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[Medicine In The US]: An American Cluster*@#%

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Posts

  • DetharinDetharin Registered User regular
    edited May 2011
    Health care will be a problem as long as people mistakenly believe it is a right, and not a privilege.

    Treating people is expensive, from doctors up to their eyeballs in debt working insane hours, to pharmaceutical companies dumping billions of dollars into drug research. Moreover despite poaching the worlds doctors, we are still running a doctor shortage. Hell just getting people to understand that having health insurance does not guarantee health care is a miracle unto itself.

    Solutions? Well if we cut how much companies can make off of life saving drugs/technologies they have both less money and inclination to develop more life saving drugs and technologies. We could lower the qualifications required of doctors/move some of their more expensive jobs to nurses except various alphabet groups would shit bricks. Also we also have a nursing shortage, and let us not even get into just how stressful that job can be. 1 in 5 new nurses will walk away from their job in the first year. Now lets pile on more responsibilities? Not so much. Moreover what we really want is to get people to utilize primary care, so we can catch medical conditions early. Unfortunately with less qualified doctors you are less likely to catch said conditions early. Furthermore the illusion that giving people health insurance will cause them to utilize primary care more is just that. Take Massachusetts, their insurance reform has lead to higher costs due to people using the ER even more. Apparently as opposed to making an appointment and taking off work sick people will instead tough it out and go to the ER after/before work. Shocking I know.

    Detharin on
  • psyck0psyck0 Registered User regular
    edited May 2011
    You are insane. Lowering the qualifications of doctors is madness. We already don't have enough time to learn everything we need to in medical school. I will agree that to some extent a few duties could be shifted over to nurses, but they are trained COMPLETELY differently from doctors. If you want an IV put in or a wound dressed, a nurse will do a much better job than any doctor, because that is what they go to school for. They don't go to school to learn drug mechanisms of action, side effects and interactions, and so giving them prescription rights beyond a few very common drugs is madness because that shit is COMPLICATED. They also don't go to school to learn extremely complicated physiology or exhaustive lists of differentials, and so again giving them primary care duties beyond a fairly narrow scope isn't right because they don't have all the information.

    I hope this doesn't come across as arrogant, it's just a statement of facts.

    psyck0 on
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  • DivideByZeroDivideByZero Social Justice Blackguard Registered User regular
    edited May 2011
    Hahnsoo1 wrote: »
    I'd be interested in what "cancer medicine" that news story was talking about. I mean, if it's sold at Costco, then it's some sort of over-the-counter drug, and not something like monoclonal antibody derivatives or other esoteric expensive stuff (which are genuinely pretty expensive).

    If someone is going through cancer treatment, though, that's a very very small drop in a very very large cost bucket. I can see how laundering higher costs for OTC drugs by folding it into cancer treatment reimbursements would be a wonderful scam.

    Well here's a recent example:

    http://abcnews.go.com/Health/WomensHealth/price-preventing-premature-births-skyrockets-drug/story?id=13104588&page=1

    Drug that prevents premature births and was previously available for $10-$15 per dose jumps to $1,500 per dose once a pharma company gets exclusivity. (Typical treatment regimen calls for 20 doses, so $200 becomes $30,000.)
    The drug company gained exclusive rights to produce a progesterone shot used to prevent premature births in high-risk mothers from the Food and Drug Administration in February, and soon after announced that they would list the drug at a price 150 times higher than the cost of the non-branded version women have been using for years. The shot has been available in unregulated form from specialty compounding pharmacies for years for $10 a pop for years, but now, marketed as Makena, the drug will cost $1,500 per dose -- an estimated $30,000 in total per pregnancy.
    Hydroxyprogesterone caproate injections have been around since 1956, and were commercially available up until 1999 when Squibb, the pharmaceutical company making them, withdrew the product from the market. In the past few years however, studies have shown that these injections had a positive effect in preventing pre-term birth among women who had previously had a spontaneous pre-term birth in the past. Since then, doctors have been able to fill prescriptions for the synthetic progesterone using compounding pharmacies at a price of $10 to $15 per injection.

    Most health insurances did not cover these shots as they were not FDA approved, but given the low price of progesterone, women were able to pay out of pocket for the treatment, says Moritz.


    Soo, this drug has been around for years but only at specialty pharmacies, and in an inconsistent form. FDA grants KV Pharmaceuticals the exclusive rights to it in order to standardize it and make it available at every pharmacy. Health professionals cheer.

    Then they mark it up 15,000% :x

    They're not even recouping the costs of R&D, as all the development was done by the National Institute for Health.

    Oh, but wait - the generous pharma co. offers to give the drug away for free to anyone making less than $60,000 a year, and subsidize it so anyone making $60k-$100k AND is insured only pays a $20 co-pay (and you can bet your ass they're hitting those insurance companies up for the balance). Make over $100k? Full price. $30,000 for one drug that the free market says should cost $200.

    Granted, the FDA said it would not take action against pharmacies that continued to compound their own versions of the drug, but that's after the company sent letters to pharmacies threatening them with FDA sanctions if they tried to compete.

    There's a detachment from the economics of medicine in place. People see their co-pay and have no clue of the hidden costs that their insurance is paying, which is ultimately passed on to everyone else in the insurance pool, and everyone in the country in terms of medicare/medicaid. There are absolutely entities seeking to extract as much revenue from the system as they possibly can get away with, regardless of the outcome on the system as a whole. This is just the most recent example that came to mind.

    DivideByZero on
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  • DetharinDetharin Registered User regular
    edited May 2011
    Before calling me mad, just be sure you realize I agree with you. While nursing is often a very unappreciated job, there is quite a bit to it beyond what most people appreciate however trying to turn already overworked nurses into mini-doctors is not a viable solution which was my original point.

    Just like the people asking for less regulation/less qualified doctorbs. Unfortunately the B is not for bargain. With a bad lawyer you can appeal with a better lawyer. With a bad doctor your often screwed up for life.

    Detharin on
  • RobmanRobman Registered User regular
    edited May 2011
    Actually if you're looking for the best place to start cranking up numbers in the health professions, nursing is the way to go. They're the cheapest of the "trinity" of professional care providers (Nurse, Pharmacist, Doctor) to train in school, they have the lowest professional wage, they get into the profession because they care. If you crank up the number of nurses, and mandate the hospitals to hire a certain number per patient, the attrition rate would also fall off. It just so happens that a while ago hospitals realized they could boost their profit numbers by paring down their nursing staff to the bare minimum possible.

    In Ontario, AFAIK there's a few trial clinics where there are NPs dealing with general cases, with a GP on site for more complex issues. Sore ear? Nurse gives you antibiotics. Sore back? Nurse refers you to a physiotherapist. Mysterious lump or chest pains? Triaged over to the doctor. The NPs pull 1/2-2/3ds the wage of a GP, and it means that the GP will actually handle issues they trained to deal with. A GP treating 9 cases of strep throat in a row is complete lunacy.

    Robman on
  • DetharinDetharin Registered User regular
    edited May 2011
    Except we already have problems getting and retaining new nurses. The pay is generally pretty nice, just not for the amount of work you do, or the stress you deal with. This is of course depending on exactly where you are nursing. However as it stands we are still losing 20% of all new nurses in the first year alone. Now add in more responsibilities, more training, and of course more pay and it stops being a "cheaper alternative."

    In addition given that we are trying to focus more on preventive medicine people are more likely to ask doctors other questions about other issues "while they are there" that could expose other developing conditions. Sure you may get 9 cases of strep, but case 5 may be something else entirely. Let us not even get into now we have nurses making diagnosis, which opens them up to litigation for guessing wrong.

    Detharin on
  • DeebaserDeebaser on my way to work in a suit and a tie Ahhhh...come on fucking guyRegistered User regular
    edited May 2011
    Detharin wrote: »
    Health care will be a problem as long as people mistakenly believe it is a right, and not a privilege.

    I strongly disagree with you here, bro. I think Health care in this country is a problem because we treat it too much like a privilege.


    Moreover what we really want is to get people to utilize primary care, so we can catch medical conditions early. Unfortunately with less qualified doctors you are less likely to catch said conditions early. Furthermore the illusion that giving people health insurance will cause them to utilize primary care more is just that. Take Massachusetts, their insurance reform has lead to higher costs due to people using the ER even more. Apparently as opposed to making an appointment and taking off work sick people will instead tough it out and go to the ER after/before work. Shocking I know.

    This is where social engineering goes in quite nicely. You want to encourage people to use primary care over ER care, you adjust the copays to reward/punish outcomes. If your non-trauma ER copay is $150 and your PCP copay is $15.

    Also, we just need more fucking primary care physicians, especially those willing to work evenings/weekends hours. It's absolutely absurd that in 2011 it is nigh fucking impossible to get any doctor to see you for non urgent care on a Sunday. My fucking bank is open on sunday.

    Deebaser on
  • AtomikaAtomika Live fast and get fucked or whatever Registered User regular
    edited May 2011
    First, my credentials: I have a BS in Economics with an emphasis in healthcare. I'm also an RN, and I work in critical care/ER.



    My beliefs on the healthcare system is that the system is not only broken, but broken at literally every vector of the spectrum. Medicare is frought with abuse on both the patient and doctor end, there's very little oversight to physicians' practice and treatment (and less incentive to increase it), the costs of higher medical education are prohibitive to all but the very wealthy or willing to accrue an unreasonable amount of debt, private hospitals have no incentive to provide better or more efficient care if there's no financial motivator, billing exponentially outweighs the actual costs of service, a tort-happy public (or fear thereof) cause physicians to order more tests than necessary, the insurance lobby is intractably entrenched within our legislative system, EMTALA laws force the healthcare industry into providing services without recompense, illegal immigration is taking a larger and larger portion of hospital losses, it's one of the few industries in the world where consumers are largely ignorant of the product they're paying for, and a large section of our elected representativeship actively believes that there's nothing wrong with the way things are.


    Based on all of these concurrent factors, I have theorized that while it is perhaps possible to solve our national healthcare dillema, the volume and complexity of these factors reduce the likelihood and percentage of finding a tenable solution to a nearly-zero number.

    Atomika on
  • DetharinDetharin Registered User regular
    edited May 2011
    Deebaser wrote: »
    I strongly disagree with you here, bro. I think Health care in this country is a problem because we treat it too much like a privilege.

    Rights do not create responsibilities in others.

    Being a doctor is a hard job. It requires a special type of person. They are under no obligation to treat you. That they might choose to is on them, they are not required to do so. As a society we can choose to want to extend the privilege of health care to as many people as possible and bear the associated costs of doing so to varying degrees. However at no point does this make health care a right.
    This is where social engineering goes in quite nicely. You want to encourage people to use primary care over ER care, you adjust the copays to reward/punish outcomes. If your non-trauma ER copay is $150 and your PCP copay is $15.

    Also, we just need more fucking primary care physicians, especially those willing to work evenings/weekends hours. It's absolutely absurd that in 2011 it is nigh fucking impossible to get any doctor to see you for non urgent care on a Sunday. My fucking bank is open on sunday.

    Your primary care physician cannot be at his office 24/7 unfortunately. Which leads to he has to have regular hours. Those hours are never going to match up with everyone. Personally IMO if more doctors as opposed to running 9-5 ran 1-10 it might help get more people to see their PCP. However getting doctors to do it is problematic considering most are already working long hours and have full patient schedules as is. Why work different hours when your existing hours are already booked solid?

    Changing co-pays does not work because people already cannot afford to take off work, if the copays on ER visits are to high they will just not go. Making when they are finally taken to the hospital even more expensive because their conditioned has worsened.

    Detharin on
  • DetharinDetharin Registered User regular
    edited May 2011
    Based on all of these concurrent factors, I have theorized that while it is perhaps possible to solve our national healthcare dillema, the volume and complexity of these factors reduce the likelihood and percentage of finding a tenable solution to a nearly-zero number.

    Couldn't have said it better myself.

    Detharin on
  • BeltaineBeltaine BOO BOO DOO DE DOORegistered User regular
    edited May 2011
    I see an endocrinologist quarterly.

    My health insurance also changed this year.

    I just received my statement of benefits from my first visit this year.

    Here's how it broke down:

    Dr. visit charge was $180.00
    Insurance negotiated visit price $68.00
    My copay $40.00
    Insurance payed Dr $28.00

    So now here comes the WTF.

    My insurance premium is $235/month after my employer pays 60%

    So, for over $500/month + $40 copay, my insurance pays $28 for my Dr. visit.

    I could drop the insurance and pay full cost of the Dr visit and still come out way way ahead. Except that, if i drop my insurance, I only recoup the $235 out of my paycheck. My employer will not be handing me the 60% they would have been paying.

    Why does my health insurance have to be tied to my employer anyway? My employer doesn't take care of my life/disability/homeowner's/car insurance.

    Beltaine on
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  • HamHamJHamHamJ Registered User regular
    edited May 2011
    Detharin wrote: »
    Deebaser wrote: »
    I strongly disagree with you here, bro. I think Health care in this country is a problem because we treat it too much like a privilege.

    Rights do not create responsibilities in others.

    Being a doctor is a hard job. It requires a special type of person. They are under no obligation to treat you. That they might choose to is on them, they are not required to do so. As a society we can choose to want to extend the privilege of health care to as many people as possible and bear the associated costs of doing so to varying degrees. However at no point does this make health care a right.

    This argument is just stupid.

    Being a cop is a hard job. Therefore the protection of the law is a privilege and not a right!
    Being a lawyer/judge is a hard job. Therefore the right to a fair trial is actually a privilege!
    Being a politician is a hard job. Therefore liberty is a privilege, not a right!

    Should I keep going?
    Beltaine wrote: »
    I see an endocrinologist quarterly.

    My health insurance also changed this year.

    I just received my statement of benefits from my first visit this year.

    Here's how it broke down:

    Dr. visit charge was $180.00
    Insurance negotiated visit price $68.00
    My copay $40.00
    Insurance payed Dr $28.00

    So now here comes the WTF.

    My insurance premium is $235/month after my employer pays 60%

    So, for nearly $600/month + $40 copay, my insurance pays $28 for my Dr. visit.

    I could drop the insurance and pay full cost of the Dr visit and still come out way way ahead.

    Yes. That is how insurance works. Most people do not get as much out of it as they pay. But the couple who get screwed by something major end up needing hundreds of thousands of dollars for care. By having insurance, you are mitigating your risk by insuring yourself against such a situation.

    HamHamJ on
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  • lazegamerlazegamer The magnanimous cyberspaceRegistered User regular
    edited May 2011
    Pi-r8 wrote: »
    Chaos Punk wrote: »
    I read this article in National Affairs (I don't know if anybody has posted it yet or not), but I think it's pretty balanced for the most part, and demonstrates with good evidence why healthcare reform needs morals and economics (profit-motive):

    http://www.nationalaffairs.com/publications/detail/health-care-and-the-profit-motive

    And the idea of a "health savings account" is ridiculous, and completely defeats the purpose of insurance. Insurance isn't to protect you against the mild, likely problems- it's to protect against the really severe and unlikely ones. A normal person can't possible save up enough money to pay for a serious health problem.

    My screwdriver is terrible for eating soup with as well. HSA's aren't designed for paying for emergencies.
    The phrase was coined in the 1990s by Regina Herzlinger, a Harvard Business School professor, to describe health plans that combine third-party insurance against catastrophic medical costs with tax-free savings accounts for direct spending on chronic and routine health care.

    lazegamer on
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  • ShanadeusShanadeus Registered User regular
    edited May 2011
    Preventive care.
    Preventive care.
    Preventive care.

    There's a lot of focus on preventive care over here (Sweden) which is probably easier to focus on when the state is willing to pay for it as people have this tendency to not give a damn until they're standing there obese and with diabetes that could have been avoided but wasn't because going to a dietician was too expensive.

    In the USA I imagine it'd be the individual who would have to shoulder the costs associated with preventive care - which I find unlikely to happen anytime soon.

    Shanadeus on
  • DeebaserDeebaser on my way to work in a suit and a tie Ahhhh...come on fucking guyRegistered User regular
    edited May 2011
    Detharin wrote: »
    This is where social engineering goes in quite nicely. You want to encourage people to use primary care over ER care, you adjust the copays to reward/punish outcomes. If your non-trauma ER copay is $150 and your PCP copay is $15.

    Also, we just need more fucking primary care physicians, especially those willing to work evenings/weekends hours. It's absolutely absurd that in 2011 it is nigh fucking impossible to get any doctor to see you for non urgent care on a Sunday. My fucking bank is open on sunday.

    Your primary care physician cannot be at his office 24/7 unfortunately. Which leads to he has to have regular hours. Those hours are never going to match up with everyone.


    If only there were more than one doctor that could treat me when I am ill...
    Personally IMO if more doctors as opposed to running 9-5 ran 1-10 it might help get more people to see their PCP. However getting doctors to do it is problematic considering most are already working long hours and have full patient schedules as is. Why work different hours when your existing hours are already booked solid?

    This is a good point. Docs have no real incentive to change their schedules because there isn't enough competition (Thanks AMA!).
    Changing co-pays does not work because people already cannot afford to take off work, if the copays on ER visits are to high they will just not go. Making when they are finally taken to the hospital even more expensive because their conditioned has worsened.

    I disagree, copays can provide an incentive to change behavior. Insurance companies already use this to great effect.

    Deebaser on
  • DetharinDetharin Registered User regular
    edited May 2011
    HamHamJ wrote: »
    [

    Being a cop is a hard job. Therefore the protection of the law is a privilege and not a right!
    Being a lawyer/judge is a hard job. Therefore the right to a fair trial is actually a privilege!
    Being a politician is a hard job. Therefore liberty is a privilege, not a right!

    Should I keep going?

    Sure, would you like to start with a right?
    As for your examples might want to start by looking up Castle Rock v. Gonzales.
    Lawyers are not required to take cases, and can fire clients. Let us not even get into what a Judge can do. Both may choose to listen to your case and grant you a fair trial, but neither is compelled to be there.
    As for putting politicians and liberty in the same sentence, that is just silly goosery and you know it.

    You cannot claim something is an inalienable right, that is yours merely by virtue of you existing, that requires another individual to labor or toil to make it so. I can say whatever i damn well please whether someone is around to hear me or not. I can decide I would rather be other there and start walking. When you have to compel someone to do something you cannot claim it as a right.

    Detharin on
  • bowenbowen How you doin'? Registered User regular
    edited May 2011
    The problem with nurses is that the degree of difference between an RN, a PA, and a full blown MD is practically a year. I think most RN degrees want a 4 year degree, require a test that is practically the MCATs, and then you go for another 4 years. When I was looking into an MD, it was pretty indistinguishable from the RN track at the same school. Except for the obvious clinical stuff doctors do that nurses don't.

    This is why it's hard to get RNs. It's not that it's hard, lots of things are hard, it is difficult from a random viewpoint but people who have trained in it are not especially frustrated by the level of difficulty in their career. No, you see, the problem is there is no incentive to go to school for practically the same amount of time for what is roughly 1/8th of a specialist's salary.

    I think RNs start at 85K here in specialty practices. Your average specialist makes anywhere from 250,000 to 1,000,000. Why would that be appealing at all? You get to take care of patients? I know doctors that care way more than RNs, that's silly. I've seen doctors see patients for free and even help pay for procedures because they want them to get better and healthy and having a healthy patient is much more satisfying than having one that's dying because Blue Cross won't approve a risky procedure but instead wants them to suffer for another few months to verify that they need it. The problem is not the doctors, the problem is the insurances.

    bowen on
    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
  • DetharinDetharin Registered User regular
    edited May 2011
    Deebaser wrote: »
    I disagree, copays can provide an incentive to change behavior. Insurance companies already use this to great effect.

    However the behavior you will change will not end up with the result you desire. Problem. You are sick and should see a doctor. Problem Your PCP is only available from 9-5. Problem if you call in sick to work they might fire you, plus you cannot afford to lose the pay.

    Solution. You go to the ER which is open 24/7. Now lets factor in if you make it so the ER is even more expensive. People just do not go, therefore when they end up there they are sicker, end up spending more time out of work, and end up in worse shape.

    Our desired outcome is for people to go to the doctor more often, not less. Sadly we cannot just create doctors out of whole cloth by throwing money at it.

    Detharin on
  • bowenbowen How you doin'? Registered User regular
    edited May 2011
    You could, actually, Detharin.

    The largest issues is the AMA is keeping the entry to MD-hood artificially high. Keeping demand for doctors high. There are many a people who would make great doctors, and whom we could give a free ride through medical school. There needs to be a focus on better care for the sick and less focus on how big of a paycheck can we make.

    bowen on
    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
  • DeebaserDeebaser on my way to work in a suit and a tie Ahhhh...come on fucking guyRegistered User regular
    edited May 2011
    Detharin wrote: »
    Deebaser wrote: »
    I disagree, copays can provide an incentive to change behavior. Insurance companies already use this to great effect.

    However the behavior you will change will not end up with the result you desire. Problem. You are sick and should see a doctor. Problem Your PCP is only available from 9-5. Problem if you call in sick to work they might fire you, plus you cannot afford to lose the pay.

    Solution. You go to the ER which is open 24/7. Now lets factor in if you make it so the ER is even more expensive. People just do not go, therefore when they end up there they are sicker, end up spending more time out of work, and end up in worse shape.

    Our desired outcome is for people to go to the doctor more often, not less. Sadly we cannot just create doctors out of whole cloth by throwing money at it.

    This is the problem we should also be working on.

    You don't need to create doctors out of whole cloth. We need to build more pylons, build more medical schools, and train additional units. This obviously can't happen over night, but if we don't start working on it now, it's just going to get worse in the future.

    Deebaser on
  • shrykeshryke Member of the Beast Registered User regular
    edited May 2011
    Detharin wrote: »
    HamHamJ wrote: »
    [

    Being a cop is a hard job. Therefore the protection of the law is a privilege and not a right!
    Being a lawyer/judge is a hard job. Therefore the right to a fair trial is actually a privilege!
    Being a politician is a hard job. Therefore liberty is a privilege, not a right!

    Should I keep going?

    Sure, would you like to start with a right?
    As for your examples might want to start by looking up Castle Rock v. Gonzales.
    Lawyers are not required to take cases, and can fire clients. Let us not even get into what a Judge can do. Both may choose to listen to your case and grant you a fair trial, but neither is compelled to be there.
    As for putting politicians and liberty in the same sentence, that is just silly goosery and you know it.

    You cannot claim something is an inalienable right, that is yours merely by virtue of you existing, that requires another individual to labor or toil to make it so. I can say whatever i damn well please whether someone is around to hear me or not. I can decide I would rather be other there and start walking. When you have to compel someone to do something you cannot claim it as a right.

    So no one has a right to, say, an education in your mind?

    Because your entire argument is just as applicable to public education.

    shryke on
  • UseskaforevilUseskaforevil Registered User regular
    edited May 2011
    Deebaser wrote: »

    Personally IMO if more doctors as opposed to running 9-5 ran 1-10 it might help get more people to see their PCP. However getting doctors to do it is problematic considering most are already working long hours and have full patient schedules as is. Why work different hours when your existing hours are already booked solid?

    This is a good point. Docs have no real incentive to change their schedules because there isn't enough competition (Thanks AMA!).

    "most are already working long hours and have full patient schedules. " why would changing the block of time help with the # of patients seen?

    Useskaforevil on
  • bowenbowen How you doin'? Registered User regular
    edited May 2011
    Deebaser wrote: »
    Detharin wrote: »
    Deebaser wrote: »
    I disagree, copays can provide an incentive to change behavior. Insurance companies already use this to great effect.

    However the behavior you will change will not end up with the result you desire. Problem. You are sick and should see a doctor. Problem Your PCP is only available from 9-5. Problem if you call in sick to work they might fire you, plus you cannot afford to lose the pay.

    Solution. You go to the ER which is open 24/7. Now lets factor in if you make it so the ER is even more expensive. People just do not go, therefore when they end up there they are sicker, end up spending more time out of work, and end up in worse shape.

    Our desired outcome is for people to go to the doctor more often, not less. Sadly we cannot just create doctors out of whole cloth by throwing money at it.

    This is the problem we should also be working on.

    You don't need to create doctors out of whole cloth. We need to build more pylons, build more medical schools, and train additional units. This obviously can't happen over night, but if we don't start working on it now, it's just going to get worse in the future.

    This is what I'm getting at.

    bowen on
    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
  • AtomikaAtomika Live fast and get fucked or whatever Registered User regular
    edited May 2011
    bowen wrote: »
    The problem with nurses is that the degree of difference between an RN, a PA, and a full blown MD is practically a year. I think most RN degrees want a 4 year degree, require a test that is practically the MCATs, and then you go for another 4 years. When I was looking into an MD, it was pretty indistinguishable from the RN track at the same school. Except for the obvious clinical stuff doctors do that nurses don't.

    This is why it's hard to get RNs. It's not that it's hard, lots of things are hard, it is difficult from a random viewpoint but people who have trained in it are not especially frustrated by the level of difficulty in their career. No, you see, the problem is there is no incentive to go to school for practically the same amount of time for what is roughly 1/8th of a specialist's salary.

    I think RNs start at 85K here in specialty practices. Your average specialist makes anywhere from 250,000 to 1,000,000. Why would that be appealing at all? You get to take care of patients? I know doctors that care way more than RNs, that's silly. I've seen doctors see patients for free and even help pay for procedures because they want them to get better and healthy and having a healthy patient is much more satisfying than having one that's dying because Blue Cross won't approve a risky procedure but instead wants them to suffer for another few months to verify that they need it. The problem is not the doctors, the problem is the insurances.

    Where are you getting this from?

    The minimum RN requirements are usually no more than 1-2 years of science requisites, and then however long the actual RN program is. My alma mater has now gone to a 18-month program.

    As well, $85K is a ton of money. I didn't make that in New York City, and most critical care nurses (a specialty) in Texas start at around $48-50K.


    However, you've reminded me of another point in the cycle that makes thing needlessly difficult: education vs. accreditation and licensure. Many of the big private hospital systems are now preferring or demanding their RN staff to have advanced academic degrees (MSN or PhD). These degrees can take as long as 4 years to acheive and tens of thousands of dollars, yet the degrees themselves yield little-to-no increase in overall pay, and what's worse, the degrees themselves have virtually no practical workplace application, as being academic degrees they almost solely deal with topics of research and theory.

    Private hospitals are slowly raising the barrier for entry into the field for completely artificial and impractical standards, and they're doing so only for the reason that it makes them more appealing to customers (i.e. patients) who have no idea about any of that stuff anyway. They just like hearing their nurse has a master's degree.

    Atomika on
  • OctoparrotOctoparrot Registered User regular
    edited May 2011
    shryke wrote: »
    Detharin wrote: »
    HamHamJ wrote: »
    [

    Being a cop is a hard job. Therefore the protection of the law is a privilege and not a right!
    Being a lawyer/judge is a hard job. Therefore the right to a fair trial is actually a privilege!
    Being a politician is a hard job. Therefore liberty is a privilege, not a right!

    Should I keep going?

    Sure, would you like to start with a right?
    As for your examples might want to start by looking up Castle Rock v. Gonzales.
    Lawyers are not required to take cases, and can fire clients. Let us not even get into what a Judge can do. Both may choose to listen to your case and grant you a fair trial, but neither is compelled to be there.
    As for putting politicians and liberty in the same sentence, that is just silly goosery and you know it.

    You cannot claim something is an inalienable right, that is yours merely by virtue of you existing, that requires another individual to labor or toil to make it so. I can say whatever i damn well please whether someone is around to hear me or not. I can decide I would rather be other there and start walking. When you have to compel someone to do something you cannot claim it as a right.

    So no one has a right to, say, an education in your mind?

    Because your entire argument is just as applicable to public education.

    He's fucking insane.

    A police precinct decides they won't investigate a house being robbed and torched, all charred bodies lying inside and bloody footprints leading away from the scene. They just don't feel like it. Why should we compel free men to do something they don't want to do?

    Octoparrot on
  • bowenbowen How you doin'? Registered User regular
    edited May 2011
    bowen wrote: »
    The problem with nurses is that the degree of difference between an RN, a PA, and a full blown MD is practically a year. I think most RN degrees want a 4 year degree, require a test that is practically the MCATs, and then you go for another 4 years. When I was looking into an MD, it was pretty indistinguishable from the RN track at the same school. Except for the obvious clinical stuff doctors do that nurses don't.

    This is why it's hard to get RNs. It's not that it's hard, lots of things are hard, it is difficult from a random viewpoint but people who have trained in it are not especially frustrated by the level of difficulty in their career. No, you see, the problem is there is no incentive to go to school for practically the same amount of time for what is roughly 1/8th of a specialist's salary.

    I think RNs start at 85K here in specialty practices. Your average specialist makes anywhere from 250,000 to 1,000,000. Why would that be appealing at all? You get to take care of patients? I know doctors that care way more than RNs, that's silly. I've seen doctors see patients for free and even help pay for procedures because they want them to get better and healthy and having a healthy patient is much more satisfying than having one that's dying because Blue Cross won't approve a risky procedure but instead wants them to suffer for another few months to verify that they need it. The problem is not the doctors, the problem is the insurances.

    Where are you getting this from?

    The minimum RN requirements are usually no more than 1-2 years of science requisites, and then however long the actual RN program is. My alma mater has now gone to a 18-month program.

    As well, $85K is a ton of money. I didn't make that in New York City, and most critical care nurses (a specialty) in Texas start at around $48-50K.


    However, you've reminded me of another point in the cycle that makes thing needlessly difficult: education vs. accreditation and licensure. Many of the big private hospital systems are now preferring or demanding their RN staff to have advanced academic degrees (MSN or PhD). These degrees can take as long as 4 years to acheive and tens of thousands of dollars, yet the degrees themselves yield little-to-no increase in overall pay, and what's worse, the degrees themselves have virtually no practical workplace application, as being academic degrees they almost solely deal with topics of research and theory.

    Private hospitals are slowly raising the barrier for entry into the field for completely artificial and impractical standards, and they're doing so only for the reason that it makes them more appealing to customers (i.e. patients) who have no idea about any of that stuff anyway. They just like hearing their nurse has a master's degree.

    The nursing programs are really competitive here. There's talks of, like you're referring to, requiring masters and phd's for nursing in the area.

    Even the lower level of nurses (the exact abbreviation escapes me) they're looking for an associates first, but most have moved to bachelors with at least a minor in biology.

    bowen on
    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
  • DetharinDetharin Registered User regular
    edited May 2011
    shryke wrote: »
    So no one has a right to, say, an education in your mind?

    Because your entire argument is just as applicable to public education.

    An eduction, like most things are a privilege. Quite a few of the privileges we enjoy people assume are rights, but it really is not the case. Some people are lucky enough to live in cultures that treat them as such, others do not.

    Frankly if oftentimes seems people have developed an entitlement mentality, and it sickens me. No that doctor chooses to treat you, he is not required to. We are not required to built a school, and pay teachers to cram knowledge in kids heads. There is no guarantee to food, clean water, warm clothing, or a roof over anyones head. We as a society have chosen to invest in these privileges for various reasons. However at any point they can be taken away. Pretending we have to teach kids or have to treat the sick is completely disingenuous. A doctor refusing to treat you does not violate your rights.

    Detharin on
  • bowenbowen How you doin'? Registered User regular
    edited May 2011
    Life is a right, guess what, sometimes in your life you get sick. Which is why, surprise surprise, you can't be turned away from treatment if it can save your life.

    bowen on
    not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
  • shrykeshryke Member of the Beast Registered User regular
    edited May 2011
    Detharin wrote: »
    shryke wrote: »
    So no one has a right to, say, an education in your mind?

    Because your entire argument is just as applicable to public education.

    An eduction, like most things are a privilege. Quite a few of the privileges we enjoy people assume are rights, but it really is not the case. Some people are lucky enough to live in cultures that treat them as such, others do not.

    Frankly if oftentimes seems people have developed an entitlement mentality, and it sickens me. No that doctor chooses to treat you, he is not required to. We are not required to built a school, and pay teachers to cram knowledge in kids heads. There is no guarantee to food, clean water, warm clothing, or a roof over anyones head. We as a society have chosen to invest in these privileges for various reasons. However at any point they can be taken away. Pretending we have to teach kids or have to treat the sick is completely disingenuous. A doctor refusing to treat you does not violate your rights.

    You really need to read up on positive/negative liberty and such.

    You also need to look up what "entitlement" actually means.

    shryke on
  • AngelHedgieAngelHedgie Registered User regular
    edited May 2011
    Detharin wrote: »
    Deebaser wrote: »
    I disagree, copays can provide an incentive to change behavior. Insurance companies already use this to great effect.

    However the behavior you will change will not end up with the result you desire. Problem. You are sick and should see a doctor. Problem Your PCP is only available from 9-5. Problem if you call in sick to work they might fire you, plus you cannot afford to lose the pay.

    Solution. You go to the ER which is open 24/7. Now lets factor in if you make it so the ER is even more expensive. People just do not go, therefore when they end up there they are sicker, end up spending more time out of work, and end up in worse shape.

    Our desired outcome is for people to go to the doctor more often, not less. Sadly we cannot just create doctors out of whole cloth by throwing money at it.

    Do...do you not have urgent care facilities where you live?

    AngelHedgie on
    XBL: Nox Aeternum / PSN: NoxAeternum / NN:NoxAeternum / Steam: noxaeternum
  • DetharinDetharin Registered User regular
    edited May 2011
    Octoparrot wrote: »
    He's fucking insane.

    A police precinct decides they won't investigate a house being robbed and torched, all charred bodies lying inside and bloody footprints leading away from the scene. They just don't feel like it. Why should we compel free men to do something they don't want to do?

    Castle Rock v. Gonzales for one. For two yes do you really think you can force the police to pursue an investigation? It really seems your not understanding what a right is.
    Bowen wrote:
    Life is a right, guess what, sometimes in your life you get sick. Which is why, surprise surprise, you can't be turned away from treatment if it can save your life.

    Because we as a society choose not to, not because it is a right. Really this is not a confusing concept. You are mistaking privileges granted to us by how we choose to run our society and declared them natural. Saying "hospitals should not turn anyone away" has lead to "we will do what we can to save your life." That is how we have chosen our society to work. This is not how it works in every country however. Again it is really simple, if whatever "right" you think you have creates responsibility in another it is privilege and should be treated as such.

    Detharin on
  • KistraKistra Registered User regular
    edited May 2011
    bowen wrote: »
    bowen wrote: »
    The problem with nurses is that the degree of difference between an RN, a PA, and a full blown MD is practically a year. I think most RN degrees want a 4 year degree, require a test that is practically the MCATs, and then you go for another 4 years. When I was looking into an MD, it was pretty indistinguishable from the RN track at the same school. Except for the obvious clinical stuff doctors do that nurses don't.

    This is why it's hard to get RNs. It's not that it's hard, lots of things are hard, it is difficult from a random viewpoint but people who have trained in it are not especially frustrated by the level of difficulty in their career. No, you see, the problem is there is no incentive to go to school for practically the same amount of time for what is roughly 1/8th of a specialist's salary.

    I think RNs start at 85K here in specialty practices. Your average specialist makes anywhere from 250,000 to 1,000,000. Why would that be appealing at all? You get to take care of patients? I know doctors that care way more than RNs, that's silly. I've seen doctors see patients for free and even help pay for procedures because they want them to get better and healthy and having a healthy patient is much more satisfying than having one that's dying because Blue Cross won't approve a risky procedure but instead wants them to suffer for another few months to verify that they need it. The problem is not the doctors, the problem is the insurances.

    Where are you getting this from?

    The minimum RN requirements are usually no more than 1-2 years of science requisites, and then however long the actual RN program is. My alma mater has now gone to a 18-month program.

    As well, $85K is a ton of money. I didn't make that in New York City, and most critical care nurses (a specialty) in Texas start at around $48-50K.


    However, you've reminded me of another point in the cycle that makes thing needlessly difficult: education vs. accreditation and licensure. Many of the big private hospital systems are now preferring or demanding their RN staff to have advanced academic degrees (MSN or PhD). These degrees can take as long as 4 years to acheive and tens of thousands of dollars, yet the degrees themselves yield little-to-no increase in overall pay, and what's worse, the degrees themselves have virtually no practical workplace application, as being academic degrees they almost solely deal with topics of research and theory.

    Private hospitals are slowly raising the barrier for entry into the field for completely artificial and impractical standards, and they're doing so only for the reason that it makes them more appealing to customers (i.e. patients) who have no idea about any of that stuff anyway. They just like hearing their nurse has a master's degree.

    The nursing programs are really competitive here. There's talks of, like you're referring to, requiring masters and phd's for nursing in the area.

    Even the lower level of nurses (the exact abbreviation escapes me) they're looking for an associates first, but most have moved to bachelors with at least a minor in biology.

    I think you mean RNs. RN is basically an associates degree in nursing, two years with no prior education, one year if you already have a bachelors in anything.

    BSN (bachelors of nursing) is a four year degree (or an additional 12 months if you already have an RN).

    The nursing program at my undergrad was very competitive in that it admitted a small percentage of the people that applied and wanted good grades and recs and stuff, but they still primarily admitted kids straight out of high school.

    There is a new DNP (doctorate of nursing) but it is primarily designed to take in current nurses and train them to become professors at nursing schools. So it is usually part time and done by older people.

    PA school is usually ~2 years after getting a bachelors.

    None of these approach 4 years of undergrad + 4 years of med school + 3-7 years of residency for a doctor. And for a a good reason, they are each supposed to be doing different things.

    Kistra on
    Animal Crossing: City Folk Lissa in Filmore 3179-9580-0076
  • AtomikaAtomika Live fast and get fucked or whatever Registered User regular
    edited May 2011
    shryke wrote: »
    Because your entire argument is just as applicable to public education.

    We've had this argument a bajillion times here, and I think we all settled on the phraseology:

    "Everyone should have the right to access to healthcare."


    If we're using the public education analogy (which isn't perfect) and hospitals are the schools, teachers can't make people smarter the same way doctors can (albeit sometimes temporarily) make people healthy.

    Atomika on
  • TenekTenek Registered User regular
    edited May 2011
    Detharin wrote: »
    Octoparrot wrote: »
    He's fucking insane.

    A police precinct decides they won't investigate a house being robbed and torched, all charred bodies lying inside and bloody footprints leading away from the scene. They just don't feel like it. Why should we compel free men to do something they don't want to do?

    Castle Rock v. Gonzales for one. For two yes do you really think you can force the police to pursue an investigation? It really seems your not understanding what a right is.
    Bowen wrote:
    Life is a right, guess what, sometimes in your life you get sick. Which is why, surprise surprise, you can't be turned away from treatment if it can save your life.

    Because we as a society choose not to, not because it is a right. Really this is not a confusing concept. You are mistaking privileges granted to us by how we choose to run our society and declared them natural. Saying "hospitals should not turn anyone away" has lead to "we will do what we can to save your life." That is how we have chosen our society to work. This is not how it works in every country however. Again it is really simple, if whatever "right" you think you have creates responsibility in another it is privilege and should be treated as such.

    We as a society could choose to deny you free speech, too. "Right" is a label you can apply to whatever things you consider that people are automatically entitled to. It's an opinion question.

    Tenek on
  • AtomikaAtomika Live fast and get fucked or whatever Registered User regular
    edited May 2011
    Kistra wrote: »
    bowen wrote: »
    bowen wrote: »
    The problem with nurses is that the degree of difference between an RN, a PA, and a full blown MD is practically a year. I think most RN degrees want a 4 year degree, require a test that is practically the MCATs, and then you go for another 4 years. When I was looking into an MD, it was pretty indistinguishable from the RN track at the same school. Except for the obvious clinical stuff doctors do that nurses don't.

    This is why it's hard to get RNs. It's not that it's hard, lots of things are hard, it is difficult from a random viewpoint but people who have trained in it are not especially frustrated by the level of difficulty in their career. No, you see, the problem is there is no incentive to go to school for practically the same amount of time for what is roughly 1/8th of a specialist's salary.

    I think RNs start at 85K here in specialty practices. Your average specialist makes anywhere from 250,000 to 1,000,000. Why would that be appealing at all? You get to take care of patients? I know doctors that care way more than RNs, that's silly. I've seen doctors see patients for free and even help pay for procedures because they want them to get better and healthy and having a healthy patient is much more satisfying than having one that's dying because Blue Cross won't approve a risky procedure but instead wants them to suffer for another few months to verify that they need it. The problem is not the doctors, the problem is the insurances.

    Where are you getting this from?

    The minimum RN requirements are usually no more than 1-2 years of science requisites, and then however long the actual RN program is. My alma mater has now gone to a 18-month program.

    As well, $85K is a ton of money. I didn't make that in New York City, and most critical care nurses (a specialty) in Texas start at around $48-50K.


    However, you've reminded me of another point in the cycle that makes thing needlessly difficult: education vs. accreditation and licensure. Many of the big private hospital systems are now preferring or demanding their RN staff to have advanced academic degrees (MSN or PhD). These degrees can take as long as 4 years to acheive and tens of thousands of dollars, yet the degrees themselves yield little-to-no increase in overall pay, and what's worse, the degrees themselves have virtually no practical workplace application, as being academic degrees they almost solely deal with topics of research and theory.

    Private hospitals are slowly raising the barrier for entry into the field for completely artificial and impractical standards, and they're doing so only for the reason that it makes them more appealing to customers (i.e. patients) who have no idea about any of that stuff anyway. They just like hearing their nurse has a master's degree.

    The nursing programs are really competitive here. There's talks of, like you're referring to, requiring masters and phd's for nursing in the area.

    Even the lower level of nurses (the exact abbreviation escapes me) they're looking for an associates first, but most have moved to bachelors with at least a minor in biology.

    I think you mean RNs. RN is basically an associates degree in nursing. The program at my school is 12 months long if you already have a bachelors in anything.

    BSN (bachelors of nursing) is a four year degree (or an additional 12 months if you already have an RN).

    The nursing program at my undergrad was very competitive in that it admitted a small percentage of the people that applied and wanted good grades and recs and stuff, but they still primarily admitted kids straight out of high school.

    There is a new DNP (doctorate of nursing) but it is primarily designed to take in current nurses and train them to become professors at nursing schools. So it is usually part time and done by older people.

    PA school is usually ~2 years after getting a bachelors.

    None of these approach 4 years of undergrad + 4 years of med school + 3-7 years of residency for a doctor. And for a a good reason, they are each supposed to be doing different things.

    As well, 4-year degrees or higher in nursing are a waste of time and money in the context of clinical practice.

    And the term is still "RN" no matter what level your education is at. "RN" just means you've passed the federal requirement exam, the NCLeX.

    Atomika on
  • OctoparrotOctoparrot Registered User regular
    edited May 2011
    Detharin wrote: »
    Octoparrot wrote: »
    He's fucking insane.

    A police precinct decides they won't investigate a house being robbed and torched, all charred bodies lying inside and bloody footprints leading away from the scene. They just don't feel like it. Why should we compel free men to do something they don't want to do?

    Castle Rock v. Gonzales for one. For two yes do you really think you can force the police to pursue an investigation? It really seems your not understanding what a right is.

    You've decided that nothing, neither life nor liberty, is a right.

    Octoparrot on
  • AtomikaAtomika Live fast and get fucked or whatever Registered User regular
    edited May 2011
    bowen wrote: »
    The nursing programs are really competitive here. There's talks of, like you're referring to, requiring masters and phd's for nursing in the area.

    Even the lower level of nurses (the exact abbreviation escapes me) they're looking for an associates first, but most have moved to bachelors with at least a minor in biology.

    It's going that way all over country.

    And it's a colossal crock of shit.

    Atomika on
  • DetharinDetharin Registered User regular
    edited May 2011
    Saying whatever I damn well please does not protect me from the consequences of saying whatever I damn well felt. Which is why we have damn few rights, and a heck of a lot of privileges. As a society it is vital to both understand the difference, and understand privileges can be taken away.

    Detharin on
  • ShanadeusShanadeus Registered User regular
    edited May 2011
    You can force a doctor to treat you.
    By making it one of the requirements for being accepted into medicine school and training to become a doctor.

    Otherwise known as the hippocratic oath.
    Don't follow it and you will no longer fulfil the requirements of being a doctor.

    But I understand your point.

    Shanadeus on
  • TenekTenek Registered User regular
    edited May 2011
    Detharin wrote: »
    Saying whatever I damn well please does not protect me from the consequences of saying whatever I damn well felt. Which is why we have damn few rights, and a heck of a lot of privileges. As a society it is vital to both understand the difference, and understand privileges can be taken away.

    Which are the rights that can't be taken away?

    Tenek on
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