Living in Leftlandia

[Medic007]

I hate it when you make me connect the dots. You said people choose ERs because they provide "healthcare regardless of your ability to pay." I said "where have I heard that before," because the place I have heard that before is Bernie Sanders stump speeches on healthcare. The point I was making was that ERs will no longer have the advantage of being the only "free" source of care under berniecare.

Bernie's stump speeches on healthcare? Are you serious? I don't know whether to laugh or cry. Why in the fvck would I be listening to Bernie's stump speeches on healthcare? I've learned to not listen to much of what politicians say about healthcare. They get it wrong more than they get it right. The most glaring recent example is the ACA, and that's not a minor mistake.

Your point that ERs won't "have the advantage" being the only "free" source of care isn't the only issue. It's access, dummy. People that are insured by Medicaid, Medicare, and private insurance go to the ER because it takes too long to get into a primary care office even if you are an established patient. Do you think Berniecare will cause it to rain primary care providers? It won't, especially when you dangle a nice fat pay cut in front of doctors deciding what specialty to pursue. This isn't communist Russia or China. Smart people have plenty of career options.

 

[imprimis]

People that are insured by Medicaid, Medicare, and private insurance go to the ER because it takes too long to get into a primary care office even if you are an established patient.

And if the call 911 and get transported, they go to the head of the line and not have to wait a day or two to be seen.

 

[Medic007]

I hate it when you make me connect the dots. You said people choose ERs because they provide "healthcare regardless of your ability to pay." I said "where have I heard that before," because the place I have heard that before is Bernie Sanders stump speeches on healthcare. The point I was making was that ERs will no longer have the advantage of being the only "free" source of care under berniecare.

Medicaid patients are the only ones that end up with no financial stake in their ER visit. Medicare and private insurance both have copays. Private insurance also has deductibles. Bernie says Berniecare won't have any copays! What do you think an entire payer system with nothing but premiums will look like in regards to ER utilization? ER care is expensive because you have to staff it 24/7 regardless of how many people show up. Primary care doesn't have the same cost to operate. Even if you create a policy that says you won't be able to get care for your non-emergency problem in the ER, someone that isn't cheap labor has to decide whether or not you have an actual medical emergency or not.

 

[07pilt]

Bernie's stump speeches on healthcare? Are you serious? I don't know whether to laugh or cry. Why in the fvck would I be listening to Bernie's stump speeches on healthcare? I've learned to not listen to much of what politicians say about healthcare. They get it wrong more than they get it right. The most glaring recent example is the ACA, and that's not a minor mistake.

Holy shit dude. "healthcare regardless of your ability to pay." is the main ****ing point of M4A.

Your point that ERs won't "have the advantage" being the only "free" source of care isn't the only issue.

but that was the easily identified point that you zoomed right past so you could wow with your EMTALA knowledge.

It's access, dummy. People that are insured by Medicaid, Medicare, and private insurance go to the ER because it takes too long to get into a primary care office even if you are an established patient.

People are insane if they do that without using the ambulance loophole.

Do you think Berniecare will cause it to rain primary care providers? It won't, especially when you dangle a nice fat pay cut in front of doctors deciding what specialty to pursue. This isn't communist Russia or China. Smart people have plenty of career options.

Berniecare will allow ERs to humanely turn away people who don't have an emergency. But, to your point about raining primary care physicians, it absolutely will allow things like fine tuning the ratio primary care physicians to orthopedists and ER doctors by controlling the reimbursement rates for that care/procedures.

 

[Medic007]

And if the call 911 and get transported, they go to the head of the line and not have to wait a day or two to be seen.

That is true regarding waiting days, but an ambulance ride doesn't guarantee that you will get seen before the 35 people in the waiting room who got checked in before you. A lot of people who have no business using an ambulance have used it to bypass triage and get seen immediately.

 

[07pilt]

someone that isn't cheap labor has to decide whether or not you have an actual medical emergency or not.

cheaper than an ER physician to take care of everyone's sore throat tho?

 

[Medic007]

but that was the easily identified point that you zoomed right past so you could wow with your EMTALA knowledge.

lol

People are insane if they do that without using the ambulance loophol

Do what? Ambulances won't transport you to the doctor's office for em

Berniecare will allow ERs to humanely turn away people who don't have an emergency. But, to your point about raining primary care physicians, it absolutely will allow things like fine tuning the ratio primary care physicians to orthopedists and ER doctors by controlling the reim

Can you point me to any Berniecare talking point about "humanely" turn away people who don't have an emergency? I'm not saying one exists, I just haven't seen it.

Do we have an over-abundance of specialists? Which ones? What is the ratio of primary care to specialists that we need? We'll fine tune the ratio by paying specialists less? Will we then pay primary care doctors more? If that's the strategy, it sounds like you're just shuffling money in the already underpayment bucket. If that's not the strategy, and primary care will also be getting a pay cut, we'll still have a shortage of primary care providers.

What happens when there aren't enough cardiologists to meet demand? Orthopedists? Interventional neurologists? Gastroenterologists? Oncologists? Radiologists? Nephrologists? Pediatric neurosurgeons? Obstetricians?

 

[Medic007]

cheaper than an ER physician to take care of everyone's sore throat tho?

Who do you think EMTALA requires a screening exam from? It isn't the housekeeper. Triage is fraught with liability. That's why ERs don't turn you away for your sore throat. Are you aware of the life threatening things that can cause a sore throat? What do you think happens if the ER turns you away for your sore throat and your family finds you dead 2 days later from epiglottitis?

 

[Cowguy]

Supplies (medical supplies, not general use ones like paper and pens and staples) (wrong BIGLY. On average this is 5% or less of budgeted expenditures and even if you bought everything at cost, it wouldn’t impact the overall by even a percent)
Capital equipment (medical capital equipment, not elevators or air conditioners) (please extrapolate. You mean when the government mandates you have to move X-ray from cr to dr you can just ignore it? You’d be shocked how much the capital budget has dried up as it is. It’s not like there is a bunch or pioneering technology new capital purchases. The capital purchases are mostly to replace outdated or flat out broken product. Unless you’re talking about mandated federal government items. You could have a capital freeze and not save 50 basis points)
Labor (you have to be trolling now. Who do we cut that doesn’t hurt care?)
Electronic medical records (enlighten me here. It’s not like an idn goes out and just buys software. There are rfps and arduous processes to decide on what to buy. It’s competitive. When you convince me there’s a way to make a tech company sell more cheaply, I’ll maybe grant this.
Marketing (This can be zero)(it could be and your idn could go away tomorrow too

You know nothing about this world. Nothing.

 

[Cowguy]

Their prices aren't as sensitive to healthcare spending as say a sharps container is.

I’m just going to spill the beans and tell you that I work for one of the largest healthcare distributors in the world. You have zero clue what you’re talking about. Zero.

 

[Medic007]

I’m just going to spill the beans and tell you that I work for one of the largest healthcare distributors in the world. You have zero clue what you’re talking about. Zero.

You know you guys have all become billionaires from selling syringes and sharps containers. Just admit it already.

 

[07pilt]

Do what? Ambulances won't transport you to the doctor's office for em

Jesus

Can you point me to any Berniecare talking point about "humanely" turn away people who don't have an emergency? I'm not saying one exists, I just haven't seen it.

I don't know if such a talking point exists, but section 613 of berniecare is specifically about increasing access to primary care.

Do we have an over-abundance of specialists?

Based on your previous comments, we have an over-abundance of specialists relative to primary care physicians. No?

Which ones? What is the ratio of primary care to specialists that we need? We'll fine tune the ratio by paying specialists less? Will we then pay primary care doctors more? If that's the strategy, it sounds like you're just shuffling money in the already underpayment bucket. If that's not the strategy, and primary care will also be getting a pay cut, we'll still have a shortage of primary care providers.

I am going with your premise that there aren't enough primary care physicians. Here is an example (don't nitpick it, it is a hypothetical and obviously a simplification and I know that for example specialist pay varies widely): lets say there are 5 primary to every 1 specialist right now and that specialist make 50% more on average. Lets say it is determined that a better ration would be 6:1 you can reduce the pay difference until you get that ratio. The pay gap can be reduced by paying primary care physicians more, or by paying specialists less or by paying both less but cutting specialists more severely or by paying them both more but making the primary care physician's increase greater.

QUOTE="Medic007, post: 1454365, member: 2402"]What happens when there aren't enough cardiologists to meet demand? Orthopedists? Interventional neurologists? Gastroenterologists? Oncologists? Radiologists? Nephrologists? Pediatric neurosurgeons? Obstetricians?[/QUOTE] You pay more for specialties that are in short supply.

 

[07pilt]

Supplies (medical supplies, not general use ones like paper and pens and staples) (wrong BIGLY. On average this is 5% or less of budgeted expenditures and even if you bought everything at cost, it wouldn’t impact the overall by even a percent)Are you telling me that if every health provider in the US demanded a 10% reduction in the price of medical supplies from their suppliers, those suppliers would just refuse? Keep in mind it this is every provider not just the one single provider you work for. (1% of 33 trillion is still a lot of meat)
Capital equipment (medical capital equipment, not elevators or air conditioners) (please extrapolate. You mean when the government mandates you have to move X-ray from cr to dr you can just ignore it? You’d be shocked how much the capital budget has dried up as it is. It’s not like there is a bunch or pioneering technology new capital purchases. The capital purchases are mostly to replace outdated or flat out broken product. Unless you’re talking about mandated federal government items. You could have a capital freeze and not save 50 basis points)Same deal as above. But this discussion does make me wonder how the costs for depreciation of capital are allocated. Maybe JimmyBob can step in.
Labor (you have to be trolling now. Who do we cut that doesn’t hurt care?)Administration is where most of the meat is, but doctors and nurses too.
Electronic medical records (enlighten me here. It’s not like an idn goes out and just buys software. There are rfps and arduous processes to decide on what to buy. It’s competitive. When you convince me there’s a way to make a tech company sell more cheaply, I’ll maybe grant this. There is a way and it is every provider in the US hit up their software provider for a discount. Do you know what the margin is on an incremental copy of a piece of software?
Marketing (This can be zero)(it could be and your idn could go away tomorrow too Where would the patients go?

 

[07pilt]

I’m just going to spill the beans and tell you that I work for one of the largest healthcare distributors in the world. You have zero clue what you’re talking about. Zero.

I am starting to think that you think I mean that providers are run inefficiently, when what I really mean is that providers are getting gouged across the board by their suppliers because they are competing against each other and have no power to negotiate their costs down (especially labor).

 

[07pilt]

Who do you think EMTALA requires a screening exam from? It isn't the housekeeper. Triage is fraught with liability. That's why ERs don't turn you away for your sore throat. Are you aware of the life threatening things that can cause a sore throat? What do you think happens if the ER turns you away for your sore throat and your family finds you dead 2 days later from epiglottitis?

So going to the ER for a sore throat is legit?

 

[07pilt]

You know you guys have all become billionaires from selling syringes and sharps containers. Just admit it already.

I am fully aware that no one becomes a billionaire from being a distributor.

 

[Medic007]

Are you telling me that if every health provider in the US demanded a 10% reduction in the price of medical supplies from their suppliers, those suppliers would just refuse? Keep in mind it this is every provider not just the one single provider you work for. (1% of 33 trillion is still a lot of meat)

Do you really believe that single hospitals are buying as single hospitals? If so, you know much less than I expected.

Same deal as above. But this discussion does make me wonder how the costs for depreciation of capital are allocated. Maybe JimmyBob can step in.

How do you think capital is depreciated in healthcare? What is the life expectancy of a CT scanner vs an air conditioner, cargo van, CNC machine, building, automated manufacturing equipment, etc?

Administration is where most of the meat is, but doctors and nurses too.

Nurses? LOL. How much do you think nurses make? Yeah, nurses are a bunch of fat right there. Lemme guess, you think they sit around playing cards too?

 

[Medic007]

I am starting to think that you think I mean that providers are run inefficiently, when what I really mean is that providers are getting gouged across the board by their suppliers because they are competing against each other and have no power to negotiate their costs down (especially labor).

Do you agree with a $15/hour minimum wage? Do you know what a demand labor market is? What do you think the current labor market looks like for skilled labor like nursing? What happens when demand outstrips supply in the labor market?

Outside of pharmaceuticals, what supplies are providers being gouged on?

 

[Medic007]

So going to the ER for a sore throat is legit?

You're going to have to give me a lot more information to make that decision. A sore throat is a symptom. What other signs and symptoms are present?

 

[CBradSmith]

Do you agree with a $15/hour minimum wage? Do you know a demand labor market is? What do you think the current labor market looks like for skilled labor like nursing? What happens when demand outstrips supply in the labor market?

Outside of pharmaceuticals, what supplies are providers being gouged on?

Shareholder returns, duh.

 

[CBradSmith]

You're going to have to give me a lot more information to make that decision. A sore throat is a symptom. What other signs and symptoms are present?

Your first order thinking doesn't cut it Medic. Facts are facts.

 

[Medic007]

Your first order thinking doesn't cut it Medic. Facts are facts.

I am such a first order thinker, as are most healthcare providers. Chest pain means you're having a heart attack. There's nothing else that exists in human pathophysiology that causes chest pain but heart attacks.

I hope he doesn't think that all sore throats are created equal. I once cut a guy's neck open to get an airway two hours after he was sent home from the ER with a sore throat.

 

[CBradSmith]

I am such a first order thinker, as are most healthcare providers. Chest pain means you're having a heart attack. There's nothing else that exists in human pathophysiology that causes chest pain but heart attacks.

I hope he doesn't think that all sore throats are created equal. I once cut a guy's neck open to get an airway two hours after he was sent home from the ER with a sore throat.

You obviously created an unnecessary expense. And you're likely paid too much.

 

[07pilt]

Do you really believe that single hospitals are buying as single hospitals? If so, you know much less than I expected.

no

How do you think capital is depreciated in healthcare? What is the life expectancy of a CT scanner vs an air conditioner, cargo van, CNC machine, building, automated manufacturing equipment, etc?

exactly.

Nurses? LOL. How much do you think nurses make? Yeah, nurses are a bunch of fat right there. Lemme guess, you think they sit around playing cards too?

median salary for an RN is 71k

 

[07pilt]

You're going to have to give me a lot more information to make that decision. A sore throat is a symptom. What other signs and symptoms are present?

Wait so are people over using the ER or not?

 

[07pilt]

Do you agree with a $15/hour minimum wage? Do you know what a demand labor market is? What do you think the current labor market looks like for skilled labor like nursing? What happens when demand outstrips supply in the labor market?

Outside of pharmaceuticals, what supplies are providers being gouged on?

What does Baxter and Medtronic make?

 

[Medic007]

median salary for an RN is 71k

How much do you think nurses should make?

 

[Medic007]

Wait so are people over using the ER or not?

Yes, yes they are, but you can't take "sore throat" as the only information and determine that it's inappropriate for ER care.

 

[Medic007]

What does Baxter and Medtronic make?

They both make a bunch of stuff. Are Medtronic and Baxter overcharging for their goods? There are plenty of other options out there.

 

[Medic007]

You obviously created an unnecessary expense. And you're likely paid too much.

LOL. Probably true to both in the eyes of pilt. He just had a sore throat. He didn't need an airway.

 

[07pilt]

How much do you think nurses should make?

Its more of a question of how much could we get away with cutting. I think 3%

 

[07pilt]

Yes, yes they are, but you can't take "sore throat" as the only information and determine that it's inappropriate for ER care.

Probably a medical professional should make that determination?

 

[07pilt]

They both make a bunch of stuff. Are Medtronic and Baxter overcharging for their goods? There are plenty of other options out there.

Both have really high profit margins

 

[Medic007]

Its more of a question of how much could we get away with cutting. I think 3%

Do folks like National Nurses United that support Berniecare know that Bernie is going to cut their pay? They seem to think nurses need more pay and less patients per nurse. Less patients per nurse means higher labor costs for providers. Oh wait, we can just get that money from the doctors!

I have a better idea. Let's tax all capital gains at 90%. How much money would that raise? People aren't doing any actual work for that money anyhow. That will actually raise taxes on the wealthy. I will support Berniecare if we can fund it with a 90% capital gains tax.

 

[Medic007]

Probably a medical professional should make that determination?

Duh. When people show up to the ER with a sore throat, who do you think they get seen by?

 

[Medic007]

Both have really high profit margins

Isn't that the goal of businesses like Baxter and Medtronic?

 

[Cowguy]

I am starting to think that you think I mean that providers are run inefficiently, when what I really mean is that providers are getting gouged across the board by their suppliers because they are competing against each other and have no power to negotiate their costs down (especially labor).

Providers have more power to negotiate than ever. You have to remember that companies like mine will never get business by being more expensive. Take a group like Integris, they go out to rfp and everyone responds. It’s a highly competitive process with margin compression the result. It’s gotten to the point that we have had to walk away from deals, because we couldn’t afford to win the business.

I don’t understand your thoughts on labor either. Can you go hire a family practice doc for 150k? Probably. Is that who you’d want working on your family? Likely not. We’ve already seen nurse practitioners and physicians assistants bridge care gaps, as less expensive options for care. You have medical assistants doing things in offices that only doctors and nurses used to do. There is an absolute law of diminishing returns - if you get cheap on labor.

I’ve lived in this world my whole career. Health care is in crisis and it’s a funding issue. There are several rural hospitals that are likely to get moth balled in the next six months. These hospitals have been under multiple ownership or management groups ... yet no one has found a way to operate them profitably.

As much as you think you know - you just don’t.

 

[07pilt]

Do folks like National Nurses United that support Berniecare know that Bernie is going to cut their pay? They seem to think nurses need more pay and less patients per nurse. Less patients per nurse means higher labor costs for providers. Oh wait, we can just get that money from the doctors!

I have a better idea. Let's tax all capital gains at 90%. How much money would that raise? People aren't doing any actual work for that money anyhow. That will actually raise taxes on the wealthy. I will support Berniecare if we can fund it with a 90% capital gains tax.

Doctors better get their own union

 

[Sunburnt Indian]

I went to Waco Hillcrest ER in January after a January 11 pit bull attack at the Petro in Weatherford, TX. The truck driver team dog owners bolted before Weatherford animal control could arrive.

My clinic doesn't carry the rabies medicine. My left shoulder and hip felt like anvils for 20 minutes after the initial gobulin injections. Rabies injections 1, 3 and 4 were breezes. 2 turned beet red for 48 hours with intense itching. I didn't have to do the abdomen injections. They tell me that's old school.

My co-pay was $220.80. Before Mugabecare, my copay would have been $0.

 

[07pilt]

Duh. When people show up to the ER with a sore throat, who do you think they get seen by?

so if every sore throat requires a professional to determine if it is life threatening it seems to me like a sore throat is a legit use of an ER