eth2 Posted February 15, 2015 Share Posted February 15, 2015 -in the USA a Doctor earns 20-30 times more than a doctor in the UK -10 times more than in Canada -could you convince the Doctors to accept lower pay to work in a universal public system - The law of supply and demand would cure that problem if only the AMA were not such an effective lobby. Increasing numbers of physicians equals better consumer prices. It is just that simple. More doctors = lower costs. Quote Link to comment Share on other sites More sharing options...
wvu80 Posted February 16, 2015 Share Posted February 16, 2015 The police should be trained and have available in every vehicle a rope that can be used to lasso perpetrators of crime. Instead of drawing weapons in a situation such as this one officer could simply call out 'calf rope' and the non-lethal apprehension could then take place, with the ensuing officers rubbing the criminals little dickie to calm him. Keith even a tranquilizing gun would have done the job - and put the man to sleep - it 's a gun , but it doesnt kill - I vote for the fact that police should all have one of these in the car for mentally distressed individuals that are erratic and hard to control- There you go! Darts with Ativan! Makes perfect sense. Seriously. As long as you aim for the legs. +++ Seriously, I'm trying to illustrate absurdity by being absurd. The reason the cops don't shoot for the legs is 1) it would be very hard to hit on a moving target and 2) if the suspect has a gun, all they have to do is turn around and shoot the officer. Being shot in the leg doesn't prevent lethal force from being used against the officer. It's the same reason a "tranquilizer dart" is not a good idea. This isn't Daktari (for those of you old enough to remember that old jungle show ) Quote Link to comment Share on other sites More sharing options...
twistedcrankcammer Posted February 16, 2015 Share Posted February 16, 2015 -in the USA a Doctor earns 20-30 times more than a doctor in the UK -10 times more than in Canada -could you convince the Doctors to accept lower pay to work in a universal public system - The law of supply and demand would cure that problem if only the AMA were not such an effective lobby. Increasing numbers of physicians equals better consumer prices. It is just that simple. More doctors = lower costs. The only problem with your Hypothesis is there still exists a shortage.... Roger Quote Link to comment Share on other sites More sharing options...
twistedcrankcammer Posted February 16, 2015 Share Posted February 16, 2015 The police should be trained and have available in every vehicle a rope that can be used to lasso perpetrators of crime. Instead of drawing weapons in a situation such as this one officer could simply call out 'calf rope' and the non-lethal apprehension could then take place, with the ensuing officers rubbing the criminals little dickie to calm him. Keith even a tranquilizing gun would have done the job - and put the man to sleep - it 's a gun , but it doesnt kill - I vote for the fact that police should all have one of these in the car for mentally distressed individuals that are erratic and hard to control- There you go! Darts with Ativan! Makes perfect sense. Seriously. As long as you aim for the legs. +++ Seriously, I'm trying to illustrate absurdity by being absurd. The reason the cops don't shoot for the legs is 1) it would be very hard to hit on a moving target and 2) if the suspect has a gun, all they have to do is turn around and shoot the officer. Being shot in the leg doesn't prevent lethal force from being used against the officer. It's the same reason a "tranquilizer dart" is not a good idea. This isn't Daktari (for those of you old enough to remember that old jungle show ) Like defending ones self from perps with really big rocks!!! Roger Quote Link to comment Share on other sites More sharing options...
twistedcrankcammer Posted February 16, 2015 Share Posted February 16, 2015 (edited) The only problem with your Hypothesis is there still exists a shortage....Yes. Especially in undesirable areas. The pressure is on to create a two-tiered system, or maybe even three tiers. At the top will be doctors, in the middle will be PAs and NPs to care for all but the most serious, and at the bottom will be outfits like Remote Area Medical to serve the indigent. Many of the clinics today have 1 doctor and 12 PAs. Or similar kinds of arrangements. And PAs are totally adequate for almost all routine medicine. Even an RN can manage people's HTN and Diabetes. It surely doesn't take a doctor for that stuff. Routine medicine is all heuristics anyway. Very little skill is involved. Yes, but these PAs and nurse practitioners still have to practice under a doctors Liscense, so it is all about putting more money in the physicians pocket... Roger Edited February 16, 2015 by twistedcrankcammer Quote Link to comment Share on other sites More sharing options...
eth2 Posted February 16, 2015 Share Posted February 16, 2015 -in the USA a Doctor earns 20-30 times more than a doctor in the UK -10 times more than in Canada -could you convince the Doctors to accept lower pay to work in a universal public system - The law of supply and demand would cure that problem if only the AMA were not such an effective lobby. Increasing numbers of physicians equals better consumer prices. It is just that simple. More doctors = lower costs. The only problem with your Hypothesis is there still exists a shortage.... Roger Roger, Read the entire post. The AMA has been successful in restricting the number of physicians by limiting medical school enrollment. They argue tat hospitals can only accommodate so many students, hence the enrollment is artificially limited. Quote Link to comment Share on other sites More sharing options...
oscarsear Posted February 16, 2015 Author Share Posted February 16, 2015 The only problem with your Hypothesis is there still exists a shortage....Yes. Especially in undesirable areas. The pressure is on to create a two-tiered system, or maybe even three tiers. At the top will be doctors, in the middle will be PAs and NPs to care for all but the most serious, and at the bottom will be outfits like Remote Area Medical to serve the indigent. Many of the clinics today have 1 doctor and 12 PAs. Or similar kinds of arrangements. And PAs are totally adequate for almost all routine medicine. Even an RN can manage people's HTN and Diabetes. It surely doesn't take a doctor for that stuff. Routine medicine is all heuristics anyway. Very little skill is involved. Yes, but these PAs and nurse practitioners still have to practice under a doctors Liscense, so it is all about putting more money in the physicians pocket... Roger PA's may have to work under a medical doctor but nurse practitioners can be independent in most states. The ACA was written by the insurance industry and it has been rendered the golden goose for health care. Essentially the feds told the insurance industry to write what they wanted, charge what they desired, cover what they wished and then the gov't would force the citizens to buy the product for themselves and pay extra for those unable to afford the product on their own (stated) income. What may have been a noble idea has morphed into precisely the opposite of the causes championed. It really is a shambles and will be a real mess to unravel and replace with ?????. Also when we have lawyers writing the laws they never curtail their own piggy banks - malpractice law remains unchanged and that leads to unnecessary tests and tons of wasted $$$$$$. 1 Quote Link to comment Share on other sites More sharing options...
Paducah Home Theater Posted February 17, 2015 Share Posted February 17, 2015 As for the original topic: http://blog.tenthamendmentcenter.com/2015/02/bill-to-reject-federal-militarization-of-local-police-passes-montana-committee-20-1/ As for the healthcare stuff, I was able to spend a few days with a consultant from New Zealand who also lived in England for 20 year, as well as here. He thinks the European model is absolutely superior. Reason being, his example, if you walk across the road and get hit by a car and break your arm, you instantly get patched up, for free. Basic health care is very good. The problem comes when you have a complicated issue, as state ran health care is very slow, plus they don't have the latest diagnostic equipment. To counter this, many people have supplemental insurance so they can see a private hospital if the need arises. Best of both worlds. A big problem he sees with our proposed system is that over in Europe, basic means basic, while over here we are spoiled. An overnight stay might be in a 120 person ward. Over here, we are somehow expecting the same cost yet if we stay overnight we want it to be similar to a 5 star hotel. Until we get used to the idea that basic care means less sophisticated equipment, slower service, large wards, etc., we are always going to struggle with it. Quote Link to comment Share on other sites More sharing options...
derrickdj1 Posted February 17, 2015 Share Posted February 17, 2015 Patients like nice rooms but, are not the driving force. Most hospital are non-profit, so any profits go into renovations and expansions to avoid tax problems and to keep the non-profit status. Catholic hospitals are some of the largest land owners in medium size and smaller communities. Quote Link to comment Share on other sites More sharing options...
Moderators Travis In Austin Posted February 17, 2015 Moderators Share Posted February 17, 2015 -in the USA a Doctor earns 20-30 times more than a doctor in the UK -10 times more than in Canada -could you convince the Doctors to accept lower pay to work in a universal public system - The law of supply and demand would cure that problem if only the AMA were not such an effective lobby. Increasing numbers of physicians equals better consumer prices. It is just that simple. More doctors = lower costs. The only problem with your Hypothesis is there still exists a shortage.... Roger Roger, Read the entire post. The AMA has been successful in restricting the number of physicians by limiting medical school enrollment. They argue tat hospitals can only accommodate so many students, hence the enrollment is artificially limited. I don't really like using Wikipedia as a source, but in this instance they seemed to have a well up to date matrix of the currently accredited medical and osteopathic schools in the U.S. They also have a list of schools that are awaiting accreditation. http://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States The Liaison Committee on Medical Education is the entity that accredits medical schools, they are funded in part by the AMA. Here is a link to their website http://www.lcme.org/directory.htm There is a separate entity that accredits D.O. schools. It doesn't look like the number of medical schools are keeping up with with population increases. When I graduated in 1986 it was a pretty universal notion that the AMA had the largest and most influential lobby in Washington. I think that must have lessened slightly as osteopaths were able to go in and influence state legislatures to allow them to do anything that an M.D. could do, at least in the non-surgical context. My understanding is that they are now pretty much the same, you can go on and do whatever specialized training you want to do with a D.O. Also in the 1986 time frame, if I recall correctly, there was a major shortage of nurses in the U.S. Hospitals were bringing in nurses from other countries, specifically the Philippines. It does not seem like we do the same with physicians. What is the situation with nursing schools in the U.S.? It seems like we need to do more to get the number of doctors up. I have a sister in medicine, and a close cousin here in Texas in nursing (NP, Phd RN). My cousin was able to get advanced certifications and degrees with special programs that were sponsored by her hospital where a group of nurses studied together, while continuing to work. The UTMB is in Galveston and they live about 2 hours North of there. It seems like they drove down for one long weekend a month, or twice a month, and every six weeks they went down for a week. She of course did this after her kids were grown. Texas seems to be embracing the "tiered approach" fully. There are urgent care facilities inside our HEB grocery stores, staffed by an NP. They write scripts and I don't know what else. I don't know whether they have to have a physician as a medical director or not. I heard they were phasing into freestanding clinics that were going to be entirely NPs. I went to one for a really bad cold/flu, and I think she obtained a very detailed history and, what I considered, a through exam. I think it is entirely a case of supply and demand, and it appears that it is going to take a good long while for there to be the right number of doctors. I think this system of licensing nurses as NPs should be utilized more fully, if it isn't in the process already. Travis Quote Link to comment Share on other sites More sharing options...
colterphoto1 Posted February 17, 2015 Share Posted February 17, 2015 Don't worry, DHS has the box cars ready to round up dissenters at any moment now.... Quote Link to comment Share on other sites More sharing options...
twk123 Posted February 17, 2015 Share Posted February 17, 2015 "Objective reasonableness" versus mass paranoia. Paranoia is a state of irrational fear that has become anchored in the psyche. Mass paranoia is the state where a group collectively suffers from an unreasonable excess of fear. While there is no question that police work in a milieux of confrontation they need to have genuine and clear understanding of their own abilities to manage peril and do the least harm. More and more what the public is witnessing is a loss of this clarity of judgment. Instead of deploying training and tactics and 'thinking' threats to a more peaceful resolution guns get drawn and utilized. So - are the police simply more lax knowing that the courts are lax and will accept a broad definition of peril exonerating even outrageous conduct? Or - are the police genuinely paranoid? Have they psychologically adapted their own mindset to see life threatening situations in the mildest of conflicts? Are they in some way suffering from some degree of mass insanity? Are some departments suffering from institutional psychosis? Have they lost any realistic sense of objectivity and replaced it with rote overreaction? The blue advocates on this thread express this paranoia suggesting that every traffic stop could be Bonnie and Clyde......... so treat them ALL as if they will be Bonnie and Clyde. Yet the statistics do not support this level of paranoia and thus do not support the unwarranted hyper paranoid posturing. Bonnie and Clyde events are extremely rare relatively speaking. Is there any doubt that 4 trained police officers could not have subdued this 45 y/o man without too much trouble or harm to themselves? A lethal hail of bullets is too often the quick and easy cure-all for any confrontation. Police are hired to 'police' and not to determine guilt, define and execute the penalty. The issue comes from the Federal Government and Homeland Security retraining of local police departments to be militarized units. This has fostered a new "Us vs them" mindset among police officers who have more fear and mistrust of the public and value their own 'protection' above the safety of the citizens. Not to mention the billions of rounds of ammo the government is stockpiling and the new paper target depicting citizens... Quote Link to comment Share on other sites More sharing options...
Paducah Home Theater Posted February 17, 2015 Share Posted February 17, 2015 (edited) What's actually important in any health care system is outcomes. All the talk about basic and deluxe, and wards and private rooms, and such is interesting but not the right measure of a health system. That's actually a big part of it though. In the study you referred to there is a section called "efficiency", meaning are costs under control. How can costs be under control when everybody has super nice hotel rooms, the latest diagnostic equipment is always used, and needless tests are routinely done out of fear of litigation? Your dollars don't go as far when they are forced to pay for luxury items, therefore we get docked in the efficiency category. Another section is "access", half of which revolve around people not getting the care they need due to the costs involved. Yet a third is "equity", which is also similar in nature. Three of the five major sections in this study are largely affected by runaway costs, and a fourth has to do with people's lifestyles rather than how well they're fixed after they wreck themselves. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror Edited February 17, 2015 by MetropolisLakeOutfitters Quote Link to comment Share on other sites More sharing options...
Moderators Travis In Austin Posted February 17, 2015 Moderators Share Posted February 17, 2015 What's actually important in any health care system is outcomes. All the talk about basic and deluxe, and wards and private rooms, and such is interesting but not the right measure of a health system. We want to know about outcomes. How healthy are the people in each system? To end the suspense, the USA is dead last in outcomes among the dozen most prosperous countries. Dead last, no pun. Here's the list: 1. United Kingdom 2. Switzerland 3. Sweden 4. Australia 5. Germany & Netherlands (tied) 7. New Zealand & Norway (tied) 9. France 10. Canada 11. United States Oh, what we are #1 at is the cost! We should start a seperate thread on Quality of Health Care in US so that we might get Larry to chime in. He is one of the most knowledgeable people I know about medicine fron a policy perspective. I too read the Commonwealth Fund's rankings when they come out and hope for a change (at least I think that is the source of Mark's rankings). Here is a link to their site, and a breakdown of the factors used in the rankings and where the US is on every factor. We are much better is some factors, and the UK is clearly the model according to them. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror It is surprising that we are at the forefront of medical research and equipment, yet are so far behind in medical information technology. Travis Quote Link to comment Share on other sites More sharing options...
oscarsear Posted February 17, 2015 Author Share Posted February 17, 2015 IMHO most routine care can easily be delivered by NP's. Even some specialized care works better when done by NP's. Diabetes care is one notable example because the NP can afford to take the time really needed to tailor a care plan for each patient. I'd say that the medical tier of Family Practitioner should be retired and most intake could run through NP's and PA's. There is no defense for how our health system has evolved but it is quite the mess economically and politically. Insofar as where America healthcare sits internationally keep in mind that much of the world still relies upon America for military defense. They do not turn to Switzerland or Norway for such assistance. We have way too many irons in the fire and seem to be looking around for more before addressing our own needs. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.