Health Care Thread

Frenzied Wombat · Dec 17, 2015

Vaclav_sl said:
If you actually read the article itself, it never cites anyone for the 90% source, its just a lead-in title with no meat that verifies it - just makes the claim then quotes the generally accepted 30-40% number.

You know, like a tabloid does. Takes a fact like someone saying "rates might even be better than we though" and blows it up to some overstated figure that gets attention. (even the video again says "as much as 4 in 10" - aka 40% or maybe a smidge less)

Bad article is bad - and for reasons of tabloiding up the actual figures with a terrible title - it's a fine article if you ignore the title though. Or if they alter it to "30-40% maybe even a little better than that" - rather than assuming "might be a bit better" = 2-3x off.

Well there you go! Disputing the facts rather than posting some dumb parody video-- that's exactly what was needed. I don't need to "actually read the article", because I was not making a comment on its validity, but thanks for arguing with me as if I was... Just pointing out that if you want to debate someone, debate facts instead of parodying the source. I can post numerous articles from the NYTimes containing missing or obscured facts as well btw, which is again a reason to dispute the content, not the source.

Vaclav · Dec 17, 2015

Frenzied Wombat_sl said:
Well there you go! Disputing the facts rather than posting some dumb parody video-- that's exactly what was needed. I don't need to "actually read the article", because I was not making a comment on its validity, but thanks for arguing with me as if I was... Just pointing out that if you want to debate someone, debate facts instead of parodying the source. I can post numerous articles from the NYTimes containing missing or obscured facts as well btw, which is again a reason to dispute the content, not the source.

Wasn't meaning to debate it with you, just explaining. My tone gets misinterpreted alot. =/

Seems simpler to just summarize that with a reminder that they're tabloidy though.

General Antony · Dec 17, 2015

karma_sl said:
Our local hopsital (less than a mile from the house) and BCBS were not able/willing? to come to an agreement, so now the hospital is no longer "in network". If Im dying they will still see me, but if I can drive an hour before I die, they would prefer I do that.

This in network out of network bullshit is tiresome, Im going to channel General Anthony for a moment and say we need to fuck some shit up and start all over.

The fuck kind of pansy ass shit is this?

Big Phoenix · Dec 17, 2015

Vaclav_sl said:
Seriously? There waivers you can get to extend VA benefits out for such? Kinda confused why friends have gotten stuff like thyroid covered then. Unless it was under family benefits.

Pretty sure if you are 50% or greater disabled you get va healthcare.

Cad · Dec 17, 2015

Vaclav_sl said:
50/50 chance - and as far as my geneticist said the only testing known - when I lost spoke to them in 2013, at least - works with IVF only. (blood test to verify the condition in adults was a recent discovery - like 2009 or something - previously it was just a clinical diagnosis based on symptoms presented [not that microcornea and digital syndactyly have too many other things they can be])

Well ok. That sucks. I really don't like IVF as a procedure, I'd do a lot to avoid it. Sounds like you've done your homework though.

Vaclav · Dec 17, 2015

Cad_sl said:
Well ok. That sucks. I really don't like IVF as a procedure, I'd do a lot to avoid it. Sounds like you've done your homework though.

More that my geneticist did, and they were really pushy about the information, I'd been relegated to the "nope, not bothering with that roulette wheel" after I'd heard the 50/50 chance and knowing how much all my surgeries costed my parents (with Federal insurance not crap) and realizing the math didn't work out.

IVF + Genetic Testing is better costed, but still costly. (Estimates I'd heard were $20k per IVF treatment until one takes, and $7-10k per batch of genetic testing to see if the batch is viable for implantantion - AKA not having my condition or others they'd also test for... ~$30k for just a chance sucks though)

Rescorla_sl · Dec 18, 2015

Vaclav_sl said:
If you actually read the article itself, it never cites anyone for the 90% source, its just a lead-in title with no meat that verifies it - just makes the claim then quotes the generally accepted 30-40% number.

You know, like a tabloid does. Takes a fact like someone saying "rates might even be better than we though" and blows it up to some overstated figure that gets attention. (even the video again says "as much as 4 in 10" - aka 40% or maybe a smidge less)

Bad article is bad - and for reasons of tabloiding up the actual figures with a terrible title - it's a fine article if you ignore the title though. Or if they alter it to "30-40% maybe even a little better than that" - rather than assuming "might be a bit better" = 2-3x off.

Perhaps you prefer the BBC version of the story?

Cancer is not just 'bad luck' but down to environment, study suggests - BBC News

Rescorla_sl · Dec 18, 2015

Vaclav_sl said:
"For multiple national elections"? The term "Cadillac Plan" wasn't something even referenced to in any law until THIS UPCOMING ELECTION. (Well that's mostly true, it TECHNICALLY was referenced in law as of the passing of the ACA - but it doesn't do anything until this upcoming year)

And if Democrats really care so strongly about it, why is it 27/188 that are standing against the bill on those grounds? Shouldn't it be overwhelming Democrat support? There's an obvious logic failure here that you're completely blind to. Did Merlin change account names or something?

.

Obama has been delaying provisions of Obamacare that are going to hit pocketbooks the hardest for a few years now (after the 2012 election) The Employer Mandate is another example. As bad as Obamacare has failed so far, it's going to get worse starting soon. The Employer mandate kicks in January 2016.

Also, you are misinformed on the level of Democrat support.

Dem fault lines emerge on 'Cadillac tax' | TheHill

Vaclav · Dec 18, 2015

Rescorla_sl said:
Perhaps you prefer the BBC version of the story?

Cancer is not just 'bad luck' but down to environment, study suggests - BBC News

One study, done days ago that is "convincing" but no secondary research has been done yet - at least that one cites what they're talking about though. But plenty of research results come out with a single case that gets flipped once a proper multigroup case study is done. I'm not holding my breath that something that involved the NIH testing to get the old 30-40% numbers was that drastically off and that Stony Brook Cancer Center in NY suddenly hit on the perfect testing method.

Especially since reading deeper into it - their percent is basically theoretical - since they say they don't know what the factors for most are - just that they think they exist. It could be "living on planet Earth" for a factor as far we we know even if they were correct - since they're not researching specific factors just analyzing data patterns and saying that due to incidence rate it can't be as spontaneous as it is. As far as we know it could EASILY be something unavoidable like impact from space radiation or radio signals since they weren't looking at any specific factors for odds.

It's that type of fringe research that usually gets overturned with further testing that leads to people doing stupid shit. Look at the discredited research that started the whole "anti-vax" campaign - that was research that got similar airplay until people retested it and found it was wrong as hell.

Rescorla_sl · Dec 18, 2015

Vaclav_sl said:
One study, done days ago that is "convincing" but no secondary research has been done yet - at least that one cites what they're talking about though. But plenty of research results come out with a single case that gets flipped once a proper multigroup case study is done. I'm not holding my breath that something that involved the NIH testing to get the old 30-40% numbers was that drastically off and that Stony Brook Cancer Center in NY suddenly hit on the perfect testing method.

Especially since reading deeper into it - their percent is basically theoretical - since they say they don't know what the factors for most are - just that they think they exist. It could be "living on planet Earth" for a factor as far we we know even if they were correct - since they're not researching specific factors just analyzing data patterns and saying that due to incidence rate it can't be as spontaneous as it is. As far as we know it could EASILY be something unavoidable like impact from space radiation or radio signals since they weren't looking at any specific factors for odds.

It's that type of fringe research that usually gets overturned with further testing that leads to people doing stupid shit. Look at the discredited research that started the whole "anti-vax" campaign - that was research that got similar airplay until people retested it and found it was wrong as hell.

You can go to nature.com and buy the study if you are so inclined. Does nature.com typically publish fringe research?

http://www.nature.com/nature/journal...ture16166.html

Vaclav · Dec 18, 2015

Rescorla_sl said:
.

Obama has been delaying provisions of Obamacare that are going to hit pocketbooks the hardest for a few years now (after the 2012 election) The Employer Mandate is another example. As bad as Obamacare has failed so far, it's going to get worse starting soon. The Employer mandate kicks in January 2016.

Also, you are misinformed on the level of Democrat support.

Dem fault lines emerge on 'Cadillac tax' | TheHill

Other articles quote 27 (of 118) in the House, that doesn't dispute it - beyond mentioning leadership and voting record in the Senate, which isn't the House - which leadership means nothing when others don't follow.

Even lumping both Houses together and assuming the 10 Senators against were D - that's still not even half of the Democrats between both sections of Congress. Maths are hard.

The Ancient_sl · Dec 18, 2015

Yes. They'll publish anything that's submitted to them in the name of "peer review". Do some research.

It's actually a recognized problem, because some half-cocked journalist will pick out a study from them and publish it as scientific discovery, just like what you've presented.

Vaclav · Dec 18, 2015

Rescorla_sl said:
You can go to nature.com and buy the study if you are so inclined. Does nature.com typically publish fringe research?

http://www.nature.com/nature/journal...ture16166.html

Journals publish things, I don't believe they require peer review first (I'm no PhD though, so grain of salt, I could be wrong [Edit: Apparently my thought, although perhaps wrong terminology, was correct - crosspost FTW!]). However, doing a search for autism nature.com shows the discredited example I gave in their backlog - so I do tend to think I'm correct in that. (They do have DOZENS of articles they followed that one up with which thoroughly debunk it IMO - but it's still in their article list)

Give it 5-10 years and we'll see this research either be debunked or springboarded into something meaningful with ACTUAL FACTORS UNDERSTOOD. Not knowing WHAT to avoid is worthless by itself even if they are right. Seeing a pattern look like it's "too clustered" to not be random (which is basically what their research says) but not having something they actually follow up on when it comes to the actual environmental factor isn't very valuable - it's the same as saying "Don't do anything, stuff can kill you".

Not to mention personally, reading the review - they largely talk about clusters of types of cancer within a population - but they seem to neglect genetic heritage as a potential primary factor in such from how I read it - and we already know FOR A FACT (20+ yrs of NIH research) that certain cancers go up and down in certain genetic groups - like other mutations. (Norweigan heritage for example is one of the most prone to dysplasial (physical mutation) conditions like my own [too lazy to look it up ATM, but I think it's something like 80% of dysplasial conditions can track to Norweigan ancestry] - also tend to have some of the highest cancer risks overall of any genetic group [which is another form of mutation] -- in fact, no research behind me, but being we tend to be low-pigmented people that don't tan very much, I'd posit that its an indication of the sun being an environmental risk to most if not all cancers - which while technically "environmental" its unavoidable])

Rescorla_sl · Dec 18, 2015

Frenzied Wombat_sl said:
That's not what I said. Someone paying cash is not the same as your "Cadillac" reference. I have a gold tier plan through work that has a 0$ in network annual deductible and $2000 out of network one. It also has something called "whiteglove health" where I can call a 1-800 number from anywhere in the city and have a nurse practitioner show up at my location within two hours to make basic diagnoses and issue prescriptions-- at no charge. Yet even this doesn't approach the quality of service I am referencing for people who pay cash, either locally or through medical tourism. Someone that travels and pays cash gets a) a limo at the airport, b) NO wait at doctors office/hospital, a private room, a dedicated nurse, and recovery at a hotel and/or by the beach depending on location. Case in point, despite my "gold tier" plan, when Obamacare hit the scene my internist (who is rated top 10 in Dallas) decided he wouldn't see patients outside a new "premier plan" service he setup and that he has a new doctor on staff for patients that did not want to pay for the plan. In exchange for $3000/year, you get to continue to see him, as well as getting access to a plethora of other perks, like same day appointments and his cell phone number. This is the type of service that is the 1%, and this is the service that exceeds what you can get in Canadia. Your "Cadillac" plans make no difference in terms of quality of service, they just have lower deductibles and co-pays, and may cover services like IVF. You want to go to that top tier doc out of network? Pay the fuck up.

I got exactly what you said and I still think you are completely off base. Concierge medicine does requires patients to pay an annual membership for better access to the doctor but after that your insurance plan covers the actual cost of his services.

Perhaps your concept of "quality" is different than mine. Concierge medicine offers direct access, no waits and a more personal one on one relationship with the doctor. He is more likely to remember who you are when he only has 500 patients compared to 3000-5000 for doctors with a traditional practice. Your statements indicate this higher level of customer service is what separates the difference in quality between the U.S. and Canada. Unless you have a citation you can provide, there is no evidence that a doctor who practices concierge medicine is more technically competent than a doctor with a traditional practice. As some articles point out, the driving force behind the rising popularity of concierge medicine is Obamacare. Doctors loathe it for multiple reasons so instead of dealing with it they are turning to concierge medicine so they can ignore it.

For me "quality" means if there is something seriously wrong with me, my doctor diagnoses it correctly and he does whatever treatment required to resolve the problem.

Based on every article I have ever read comparing the US healthcare system to Canada's, the US provides better quality (my concept) healthcare compared to Canada. It is however also ridicously expensive. If you want to use a Cost/Benefit ratio and say Canadian healthcare has better cost/benefit ratio then that is a different argument.

Edit: Americans don't engage in medical tourism because they want higher quality (my definition) healthcare. They go because it is a lot cheaper and they are willing to take the risk that the lower quality of service will be good enough.

Rescorla_sl · Dec 18, 2015

The Ancient_sl said:
Yes. They'll publish anything that's submitted to them in the name of "peer review". Do some research.

It's actually a recognized problem, because some half-cocked journalist will pick out a study from them and publish it as scientific discovery, just like what you've presented.

The BBC is half-cocked journalism? Lot of other news organizations are also reporting on the study. Google it

Vaclav · Dec 18, 2015

Rescorla_sl said:
The BBC is half-cocked journalism? Lot of other news organizations are also reporting on the study. Google it

They're reporting is "a study has found" not that it's scripture. Learn how to read things properly.

If they report tomorrow that Donald Sutherland said "All black people were created on the moon by the Devil to cause trouble to the white man" - that doesn't make anything other than that he said that a fact.

Frenzied Wombat · Dec 18, 2015

Rescorla_sl said:
I got exactly what you said and I still think you are completely off base. Concierge medicine does requires patients to pay an annual membership for better access to the doctor but after that your insurance plan covers the actual cost of his services.

Perhaps your concept of "quality" is different than mine. Concierge medicine offers direct access, no waits and a more personal one on one relationship with the doctor. He is more likely to remember who you are when he only has 500 patients compared to 3000-5000 for doctors with a traditional practice. Your statements indicate this higher level of customer service is what separates the difference in quality between the U.S. and Canada. Unless you have a citation you can provide, there is no evidence that a doctor who practices concierge medicine is more technically competent than a doctor with a traditional practice. As some articles point out, the driving force behind the rising popularity of concierge medicine is Obamacare. Doctors loathe it for multiple reasons so instead of dealing with it they are turning to concierge medicine so they can ignore it.

For me "quality" means if there is something seriously wrong with me, my doctor diagnoses it correctly and he does whatever treatment required to resolve the problem.

Based on every article I have ever read comparing the US healthcare system to Canada's, the US provides better quality (my concept) healthcare compared to Canada. It is however also ridicously expensive. If you want to use a Cost/Benefit ratio and say Canadian healthcare has better cost/benefit ratio then that is a different argument.

Edit: Americans don't engage in medical tourism because they want higher quality (my definition) healthcare. They go because it is a lot cheaper and they are willing to take the risk that the lower quality of service will be good enough.

If you define quality as the doctor's "skill" rather than "accessibility", then your claim is still inaccurate. If skill/experience wasn't a factor then EVERY doctor would be pushing a concierge plan, because they make bank while seeing less patients. The only ones that can successfully implement a concierge based plan, or alternatively be out of network with every insurance plan and charge what theyw ant, are those doctors that are recognized as top tier in their field. These are the doctors that have more patients than time available because they are in such demand due to their skill and experience. Newblet doctor fresh out of med school is not going to attract many people willing to pay 3K a year for concierge based service.. Like I said, my stepdad is a neurosurgeon that is world famous for his skill in treating spinal cord tumors-- he is out of network with every insurance provider and still has more potential patients than he has time to operate. He charges what he wants and sees who he wants, and people are expected to pay whatever their insurance doesn't to make up the difference. Most doctors that are recognized as top of their field (the quality you are referencing) are inaccessible to even people with the Cadillac plan you mention. A typical spinal cord tumor operation can be upwards of 150K including hospital care. An out of network insurance provider may pay 80K of that. That leaves 70K out of pocket for the person that wants the best doctor there is-- hence again the top tier quality you mention that the US provides is inaccessible to the vast majority of people/patients.

Again, better quality/accessibility that's available to a tiny minority while everybody else gets fucked doesn't make for a better system..

EDIT: An unrelated example, but my Dad lived in Canada until he died at 69 of an arterial venus malformation that burst. In the last 10 years of his life he had a hernia operation, hip replacement (between ages of 60-63), and then four days in the ICU in a coma before he died. He got great care in all incidences, and literally never paid a penny. When he passed after four days of anguish and intensive care, we weren't saddled with a single penny. The system works.

Rescorla_sl · Dec 18, 2015

Vaclav_sl said:
They're reporting is "a study has found" not that it's scripture. Learn how to read things properly.

If they report tomorrow that Donald Sutherland said "All black people were created on the moon by the Devil to cause trouble to the white man" - that doesn't make anything other than that he said that a fact.

Do you feel better now that you have insulted my reading comprehension? You're coming across as butthurt that not only did you get caught making a logical fallacy about my original citation but you also don't want to admit I was able to back up my point about poor lifestyle choices with a citation to a scientific study.

Vaclav · Dec 18, 2015

Rescorla_sl said:
Do you feel better now that you have insulted my reading comprehension? You're coming across as butthurt that not only did you get caught making a logical fallacy about my original citation but you also don't want to admit I was able to back up my point about poor lifestyle choices with a citation to a scientific study.

I never disputed that its a factor - the degree of factor is in dispute - which comes down 100% to your lack of reading comprehension. You keep either quoting tabloids (that trump up things) and a study that hasn't had a follow up to it yet as if that proves FACT enough to dispute research that the NIH has been doing since before I was born. (And continues to do - I remember high power lines being a cancer worry when I was younger, they're off the list of environmental factors anymore thanks to the NIH researching it)

When you've got a study by the best medical minds in the world spanning multiple decades, it's hard to say "Hey, these new guys I've personally never heard of are probably right" without anything else to follow up on their initial hypothesis. Especially since their "research" is entirely statistics based not really tested in sterile conditions over a long time frame as cancer would require.

Hell, another thing they missed in their "research" too is the fact that rates of actually identifying cancer vary by technology level - cancer rates have gone up right alongside our ability to detect smaller and smaller distortions of the human body. It could be that the rates are actually going up, or it could be we're just getting better at identifying it. (a la increased rate of autism)

Rescorla_sl · Dec 18, 2015

Frenzied Wombat_sl said:
If you define quality as the doctor's "skill" rather than "accessibility", then your claim is still inaccurate. If skill/experience wasn't a factor then EVERY doctor would be pushing a concierge plan, because they make bank while seeing less patients. The only ones that can successfully implement a concierge based plan, or alternatively be out of network with every insurance plan and charge what theyw ant, are those doctors that are recognized as top tier in their field. These are the doctors that have more patients than time available because they are in such demand due to their skill and experience. Newblet doctor fresh out of med school is not going to attract many people willing to pay 3K a year for concierge based service.. Like I said, my stepdad is a neurosurgeon that is world famous for his skill in treating spinal cord tumors-- he is out of network with every insurance provider and still has more potential patients than he has time to operate. He charges what he wants and sees who he wants, and people are expected to pay whatever their insurance doesn't to make up the difference. Most doctors that are recognized as top of their field (the quality you are referencing) are inaccessible to even people with the Cadillac plan you mention. A typical spinal cord tumor operation can be upwards of 150K including hospital care. An out of network insurance provider may pay 80K of that. That leaves 70K out of pocket for the person that wants the best doctor there is-- hence again the top tier quality you mention that the US provides is inaccessible to the vast majority of people/patients.

Again, better quality/accessibility that's available to a tiny minority while everybody else gets fucked doesn't make for a better system..

EDIT: An unrelated example, but my Dad lived in Canada until he died at 69 of an arterial venus malformation that burst. In the last 10 years of his life he had a hernia operation, hip replacement (between ages of 60-63), and then four days in the ICU in a coma before he died. He got great care in all incidences, and literally never paid a penny. When he passed after four days of anguish and intensive care, we weren't saddled with a single penny. The system works.

If you can provide any factual evidence based on statistics, studies etc that concierge doctors are more technically competent than doctors with traditional practices I would be more than willing to change my opinion. Until then you are just making an assumption and using your own stepdad as evidence to back up your point. I can counter your one example with one example of my own. Dr James Andrews is one of, if not the #1, most famous orthopedic surgeon in the world. He built his reputation performing surgeries on superstar professional athletes. His sports medicine practice is in Birmingham, Alabama and his primary clientele are high school athletes from all walks of life with basic insurance.

Lastly, I don't doubt you when you say the Canadian system works. If you are happy with it then more power to you. The US system works too. Back to the original topic of this thread, the issue is does the US system work better now than it did before Obamacare. The evidence so far clearly indicates it does not work better and appears to be getting even worse.

Health Care Thread

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