salaried exempt' employees has been bent over the table and given such a pounding that it makes the goatse guy feel ashamed at his lack of capacity, and the hourly side has just started giving everyone 25 hours a week so everyone's got two jobs to make ends meet at minimum.

Liquid Communism fucked around with this message at 13:51 on Aug 8, 2023

# ? Aug 8, 2023 13:48

ummel: Jun 17, 2002; <3 Lowtax; Fun Shoe

koolkal posted:

Is that really true? I would figure the ones at the top of the income scale are the ones who are working in surgical roles. Not exactly the ones seeing 100 patients a day.

Yeah but even cardiothoracic surgeons can increase from 1 to 3 cases per day, working 16 hrs, etc. I want to emphasize that *sometimes* this conflicts with what might be arguably more compassionate care (e.g., does this 75 year old *need* a heart transplant?), but not all the time or even the majority of cases.

The vast majority of docs, even the wealthy ones are good docs, but there are greedy ones who are incentivized into the profession just for money. And then there are good doc who are also greedy and overbill, overconsult, etc. They are only kept in check by CMS metrics (their reimbursement goes down if their patients don't get good outcomes) and the hippocratic oath. For-profit hospital chains can compound this issue and concentrate these types in one location.

This is all my personal opinion from first hand experience, so ymmv.

# ? Aug 8, 2023 13:53

Ghost Leviathan: Mar 2, 2017; Exploration is ill-advised.

Mooseontheloose posted:

Isn't that the point of the essay?

Then she has failed miserably at addressing it, because again, it claims the actual causes and solutions are mysterious and unknowable, and this is from someone who was considered the most qualified ever Presidential candidate by literally all the Very Serious People.

It's difficult to overstate just how badly this reflects on the author and their immense and blinding privilege.

# ? Aug 8, 2023 14:09

selec: Sep 6, 2003

Mooseontheloose posted:

Isn't that the point of the essay?

It�s weird to hear someone do a literal �the problems are very bad but the causes are very good� even to this day, even if that�s been basically HRC�s entire career. You couldn�t come up with many worse messengers for this particular story than the woman who wanted to pick up the neoliberal torch after her husband did a gangbusters job helping these phenomena along the way.

# ? Aug 8, 2023 14:10

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

Liquid Communism posted:

The 40 hour work week's a joke any way. The concept of 'salaried exempt' employees has been bent over the table and given such a pounding that it makes the goatse guy feel ashamed at his lack of capacity, and the hourly side has just started giving everyone 25 hours a week so everyone's got two jobs to make ends meet at minimum.

Very few people actually work multiple jobs. It has been increasing over the past 20 years, though.

It's only about 4.9%. It used to be closer to 3.5%.

4.9% is still objectively a decent number of people, but it isn't really a universal thing.

https://fred.stlouisfed.org/series/LNU02026631

Leon Trotsky 2012 fucked around with this message at 14:32 on Aug 8, 2023

# ? Aug 8, 2023 14:17

SpeakSlow: May 17, 2004; by Fluffdaddy

If they had time to type, pharmacy employees always have a fun perspective on the health care system.

# ? Aug 8, 2023 14:23

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

The House plans to file articles of impeachment and officially open an impeachment inquiry against Biden this fall - and as early as next month.

McCarthy is trying to balance the concerns of more moderate members and the hard right members by impeaching Biden, but saying that an impeachment inquiry is not the same as voting to convict, so House members can vote to impeach just to do their due diligence and open an investigation. It will be the Senate's job to vote on conviction. That way the conservative members and base are happy they impeached Biden and the moderate members who might get heat for voting for impeachment when they have no evidence can say, "We just voted to investigate. We weren't doing this as revenge for Trump. Isn't more information better than none?" while knowing that the average person doesn't know that impeachment is separate from conviction.

quote:

McCarthy has also emphasized to his members that opening an inquiry is not the same as voting for articles of impeachment � a key messaging distinction that could help convince on-the-fence moderates to back an inquiry.

The current estimated timeline is to have an impeachment inquiry from September through December and then send it over to the Senate for a vote in 2024.

quote:

Biden will face an impeachment inquiry in the fall and could be just the fourth US president ever charged with high crimes or misdemeanors � and that it might all happen by year�s end.

quote:

To move ahead on impeachment, the House is expected to vote to formally launch an inquiry � something that could happen as soon as next month, GOP sources say. At that point, several committees that have played a major role in aspects of the Biden investigation � House Oversight, Judiciary, and Ways and Means � are expected to play major roles in the probe, though it�s unclear if one will take the lead.

https://twitter.com/mkraju/status/1688890950834085889

quote:

Speaker Kevin McCarthy has been insistent: House Republicans are still gathering evidence and have yet to decide whether to open up a formal impeachment inquiry against President Joe Biden.

�I didn�t say I was doing an impeachment inquiry,� McCarthy recently insisted to reporters.

But many House Republicans privately say that it appears to be a foregone conclusion: Biden will face an impeachment inquiry in the fall and could be just the fourth US president ever charged with high crimes or misdemeanors � and that it might all happen by year�s end.

Republicans say if they don�t move forward with an impeachment inquiry now, it will create the impression that House Republicans have essentially cleared Biden of any wrongdoing over his ties to his son Hunter Biden�s business entanglements, allegations they say show a pay-to-play scheme when the elder Biden was vice president, even as they have yet to corroborate that provocative allegation.

But the accusations alone, they say, are worthy of opening up a formal impeachment inquiry, which McCarthy and top Republicans argue would strengthen the House�s oversight power in legal battles to obtain more documents and testimony � potentially from Hunter Biden himself.

McCarthy has also emphasized to his members that opening an inquiry is not the same as voting for articles of impeachment � a key messaging distinction that could help convince on-the-fence moderates to back an inquiry. Yet one GOP lawmaker who supports impeachment acknowledged that some Republican donors have expressed nervousness about whether that is a smart political move, a concern that has been conveyed to GOP leaders and underscoring the political risks of taking the dramatic step.

But most Republicans think that if they open a formal inquiry, they will ultimately wind up impeaching Biden � especially as they move to shift the focus away from former President Donald Trump�s criminal charges.

�Once the barn doors are open, so to speak, the horses are out,� a senior House Republican told CNN. �You�re not gonna get them back in the barn.�

To move ahead on impeachment, the House is expected to vote to formally launch an inquiry � something that could happen as soon as next month, GOP sources say. At that point, several committees that have played a major role in aspects of the Biden investigation � House Oversight, Judiciary, and Ways and Means � are expected to play major roles in the probe, though it�s unclear if one will take the lead.

�It will happen,� Rep. Tim Burchett, a conservative Tennessee Republican, said of impeachment proceedings. �But it won�t pass the Senate.�

Indeed, even if the House were to impeach Biden, convicting him and removing him from office almost certainly won�t happen in the Senate, where there are 51 members of the Democratic caucus and 67 votes are needed for a conviction. But getting the votes alone in the narrowly divided House won�t be an easy task, given that McCarthy can only afford to lose four GOP votes if all Democrats oppose the effort.

In recent weeks, some senior Republicans have been conducting informal temperature checks to gauge the conference�s appetite for a Biden impeachment, according to a GOP source familiar with the matter. While the votes to open up an impeachment inquiry aren�t there yet, Republicans believe their Hunter Biden probes are gaining traction.

But to move ahead with a formal probe, they�ll have to convince Republicans like Rep. Don Bacon, who hails from a Nebraska district Biden carried in 2020 and will be targeted again by Democrats in 2024. Indeed, already a liberal group, the Congressional Integrity Project, launched on Monday a paid digital ad campaign targeting the 18 Republicans who hail from Biden districts over the GOP investigations, and Democrats expect similar efforts to take shape in the months ahead.

Bacon told CNN the Oversight and Judiciary committees should continue to dig into Hunter Biden�s business affairs and get more facts before moving ahead with any impeachment proceedings.

�It seems apparent that President Biden wasn�t being honest when he denied any involvement in his son�s business dealings,� Bacon said Monday. �Further, it�s apparent tens of millions of dollars were involved that prospered the family.�

Bacon added: �Did the president commit high crimes or misdemeanors? The committees need to do more digging to clarify this. There�s tons of smoke, but let�s verify what�s beneath that all.�

One GOP House source said Monday that there�s also a question of how much more the committees can turn up without launching an impeachment inquiry amid concerns from their voters who have little appetite for more strongly worded letters without taking more direct aim at the president.

Another senior House Republican, who has been fielding calls from fired-up constituents on the issue, told CNN: �Basing it on the handful of colleagues I�ve spoken to over the last two to three days by phone, and the people here, I think there�s a growing sense that people understand we have a responsibility here.�

If the House GOP launches an impeachment proceeding from September until December, as many Republicans suspect, it will follow a similar timeline as Democrats� first impeachment in 2019 when they charged Trump with abusing his power and obstructing Congress by allegedly withholding aid to Ukraine to press for probes into the Bidens.

The second Trump impeachment proceeding lasted just one week with Democrats charging him with inciting the January 6, 2021, attack on the Capitol.

Trump was acquitted by the Senate twice.

GOP seeks to tie Biden to his son as Dems rail on �desperate effort�
With the House at the beginning of its six-week summer recess, GOP investigators are expected to try to secure more documents as part of its Biden family probe and try to line up more depositions with Hunter Biden�s business associates in the fall.

Rep. James Comer, chairman of the House Oversight Committee, told CNN on Saturday in Fancy Farm, Kentucky, that the panel would look to bring in additional witnesses after last week�s interview with Hunter Biden�s business partner, Devon Archer.

�Now we�re going to try to bring in some more associates,� said Comer, a Kentucky Republican, noting that his panel planned to release more records this week about Hunter Biden�s business dealings. �We will release more bank records, we�ll do our third bank memo, where we show some interesting wire transfers and some suspicious bank activity that I think the American people will have a lot of questions about.�

What remains unclear: Whether they will be able to prove that Joe Biden directly profited from his son�s foreign business dealings or if Hunter Biden�s entanglements influenced his decision-making while vice president. So far, they have yet to do so � something the White House and Democrats have repeatedly stressed.

Maryland Rep. Jamie Raskin, the top Democrat on the House Oversight Committee, said the GOP probe is a �desperate effort to distract everyone from former President Donald Trump�s mounting criminal indictments and deepening legal morass.�

White House spokesperson Ian Sams responded to House Republicans� impeachment efforts in a statement Monday: �House Republicans should listen to the American people who want them to work with the President to focus on real issues like continuing to bring down inflation and creating jobs instead of relentlessly pursuing partisan stunts that prioritize their own extreme political agenda over improving Americans� daily lives.�

In his roughly five hours behind closed doors last week with committee investigators, Archer told the committee that Hunter Biden was selling the �illusion� of access to his father, according to the interview transcript. In particular, Archer said there were some 20-plus calls where Hunter Biden placed his father on speakerphone while in the presence of foreign business partners, something Republicans say is clear evidence of potential impropriety even as Archer also said business was not discussed in those interactions.

Both Republicans and Democrats have sought to frame that part of his testimony in a way that supports their diverging political narratives.

Democrats say that Archer�s description clears Biden from his son�s efforts to capitalize on the family name and position in government. Republicans insist the testimony bolsters their case that the president�s �brand� was inextricably linked to shady foreign business deals Hunter Biden sought to profit from.

Republicans also have not provided evidence to corroborate unverified allegations that Joe and Hunter Biden were each paid $5 million in bribes from a foreign business official. Archer told the panel that he was not aware of any $5 million payment to Hunter or his father from the foreign official.

That�s one reason why Republican sources have told CNN that they do not expect the bribery allegation to be a focal point of any impeachment inquiry because it remains unsubstantiated.

Instead, House Republicans will likely lean into claims that Biden has not been truthful about interactions with Hunter�s foreign business partners, pointing to the conversations detailed by Archer, including Biden�s presence at two dinners attended by Hunter and his foreign business associates. While Archer indicated no business was discussed at those dinners, Republicans say it�s evidence Biden lied when questioned about his son�s business dealings in the 2020 campaign.

Another aspect of a possible impeachment inquiry: Whether the Biden administration had undue influence over his son�s criminal case that recently led to the collapse of his plea deal with the Justice Department, sources told CNN. The Justice Department has furiously denied any improper interference, despite the testimony of IRS whistleblowers who argue that the probe was too limited in scope and deviated from normal procedures.

Chasing the money
In the weeks ahead, Republicans plan to continue to probe the money that went to Hunter Biden as part of his business arrangements.

The panel has already subpoenaed six banks for records of Biden family members, associates and their related companies, but has yet to tie any of the payments they presented as being directly connected to the president.

These records have shown that members of Joe Biden�s family, including Hunter received millions of dollars in payments from foreign entities in China and Romania, including when Biden was vice president. For example, bank records the panel obtained via subpoena show that Hunter Biden indirectly received approximately $1 million in various installments from Romania and a Chinese-based energy company, State Energy HK Limited, over the years.

They also have pored over suspicious activity reports to suggest potential wrongdoing by the president�s family members, but such reports are not considered conclusive.

While Republicans say these payments substantiate allegations that Biden family members have enriched themselves off the family name and raise questions about Hunter Biden�s business activities while his father was vice president, their work has not uncovered any illegality about the payments from foreign sources, demonstrated that Joe Biden has been improperly influenced by the financial dealings or shown evidence that the president directly received any of these payments.

Republicans say there�s a lot more to find out.

�A lot of the things the president said about his family�s shady business dealings, we�re proving every day that they�re not true,� Comer said.

Leon Trotsky 2012 fucked around with this message at 14:37 on Aug 8, 2023

# ? Aug 8, 2023 14:28

haveblue: Aug 15, 2005; Toilet Rascal

*ten years from now, on msnbc* don't worry about it, every president gets impeached a few times in their first term

# ? Aug 8, 2023 14:33

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# ? May 25, 2024 14:14

Sir Lemming: Jan 27, 2009; It's a piece of JUNK!

I suppose the unbreakable rule of Everything Is Projection demands that Republicans launch a blatantly politicized impeachment of every Democratic president now.

# ? Aug 8, 2023 14:33

The Something Awful Forums > Discussion > Debate & Discussion > USCE 2023: Please let them shove a camera up your butt

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