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Paul Pless
10-17-2009, 10:13 AM
The debate, at all levels, from the executive to the legislative, has shifted from heath care reform to health insurance reform.

Phillip Allen
10-17-2009, 10:15 AM
that was always the agenda...I do not trust liars of any kind

Paul Pless
10-17-2009, 10:36 AM
Seriously Norman?

Paul Girouard
10-17-2009, 10:37 AM
There's nothing wrong with health care in this country , it's the best in the world.

It's how much it costs thats the issue / whats broke / broken , or driving us to being broke is the insurance or lack there of insurance.

In short how people pay for the care they recieve.

Maybe thats PP's point?

Phillip Allen
10-17-2009, 10:45 AM
if you want to see how compensation for health care has changed...read WC Williams...all of it!

ljb5
10-17-2009, 10:46 AM
The debate, at all levels, from the executive to the legislative, has shifted from heath care reform to health insurance reform.

The debate has always been large and broad.

Perhaps it's just a shift in what you're noticing.

Can you show us any evidence of this shift?

Milo Christensen
10-17-2009, 11:04 AM
The White House first started using "insurance" instead of "care" as the middle word in early June. Somewhere along the way, both insurance and care were dropped and it's just health reform now, although the folks paid to continuously edit all the previously posted stuff on all the different White House websites are really having trouble keeping up and making all the changes. I suspect the word health will be the next to go, and it'll just be reform, until the original empty promises are revealed and we'll see that reform was never really part of the plan, only new taxes and fines and more customers for the industry we all love to hate.

ljb5
10-17-2009, 11:09 AM
...the folks paid to continuously edit all the previously posted stuff on all the different White House websites are really having trouble keeping up and making all the changes.


Ooh, that's some spooky stuff!

Better put on your tin foil hat and watch out for those black helicopters.

StevenBauer
10-17-2009, 11:11 AM
There's nothing wrong with health care in this country , it's the best in the world.




Wrong, Paul. The US is rated 37th by the World Health Organization.

1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 United Kingdom
19 Ireland
20 Switzerland
21 Belgium
22 Colombia
23 Sweden
24 Cyprus
25 Germany
26 Saudi Arabia
27 United Arab Emirates
28 Israel
29 Morocco
30 Canada
31 Finland
32 Australia
33 Chile
34 Denmark
35 Dominica
36 Costa Rica
37 United States of America (http://allcountries.org/health/usa_health_care_2008_nyt.html)
38 Slovenia
39 Cuba
40 Brunei
41 New Zealand
42 Bahrain
43 Croatia
44 Qatar
45 Kuwait
46 Barbados
47 Thailand
48 Czech Republic
49 Malaysia
50 Poland


Steven

John Smith
10-17-2009, 11:16 AM
I think you'd have to explain the difference to me.
Me too. It's reforming how we access and pay for our healthcare, which is insurance coverage.

It's about changing the rules under which health care insurance functions, and choices we can have for our health insurance carrier.

Rick-Mi
10-17-2009, 11:16 AM
The debate, at all levels, from the executive to the legislative, has shifted from heath care reform to health insurance reform.


Yes, the debate has radically changed as the executive branch attempts to politically salvage something, anything from the ashes of a rebuffed agenda that was supposed to be the centerpiece of a presidency.

Which reminds me, how is the end of the war coming along?


.

Milo Christensen
10-17-2009, 11:22 AM
Ooh, that's some spooky stuff! . . .

No, what's spooky is that you appear to be unaware of the constant and continuous shift away from truly reforming the health care system in this country to a laughingstock called "reform" that simply drops 30 million new customers into the laps of the health insurance industry.

Explalin three things to me, please:

If you want to lower the cost of health insurance, why add a new tax on top of the 35% corporate tax the health insurance companies are already paying? Why tax health insurance profits at all?

If you want to lower the cost of health insurance, why not repeal the special anti-trust legislation the health insurance companies enjoy and allow true inter-state commerce in health insurance?

If you want to lower the cost of health insurance, even if only a little, why not enact medical malpractice tort reform at the Federal level?

Phillip Allen
10-17-2009, 11:41 AM
No, what's spooky is that you appear to be unaware of the constant and continuous shift away from truly reforming the health care system in this country to a laughingstock called "reform" that simply drops 30 million new customers into the laps of the health insurance industry.

Explain three things to me, please:

If you want to lower the cost of health insurance, why add a new tax on top of the 35% corporate tax the health insurance companies are already paying? Why tax health insurance profits at all?

If you want to lower the cost of health insurance, why not repeal the special anti-trust legislation the health insurance companies enjoy and allow true inter-state commerce in health insurance?

If you want to lower the cost of health insurance, even if only a little, why not enact medical malpractice tort reform at the Federal level?

point one: to lower the governmental revenue by reducing profits of insurance is a direct conflict of interest.

point two: really, "trust" speaks for itself...it is corruption. That the government allows an exception is proof, prima fascia, of complicity…and it has NEVER been limited to political party or sitting presidents.

Point three: I consider this a separate issue…the theory is that allowing huge settlements improves health care…sorta like hiring the fox to guard the chicken house to help eliminate the stupid chickens “who’ll only end up being eaten by foxes anyway.”

Dan McCosh
10-17-2009, 11:45 AM
It would seem obvious that virtually no attention is being paid to the actual cost--i.e. the price--of heath care in the US. The prices being charged collectively are about twice what any other country pays in terms of percentage of GDP. individually, the fees are also very high, as illustrated by the differences in prices for drugs here and abroad, not to mention the growing "medical tourism" business. The current insurance system underwrites the high prices. Efforts to control the actual cost of health care do appear to have been thwarted with bipartisan support. I would agree that the current debate has focused almost exclusively on expanding the current insurance system, with virtually no attention paid to controlling health care costs. Oddly, any mention of controlling cost seems to be fodder for an attack on any reform at all.

paladin
10-17-2009, 11:46 AM
I can't argue with that list....I've been worked on, surgically, in Singapore, Thailand, Iceland, Greece, Turkey, Luxembourg and others and they had what I considered some of the finest health care available....and far, far, less expensive than the U.S.

Gonzalo
10-17-2009, 11:48 AM
I've always understood that "health care reform" meant reform of insurance. Other than a few proposals for tinkering around the edges like computerizing medical records, practically everything discussed since the campaign has involved reform of the way insurance companies do business, taxes on high value plans, mandates for everyone to have insurance, or the public alternative to insurance companies. That reforms focus on insurance shouldn't be surprising to anyone who has been paying attention.

Non-politicians have brought up some of the cost drivers such as unnecessary tests, ownership of labs by physicians' practices, and so forth, but almost everything--but not quite everything--discussed by politicians or congressmen has involved insurance reform.

Dan McCosh
10-17-2009, 12:02 PM
Atlantic magazine recently published one of the best analysis I've read on the issue of cost vs. insurance. http://www.theatlantic.com/doc/200909/health-care

I don't agree with all the suggested reforms, but it at least looks directly at why health care in the US costs so much, and what we get for it.

ljb5
10-17-2009, 12:13 PM
Explalin three things to me, please:

If you want to lower the cost of health insurance, why add a new tax on top of the 35% corporate tax the health insurance companies are already paying? Why tax health insurance profits at all?

Welcome to the real world where bills come due and have to get paid. Republicans tend to think you can go on forever without taxing anything, ever... but it doesn't work that way.


If you want to lower the cost of health insurance, why not repeal the special anti-trust legislation the health insurance companies enjoy and allow true inter-state commerce in health insurance?

I might be okay with that, but it won't fix anything by itself. The real problem is that health insurance companies can screw customers. Allowing them to screw customers across state lines might not help the situation.


If you want to lower the cost of health insurance, even if only a little, why not enact medical malpractice tort reform at the Federal level?

Partly because holding people responsible for their errors or poor choices is the right thing to do.

If you allow people to get away with malpractice, it reduces the value of human life to nothing more than a debit on the cost/benefit analysis. It will become routine to withhold care whenever the cost is more expensive than the maximum payout.

Partly because we still have a Seventh Amendment in the Bill of Rights which allows the lowliest pauper to be heard just as much as the loftiest corporation.

Partly because there really isn't enough money there to matter.

Phillip Allen
10-17-2009, 12:18 PM
question:
if a doctor working in a hospital gets paid one dollar, what part of it goes to the:
hospital
hospital's insurance company
doctor
doctor's overhead (thinking of accountants here) and the doctor's insurance company

Phillip Allen
10-17-2009, 12:26 PM
I certainly understand Norman's point...

Gonzalo
10-17-2009, 12:37 PM
If you want to lower the cost of health insurance, even if only a little, why not enact medical malpractice tort reform at the Federal level?Partly because malpractice suits aren't a significant driver in the cost of health care. See Keith's post on the subject in another thread. Edited to add: I see that Norman referenced the same CBO study while I was writing.

Some interesting research that has been getting attention lately, but not by politicians, shows that the ways physicians are compensated--by the procedure--as a significant contributor to costs. The famous case of McAllen, TX, is one such study. Another involved small towns in Maine, in which it was clear that if there are more physicians in a town, doctors ordered more frequent follow-up visits, performed significantly more procedures, and ordered more tests, sometimes to the detriment of the patient, not to their benefit. When interviewed, doctors were frank in saying that they ordered more "care" for their patients because in a small town with more doctors, there just weren't enough patients to go around. I recently heard an interview with the researcher, himself a doctor.

ljb5
10-17-2009, 12:38 PM
If you want to lower the cost of health insurance, even if only a little, why not enact medical malpractice tort reform at the Federal level?

Of course, if we were to do that, some dumbass on the internet would start whining that the language of the debate had shifted from Health Care Reform to Tort Reform.


:eek::eek::eek:

ljb5
10-17-2009, 12:41 PM
I certainly understand Norman's point...

Me too. Thanks for pointing that out, Norman.

Those of us who are sincerely interested in improving the situation sometimes have trouble anticipating the duplicity of those who are only interested in bending it to their needs.

Keith Wilson
10-17-2009, 12:44 PM
The debate, at all levels, from the executive to the legislative, has shifted from heath care reform to health insurance reform.OK, perhaps it has. So what?

Milo, tort reform won't do much alone; the CBO just did a pretty exhaustive study that said at most we could save about 0.5% of US health care costs.

Phillip Allen
10-17-2009, 12:44 PM
Me too. Thanks for pointing that out, Norman.

Those of us who are sincerely interested in improving the situation sometimes have trouble anticipating the duplicity of those who are only interested in bending it to their needs.

agreed
(must be embarrassing to have an idiot agree with your thinking)

Paul Girouard
10-17-2009, 12:47 PM
Wrong, Paul. The US is rated 37th by the World Health Organization.

Steven



Do you have a link to that site? I'd guess that was based on availability of H/C not the care itself. Remember thats a guess, it could be that Poland's the place to go for open heart surgery and the such.

I should read the rest of the posts that where made after your post, which I will do after I post this , and can always go back and delete this if this has been asked.

ljb5
10-17-2009, 12:48 PM
agreed
(must be embarrassing to have an idiot agree with your thinking)

I've told you before, Phillip. My greatest weakness is that I still hold out hope for you. :)

You and I have agreed on a number of things. I've never hesitated to point out where we agree. Nor will I hesitate to point out where we differ.

Phillip Allen
10-17-2009, 12:49 PM
perhaps we could agree to leave out the epithets

Gonzalo
10-17-2009, 12:53 PM
...I'd guess that was based on availability of H/C not the care itself....I think this is true. When outcomes of specific types of care are considered, such as cancer survival rates, U.S. care ranks well. When overall outcomes within the population is the measure, the U.S. doesn't do so well.

Phillip Allen
10-17-2009, 01:06 PM
question:
if a doctor working in a hospital gets paid one dollar, what part of it goes to the:
hospital
hospital's insurance company
doctor
doctor's overhead (thinking of accountants here) and the doctor's insurance company

thought I'd repeat myself...

Milo Christensen
10-17-2009, 01:29 PM
OK, perhaps it has. So what?

Milo, tort reform won't do much alone; the CBO just did a pretty exhaustive study that said at most we could save about 0.5% of US health care costs.

A half a percent of 2.3 trillion dollars is actually quite a lot of money, it reduces the cost upon which all future cost increases would be multiplied from now until forever, which is really, really a lot of money. It would shut up the conservatives objection on that point. Unfortunately it would also starve folks like John Edwards and his fellows from the millions of dollars the trial lawyers are able to flow into the coffers of Democrats. So, yeah, I can understand why we wouldn't want to save a half percent, shut the conservatives up and reduce the windfall from the trial lawyers.

Peer reviewed malpractice claims, mandatory arbitration, payment of all lifetime health costs incurred by the victim, what's wrong with this? You want folks like John Edwards to keep dragging cerebral palsy kids into courtrooms for 10's of millions in punitive damages, of which the kind soul only keeps a third?

Edited with a nod to Norman.

Milo Christensen
10-17-2009, 01:35 PM
Invest 11.5 billion dollars a year, inflated yearly, over 10 years? Not worth doing? It puts almost a million people a year on a Medicare level gold plated insurance plan of $12,000 a year. Not worth doing? Tell that to a million people.

George Roberts
10-17-2009, 01:43 PM
"Those $2 aspirins in the hosiptal are the direct result of having to balance the paid compensation of the insurance companies with the uncompensated care the hospitals are compelled to provide."

That is a lie.

There is a lot of bookkeeping and standardization related to dispensing drugs in a hospital.

Each aspirin comes in a single pill package. They are stored in a pharmacy. Someone gets paid to stock the shelves. THe pharmacist gets paid to pull the pill from the shelf - read the prescription, check that the pill is actually an asprin, record that the pill was dispensed, and place the pill in the proper patient area on a cart - check the patient name against the prescription. A tech gets paid to push the cart to the proper patient area and hand it off to a nurse. The nurse wheels the cart to the various patient rooms and administers the pills - checks the patient name against the cart, reads the pill description to the patient, puts the pills in a cup, gets water for the patient, makes sure the pill is taken, and records the medication in the log.

You want an additional aspirin during the day. The nurse needs to contact the doctor to get a prescription. Often times the floor doctor has authority, but if your doctor needs to be contected expect a several hour wait. The tech needs to make a special trip to the pharmacy. The pharmacist needs to break out of his normal reoutine to handle the pill. Then the nurse has to find the patient and provide water. Not a cheap process.

I am sure that you can hamdle pills in a much more efficient manner.

---

My wounds were stapled together. I now own 2 tools for pulling the staples out. I also have several pair of surgical sissors and tweezers. Expensive tools that came individually packed. I suspect the sterial plastic urinal bottles were expensive also - I brought 3 home.

A hard part of health care is preventing cross contamination. It is not cheap.

Milo Christensen
10-17-2009, 01:47 PM
No, I corrected my mistake, now correct yours. I'm working on a "conservative" figure of 2.3 trillion dollars for 2008. Let google calculate it. (http://www.google.com/search?sourceid=navclient&ie=UTF-8&rlz=1T4HPIA_enUS314US314&q=.5+percent+of+2.3+trillion)

Horace
10-17-2009, 02:06 PM
The current system of private insurance distorts the prices of everything in the entire health care chain. Those $2 aspirins in the hosiptal are the direct result of having to balance the paid compensation of the insurance companies with the uncompensated care the hospitals are compelled to provide. The only true solution to that would be single-payer, so that the actual costs could be assessed evenly, not distorted all to hell... and it weould be easier to figure out where the irrational costs are, and what their solution would be.

Why do you have such an animus against insurance companies? What they pay out, plus administrative expenses (about 7.3%? of total costs, averaging both private insurers and Medicare/Medicaid), equals premiums. Insurance companies may be enablers, but I think you need to look elsewhere for the excessive costs present in the system. (Eliminating all administrative costs, including insurance company profits, still leaves us far and away the most expensive system, with unequal delivery and individual costs.)

Phillip Allen
10-17-2009, 02:12 PM
Obviously, it's not an easy question to answer.... and the answer is HIGHLY variable.

When you say 'working in a hospital', do you mean a doctor on staff, paid by the hospital? If so, the doctor is getting a salary, and a portion of the revenues generated by his efforts go to hospital overhead and insurance. It's no different than for any other working stiff.

On the other hand, many doctors you find working IN a hospital aren't on staff, paid by the hospital... they are independent contractors, either sole practitioners, or part of a group. The dollar the doctor earns in fees from the patient (or the patient's insurance company) is diminished by the doctor's own overhead (office, staff, malpractice insurance). The patient of this doctor pays two bills: one to the doctor, and one to the hospital, for the use of the facilites and the cost of the care provided by the hospital (more correctly, the patient's insurance pays the two bills).

There can be 'mixed' situations: when he performs a colonoscopy, my gastroenterologist, for example, might be paid his fee by the hospital, and the hospital bills the insurance company for the full cost.... in which case, a portion goes to the independent doctor, and the rest goes to the hospital.

I understand it is complicated...

ny neighbor and friend was a neonatalogist...worked for and was paid by the hospital. Once he told me his personal insurance amounted to about half of his salery...I'm not ever sure that I remember it right...I'd like to see it broken down by saleried and independant doctors. what I ultimatly want to do is expose the hidden middle men...nurses and equipment I understand...I am also aware that the insurance industry collects from the hospital, doctor, equipment seller/maker/repairman snd is very convoluted...I, however put the insurance industry into one bucket...they collect many times for the same service

oznabrag
10-17-2009, 02:13 PM
Smoke and mirrors, just different jimmy's on your cone of poo.;)

Lick-lick.:D

So you've been back on this board for less than an hour, and you're already making with the 'eat s**t, suckers'.

You really are sick, Mark, and this board was very noticeably more pleasant without you.

I almost tagged your post, and I'm not really sure why I didn't, but I think you ought to remove it. I'll remove this one if you do.

Thanks in advance! :)

JimD
10-17-2009, 02:16 PM
Wrong, Paul. The US is rated 37th by the World Health Organization.

Steven

That's quite a list. The US, Canada, Australia and New Zealand are all behind Morocco and Colombia, among others. Of the major English speaking countries only the UK and Ireland are ahead of them and in the top twenty. Maybe Obama should be studying Andorra's system.

Milo Christensen
10-17-2009, 02:45 PM
So now the numbers don't matter. Nice attempt. A million more folks could be on a gold plated, $12,000 a year Medicare policy and that doesn't matter.

If, as you contend, the majority of states have enacted tort reform, despite the claim of yours about some Constitutional issue which should be preventing tort reform, why is there still $11,500,000,000 in CBO estimated savings and since when does that much money not matter? Year after year after year.

It's all crap anyway, no legislator in this country has the guts to really deal with the cost issue. They all love to increase benefits though.

And that whole thing about Bush's war is just more crap. Nice try Norman, but I got you beat on pacifism, I don't want a single soldier, airman or sailor to be beyond the borders of this country and it's territories, so don't do the YWWAB thing with me.

ljb5
10-17-2009, 03:01 PM
What Milo is really arguing for is Conservative Utopia.

That mythological place free of accountability, where rich people and corporations can injure you or simply decide you're not worth the cost.

And there's nothing you can do about it, because he's decided your voice isn't worth hearing.

Milo Christensen
10-17-2009, 03:17 PM
What Milo is really arguing for is Conservative Utopia.

That mythological place free of accountability, where rich people and corporations can injure you or simply decide you're not worth the cost.

And there's nothing you can do about it, because he's decided your voice isn't worth hearing.

No, after years of crap like that from you, I've decided that your voice generally isn't worth responding to unless you directly attack me. Why was this particular post of yours necessary? What does it add to the discussion? I am used to this, however, whenever I'm winning a particular debate folks either just stop posting or start attacking me as opposed to my positions.

Bob Triggs
10-17-2009, 05:04 PM
We will only get what they allow us to have.

ljb5
10-17-2009, 05:32 PM
Why was this particular post of yours necessary? What does it add to the discussion?


I think I made my point clearly, but I'll make it again for you.

Tort law allows us to seek redress of grievance from those who have injured us, either through malice, negligence or cold-blooded calculation.

It is one of the most important protections in our Constitution because it creates equality between rich and poor, the powerful and the powerless, people and corporations. Everyone has the right to be heard.

If you remove the right of torts, you remove accountability. In the most extreme cases, you allow people to deliberately withhold care if they determine that the cost of providing care is greater than the cost of withholding it.

Aside from the fact that there isn't enough money to be saved in tort reform, there is the problem that it removes our basic right to be heard and for others to be held accountable for their actions, mistakes and decisions.

================================================== ================================================== ======

Besides.... if we change the debate from Health Care Reform to Tort Reform, how long will it be before some dumbass comes along to complain about the shift?

Phillip Allen
10-17-2009, 05:53 PM
I think I made my point clearly, but I'll make it again for you.

Tort law allows us to seek redress of grievance from those who have injured us, either through malice, negligence or cold-blooded calculation.

It is one of the most important protections in our Constitution because it creates equality between rich and poor, the powerful and the powerless, people and corporations. Everyone has the right to be heard.

If you remove the right of torts, you remove accountability. In the most extreme cases, you allow people to deliberately withhold care if they determine that the cost of providing care is greater than the cost of withholding it.

Aside from the fact that there isn't enough money to be saved in tort reform, there is the problem that it removes our basic right to be heard and for others to be held accountable for their actions, mistakes and decisions.

================================================== ================================================== ======

Besides.... if we change the debate from Health Care Reform to Tort Reform, how long will it be before some dumbass comes along to complain about the shift?

well, that's a better argument than I have seen lately

Keith Wilson
10-17-2009, 06:46 PM
Keith, does that study reflect the cost of CYA medicine, or just the raw costs of litigation?It includes both. The effect of CYA is harder to measure, but they did their best to estimate it. The specific document that was released recently was a letter to Senator Orrin Hatch, summarizing a lot of previous work. Go here and click on "PDF". (http://www.cbo.gov/doc.cfm?index=10641)
What they pay out, plus administrative expenses (about 7.3%? of total costs, averaging both private insurers and Medicare/Medicaid), equals premiums.Eh? This is misleading. The administrative costs for Medicare/Medicaid are very low - a couple of percent by all estimates, so combining private insurance and government programs is confusing if not deliberately deceptive. Administrative costs for private insurance are much higher, but more difficult to estimate, since much of the overhead occurs in the offices of the providers, while they're trying to get paid. I've seen estimates from about 15% to over 30%.

Horace
10-17-2009, 07:21 PM
Thanks, Keith, for the link.

Notice the "?" after the 7.3%--I regretted that statistic soon after posting, especially since I was aware of the same point you made when it was submitted. However, that still doesn't negate the point that private insurance company overhead isn't the prime cause of the extraordinary cost of US health care (nor that the management necessary to achieve significant waste and fraud controls in Medicaid/Medicare will result in administrative costs comparable to those of private insurers--less the profit, of course).

It's interesting that the savings from tort reform were increased by a factor of 10 in the later iteration of the CBO report.

John Smith
10-17-2009, 07:31 PM
Actually, the 'across state lines' thing is a well-disguised screw job proposed by Republicans (along with tort reform, which, as the CBO has shown, doesn't amount to a piss in the ocean).

What people fail to realize is that the Republican call for allowing insurance companies to sell across state lines has nothing to do with improving competition, or lowering costs.... it's a thinly disguised desire to re-incorporate in whatever state has the most lenient legislation, and/or lax enforcement of legislation. It's precisely the same thing as the credit card companies being based out of North Dakota, or Nevada..... it's cheaper to be there, and the state authorities are far more compliant.

It's just amazing that normally intelligent people would fall for that kind of scam.

I cringe whenever I hear the "buy across state lines" thing, as it's really not possible. Even though my plan is federal, and available in all fifty states, it's premiums and benefits are state by state. Federal Blue Cross is actually Horizon Blue Cross of NJ.

If you lived in Texas and were to buy my insurance, you'd have a hell of a time finding a participating provider in your area.

John Smith
10-17-2009, 07:37 PM
A half a percent of 2.3 trillion dollars is actually quite a lot of money, it reduces the cost upon which all future cost increases would be multiplied from now until forever, which is really, really a lot of money. It would shut up the conservatives objection on that point. Unfortunately it would also starve folks like John Edwards and his fellows from the millions of dollars the trial lawyers are able to flow into the coffers of Democrats. So, yeah, I can understand why we wouldn't want to save a half percent, shut the conservatives up and reduce the windfall from the trial lawyers.

Peer reviewed malpractice claims, mandatory arbitration, payment of all lifetime health costs incurred by the victim, what's wrong with this? You want folks like John Edwards to keep dragging cerebral palsy kids into courtrooms for 10's of millions in punitive damages, of which the kind soul only keeps a third?

Edited with a nod to Norman.
I used to pester Robert Novac about this. He took the position that these suits should be capped at $250,000. I tried, to no avail, to ask him if he'd settle for that as net to the injured party. By the time the lawyers and witnesses take their share of that money, not so much goes to the injured party.

John Smith
10-17-2009, 07:41 PM
"Those $2 aspirins in the hosiptal are the direct result of having to balance the paid compensation of the insurance companies with the uncompensated care the hospitals are compelled to provide."

That is a lie.

There is a lot of bookkeeping and standardization related to dispensing drugs in a hospital.

Each aspirin comes in a single pill package. They are stored in a pharmacy. Someone gets paid to stock the shelves. THe pharmacist gets paid to pull the pill from the shelf - read the prescription, check that the pill is actually an asprin, record that the pill was dispensed, and place the pill in the proper patient area on a cart - check the patient name against the prescription. A tech gets paid to push the cart to the proper patient area and hand it off to a nurse. The nurse wheels the cart to the various patient rooms and administers the pills - checks the patient name against the cart, reads the pill description to the patient, puts the pills in a cup, gets water for the patient, makes sure the pill is taken, and records the medication in the log.

You want an additional aspirin during the day. The nurse needs to contact the doctor to get a prescription. Often times the floor doctor has authority, but if your doctor needs to be contected expect a several hour wait. The tech needs to make a special trip to the pharmacy. The pharmacist needs to break out of his normal reoutine to handle the pill. Then the nurse has to find the patient and provide water. Not a cheap process.

I am sure that you can hamdle pills in a much more efficient manner.

---

My wounds were stapled together. I now own 2 tools for pulling the staples out. I also have several pair of surgical sissors and tweezers. Expensive tools that came individually packed. I suspect the sterial plastic urinal bottles were expensive also - I brought 3 home.

A hard part of health care is preventing cross contamination. It is not cheap.
Reasoning here is not entirely without fault. The nurse, the phramacist, the pharmacy technician, are all salaried employees. They get paid the same regardless of how many aspirins they dispense.

And there certainly IS cross billing to the insured.

Keith Wilson
10-17-2009, 07:43 PM
However, that still doesn't negate the point that private insurance company overhead isn't the prime cause of the extraordinary cost of US health careI'll reiterate the obvious point that every other civilized country treats health care as public good like roads or schools or the fire department. The US is the only one that has a predominately private for-profit system. They cover everybody all the time. We have a lot of people with no insurance at all, and anyone under 65 can lose insurance coverage at any time. We spend 17 or 18% of GDP on heath care, They spend an average of 10%, and the average outcomes in the US are no better. Why do you think we have such an inefficient system? It sure isn't our tort laws.
. . . nor that the management necessary to achieve significant waste and fraud controls in Medicaid/Medicare will result in administrative costs comparable to those of private insurers--less the profit, of course.Eh? Comparable to private insurers? And you know this how?

Actually one major cost driver in the US is the sheer number of different insurers and plans - each with their own procedures and forms and numbers to call and hassles. Unfortunately, none of the proposed reforms do anything at all about that.

John Smith
10-17-2009, 07:44 PM
Why do you have such an animus against insurance companies? What they pay out, plus administrative expenses (about 7.3%? of total costs, averaging both private insurers and Medicare/Medicaid), equals premiums. Insurance companies may be enablers, but I think you need to look elsewhere for the excessive costs present in the system. (Eliminating all administrative costs, including insurance company profits, still leaves us far and away the most expensive system, with unequal delivery and individual costs.)
Your "average" figure is deceiving. Medicare spends considerably less on overhead than do the private corps. Medicare also covers that part of the civilian population with the highest per capita medical needs.

Horace
10-17-2009, 07:53 PM
Actually one major cost driver in the US is the sheer number of different insurers and plans - each with their own procedures and forms and numbers to call and hassles. Unfortunately, none of the proposed reforms do anything at all about that.

And you know this, how?

Keith Wilson
10-17-2009, 08:00 PM
Just anecdotal; I wish I had better data. It comes from conversations with quite a few pharmacists, doctors, clinic management folks. Their estimates were that over 30% of the man-hours expended went toward dealing with insurance companies.

Horace
10-17-2009, 08:07 PM
As was mine, and for the same reasons--anecdotal and first-hand experience with Medicare unquestioningly paying inappropriate charges and declining to pursue the issue when it was reported to them.

Keith Wilson
10-17-2009, 08:12 PM
Ah, well - two guys talking about stuff they don't really know about in the Bilge? Who would have believed it! :D;)

Horace
10-17-2009, 08:20 PM
:D. I've got a cold, so I'm going to bed with the Gougeon Bros.--their book, that is.

Looking forward to tomorrow in the Bilge.

Back to the cave.

johnw
10-17-2009, 08:35 PM
20 years ago, anesthesiologists were sued for malpractice more than anyone else in the medical profession and complained a lot about malpractice insurance. Then they made a major drive to reduce medical errors, and it paid off, according to that known socialist rag, the Wall Street Journal:


One group of doctors changes its ways
Tuesday, June 21, 2005
By Joseph T. Hallinan, The Wall Street Journal
The rising cost of medical-malpractice insurance has hit many doctors, especially surgeons and obstetricians. But one specialty has largely shielded itself:
Anesthesiologists pay less for malpractice insurance today, in constant dollars, than they did 20 years ago. That's mainly because some anesthesiologists chose a path many doctors in other specialties did not. Rather than pushing for laws that would protect them against patient lawsuits, these anesthesiologists focused on improving patient safety. Their theory: Less harm to patients would mean fewer lawsuits.
Over the past two decades, anesthesiologists have advocated the use of devices that alert doctors to potentially fatal problems in the operating room. They have helped develop computerized mannequins that simulate real-life surgical crises. And they have pressed for procedures that protect unconscious patients from potential carbon-monoxide poisoning.
All this has helped save lives. Over the past two decades, patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies, a leading scientific advisory body.
Malpractice payments involving the nation's 30,000 anesthesiologists are down, too, and anesthesiologists typically pay some of the smallest malpractice premiums around. That's a huge change from when they were considered among the riskiest doctors to insure. Nationwide, the average annual premium for anesthesiologists is less than $21,000, according to a survey by the American Society of Anesthesiologists. An obstetrician might pay 10 times that amount, Medical Liability Monitor, an industry newsletter, reports.
In some areas, anesthesiologists can now buy malpractice insurance for as little as $4,300 a year, although premiums ranged as high as more than $56,000, according to the ASA. The ASA survey gave no general explanation for the disparity but did note that premiums were higher for anesthesiologists who had been sued before and for those who perform higher-risk procedures.
A 1999 report by the Institute of Medicine noted that "few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety." It identified one exception: anesthesiologists.
"If there were any specialty where you said, 'Show me who has done anything right,' I would point to the anesthesiologists," says Neil Kochenour, medical director at the University of Utah Hospitals and Clinics. "They have really made some inroads and some impact."
Medical errors are a leading cause of death in the U.S., killing between 44,000 and 98,000 Americans each year, according to various studies.


Read more: http://www.post-gazette.com/pg/05172/525947.stm#ixzz0UFNPgfDB

Canoeyawl
10-18-2009, 12:37 PM
I think that some of the people espousing "Tort Reform" just like to be able to use big words.

Phillip Allen
10-18-2009, 01:10 PM
I warn ya...I get bored easy...but if genuine education is available on this thread, I'll keep up with it...as soon as it gets partisan...I'm outa here

Keith Wilson
10-18-2009, 01:19 PM
Paul, the CBO report is genuine education. It's the best work I know of on the likely economic effects of tort reform.

Phillip Allen
10-18-2009, 01:28 PM
genuine education IS partisan.... if it has to counter genuine partisan ignorance (like the prevailing 'conservative' viewpoint about malpractice tort reform). One can argue political ideology all day long.... but facts are inarguable things.

no...it is not...don't make me click this thread, it has good potential

Nicholas Carey
10-18-2009, 03:09 PM
...one major cost driver in the US is the sheer number of different insurers and plans - each with their own procedures and forms and numbers to call and hassles.I've met doctors that tell me that they spend at least 1 full day per week (20% of their time) dealing with insurance -- paper work and other hassles like pre-approval or fighting over how a claim was adjudicated. A large provider may have to inventory literally hundreds of different forms and maintain an office staff that knows how to fill each of them out and how to deal with each of the involved insurance companies.

That's a huge amount of overhead.

Phillip Allen
10-18-2009, 04:58 PM
I've met doctors that tell me that they spend at least 1 full day per week (20% of their time) dealing with insurance -- paper work and other hassles like pre-approval or fighting over how a claim was adjudicated. A large provider may have to inventory literally hundreds of different forms and maintain an office staff that knows how to fill each of them out and how to deal with each of the involved insurance companies.

That's a huge amount of overhead.

one way to look at that is, remove the time needed to do the paperwork and effectively get more doctors for the public

Horace
10-18-2009, 06:10 PM
I've met doctors that tell me that they spend at least 1 full day per week (20% of their time) dealing with insurance -- paper work and other hassles like pre-approval or fighting over how a claim was adjudicated.
Wouldn't you think most physicians hire specialized billing staff to handle all but the most technical of exchanges with insurers?


A large provider may have to inventory literally hundreds of different forms and maintain an office staff that knows how to fill each of them out and how to deal with each of the involved insurance companies.

That's a huge amount of overhead.Now how could there possibly be that many different forms? Did you miss Norm's assertion that "there's only a very small handful of huge insurors (sic)"?http://www.woodenboat.com/forum/images/icons/icon12.gif

Actually:
http://www.ourbenefits.org/eb_medical_form.pdf


Now, one might have to keep a record in each patient's billing file to know where to send the claim; I would think most offices use computerized billing programs and printer claim forms, or, more likely, direct digital billing. (Or did you mean intra-office forms, like health histories, privacy notices, disclosure forms, etc.?)

ljb5
10-18-2009, 06:23 PM
Wouldn't you think most physicians hire specialized billing staff to handle all but the most technical of exchanges with insurers?

Sure, but that's just extra staffing and overhead. Who do you think gets billed for that?

Specialized billing staff is a huge expense... much more than malpractice torts. Every new staff member needs training and a desk and a chair and a computer and health insurance and dental, etc. Pretty soon, a doctor in private practice finds himself running a large office full of bureaucrats and paper pushers. A lot of them just throw up their arms and say 'this isn't why I got into medicine.' That's a huge discouragement to private practice.

On top of that, there's a lot of stuff the staff can't do. The doctors need to be involved in all levels of discussion with the insurers. Often, they simply decide not to work with a certain insurer because they don't like the terms.

That's why we have the mess of "in network" and "out of network" and "approved providers" and mandatory pre-approval, etc.


Now how could there possibly be that many different forms?

Are you asking seriously, or just trying to show your ignorance?


I would think most offices use computerized billing programs and printer claim forms, or, more likely, direct digital billing. (Or did you mean intra-office forms, like health histories, privacy notices, disclosure forms, etc.?)

There is, of course, a major effort underway to simplify and automate a lot of this.... but it's still a major problem.

paladin
10-18-2009, 07:29 PM
Gentleman, I was told by one of my doctors the reason they will not accept patients with certain insurance is because of the complexity of their forms and they have a tendency to make them submit the same documents a second and third time to get them to cut fees even lower than what the insurance company requires. I guess I am lucky to have multiple insurances.. I also purchased eye care and dental care outside my normal insurance. New "patients" I understand pay several times my current rate (I've had mine for over 20 years)....and when overseas, even though I was covered under some government type plans, I purchased Sears "world traveler" insurance, guaranteeing immediate local medical care or an emergency plane flight to the nearest approved country for care.

Milo Christensen
10-18-2009, 07:29 PM
I love the way the Norman and ljb5 make extremely valid arguments against adopting any of the current nightmare of 5 reform bills, which will more than likely increase competition - ie: more forms, more new plans, more government paperwork.

John Smith
10-18-2009, 07:30 PM
They do... and they're expensive. In my dermatologist friend's group practice (4 doctors), the office headcount is over 20 people. Some are nurses and medical assistants, but there's a heaping handful of people who do mothing but billing. Those people cost money.



What's the 'sic' for? 'Insurors' is the plural of insuror.

The problem has less to do with forms, and more to do with the fact that the billing staff can't argue with the claims adjustor about pre-authorizations or approvals... the doctor him/herself has to do that.

You might try talking to independent practitioners, or practitioners in small groups... the administrative overhead, including the issues of dealing with insurance companies in disputes, outstrips the cost of malpractice insurance by a huge margin (true for both my dermatoligist friend, as well as my own doc, who is an internist/gastroenterologist).
These are strange times in many respects, and people who hold one position or another like to find things they can hang their hat on.

What I've been unable to get anyone to address is where the money the insurance companies are spending on lobbyists is coming from, if not our premiums, and this is a LOT of money.

Phillip Allen
10-18-2009, 07:34 PM
if someone had a "magic" button and put ALL lobbists out of work tonight...where would they go?

Milo Christensen
10-18-2009, 07:38 PM
if someone had a "magic" button and put ALL lobbists out of work tonight...where would they go?

or trial lawyers specializing in medmal.
or claims examiners
or medical billing staff
or . . .

Horace
10-18-2009, 07:58 PM
Sure, but that's just extra staffing and overhead. Who do you think gets billed for that?

Do you really think there’ll be appreciably less staff needed to handle routine billing , preauthorization, etc., with a single payer system? Do you think Medicare billing, for example, is significantly simpler or uses different coding than private insurance? Or are you just making the rather breathtaking assumption that all of this would just go away? Salaried doctors, perhaps?



Specialized billing staff is a huge expense... much more than malpractice torts. Every new staff member needs training and a desk and a chair and a computer and health insurance and dental, etc. Pretty soon, a doctor in private practice finds himself running a large office full of bureaucrats and paper pushers. A lot of them just throw up their arms and say 'this isn't why I got into medicine.' That's a huge discouragement to private practice.

On top of that, there's a lot of stuff the staff can't do. The doctors need to be involved in all levels of discussion with the insurers. Often, they simply decide not to work with a certain insurer because they don't like the terms.

That's why we have the mess of "in network" and "out of network" and "approved providers" and mandatory pre-approval, etc.And you know all of these assertions, how?


Are you asking seriously, or just trying to show your ignorance?Hundreds of different forms or a (very) few universal ones—you can’t have it both ways. (Oh, wait a minute—yes, you can.
This is the Bilge.:))


There is, of course, a major effort underway to simplify and automate a lot of this.... but it's still a major problem.To simplify and automate a lot of this, what?—please elaborate on your assertion, to our mutual benefit.

Phillip Allen
10-18-2009, 08:01 PM
"To simplify and automate a lot of this, what?—please elaborate on your assertion, to our mutual benefit."

maybe we'll get numbered tags in our ears? :)

Horace
10-18-2009, 08:14 PM
They do... and they're expensive. In my dermatologist friend's group practice (4 doctors), the office headcount is over 20 people. Some are nurses and medical assistants, but there's a heaping handful of people who do mothing but billing. Those people cost money.



What's the 'sic' for? 'Insurors' is the plural of insuror.

The problem has less to do with forms, and more to do with the fact that the billing staff can't argue with the claims adjustor about pre-authorizations or approvals... the doctor him/herself has to do that.

You might try talking to independent practitioners, or practitioners in small groups... the administrative overhead, including the issues of dealing with insurance companies in disputes, outstrips the cost of malpractice insurance by a huge margin (true for both my dermatoligist friend, as well as my own doc, who is an internist/gastroenterologist).

Insuror/Insurer, potayto/potahto--my bad, but spell-check doesn't like yours. :) And it's dermatologist. :D

Are you suggesting that insurance reform will do away with office overhead? Otherwise, pretty much the same response applies to your assertions as to ljb's.

Horace
10-18-2009, 08:18 PM
Ah, well - two guys talking about stuff they don't really know about in the Bilge? Who would have believed it! :D;)

Ah, me.

Good night.:)

ljb5
10-18-2009, 08:30 PM
Do you really think there’ll be appreciably less staff needed to handle routine billing , preauthorization, etc., with a single payer system?

It is well established that government run health care spends less on bureaucratic overhead. Norman has excellent data to support that claim.

Other countries also do just fine with less staff for routine billing. In Europe, there is appreciably less paperwork... fewer people to fill it out, fewer disputes about it... and they get cheaper and better health care.


Do you think Medicare billing, for example, is significantly simpler or uses different coding than private insurance?

Private insurance actually uses government coding. They just use it on a thousand different forms from an endless spectrum of plans.


And you know all of these assertions, how?

How is it you don't know this stuff? Why do you keep talking about it if you don't know?


To simplify and automate a lot of this, what?—please elaborate on your assertion, to our mutual benefit.

Billing, patient records and insurance submissions, of course. I thought that was obvious.

Epic is just one of many companies operating in this space. (http://en.wikipedia.org/wiki/Epic_Systems)

Let's not forget the world's largest and most advanced technology company (http://www.intel.com/healthcare/) also has a major initiative in health care.

Milo Christensen
10-18-2009, 08:36 PM
Do you just invent this stuff, Milo?. . .

Did you take an extra stupid pill today on purpose?


. . . First, the 'nightmate of 5 reform bills' will get reduced to a single bill, so it's pretty disingenuous to talk about FIVE bills, just to make it sound bad... only one bill will pass... or not pass. . . .

More disingenuous than to support some hodgepodge "compromise" of a "compromise" that you will have no clue what's included until it's passed by both houses with no chance for the public to know what has just happened to them? Tell me what the final bill will contain. In detail. You can't. Who's being disingenuous here?


. . . Next, don't blame the bill for forms and paperwork.... that's completely the responsibility of the insurors. . . .

That extra stupid pill is really showing tonight, you really have to back off on the medication.

You're backing an unknown double compromise bill that should be called the health insurance double cross bill. It will create more competition, it will create more plans, it will create more customers for the horrid health insurors, it will create more paperwork, it will create more expense, it will dramatically change Medicare.


. . . remember, thy have an anti-trust exemption. Why don't they? Why SHOULD they?

The only legitimate question you should be asking, is, why do they? Oh, I forgot, that would enable interstate commerce in health insurance, can't have that.

Can't you see the logical flaws you're piling on top of logical flaws?

Milo Christensen
10-18-2009, 08:39 PM
Of course not. The current bill, with or without a public option, won't do a damn thing about physician's overheads.... the ONLY thing that could help that would be a true single-payer system, and although it's the only sensible solution, it ain't never gonna happen in these here United States.

The only reason to support the current bill, in my opinion, is if it ends up with a public option... because without that, the current bill is indeed worse than nothing.... not for the reasons the right wingers state, but because without the public option, the curent bill is nothing more than a license for insurance companies to skyrocket rates.

Not to worry.... by 2018, when the average family has to spend over $30K/yr on health insurance, the torches and pitchforks will come out... and we'll get the health care reform we need.

Wow, the stupid pill stopped working and there's been an incredible upsurge in intelligence.

ljb5
10-18-2009, 08:45 PM
Can't you see the logical flaws you're piling on top of logical flaws?

Actually, Milo, you're the one who is having problems with logic.... and being rude.

First: you keep saying no one knows what's in the bill. Then you tell us that there are bad things in it. If you haven't seen it, how do you know?

Second: The objection to out-of-state insurers has already been explained in detail and it makes a lot of sense. You haven't made a strong case for why it should be allowed.

Third: you just said more competition and more insured people is a bad thing. More competition has been the holy grail of conservatism for decades and the whole point of this initiative is to get people insured.

Fourth: We totally obliterated your ideas about Tort Reform and you didn't even have the decency to acknowledge it.

Milo Christensen
10-18-2009, 09:14 PM
. . . Fourth: We totally obliterated your ideas about Tort Reform and you didn't even have the decency to acknowledge it.

You think you obliterated it. I've been chimpsmirking at the thought that you think you obliterated me and now want me to be "decent" about it. What you did was present evidence of a considerable cost savings possible from tort reform and then blow off saving $34.5 billion over the next ten years as insignificant, a pittance, a trifle.

The need for tort reform is one of the very few things I happen to agree with President Obama on.

You should probably do some more research on the limitations on medical malpractice in single payer countries. New Zealand maybe, or the impact of "loser pays" that dominates throughout Europe.

You know perfectly well there's only two reasons tort reform isn't in any of the Senate bills and they are ex-medmal trial lawyer Harry Reid and the $178+ million in "contributions" from trial lawyers to Democrats from Obama on down.

ljb5
10-18-2009, 09:25 PM
You think you obliterated it.

Heck, even Phillip Allen agreed I presented a good case.


What you did was present evidence of a considerable cost savings possible from tort reform and then blow off saving $34.5 billion over the next ten years as insignificant, a pittance, a trifle.

You must have me confused with someone else.


You should probably do some more research on the limitations on medical malpractice in single payer countries.

You should do more research on the U.S. Constitution and the rights of American citizens.


You know perfectly well there's only two reasons tort reform isn't in any of the Senate bills and they are ex-medmal trial lawyer Harry Reid and the $178+ million in "contributions" from trial lawyers to Democrats from Obama on down.

Likewise, you should know that's the only reason why Republicans pretend to care about this non-issue.

Think about this: Republicans held power in Congress for most of the last 12 years, but failed to do anything about Tort Reform. Why? Because they don't care about Tort Reform as a policy matter, they only care about it as a political issue.

Every couple of years, they like to beat the drums about tort reform during election season, but when they hold office, they don't do anything about it.

It's so gosh-darned easy to make people hate lawyers. Since Republicans have no other ideas to offer, they just keep beating that same drum.

BTW: I didn't know Harry Reid was a medical malpractice attorney. You sure you got your facts straight on that one?

ljb5
10-18-2009, 10:55 PM
I wonder how it matches the contributions from health insurors to Boehner, Cantor, McConnell, and the other health insurance reform opponents.

The difference, of course, is that malpractice costs aren't the problem... insurance costs ARE a big part of the problem.

Let's not forget Bill Frist and the millions he made in personal fortune (not just campaign contributions). Of course, the problem there wasn't the fees, it was the fraud. :eek:

Phillip Allen
10-19-2009, 08:21 AM
"click"

ljb5
10-19-2009, 09:10 AM
"click"

Oh, no! He said, "click!" Argh!!!! :p

You can't run away from all the truth, Phillip.

Kaa
10-19-2009, 09:59 AM
But you might not ever get the message....until at least YOU have been a victim of malpractice...and then you'll be screaming about how your constitutional right to sue has been violated.

You keep on using this argument.

Isn't is pretty sad to live in the world where everyone is a scoundrel ready to forfeit his beliefs at the sound of the coins jingling?

Or was this an attempt at an insult?

Kaa

oznabrag
10-19-2009, 10:44 AM
Its an expression, get it? Some suffer and just eat the cone quietly.
then there are those who complain about those who complain about the taste. That's you.

So...you're complaining about the taste?

Poo-licker!

Want some more jimmies with that?

Kaa
10-19-2009, 11:03 AM
They are always 'shysters'.... EXCEPT the one representing YOU.

There we go again.

I'm starting to wonder.

Let me try to be very explicit. Why do you think that personal pecuniary interest will always trump belief and convictions? Any special reason you believe that all people are hypocrites?

Kaa

Kaa
10-19-2009, 11:19 AM
OK, let me try a different approach.

Suppose you're one of the people in this country whose health insurance were cancelled, simply because you contracted a serious, and expensive, illness? Suppose you're one of the people who was denied health insurance because of a previous condition? Suppose you were one of the people who went bankrupt due to medical expenses, because you were unable to get any health insurance.....

...if you were previously opposed to health insurance reform, would you simply sigh and say to yourself, "I deserved all of this'?

I'd challenge you to find anyone in this country who suffered one or more of the events listed above, who nonethless opposes health insurance reform on idealogical grounds.

In my own case, it isn't 'personal pecuniary interest' that prompts my desire for reform... it's empathy with others. HOWEVER, it well COULD be personal and pecuniary for me, someday.... as it could be for ANY of us (with, of course, the exception of people already on Medicare, who can easily take pot shots... as well as the very rich, who simply don't give a ****).

In fact, presuming you're not on Medicare, it could even be YOU, Kaa.

So you find it impossible to contemplate that a man would stick to his ideas and convictions even in the face of adversity -- in particular if his beliefs do not work to his personal benefit.

I see.

Kaa

oznabrag
10-19-2009, 11:25 AM
So you find it impossible to contemplate that a man would stick to his ideas and convictions even in the face of adversity -- in particular if his beliefs do not work to his personal benefit.

I see.

Kaa

A rather hollow insult, coming from a man who doesn't seem too have any ideas or convictions of his own.

Keith Wilson
10-19-2009, 11:52 AM
. I don't know what your age is, or what your medical insurance is... and I don't even know if you actually oppose meaningful health care reform or not... but a reversal of fortune could indeed happen to you... or any number of other people in the bilge who have demonstrated opposition to health care reform. No one is exempt.True enough. But while Kaa has been careful to protect his or her anonymity, there's some evidence that he or she is not a citizen of the US - or at least isn't posting from the US. Kaa might be covered by the NHS.

oznabrag
10-19-2009, 12:00 PM
Hmmm.. I always DID suspect that Kaa is far more interested in provocation than debate :)

Your suspicion is well-founded, in my opinion. Having little in the way of conviction or original thought, he tries to satisfy himself by being an equal-oportunity tweaker. He likes tweaking you, Norman, because you make the mistake of taking anything he says seriously.

oznabrag
10-19-2009, 12:35 PM
I take most everything in life seriously, even if the people I'm debating with don't.

I don't consider it to be a character flaw... OR a mistake.

Mr. Bernstein, I most certainly do NOT regard you as a person of flawed character. Nor do I believe it is a mistake for you to take your intellectual honesty seriously.

My remark was directed at the idea that, perhaps, it is a mistake for you to allow Kaa to get under your skin, because in my view, that is his sole aim: To get under your skin.

I do hope that I have not managed to offend you, sir, as that would be far from my intent. If I have offended you, I hope you will accept my sincere apology.

Regards,

John T

johnw
10-19-2009, 01:00 PM
So you find it impossible to contemplate that a man would stick to his ideas and convictions even in the face of adversity -- in particular if his beliefs do not work to his personal benefit.

I see.

Kaa

Like making the world safe for malpractice.