manufactured anger

[paul.karen]

Bill republicans dont say if they cant do it right the first time dont do anything.

They are saying lets fix the system we have in place now.

lets cut costs for all private insurance, pharmaceuticals and cut costs for medicare.

This sounds good right?

With the money we save from these costs why not start a private plan for people who are not coverd.  The BIG problem is that people are generally happy with the coverage they have.

And lets not forget all these millions that supposedly dont have coverage well many of them just dont want it.
Many YOUNG people can get insurance from where they work. But they are healthy and dont want to spend 30 or so dollars a week to be coverd.
There is the SCHIP that many parents haven't signed up for coverage for there children but it is there for the taking.
We cant MAKE people take coverage, well not yet anyhows.
As well many seniors who are eligible for medicare have chosen not to sign up for it.

I think it is easy to see we all want change.
We just dont want the government to RUN the healthcare system.  It isnt there job.   But i would like to see them help get it sorted out and lower costs and keep costs down. This is there job.

Ps.  can you show me where SS & medicare are doing fine and are far from going under?

[Aubrey]

I think you are not being told the truth about the NHS in England; it is OK; I dread the idea of a US system.

And I have horrible pictures of what goes on in the US, which may not be true: for EG: what would be happening to me now? No insurance (I didn't have any with my job; but but even if I did, I got ill just after being made redundant), dialysis three times a week; various drugs, and income (Incapacity Benefit) of £90 a week. I have a feeling that I'd be stuffed.

(By the way: there is no age limit on Dialysis on the NHS; most people in the unit I'm in are over 50 - actually, most are over 70. I'm 50, and there's a couple who are the same age or younger.)

[paul.karen]

Aubrey,
If you lived here with no job and were a dialysis patient you would qualify for Meidicare at ANY age.  If on medicare you qualify for disability monies since alot of dialysis patients dont work.

[Bill Peckham]

Bill republicans dont say if they cant do it right the first time dont do anything.

They are saying lets fix the system we have in place now.

lets cut costs for all private insurance, pharmaceuticals and cut costs for medicare.

This sounds good right?

With the money we save from these costs why not start a private plan for people who are not coverd.  The BIG problem is that people are generally happy with the coverage they have.

And lets not forget all these millions that supposedly dont have coverage well many of them just dont want it.
Many YOUNG people can get insurance from where they work. But they are healthy and dont want to spend 30 or so dollars a week to be coverd.
There is the SCHIP that many parents haven't signed up for coverage for there children but it is there for the taking.
We cant MAKE people take coverage, well not yet anyhows.
As well many seniors who are eligible for medicare have chosen not to sign up for it.

I think it is easy to see we all want change.
We just dont want the government to RUN the healthcare system.  It isnt there job.   But i would like to see them help get it sorted out and lower costs and keep costs down. This is there job.

Ps.  can you show me where SS & medicare are doing fine and are far from going under?

The Republican's had their chance, their big piece of healthcare legislation was that they passed Medicare Part D (without funding, BTW) and that didn't do any of the things that could make insurance less of a scam. For the last eight years it has gotten worse - more people dropped, more people denied, more people in bankruptcy.

People who don't want insurance won't buy into a public option either. That was the "big difference" between Clinton and Obama during the primaries - Obama didn't say everyone would have health insurance under his plan, he wasn't trying for 100%, But people who are sick, and people who have families, people who work for themselves or in small business who do want insurance should be able to get it at a community risk price.

Obama won the primary and then he talked about the same things that had to be fixed in the general election. McCain had his approach of no employer tax credit, and instead we have health savings accounts ... or something like that. Obama won. And now he is following through on what he said he would do.

Bush said he'd get immigration and Social Security done and that didn't work out too well. So I think the temptation is to think that the same thing can happen to Obama and it could. Time will tell.

I think you are not being told the truth about the NHS in England; it is OK; I dread the idea of a US system.

And I have horrible pictures of what goes on in the US, which may not be true: for EG: what would be happening to me now? No insurance (I didn't have any with my job; but but even if I did, I got ill just after being made redundant), dialysis three times a week; various drugs, and income (Incapacity Benefit) of £90 a week. I have a feeling that I'd be stuffed.

(By the way: there is no age limit on Dialysis on the NHS; most people in the unit I'm in are over 50 - actually, most are over 70. I'm 50, and there's a couple who are the same age or younger.)

The way the Republicans have demonized the health systems of our friends and allies is another of their tactics that relies on misinformation. It's a bit like having a drunken relative show up at the block party and insult all the neighbors. Sorry about that but at least you're in good company Stephen Hawking was dragged into it too.

[Hemodoc]

Dear Bill,

I have been looking at the Canadian system a little closer.  There are some aspects of this single payer system that are intriguing to me even a die hard conservative.  The interesting aspect is that it is really a universal insurance group with private practice MDs that submit their charges to the single payer system.  My sister actually lives in Canada and is a Canadian and American citizen.  I asked her about the system which she seems to be happy with.

I would really like to talk directly with some of the doctors to see what it is like to practice and how they are able to deliver their health care services.

On the other hand, what we are seeing put together in Washington would be nothing like the Canadian system.  What they are doing in Washington is still a great concern to me.  Especially the sweetheart deal with pharma.

About 10 years ago, pharmaceutical costs outpaced inpatient medical costs for the first time with Kaiser.  If Obama is making sweetheart deals with these folks, there will be no cost containment or real reform.

I am also not happy seeing all of the doctors demonized by our president over and over again.  I understand that there are some greedy docs out there and I did encounter them from time to time, but the average hardworking doc just wants to do the best job that they can.  The facts that President Obama used in his I believe Portsmouth town hall meeting are absurdly incorrect.  Claiming that an ortho doc makes $50,000 for amputating a foot when it is in the range of $1000 does not help this debate.

As always your comments are greatly appreciated.

[BigSky]

People who don't want insurance won't buy into a public option either. That was the "big difference" between Clinton and Obama during the primaries - Obama didn't say everyone would have health insurance under his plan, he wasn't trying for 100%, But people who are sick, and people who have families, people who work for themselves or in small business who do want insurance should be able to get it at a community risk price.

He didnt have say it.

It says it in the boondoggle of bills.   

Either have it or be singled out for extra taxes against your income.

[Bill Peckham]

Peter I agree that overpaying for drugs is a luxury we can no longer afford. They say negotiating the price of drugs would stifle innovation but I think we shouldn't pay for research by over paying for pharmaceuticals. We can fund research separately and to better effect, than by handing sacks of money to Amgen et al. Alas, that's not on the table, it has been kept off the table since the Part D legislation passed so to reverse it I think you'd have to repeal the previous law which makes the politics harder.

Generally I would say we'd be better off paying for things directly. Rather than over paying in the name of some good. Over paying hospital fees so they can provide charity care is another example. Better to get people covered under their own insurance at a community rate.

I don't think the President is demonizing doctors by pointing out the difference practice patterns make in cost of care. He wants more Mayos and Kaisers, and fewer McAllens. I think a system that standardized insurance would allow doctors to be doctors. Isn't that what Kaiser does?

[Hemodoc]

Bill, thank you for the input, Perhaps the two of us are actually closer in agreement on health care reform than we may of thought at the outset.

Kaiser did offer me the authority to manage all of my patients according to the dictates of my ethics.  It is certainly not a perfect system, but while I was practicing, I came to the understanding that the patient outcomes were my responsibility and depending on guidelines did not offer a defense in the event of a bad outcome.  Some doctors may not understand this situation as well as they should.  Having the doctor in control ultimately even with retrospective review that does indeed place pressure to reduce overall expenditures, but not specific expenditures review is the only system that will allow continued patient based ethics to prevail.  Any plan that takes away the authority of the individual doctor to treat to their best ability an individual patient I would always stand opposed. Unfortunately, many of my colleagues are businessmen and not defenders of a profession any more.  I was taught that being a doctor is a privilege. I readily admit that many do not treat it in that manner any more.

I do find it irresponsible on President Obama's part to use false examples which many will never understand are false.  So likewise did the American Board of Surgeons take umbrage with his comments. There is already enough polarization of the issues in the media that we don't need that kind of rhetoric from the person who is supposed to be taking the high ground of leadership on these issues.  It will only lead to more mistrust on the part of those the distrust the entire process in Washington who oppose health care reform.  It is just not helpful to his cause in my mind.

Perhaps there is a system that could be ideal, but I don't know if the current process in Washington will come anywhere near that goal.  Taking pharma off the block is just not going to get us where we need to be.  Placing a disproportionate share on dubious claims against doctors will not get us there either. 

[tyefly]

Peter 
 The rationing that I was referring to was due to my personal experience with a doctor who told me that they could only write 12 prescriptions of a certain medication per year… And if she was to give me that particular prescription than someone else may not be able to get that prescription.  That was difficult for me to believe and she made me feel guilty when I had requested the prescription.. This prescription was expensive.  Now this was done 10 years ago but I never forgot… I am a member of Kaiser, an outsider who can only develop my opinion based on my own experiences and a few from others (that have Kaiser) who have had some difficulties at times.  I do believe that you have the inside story and I am confident that you do know much more than I will ever know about how Kaiser works.  It’s just two different views.  I think the word rationing is in itself a word or concept that can have different meaning to many of us, and that may be the problem with a lot of people.    I chose Kaiser as my insurance company and I have had Kaiser most of my life.  I would not choose another insurance group because of my experience with Kaiser which has been more positive than negative experiences.   I think that when it comes to the whole health care reform most people don’t really understand everything that is before us.  There are certain key concepts that we don’t understand and then we worry about them and that becomes the main focus.  I want the best health care I can buy and I want to be able to use it when I really need it ….. Like now….. All these years of payments to the system and yet I worry about losing my health care…..  I never did until I became sick…  I believe the Kaiser system is better now than in years past.  I remember when we use to have to wait for months before we could get an appointment.  Now I can get my labs online and email my doctor any day of the week….Have telephone conversations ….. I love it….and I want to keep it….
 So I do agree with you about one thing (many things in reality )   having doctors that care about their patients and those that can work within the system to help the members achieve our goals in health is a very valuable tool.  I just wish we had more like yourself who do care about the system and the people..
Thanks again for your insight….. Kathy

[Hemodoc]

Dear Tyefly.  The physician that told you she could only give so many prescriptions is expressing the wishes of the administration not through direct prohibition to you specifically, but within the confines of population management that we are now rated on.  The perverse nature of this relationship is that there is never an overt denial of any procedure/treatment by the administrator.  Instead, they play a word game of saying you can order whatever is needed for any patient.  Thus, the doctor is still the final arbiter of responsibility and not some administrator.  There are obviously exceptions to this.  She most likely got the figure of 12/year from statistics comparing the doctors average usage of different medications.  What happens is that each time the figures come out, the old standard now becomes the high range.  In this sense, over time, it becomes a very powerful tool to reduce usage of expensive medications throughout an entire clinic.

I know some of the old time docs near to retirement completely ignored these data sets and simply kept practicing on an individual basis.  Yes, there are many pressures placed on doctors to comply, but at Kaiser it is almost always retroactive.

I simply developed thick skin and did what I thought was best for my patients.  I had many opportunities to hear about things that I had ordered after the fact.  Bottom line, the doctor is still in charge and responsible for the health care that they deliver no matter what the pressures exerted.  Once a doctor is partner, at the time I practiced, only overt acts of failure were disciplined.

How do you make the choice on which 12 people get the medicine you were seeking?  I simply tried to give what I thought was the best medicine for the situation, no matter what I had given to other patients. It is simply the difference between individual patient based outcomes vs population based outcomes.  You had an explicit example of a doctor that was putting the population before you.  That is not unique to Kaiser.  It is the new medical ethic that is already entrenched.  It is not a Republican thing or a Democratic thing.  It is the new reality of medicine.

This is even more insidious than outright rationing.  I believe that the ethics of medicine in the medical schools has indoctrinated a new generation of doctors who actually think in this light.  I have been fighting it for over ten years as have many of other colleagues who practice by the old fashioned ethics.  It seems to be rationing in a sense, but I suspect that it has an even deeper level of philosophical attachment.  I stand in opposition to this new medical ethics as I did recently in a post on DSEN.

As I said above, this new medical ethics goes beyond political boundaries since both Republicans and Democrats adhere to them.  I believe patients have sensed something different about medical practice but did not understand how entrenched it is already.  For those of us in the trenches, we noticed it coming to a forefront in the mid 1990's.  It is now the standard of practice. 

So another long round about answer, it is not rationing since there are no actual overt admonitions on any specific patient, it is left completely at the discretion of the doctor.  Yet, the doctors are very aware of population management issues as well as their own utilization profiles.  The heat in the kitchen is being turned up high on all of the doctors.  Full responsibility for the patient and full responsibility for their population they manage.  It is a perverse conflict thrown at the feet of the doctor based on a new medical ethic.  The administrator thus do not set actual goals, nor rationing guidelines.  They instead use the simple bell curve and showing each doctor where they are on that curve. 

There are ways for the doctors to counter these stats, but it takes quite a bit of thought and documentation practices.  One of the ways is to make sure you always document the denominator to give you a larger numerator and still maintain an in range percentage compared to your colleagues.  In any case, that is the way the game is played.  Not fun in any manner at all.  But it is not rationing in the same sense as Oregon did in its public health coverage.  Similar, but different.

http://www.billpeckham.com/from_the_sharp_end_of_the/2009/08/the-new-medical-ethics-population-based-outcomes.html

[Bill Peckham]

Depending on what news channel's you watch you will get a variety of ways people are looking at the debates on healthcare, cap and trade ect ect.

It seems it is ok for Obama and his PLANNED community activists to plan weeks ahead of time to go out and protest.  Groups like Acorn who have professionally made signs and intimidate people and are called community activists are ok.
But if a grass roots movement of people with hand made signs goes to protest's  like the tea parties or recently people at town hall meetings try to express there opinions it has to be that they were forced to do so and are only doing so out of hatred.
They (many democrats and the President) say it is FAKE and Manufactured and it isn't real people but puppets ect ect.  They are to well dressed to be real people, maybe people on there way to work?  Maybe if they all had on red shirts that said acorn it would be a different news story.

So i wanted to see a vote to get opinions from REAL people like us.

Are people who disagree with the president Bad people?  Are we fake? Should we not be heard?  Is he not our president or just the president to those who agree with him?

Do you believe that brandishing a firearm in proximity of the president (or any elected official) is an acceptable way of expressing opposition to their politics?

[BigSky]

Do you believe that brandishing a firearm in proximity of the president (or any elected official) is an acceptable way of expressing opposition to their politics?

Tsk tsk, the old fear and hate you have against "the People" using their Constitutional Rights is showing.

[paul.karen]

??

Bill where did this come from 12 days later?
I own guns i am for gun rights i am for responsable gun owners i am for the right to protect myself and my family, i am for the constitution.
Would i bring a gun to where a politician is at NO.
Would i bring a gun to a state park NO (unless there was a shooting range there.
Would i bring a gun to a school NO.
Would i bring a gun when i go to Trenton or camden or philly for business or pleasure YES. (that is the protection thing).

[Hemodoc]

Dear Bigsky and Bill.  I grew up in Alaska and my father provided for our family by hunting.  As a minister, his meager salary only covered the basics.  We had caribou, moose, rabbit and sometimes bear, but always a freezer full of salmon we caught ourself.  For anyone that has lived in Alaska, this is the common and usual manner in which most people provide for their families up there.

I have since given up hunting myself, but I still own guns and I completely believe in the right to own and bear arms.

However, it is really stupid in my opinion for nut jobs to show up at a presidential rally with rifles.  What are they trying to prove?  It only hurts the defense of gun ownership in the long run.  Just as anarchists don't represent the average democrat looking for political reforms, nor likewise do people like this represent the majority of us law abiding citizens that wish to have the right to protect our families when in wilderness settings or even in large cities with other predators stalking the people.  I have lived side by side with North America's largest predators and I would always prefer to have a big stick to deal with them if they should ever present that situation.

So, I really can't see any justification for defending people that are provoking an issue that does not need to be provoked by bringing rifles to a political meeting.  It is just plain stupid in my mind and only hurts the cause of people like myself that defend the right to have these rifles in the first place.  Just my opinion.

[BigSky]

The Secret Service were asked whether the individuals carrying weapons jeopardized the safety of the president and the spokesman for the US Secret Service, Ed Donovan, said  "Of course not."

[Bill Peckham]

Do you believe that brandishing a firearm in proximity of the president (or any elected official) is an acceptable way of expressing opposition to their politics?

Tsk tsk, the old fear and hate you have against "the People" using their Constitutional Rights is showing.

I don't think asking a question evinces hate. I think Pk and Hemodoc answered as I would - I wouldn't bring my gun to any sort of political rally. That doesn't mean I can't, it means I think it is not an acceptable way of expressing opposition to someone's politics. We have a bloody history of political violence in this country, referencing it to make a political point is wrong and unAmerican.

[BigSky]

Do you believe that brandishing a firearm in proximity of the president (or any elected official) is an acceptable way of expressing opposition to their politics?

Tsk tsk, the old fear and hate you have against "the People" using their Constitutional Rights is showing.

I don't think asking a question evinces hate. I think Pk and Hemodoc answered as I would - I wouldn't bring my gun to any sort of political rally. That doesn't mean I can't, it means I think it is not an acceptable way of expressing opposition to someone's politics. We have a bloody history of political violence in this country, referencing it to make a political point is wrong and unAmerican.

Carrying a gun makes no reference to any political violence and in fact the guy was not brandishing it as you tried to claim.  It was strapped into his holster. 

In fact the guy was on private property and down the road from where Obama was, was he not?
In fact he passed a background check by the FBI did he not? 

As to opposition to politics.  You might well note the guy did nothing but use his Constitutional Rights which cannot be said about those who support Obamas politics who have recently committed assault and battery on someone opposed to Obamas politics.

[Bill Peckham]

There were at least 12 people with guns outside the VFW event in Phoenix.
http://ktar.com/?nid=6&sid=1200460

You are deluding yourself if you believe carrying guns at political rallies makes no reference to political violence.

[BigSky]

There were at least 12 people with guns outside the VFW event in Phoenix.
http://ktar.com/?nid=6&sid=1200460

You are deluding yourself if you believe carrying guns at political rallies makes no reference to political violence.

Keep it up with that fear of firearms and people using their Constitutional Rights bill.


From the guy who actually was carrying the Rifle and at no point did he reference political violence.

http://www.breitbart.tv/exercising-my-rights-man-explains-why-he-carried-rifle-near-obama-event/


Notice the article you posted no armed individuals showed up in Montana, well except for those brought by Obama which btw violated our State Constitution,not a big deal, but  not throwing a fit about that are you.

I might add where was your outrage when the Black Panther members marched on the 2000 Republican Convention in Texas with AK-47's.   

[Hemodoc]

Bigsk, just because someone has the "right" to do something does not make it a smart thing to do.  It creates a polarizing effect that over time could lead to the exact opposite effect of what the man intended.

I agree with Bill, guns and political rallys just don't mix.  Keep your right to bear arms by doing it in a responsible manner.  The protest was over health care, not guns.  Just not appropriate in my view.  It is hard to defend people when they act in a stupid manner. 

Mind you, I and my wife are both members of the NRA.  I truly appreciate being able to have guns for my personal protection as well as for defense against predators in the woods.  Nevertheless, actions like bringing a weapon to a political rally are just going to provoke a backlash and lead to unintended effects.  Just plain stupid way of exercising your rights.  A whole lot more of such actions will lead to more ammunition (sorry for the pun) to restrict these rights.  Just plain stupid way to protest in my opinion.  Bill has you on this one Bigsky.  Sorry, but it is just a dumb, dumb thing to do.

[BigSky]

Oh I am quite sure those who hate the Constitution and those who exercise their Rights will try to restrict it.   Those against guns will use any excuse to try to disarm the citizens and turn them into subjects.


It is when people do not exercise their Rights that they lose them.

This issue bears that out.  In those States that have it, very few people exercise their Right to Open Carry.  As such you get hysteria over those exercising their Right as demonstrated on this board.

The guy in NH was not brandishing his firearm as was falsely and deliberately suggested on this board.

These people in AZ as the Police had said were peaceful and broke no laws. They were law abiding citizens.

That is how the system is suppose to work.  People exercise their Rights and break no laws.

[Aubrey]

I don't understand this gun thing at all.

I live in Lambeth (London), about two miles away from Brixton and Peckham, which are the two big gang places round here (though there are more), and the idea of having a gun - for any reason - is so alien to me that I don't know how to express it. I would not even know how to get one.

By the way, the people demonstrating against Obama might be regular people, but they are wrong. They have been lied to about the British Health Service, and for some reason they believe the lies.

I really object to the things that some people have been saying about the NHS (inc some dozy Conservative, who has probably never even used it - you don't have to, you know).

Last week I might have had to go into hospital (though I didn't). I was a bit annoyed about this, but not worried about how I'd pay. People do not worry about paying for treatment here. We don't have to claim for it, either. No one goes bankrupt through having to pay for treatment. No one even thinks about payment, or of whether the insurance company will accept a claim. It is not something that bothers us.


If you want to stick to what you have, fine (though for God's sake, why?) but do not tell lies about our system.

[glitter]

I don't understand this gun thing at all.

I live in Lambeth (London), about two miles away from Brixton and Peckham, which are the two big gang places round here (though there are more), and the idea of having a gun - for any reason - is so alien to me that I don't know how to express it. I would not even know how to get one

Owning a firearm is a right in the USA - thankfully.      



AS for healthcare- I have come around to thinking it should be a right- I didn't used to think that way- but after hearing the struggle of so many people here- who have lost virtually everything because of medical bills, it isn't a fair system. People should not have to lose everything they have worked for because of illness. I will gladly pay more taxes so everyone can have healthcare. But the thought of our wasteful government/greedy politicians being in charge is scary.

[Hanify]

We do pay for it in the long run - but you have to accept higher taxes for it.  It's not uncommon here to be paying over 50% of what you earn in tax.  There's 40% you pay straight off (if you earn over $70k), then we have 12.5% goods and services tax on top for everyone.  What's the taxes on your incomes in America?  Ours is less if you earn less of course.

[Zach]

What's the taxes on your incomes in America?

It's a very complicated issue, because there are allowances and deductibles, but to make it simple:

Federal Income Tax
http://www.taxfoundation.org/taxdata/show/151.html

Single Filing Status
10% on income between $0 and $8,350
15% on the income between $8,350 and $33,950
25% on the income between $33,950 and $82,250
28% on the income between $82,250 and $171,550
33% on the income between $171,550 and $372,950
35% on the income over $372,950

Then individual States may have an additional income tax, ranging from 1 % up to 11 %
http://www.taxfoundation.org/publications/show/228.html

In addition ...
Social Security is 12.4%, half of that amount is paid by the individual and the other half by the employer. (Up to incomes of $106,800.)
Medicare is 2.9%, half of that amount is paid by the individual and the other half by the employer.
http://www.taxfoundation.org/taxdata/show/24682.html