The f-ed up thing is, I’m relieved they didn’t pull this crap with cheat n’ pass… But then, the only reason they didn’t was because they got enough votes for Reconciliation after Stupak caved and covered his ass with that Presidential order. *sigh* dirty dirty dirty… Hopy changy…

The main thing we’ll need is more primary care doctors. And since we already have a shortage of them, we’re going to cut Medicare and Medicaid payments to doctors – basically giving them a pay cut. That way, current doctors will be more inclined to continue accepting Medicare and Medicaid (which is important because many currently uninsured – and insured – will be dumped into Medicaid) and future doctors will be more likely to become doctors due to the incentive of not being able to maintain a small practice and will have to work for a huge bureaucratic network – practicing defensively all the live long day.

I know you’re upset about the lack of a public option, but don’t worry. All the big Dems in Congress have assured us that this is just the first step, “a starter house”.  And if the next step is in the same direction as the first, we’ll have some socialized medicine in no time, just like Europe. That’ll keep all those foreigners out, coming here to be doctors and be treated properly by doctors. Sheesh.

But seriously, now that the Filibuster is dissolved, when Palin’s serious-teaparty-Conservatives are marching hip-to-hip shoulder-to-shoulder in the majority, she’ll cut all this crap in the name of fiscal prudence. Hell, if the Dems keep up this type of behavior, by the end of 2013 we might see the army privatized and the IRS deported. Declaring was will be in the form of an RFQ – lol. (Request for Quotation)

Isn’t this discussion about the healthcare bill funding abortion misguided? And for that matter, isn’t the whole abortion rights / anti-abortion argument misguided? Are there really that many people who think they should tell gynecologists how best to treat their patients’ complicated illnesses? Are there really that many people willing to allow our society to use abortion as a form of birth control? And aren’t abortion clinics exploiting women – physically and psychologically? And who the hell becomes and abortionist?

That’s where I think the logical split is: treatment and elective. Women can become pregnant. Women can also become ill. The human body is complicated. The human reproductive system is complicated. Sometime, for complicated reasons it takes years of study to understand, a woman’s life or health will required the abortion of a fetus to preserve.

In such a case her doctor performs the abortion or at least refers her to a trusted doctor to do it. If she has complications she returns to either doctor, she goes back to the office. If she has emergency complications and ends up in the emergency room her doctor gets a call, or whoever is on call is called. Either way the doctor is treating the patient – start to finish.

An abortion clinic is different. If you have complications after a common elective abortion you’ll likely end up in the emergency room and who knows if they’ll be able to get a hold of who actually did the abortion to get a proper history. Regardless, the abortionist isn’t treating a patient. An abortionist is just performing a service, like a piercing or tattoo. When he screws up, it’s someone else’s problem to fix. And besides that, who becomes an abortionist? Seriously. From what I hear most are vaguely qualified physicians who can’t find real employment.

What do you think Dr. Dove? I’m I just delusional again or am I onto something here?

We will get healthcare reform. If Congress can’t destroy it first, the market will destroy healthcare for us. Something will happen.

I used to think doctors would be the ones to fix it, but I’m realizing we’re a big part of the problem.  We’re human like everyone else. However, not all of us use our intellect for the greater good. Some of us are content to work hard to become good physicians, and use that skill base to help people and make an above average income. However, there are others who look for ways to make money. They’re smart, so they find ways. There are lots of ways to make money…lots of money…like a million dollars a year or more. Mohs surgeons (who perform microscopically controlled surgery) are a great example. The details of what they do are a bit complicated, but overall, they do  skin surgeries in a way that achieves cosmetically improved results, but costs volumes more than the procedure would cost if done differently. Mohs surgeons can make like a million dollars a year. Patients want improved cosmetic results; they get Mohs; insurance companies pay for it; premiums go up. That’ only one example.

Doctors need to be the ones controlling healthcare, but doctors are human. Damned being human.

Recently, while attending in the lab, I received a call from my close friend Noisy Dove who was on vacation in the wild west of Utah. He posed an interesting question to me, looking for the expertise of a Doctor to satisfy his inquiry. His question was this…

“Is it really necessary to build a nest before using a public restroom? It has always been my understanding that ass-itch and dick-rot are illnesses commonly caught from toilet seats. If so, could you recommend an effective nest building technique? I favor the quick twin-rail approach with a safety sheet over the front of the bowl to keep from accidentally touching my wank on anything. I’ve seen some pretty impressive nests constructed by making numerous loose roles of tissue and lining them up. And I’ve pondered just lifting the seat up and wrapping it thoroughly before taking a seat.

Oh, and what about those specially made seat covers in the dispenser? Will those substitute for a nest? There is a little trick to using those without tearing them in half AND having an opening through which to drop your shit through – but hell if I know what that trick is.

My other idea is to get one of those little cans of Lysol and just blast the whole thing down then dab it off.“

So first, let’s clear up a couple of facts. Ass-itch is rarely associated with public toilet seat use. There are numerous contagious rashes one could presumably catch ass-to-ass via a toilet seat, but most of these conditions are more likely to be transferred via the hand to the ass. Other causes of ass-itch are heat induced rashes and of course not properly cleaning the ass after defecation. Dick-rot will not likely be transferred via a toilet seat. This condition is almost always associated with poor hygiene – neglecting the shower and not changing underwear. Look it up.

More common dangers involving the public toilet seat are diseases in the urine and feces that inconsiderate low-lives leave on the seat. Most of these will not infect a person through the ass skin, but could be transferred other ways. Say you sit on a seat with Hepatitis piss on it. Then later you scratch your ass. Then later still you use that same hand without washing it to free a popcorn cornel from the back of your thought. You might catch Hepatitis this way. So certainly, if you reduce your ass’s contact with the toilet seat it will reduce the chance of catching disease – and so will thoroughly washing your hands often.

As for a technique, I would start before you even enter the john. I always try to kick my way to the toilet without touching anything. I then poke the toilet paper role with my pinky until I can grab a nice long piece – discarding the first foot immediately. I can then use that tissue to touch everything else – starting with the stall door and a preliminary sanitary flush or two.

The actual nesting technique I use is often more dependent on quickness rather than cleanliness – so I also usually use the twine rail method with safety sheet. But if I’m not is a hurry, or suspect I may be seated for a duration of time, I’ll certainly spend some extra time laying down a more thorough layering all around.

The Lysol idea is a good one. I might use that as well. It’s similar to another measure I often take. If I have a bottle of water with me, I’ll often give the seat a quick rinse and dry it with tissue.

In severe cases I’ve actually used toilet water to rinse off the seat by dipping a wad of tissue. When the seat is really bad – a rinse with well flushed toilet water is an improvement.

In a single payer option there would be no competition. That’s why it’s called single payer. That’s what Canada and Australia have. It only concerns the payment side, like Medicare. Obama did believe in this until just recently. I mean, that was one of the reasons many people voted for him. But now he no longer supports it.

He claims, from what I’ve heard, that he doesn’t think single payer is a good option for our country, not American. And the piles and piles of video clips the Conservatives are pounding him with – well he’s just pretending those never happened. More likely he’s either given up on it because it has totally lost popular support, or he’s still planning on getting it but – as he explained in a few of those videos – will have to start with the public option.

A public option is simply a government run or government controlled health care insurance provider. Single payer would kill – perhaps with direct legislation – any private competition. It wouldn’t directly affect the health care industry, but would almost certainly affect is through timeliness and size of payments. So – more than likely – new advancement would be slowed because – being new – the new advances would not be recognized by the single payer insurer. That happens with public insurance too, but there are options in public industry. You can leave, make demands, start a website, bitch to your employer, and all the other consumer things.

According to Obama a public option would simply add one more insurance provider to the market, and be good for competition. This directly contradicts the reasons for even having a public option though. There are uninsured people, people who can’t afford insurance, and people whose insurance doesn’t cover their illnesses. Those are the people single payer would be created to serve. To serve these people the public option would have to be comparable with the best common private insurance plans – the ones that actually pay medical bills – AND be super cheap. Great coverage at an affordable price doesn’t exist in the private sector because it’s not possible – forget about profit. Blue Cross provides great coverage, is non-profit, but still costs over $500 a month for a single person.

A public option would eventually become single payer because everyone would move there for the better deal, or be dumped there by employers looking to cut that cost. There’s no way around it, unless you have a lot of faith in complex regulations and piles of forms.

Socialized medicine is a HUGE step further – HUGE. That’s what the UK has. The medical industry its self is a government run entity. Achieving this just isn’t possible in our society. It’s also totally insane and actually against the constitution. Britain’s system was changed during WWII out of total desperation for survival.

Anyone seriously advocating socialized medicine in the US is either innocently confused about what it means or is just plain uninformed. A serious move like that could seriously cause a revolution. It would involve government taking over everything from publicly (public stock, not government) held hospital and university institutions to privately owned private practices and clinics. And the government would have to either steal them or buy them, and since the government only gets money from taxes, it would have to tax (steal) a big chunk of cash to do it. A lot. That boat wouldn’t float.

Palin is talking about two things I think. One might be the clause that provides DNR consultations. But the valid thing she’s talking about is the eventual (or immediate) need in any universal provider of anything for free (or paid for through taxes not in proportion to that service) is the need to — ration. And you don’t ration life-saving care away from productive tax revenue sources. It would only be a matter of time, a new downturn or war, before priorities would have to shift to the healthy intelligent young people and the old and deficient would all be screwed – because there aren’t any other options for someone who wants to care for a retarded child or old senile parent.

But her words were still terribly unwise. She threw her lot in with the irrational “Birthers” the Liberal media is making all Conservatives out to be. Getting overly dramatic is off-putting. And universal is totally out with even a public option under pressure. So in reality it’s a little irrational.

And remember. Health care isn’t rationed right now. I keep hearing people say insurance companies ration, or health care is rationed by the fact that people can’t afford it. That’s silly. Rationing means you only get so much, or have to wait for, an amount of something. By that logic you could say the grocery store rations steak because people can only afford so much – or can’t afford any – or food stamps only buy so much. That’s not rationing. You can buy all the steak you want – if you have the money. Regardless of money you could only have so much rationed steak.

Noisy Dove recently sat down with our medical consultant, Dr. Dove. Noisy Dove discussed the health care reform at length with Dr. Dove. Here are the highlights of Dr. Dove’s perspective as one actually in the trenches.

Noisy Dove:

So Dr. Dove, what do you think of the 1000 plus page health care reform bill?

Dr. Dove:

I haven’t read the 1400 page bill, but I do have a few thoughts.

1. Doctors need to make a lot of money. There is no damn way we should be put through the insanity we are without a giant salary waiting for us if we survive. What other profession requires you train for at least 11 years before you can practice on your own? Where else can you be sued for not being really damn smart? The 140K salary figure some have thrown out makes my stomach hurt.

2. Doctors can leave patient care. People do it frequently. If our pay drops enough, and being a doctor starts to suck worse than it already does, we will find something else to do. Of all the professions on the planet, we probably have the highest IQs. We can get creative.

3. We want our valedictorian wankers to become doctors. If they don’t, someone else will. Those someone elses will be the non-valedictorian wankers. Medicine is incredibly intellectually demanding for the brightest among us, and the quality of patient care is directly proportional to the managing physician’s brainpower.

4. We need “death boards.” At the moment, patient families basically decide if they want their loved one to be kept “alive.” A lot of patients shouldn’t be kept “alive.” For example, like you pointed out, old people with the intellectual function of an alligator shouldn’t be kept alive in the ICU or in nursing homes. It’s a vast waste of resources (money, nursing, physicians, respiratory therapists, etc, etc, etc). The resources need to be spent on people we can actually help. Committees of doctors (ONLY doctors) need to have the power to stop that kind of wastefulness. It might sound cold, but we are reaching a critical point in healthcare finance. We can’t waste money because a family can’t accept mom is dead even though her heart is beating. “Death boards” won’t fix the problem, but they will help.

5. People will get retarded about what I wrote in 4. When speaking to some concerned citizens over the weekend, they had all kinds of completely insane ideas about what “death boards” would be doing. They told me a group of bureaucrat would come to your house at age 65 and decide you can’t be resuscitated if you have a family history of heart disease. That’s lunacy. They wouldn’t function like that.

The futile medical care is a big problem. I remember being on call once, and getting on theelevator with a senior resident I knew pretty well. It was late, and I was getting my ass kicked. He asked how I was doing. I said, “I’m killing myself to keep dead people alive.” He started to chuckle and shake his head “yes.” The elevator stopped, and he got off, chuckling to himself and shaking his head in aggreement as he walked away. This isn’t a small problem.

Pikachu Death Squads image by Dark Cloak

LOL England’s health system, with 1.33 million employees, is the fourth largest employer in the world behind the Chinese Red Army (2.25 million) Wall-Mart (1.8 million) and the Indian Rail (1.4 million). There are more managers than doctors.

The UK medical system is the envy of hard core Liberals. Unlike Canada where it is illegal to practice private medicine, the UK does allow its citizens to purchase medical care – but – once they do the public system won’t care for the illness treated. UK citizens are charged no money for medical care. Actually, the hospital pays patients money for the ride home and other incidentals. The trouble is the wait and quality. Everything is rationed.

This is only natural. The English didn’t sit down one day and decide their medical system should be government run rather than publicly. They had no choice. The system began during World War II while all of the British Empire was mobilized toward the war effort. Every aspect of civil life was being rationed. Numerous businesses were being taken over. The society was literally fighting for its survival.

So why didn’t the British simply revert to a more efficient system that delivers higher quality after the war? Well they simply can’t. The bureaucracy is so huge it represents a challenging voting block – 1.33 million people. If the US matched this ratio its government run health care system would employ 6.65 million people, and would take the place of the world’s largest employer, The Chinese Red Army, with three times as many people.

Thankfully Washington isn’t talking about socializing the medical system. Obama gave up on this one and focused on socializing health coverage. Then, he gave up on that.

The goal right now for Obama and the liberal Democrats is to push a government health insurance option through. As Obama has assured us over and over, this option will be a choice and won’t compel anyone to change their coverage. However, as he and others in his camp have explained numerous times, a public option is the first step toward socialized health care. A government option will unfairly compete with private options eventually killing them off, the ones Nancy Pelosi hates for turning a profit, and the ones like Blue Cross who are non-profit.

Even with the super majority that had all the Conservatives scared out of their minds, passing any type of medical system reform will be tricky. Why? Well – Obama and the Pelosi brigade scared the fur off all of us except for the most blindly staunch Liberals by blitzing that “stimulus” monstrosity through without reading it, then confirmed the precedent and our paranoia with the cap and trade / climate control bill – battering ram through the house.

Also, there was no Change®. After six months we’ve seen even less transparency and more belligerence than we saw with the Evil Bush. He seems to have plugged right into the old Washington partisanship and political lies. No bipartisanship to be found. Sure, there was the little show Obama had initially, the meeting all his Koolaid drinkers site when they talk about his graceful treatment of the vanquished dregs. But so far Obama has had the Democrats write the bills, and then force them through running political ads calling the Republicans the party of “NO”. Wow, some change.

And oh yeah, to top all this off Obama and his press secretary are dismissive and make fun of us – along with the rest of the pompous officials claiming that the public desent is manufactured – Astroturf® – by Conservative groups paying people to put on a dramatic show. Gee, where did those Conservative groups get that idea?

The fact is our health care system is the best in the world. People come here when they can afford it. When Americans want the best health care, they stay in the US and get it. But there are problems. There are also areas needing improvement and areas that could be improved. But it’s still really great. We are doing amazing things.

The trouble is paying for all these amazing things. Often people get sent to the poor house because of illness. And we have people without a way to pay who end up in the emergency room getting the most expensive last resort type of treatment – because they put it off.

There needs to be reform. The health care system is overstretched – we need more doctors and nurses. Any reform needs to recognize this fact.

(Photo credit:  The Doctr on Flick.)

Obama, since he started his candidacy, has used somewhat rosy numbers to calculate the costs and benefits of the policies he advocates. His first big one was the promise of “tax cuts” for the poor and middle class, do you remember, even for people who don’t pay income taxes in order to “spread the wealth around”? And added to that he was also going to reduce the national debt. Yeah, campaigns are historically full of wishful promises.

After inauguration this didn’t change though. Right away we had the obnoxiously obese stimulus bill. That was based on the rosiest of rosy turn-arounds and unemployment rates. It was hard-core wrong of course, things rarely have the best possible outcome.

So let’s remember this as we examine new legislation. Here is a prime example of a rosy assumption in this health care reform effort: if we put money into prevention it will save the new health care system money in the future. That sounds perfectly logical. Seriously! Let’s make sure we treat our diabetes so we don’t have the expense of foot removal.

In some cases this logic will apply. Someone who suffers from seizures, for example, can sometimes be easily treated with a cheap daily medicine (It’s seriously cheap, my dog is on it). The alternative would be a person seizing and falling on the floor and getting hurt all the time – costing money.

However, according to the Congressional Budget Office, prevention would at best result in marginal savings, and could very well cost more. Here is a good article on the subject:http://online.wsj.com/article/SB124476182985608115.html#articleTabs%3Darticle

Disease prevention, like cancer screens, is money spent on people who weren’t going to get sick anyway. You have to screen a lot of people to find the sick ones and you get false positives that require further tests. And life style change is a touchy subject. Even if our society takes the path of compelling people to live a certain way, changing that behavior is about impossible. Look at all the expensive stop-smoking programs – and holy crap look at the diet industry.

Even though cancer, heart attacks, and other common problems are expensive to treat, preventing them isn’t any cheaper when budgeting for a whole society, and as technology improves and creates better screens it will likely get more expensive. And worse, prevention would produce another large cost these types of programs are rarely constructed to handle: people not dying at a convenient age. That is one of the main problems with Social Security. During FDR’s time you were doing well to reach 65 – now you have to get into a car accident to die that young.

Now – if you’re a person who has a difficult time grasping overall subjects and main ideas – you might disagree with a perceived conclusion – I don’t believe in prevention. If that’s the case you can relax. I haven’t made a conclusion.

Here is my conclusion: Contrary to the idea Obama is trying to sell us, prevention won’t be one of the things that miraculously gives all Americans access to health care without raising taxes on the non-rich.

So see, you had nothing to be disagreeable about. In fact, I very much believe in prevention. I also believe in health care/insurance reform. Specifically, I believe in leaving health care the hell alone, for the most part, and focus more on an electronic medical records standard and ways to grow the medical field. Insurance laws need some changes. People get screwed way too often and you should be able to buy into groups outside of an employer.

Talk to some people, maybe some Canadian patients, doctors, or medical residents.  They would describe the type of health care system that drives doctors, nurses, and patients alike to move the hell off the maple orchard.

I agree wholeheartedly with American doctors on the annoyance with politicians talking as if doctors are tapping patients for cash – likewise beating down the medical community. That’s one of the reasons I was curious as to a physician’s opinion of Obama’s talk. He slapped the doctor profession around a bit with a humorously illogical scenario where a pediatrician might do a tonsillectomy on a kid with a sore throat for the money, rather than check for an allergy problem. How do you like that? The guy who wants to reform our healthcare systems thinks pediatricians do surgery.

Don’t worry about understanding the healthcare reform bill just yet. There are several versions and all are 1000+ pages long. I’ve been hearing a number of things in the news about what those peacocks have been doing – besides bashing the healthcare system.

I think what’s actually happening now is a bit of grid-lock between the moderate Democrats and the Pelosi Democrats. Single-payer is out – officially. But a government option isn’t, which if set up right, would result in single payer. No one wants to give details.

Here is the odd thing though: We all know once they do figure something out, the Democrats can pass it on their own easy and breezy. But, they are showing some subtle signs here and there of actual bipartisanship – if you consider Reid saying, “We’ll do what we can to make sure their [Reps] issues are not buried” – a glimmer of bipartisanship.

If the Dems do put together a supermajority and push a bill though, they’re going to be totally responsible for it. Even if it is a thoughtful plan, new programs rarely come out of the gate in a healthy stride. If they pass something that puts millions of people through a goofy transition, causes employers to shed their benefits, or sends uninsured people though loops with disappointing initial outcomes, like restrictions on doctors they can see – the Dems are going to look like clumsy bastards (Edit: and bitches).

I think that fact might be keeping some of the powerhouses like Pelosi and Emanuel from getting really ruthless on this one. That and some actual resistance congress is hearing from back home – from the 50% or so of Americans not liking “the bill”.

I think these guys need to remember the US healthcare system is worth that extra $6000 per year – regardless of their handy statistics on this ailment or that (all of which can be countered using other diseases). People come here all the time for our health system. If it’s not the best in the world it’s damn close. There are some real improvements that could make a real difference of course, like electronic medical records, or curtains without vomit on them. But I think the thing that needs reform isn’t the health care system. It needs to grow – yes – but what most people are worried about and talking about is paying for health care. But if we reform health care with the primary goal of making it affordable to all – and harm the quality – it’s not really worth it, is it?

Story quoting Reid:

http://firstread.msnbc.msn.com/archive/2009/07/23/2006490.aspx