Traditional America

[MooseMom]

The cost over runs and overpayment to docs and hospitals in the early days of the Medicare program are well documented. Doctors before the 1960's were not in general in the highest income brackets, remember chickens, etc in payment especially for the old country docs.

Well, I'm not sure that doctors before the 60's, particularly the old country docs, were performing transplants or dialysis, either.  I doubt you'd be alive if is was the 60s.  Those weren't the good old days if you had ESRD.

We weren't discussing the technological revolution in the last 50 years including dialysis of course. Today, we are waiting for new technology to bring home dialysis to more patients since we have not advanced very far past the 1960's technologies of dialysis care outside of the advances in the materials used of the components. NxStage announced FDA approval of higher dialysate flow rates with the NxStage System One. This is a game changer putting NxStage in a great position with an easy to use system, ultra-pure dialysate which others are struggling to obtain and coupled with higher dialysis flow rates in my opinion makes NxStage the system to beat as far as new technology coming on the market. Note, this is private enterprise bringing these innovations, not government programs.

America is quite far behind Europe with hemodiafiltration which many believe will help patients live a longer and higher quality of life. The status quo between CMS and the LDO's has not done anything to improve the lives of hundreds of thousands of patients every year. Interjecting private enterprise competition through technological innovation will be the best way to break the current provision of dialysis stalemate with all of its dysfunction.

I certainly agree that private enterprise and competition can/does result in the technological innovation that can improve the care of dialysis patients!  But when you speak of "traditional America", you often refer to the 60's as if it was a rosy time for all people, and I'm just saying that those were not rosy times for ESRD sufferers or for sufferers of so many horrible maladies that we can now treat, if not cure.

The debate of how much government is appropriate rages on, just as it always has and will forever.  While it is PEOPLE who innovate, that doesn't mean that government can't help.  Some biomedical research needs a lot of funding, and private sources don't always answer the call.

I wonder if in "traditional America", hospital charges are as mysterious as they are now?

http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html

Is this something the government should address?

[Hemodoc]

The cost over runs and overpayment to docs and hospitals in the early days of the Medicare program are well documented. Doctors before the 1960's were not in general in the highest income brackets, remember chickens, etc in payment especially for the old country docs.

Well, I'm not sure that doctors before the 60's, particularly the old country docs, were performing transplants or dialysis, either.  I doubt you'd be alive if is was the 60s.  Those weren't the good old days if you had ESRD.

We weren't discussing the technological revolution in the last 50 years including dialysis of course. Today, we are waiting for new technology to bring home dialysis to more patients since we have not advanced very far past the 1960's technologies of dialysis care outside of the advances in the materials used of the components. NxStage announced FDA approval of higher dialysate flow rates with the NxStage System One. This is a game changer putting NxStage in a great position with an easy to use system, ultra-pure dialysate which others are struggling to obtain and coupled with higher dialysis flow rates in my opinion makes NxStage the system to beat as far as new technology coming on the market. Note, this is private enterprise bringing these innovations, not government programs.

America is quite far behind Europe with hemodiafiltration which many believe will help patients live a longer and higher quality of life. The status quo between CMS and the LDO's has not done anything to improve the lives of hundreds of thousands of patients every year. Interjecting private enterprise competition through technological innovation will be the best way to break the current provision of dialysis stalemate with all of its dysfunction.

I certainly agree that private enterprise and competition can/does result in the technological innovation that can improve the care of dialysis patients!  But when you speak of "traditional America", you often refer to the 60's as if it was a rosy time for all people, and I'm just saying that those were not rosy times for ESRD sufferers or for sufferers of so many horrible maladies that we can now treat, if not cure.

The debate of how much government is appropriate rages on, just as it always has and will forever.  While it is PEOPLE who innovate, that doesn't mean that government can't help.  Some biomedical research needs a lot of funding, and private sources don't always answer the call.

I wonder if in "traditional America", hospital charges are as mysterious as they are now?

http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html

Is this something the government should address?

Not at all Moosemom. Lets stick to the narrow point of this thread and the specific aspect we were discussing from YOUR questions on healthcare. I am glad that my grandchildren can grow up without the racism of the 50's and 60's. Is not that a blessing for everyone?

I oppose oppression no matter what form it takes whether in the organized racism against the blacks or in the loss of civil rights by our government in recent years not just under Obama, but Bush, Clinton, Bush, and Reagan. We see criminalization of ordinary behaviors more and more where people can easily commit felonies and not even have a clue that it is a felony.

Hospital charges come simply from the unfunded Federal mandates to care for all people no matter their ability to pay under EMTALA.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/

This was a law enacted during the Reagan administration to prevent patient dumping. However, it has cost hospitals millions of dollars and forced thousands of hospitals to shut down their emergency departments since that is how most of the people enter a hospital without the ability to pay.  Many hospitals have closed because of this. I am not sure if in the end, EMTALA has done more damage to our health care system than it helped. In addition, with the number of ER's closed, access to emergency care is worse than it was before EMTALA.

As far as the government helping? Sorry, the government has a very poor track record on that front. The recent debacles with green energy companies under Obama is an example of wasting billions of tax payer monies.

The 1960's is an example of how private enterprise did in fact put dialysis treatment on the map. Remember, other than a small portion of folks treated in the VA, it was private funding for dialysis until 1973 and thousands of people were saved by Scribner's "noble experiment" as he called it. It was the government that failed to intervene during the 60's except for some state grants but the Feds did not impact care substantially until 1973.

When the Feds became involved, they also did so in such a way that the greed and avarice of the LDO's took over the industry and today, the LDO's in cahoots with CMS are giving us the worlds worst developed nation's outcomes.  The government takeover of the ESRD program is filled with startling fraud and abuse and death and misery today from inadequate treatments. Sorry, but the ESRD program is not an example of wonderful outcomes with government control, just the opposite. The problem with dialysis lays squarely at the foot of CMS and congress who fail to monitor the LDO's or provide common sense and proven treatments such as extended dialysis to enough patients despite the lip service that they give to advocates.

It is my fear that the quality of health care for all patients under the government run Obamacare will end up with similar quality to that of the ESRD program which no one with their right mind would choose as their renal replacement therapy if they only truly understood the ability of home hemo and extended home hemo to reduce the "expected" side effects of dialysis. I never get nauseous, hardly ever get cramps, headaches, dizziness, or intradialytic hypotension. These "expected" complications are all iatrogenic and in most instances avoidable with modification of dialysis protocols. Instead, with the dialysis industrial complex in cahoots with CMS, people have fast, violent dialysis sessions to maximize LDO prophets. Is that how we wish to see all of our healthcare when Obamacare takes over control of everyone's healthcare.

I hope not and I pray not, but I believe that is exactly what will happen to health care in America and that is the concern of many of my friends who are physicians as well.

[MooseMom]

Well, now my questions have become less of "what is traditional America" and more of "what would certain aspects of life be like if we still lived in 'traditional America'". 

So, Hemodoc, what do you think dialysis/healthcare would look like if the government in the form of Medicare/CMS had not intervened?
 
What do you think our healthcare system would look like if we still lived in "traditional America" but had modern America's health woes? (In traditional America, it was actually thought that autism was caused by "refrigerator mothers". )
 
If the ACA were to be overturned or for whatever reason not implemented, do you think that what we would be left with would be more in line with the values of "traditional America"? 

Do you think there is no place for the NIH?

[Bill Peckham]

Sorry Bill, no agenda here. I have never been a fan of Obamacare which you know and understand. Out of respect to you, I have not voiced that concern on my blog or in yours while I was writing for you.
So, no, I haven't gone so far as to have an agenda. I simply thought we were involved in a discussion on this issue. Is that having an agenda?

Blog all you want but as always using primary sources is what makes a good and useful blog post. I didn't say you have an agenda, I pointed out that the articles you linked to to support your position, misrepresented what the CBO wrote. All the Obamacare articles you linked to commented on various CBO reports and purposely mislead the reader by strategic use of ellipsis (...)  You seem quite unconcerned that the articles were designed to mislead which does make one wonder why.

[Hemodoc]

Well, now my questions have become less of "what is traditional America" and more of "what would certain aspects of life be like if we still lived in 'traditional America'". 

So, Hemodoc, what do you think dialysis/healthcare would look like if the government in the form of Medicare/CMS had not intervened?
 
What do you think our healthcare system would look like if we still lived in "traditional America" but had modern America's health woes? (In traditional America, it was actually thought that autism was caused by "refrigerator mothers". )
 
If the ACA were to be overturned or for whatever reason not implemented, do you think that what we would be left with would be more in line with the values of "traditional America"? 

Do you think there is no place for the NIH?

Dear Moosemom, you know you have a habit of asking questions that no one can really answer.

But here goes nothing.

Traditional American medicine is focussed on the doctor-patient relationship following the protocols and philosophy of Sir William Osler, the father of modern internal medicine.  The hallmark was a doctor acting in his patient's best interest and the decision making level was between doctor and patient only.

While I am a fan of integrated medicine, I must couch that opinion in the manner in which I was able to practice medicine at Kaiser. We did not have to get prospective approval for most of what we did. In that instance, the doctor-patient relationship was the point of decision making. Unfortunately, not all integrated medical systems run in that manner giving the doctors a wide range of freedom to decide without seeking prior approval.

Unfortunately, since we are heading into a European style medical system, we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance. Instead of NICE as the Brits have, we will have PCORI doing comparative effectiveness research. The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others.  As a physician, there are times where we try lower effective treatments in patients who have failed to respond to other treatment modalities. In some cases, the patients respond well even though the data would suggest it is a bit of a long shot.

In England, many treatment options are limited by NICE which won't pay for many of the treatments currently available in the US. To change that policy, people have to lobby their representatives to over ride the NICE recommendations.

In such a system, we may find situations like the Brits where treatment failures will have fewer alternative treatment options available. Having politicians determine what should be determined by the doctor and the patient in private is not the way I would want to practice medicine.

[Bill Peckham]

Unfortunately, since we are heading into a European style medical system, we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance. Instead of NICE as the Brits have, we will have PCORI doing comparative effectiveness research. The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others.  As a physician, there are times where we try lower effective treatments in patients who have failed to respond to other treatment modalities. In some cases, the patients respond well even though the data would suggest it is a bit of a long shot.

we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance

This would be shocking if it were true - other than Terri Schiavo [Edit] and reproductive healthcare give one example.  As someone who has and continues to participate with several PCORI projects - from initiation through completion - I know you are not accurately describing CER or PCORI; please stop posting things that are not true. I feel obliged to point this out each time you do it.

[Hemodoc]

Sorry Bill, no agenda here. I have never been a fan of Obamacare which you know and understand. Out of respect to you, I have not voiced that concern on my blog or in yours while I was writing for you.
So, no, I haven't gone so far as to have an agenda. I simply thought we were involved in a discussion on this issue. Is that having an agenda?

Blog all you want but as always using primary sources is what makes a good and useful blog post. I didn't say you have an agenda, I pointed out that the articles you linked to to support your position, misrepresented what the CBO wrote. All the Obamacare articles you linked to commented on various CBO reports and purposely mislead the reader by strategic use of ellipsis (...)  You seem quite unconcerned that the articles were designed to mislead which does make one wonder why.

Bill, the bottom line is that the incentives in Obamacare favor employers paying the fines instead of the health insurance rates which have risen dramatically since the ACA passed. The articles I linked to reflected that fact and the CBO projection of 7 million to as many as 20 million who will lose their insurance and switch over to the exchanges.

[Bill Peckham]

Sorry Bill, no agenda here. I have never been a fan of Obamacare which you know and understand. Out of respect to you, I have not voiced that concern on my blog or in yours while I was writing for you.
So, no, I haven't gone so far as to have an agenda. I simply thought we were involved in a discussion on this issue. Is that having an agenda?

Blog all you want but as always using primary sources is what makes a good and useful blog post. I didn't say you have an agenda, I pointed out that the articles you linked to to support your position, misrepresented what the CBO wrote. All the Obamacare articles you linked to commented on various CBO reports and purposely mislead the reader by strategic use of ellipsis (...)  You seem quite unconcerned that the articles were designed to mislead which does make one wonder why.

Bill, the bottom line is that the incentives in Obamacare favor employers paying the fines instead of the health insurance rates which have risen dramatically since the ACA passed. The articles I linked to reflected that fact and the CBO projection of 7 million to as many as 20 million who will lose their insurance and switch over to the exchanges.

That's the whole point. The report(s) didn't say that. The quotes from the reports that I posted didn't say that - the articles use ellipses to say that but that is misleading and has clearly caused confusion.

[Hemodoc]

Unfortunately, since we are heading into a European style medical system, we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance. Instead of NICE as the Brits have, we will have PCORI doing comparative effectiveness research. The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others.  As a physician, there are times where we try lower effective treatments in patients who have failed to respond to other treatment modalities. In some cases, the patients respond well even though the data would suggest it is a bit of a long shot.

we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance

This would be shocking if it were true - other than Terri Schiavo give one example.  As someone who has and continues to participate with several PCORI projects - from initiation through completion - I know you are not accurately describing CER or PCORI; please stop posting things that are not true. I feel obliged to point this out each time you do it.

Bill, I am also on PCORI teams as well. Back to my comment which I don't believe you read accurately: "The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others."

That is indeed a legitimate concern voiced by many, especially within the physicians community. So I am not sure what you believe I have described inaccurately.

[Bill Peckham]

Unfortunately, since we are heading into a European style medical system, we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance. Instead of NICE as the Brits have, we will have PCORI doing comparative effectiveness research. The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others.  As a physician, there are times where we try lower effective treatments in patients who have failed to respond to other treatment modalities. In some cases, the patients respond well even though the data would suggest it is a bit of a long shot.

we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance

This would be shocking if it were true - other than Terri Schiavo give one example.  As someone who has and continues to participate with several PCORI projects - from initiation through completion - I know you are not accurately describing CER or PCORI; please stop posting things that are not true. I feel obliged to point this out each time you do it.

Bill, I am also on PCORI teams as well. Back to my comment which I don't believe you read accurately: "The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others."

That is indeed a legitimate concern voiced by many, especially within the physicians community. So I am not sure what you believe I have described inaccurately.

Then you know that PCORI is a real thing that has an actual mission and is constrained by federal legislation to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options. PCORI does CER through data mining and retrospective analysis, it isn't a plot to substitute politician's judgement for a physician's.

[Hemodoc]

Unfortunately, since we are heading into a European style medical system, we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance. Instead of NICE as the Brits have, we will have PCORI doing comparative effectiveness research. The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others.  As a physician, there are times where we try lower effective treatments in patients who have failed to respond to other treatment modalities. In some cases, the patients respond well even though the data would suggest it is a bit of a long shot.

we will now have politicians telling doctors what to do at the patients bedside just as happens in the NHS in England for instance

This would be shocking if it were true - other than Terri Schiavo give one example.  As someone who has and continues to participate with several PCORI projects - from initiation through completion - I know you are not accurately describing CER or PCORI; please stop posting things that are not true. I feel obliged to point this out each time you do it.

Bill, I am also on PCORI teams as well. Back to my comment which I don't believe you read accurately: "The issue is whether the CER outcomes will become limiting to those treatments that do not have significantly better benefits than others."

That is indeed a legitimate concern voiced by many, especially within the physicians community. So I am not sure what you believe I have described inaccurately.

Then you know that PCORI is a real thing that has an actual mission and is constrained by federal legislation to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options. PCORI does CER through data mining and retrospective analysis, it isn't a plot to substitute politician's judgement for a physician's.

Come,  come Bill. Let's talk turkey. You and I both know that PCORI is not a decision making organization, they conduct CER just as you state. However, the question remains how will ACA deal with CER? As I noted, the ACA is shaping much of its details based on the NHS in Britain. The NHS has a governing body called NICE which stands for the  National Institute for Health and Care Excellence. Their job is essentially rationing health care to Brits, simply cutting to the chase. They use comparative effectiveness research of their own.

The ACA has an advisory board called the Independent Payment Advisory Board, or IPAB. The IPAB was designed specifically on the NICE model in England. This is perhaps the MOST controversial aspect of Obamacare and is where the "death panels" originated for those in opposition. The AMA which supports ACA in general strongly opposes this provision and has lobbied to repeal it.

https://www.ama-assn.org/ama/pub/advocacy/topics/independent-payment-advisory-board.page

So, no, I never stated PCORI was in some sort of alleged conspiracy. I did voice my legitimate concern on how the government will use that information. The IPAB is a very controversial and potentially dangerous part of Obamacare and the AMA has good reason to oppose this. So, no conspiracy at all. Just real, legitimate concerns. I would suggest all learn what the IPAB is all about and urge their representatives to repeal it since it has powers even over congress that must have a 60 vote senate majority vote to over ride the IPAB "recommendations."

Even the left leaning Huffington Post is against IPAB:

http://www.huffingtonpost.com/kenneth-thorpe/negatively-affect-patient-access_b_3188202.html

So, no conspiracy, just legitimate concerns from both the left and the right. IPAB is a uniquely unifying issue.

[Bill Peckham]

I happened to be paying attention during the whole death panel nonsense and remember it was the republican reaction to the proposal to pay physicians for providing voluntary end of life counseling. It was complete and utter nonsense then and it is complete and utter nonsense now. This is the first time you've mentioned the IPBA in this thread so yeah another effort you can misconstrue. I don't think talking turkey means what you think it means.

[Hemodoc]

I happened to be paying attention during the whole death panel nonsense and remember it was the republican reaction to the proposal to pay physicians for providing voluntary end of life counseling. It was complete and utter nonsense then and it is complete and utter nonsense now. This is the first time you've mentioned the IPBA in this thread so yeah another effort you can misconstrue. I don't think talking turkey means what you think it means.

Sorry Bill, are you somehow denying that the IPAB exists by implying my comment was utter nonsense? Just who is it that is making an effort to misconstrue? Is the AMA opposition utter nonsense? Is the Huffington Post commentary utter nonsense?

Talk turkey  (mainly American)
to discuss a problem in a serious way with a real intention to solve it If the two sides in the dispute are to meet, they must be prepared to talk turkey.

http://idioms.thefreedictionary.com/talk+turkey

For those here in IHD that support AARP, I would recommend learning about the IPAB and ask AARP why they want more power to this unelected group while the AMA, Huff Post and many, many other concerned people and groups want the IPAB abolished.

http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/option-strengthen-the-independent-payment-advisory-board-AARP-ppi-health.pdf

[Bill Peckham]

I don't think you understood what I wrote - I am denying that talk of the death panels in 2009/10 had anything to to do with the IPAB - when you wrote:
 "This is perhaps the MOST controversial aspect of Obamacare and is where the "death panels" originated for those in opposition."
you were misstating the origin of the death panel nonsense.

In addition I am saying that you keep changing what it is you are objecting to - first it was people moving from EGHP to the Exchanges and then it was CER and PCORI and now it is the IPAB.

And my point is that your post is not an example of talking turkey it is an example of obfuscation, which is an intransitive verb meaning to be evasive, unclear, or confusing

[YLGuy]

 
Bill: I stopped arguing with Hemodoc.  When you make a valid point he just completely ignores it or changes the point of the conversation.    He has admitted to being a Troll.  He said he has made posts just to upset people.    I know for a fact that he has posted complete lies.    When he gets frustrated he resorts to name calling and tries to be patronizing. 

So glad there is one less person "packing" in southern California! 

I have been following this thread and just shaking my head.   

[Hemodoc]

I don't think you understood what I wrote - I am denying that talk of the death panels in 2009/10 had anything to to do with the IPAB - when you wrote:
 "This is perhaps the MOST controversial aspect of Obamacare and is where the "death panels" originated for those in opposition."
you were misstating the origin of the death panel nonsense.

In addition I am saying that you keep changing what it is you are objecting to - first it was people moving from EGHP to the Exchanges and then it was CER and PCORI and now it is the IPAB.

And my point is that your post is not an example of talking turkey it is an example of obfuscation, which is an intransitive verb meaning to be evasive, unclear, or confusing

Bill, yes of course you are correct. Sarah Palin made a comment about death panels and the language authorizing end of life counseling which is a standard part of medical practice. She was deservedly criticized by both the left and the right for that absurd comment.

However, the "death panel" discussion resurrected itself after the IPAB and it is actually referred to that in many right wing blogs today. Whether you like it or disagree with it, death panels is in wide use for the IPAB today.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/28/who-wants-to-sit-in-the-hot-seat-on-a-federal-health-care-panel/

Now, conversations evolve in a natural flow.  I noted that CER is now in vogue but the question was how that information will be used. You juxtaposed something about PCORI in some sort of alleged conspiracy allegation on my part and I then clarified as we both know that PCORI only does research, it is the IPAB that has the decision making power. So that was in response to your allegation of some sort of conspiracy which I never ventured. Just legitimate questions about a huge program taking over the entire health care industry in America.  Not sure why you appear not to want an honest discussion of controversial issues.

[Hemodoc]

Bill: I stopped arguing with Hemodoc.  When you make a valid point he just completely ignores it or changes the point of the conversation.    He has admitted to being a Troll.  He said he has made posts just to upset people.    I know for a fact that he has posted complete lies.    When he gets frustrated he resorts to name calling and tries to be patronizing. 

So glad there is one less person "packing" in southern California! 

I have been following this thread and just shaking my head.   

Dear YL, I have nothing against you and if I have in anyway offended you, I humble beg your forgiveness. However, all that you state about me is patently false. No name calling, no lies, just an honest discussion about a very controversial government takeover of our health care system. Is that not the purpose of the a discussion forum?

[YLGuy]

Bill: I stopped arguing with Hemodoc.  When you make a valid point he just completely ignores it or changes the point of the conversation.    He has admitted to being a Troll.  He said he has made posts just to upset people.    I know for a fact that he has posted complete lies.    When he gets frustrated he resorts to name calling and tries to be patronizing. 

So glad there is one less person "packing" in southern California! 

I have been following this thread and just shaking my head.   

Dear YL, I have nothing against you and if I have in anyway offended you, I humble beg your forgiveness. However, all that you state about me is patently false. No name calling, no lies, just an honest discussion about a very controversial government takeover of our health care system. Is that not the purpose of the a discussion forum?

Wrong again! EVERYTHING I posted was the absolute truth.

[Hemodoc]

Bill: I stopped arguing with Hemodoc.  When you make a valid point he just completely ignores it or changes the point of the conversation.    He has admitted to being a Troll.  He said he has made posts just to upset people.    I know for a fact that he has posted complete lies.    When he gets frustrated he resorts to name calling and tries to be patronizing. 

So glad there is one less person "packing" in southern California! 

I have been following this thread and just shaking my head.   

Dear YL, I have nothing against you and if I have in anyway offended you, I humble beg your forgiveness. However, all that you state about me is patently false. No name calling, no lies, just an honest discussion about a very controversial government takeover of our health care system. Is that not the purpose of the a discussion forum?

Wrong again! EVERYTHING I posted was the absolute truth.

No problem YL. Have a great day.

[Bill Peckham]

I don't think you understood what I wrote - I am denying that talk of the death panels in 2009/10 had anything to to do with the IPAB - when you wrote:
 "This is perhaps the MOST controversial aspect of Obamacare and is where the "death panels" originated for those in opposition."
you were misstating the origin of the death panel nonsense.

In addition I am saying that you keep changing what it is you are objecting to - first it was people moving from EGHP to the Exchanges and then it was CER and PCORI and now it is the IPAB.

And my point is that your post is not an example of talking turkey it is an example of obfuscation, which is an intransitive verb meaning to be evasive, unclear, or confusing

Bill, yes of course you are correct. Sarah Palin made a comment about death panels and the language authorizing end of life counseling which is a standard part of medical practice. She was deservedly criticized by both the left and the right for that absurd comment.

However, the "death panel" discussion resurrected itself after the IPAB and it is actually referred to that in many right wing blogs today. Whether you like it or disagree with it, death panels is in wide use for the IPAB today.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/28/who-wants-to-sit-in-the-hot-seat-on-a-federal-health-care-panel/

Now, conversations evolve in a natural flow.  I noted that CER is now in vogue but the question was how that information will be used. You juxtaposed something about PCORI in some sort of alleged conspiracy allegation on my part and I then clarified as we both know that PCORI only does research, it is the IPAB that has the decision making power. So that was in response to your allegation of some sort of conspiracy which I never ventured. Just legitimate questions about a huge program taking over the entire health care industry in America.  Not sure why you appear not to want an honest discussion of controversial issues.

Of course the Republicans are resurrecting the Death Panel canard, I'm sure they think that since it worked once it will work again. And I don't remember anyone in the Republican political leadership disabusing Palin of the talking point at the time, I remember the Republican leadership running with it.

The latest talk about the IPAB is in the same vein, sowing canard seeds to harvest during next year's Congressional campaigns. The IPAB is an important enough topic I'll start a new thread and this one can return to discussions of tri cornered hats and such.

[MooseMom]

The IPAB is an important enough topic I'll start a new thread and this one can return to discussions of tri cornered hats and such.

"...tri cornered hats and such."  LOL!

It would be great if you would start a new thread.  I've never heard of IPAB or CER or PCORI or those other bits and bobs from the alphabet.

TTFN

[willowtreewren]

TTFN

 

I enjoyed your ta-ta's 

Aleta

[Hemodoc]

I don't think you understood what I wrote - I am denying that talk of the death panels in 2009/10 had anything to to do with the IPAB - when you wrote:
 "This is perhaps the MOST controversial aspect of Obamacare and is where the "death panels" originated for those in opposition."
you were misstating the origin of the death panel nonsense.

In addition I am saying that you keep changing what it is you are objecting to - first it was people moving from EGHP to the Exchanges and then it was CER and PCORI and now it is the IPAB.

And my point is that your post is not an example of talking turkey it is an example of obfuscation, which is an intransitive verb meaning to be evasive, unclear, or confusing

Bill, yes of course you are correct. Sarah Palin made a comment about death panels and the language authorizing end of life counseling which is a standard part of medical practice. She was deservedly criticized by both the left and the right for that absurd comment.

However, the "death panel" discussion resurrected itself after the IPAB and it is actually referred to that in many right wing blogs today. Whether you like it or disagree with it, death panels is in wide use for the IPAB today.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/28/who-wants-to-sit-in-the-hot-seat-on-a-federal-health-care-panel/

Now, conversations evolve in a natural flow.  I noted that CER is now in vogue but the question was how that information will be used. You juxtaposed something about PCORI in some sort of alleged conspiracy allegation on my part and I then clarified as we both know that PCORI only does research, it is the IPAB that has the decision making power. So that was in response to your allegation of some sort of conspiracy which I never ventured. Just legitimate questions about a huge program taking over the entire health care industry in America.  Not sure why you appear not to want an honest discussion of controversial issues.

Of course the Republicans are resurrecting the Death Panel canard, I'm sure they think that since it worked once it will work again. And I don't remember anyone in the Republican political leadership disabusing Palin of the talking point at the time, I remember the Republican leadership running with it.

The latest talk about the IPAB is in the same vein, sowing canard seeds to harvest during next year's Congressional campaigns. The IPAB is an important enough topic I'll start a new thread and this one can return to discussions of tri cornered hats and such.

Actually, no need Bill. I will simply let all to their own beliefs. It seems discussing diverse opinions on IHD is a no go any longer with the exception of Moosemom alone. Good luck with the upcoming Obamacare implementation.