Bob Gorrell for September 16, 2009

I could have sworn we had an election that demonstrated more power than a few “demonstrations” put on by sore losers and the duped.

dtroutma, it wasn’t a landslide.

“I could have sworn we had an election that demonstrated more power than a few “demonstrations” put on by sore losers and the duped.”

Of course that is correct. And we actually have a precedent. Bush was elected and then reelected and never did the Democrats utter one word in opposition or demonstrate against his plans. We want the same response from the losers in this last election.

“Stupid people and juveniles deceived by acorn and others voted for “change” and got ineptitude corruption and hubris at odds with real Americans”

You could say this or something similar for every election. Which either means “real Americans” are inherently stupid, or the election system is screwed up, OR we have been so divided as a country from the get go that unity never was possible.

70,000 teabaggers marched on Washington. 70,000,000 Americans voted for Obama. The majority is still with the President, no matter how loud and rude the teabaggers get. GOP, continue to dream that you are the majority, and you will continue to remain asleep.

“You could say this or something similar for every election. Which either means “real Americans” are inherently stupid, or the election system is screwed up, OR we have been so divided as a country from the get go that unity never was possible.”

Actually, the last presidential election was quite different from any other, indeed it was more akin to a perfect storm:

Most news-media outlets became 0bama’s campaign centers.

No white person could be elected a dogcatcher if he had attended KKK, or other like ‘church’ meetings for 20 years.

With the fall of Global Communism a couple of decades away, Marxism, Socialism and such were all but off radar.

Most importantly though, the worldwide financial crisis that exploded weeks before the election, cementing the demise of the party in power - however wrongly perceived it was - Democrats controlled the Congress, but hardly anyone knew.

charlie, there were only 169,000,000 registered voters in 2008. There were 129,391,814 votes cast in the presidential election. So what does the 140,000,000 number represent?

Obama won 52.9% of registered voters, a larger win percentage than 2000 and 2004.

charlie555, to put context around the numbers you cite, you would need to go through the same process for previous elections. I don’t just mean Bush, go back to Clinton too. Without context, those numbers have no real meaning.

Here in NYC on Tuesday we had a primary election. there was an 11% turnout. That meant 90-95% of citizens did not vote for the winner. I think, if you don’t vote you can’t complain.

Nomad? Was Bush’s 2004 victory a “landslide?”

By the way, it’s early yet. Let’s see how the community organizer does on the back 9.

“Stupid people and juveniles deceived by acorn and others voted for “change” and got ineptitude corruption and hubris at odds with real Americans”

There might have been a few like that, yeah. However, I can bet you a cookie that most people who voted for Obama were “real Americans” themselves.

charlie555, but it is hard for me not to wonder if you felt Bush should have followed the same restraint, since he did not even win the popular vote in 2000, and won in 2004 with a smaller percentage than Obama did in 2008. Do you see what I’m getting at?

I doubt this Administration is ignoring the divisiveness and discord. The “bully pulpit” is one of any president’s greatest advantages. Obama is not confrontational in his remarks, he’s sought to seek agreement that could be built upon. I admit he was more critical of the false charges being made (death panels, etc) in his address to a joint session of Congress, but I thought he needed to be;. those false charges had been hanging out there unchallenged by the administration too long.

IMO, he’s has consistently sought to distance himself from racism brouhahas, as he did again recently. I give him credit for that.

@Charlie Welcome aboard.

I have been attempting to make your exact points for the last few months. Well articulated. But I am afraid all your logic will fall on deaf ears.

You say rationing, Obama says death panels and the response (see above) is you are lying there are no death panels. They are unable to see a connection between rationing and limiting very expensive medications and the subsequent consequences.

charlie, I appreciate your thoughtful responses … you and I have had some constructive dialogue. I hope this can be another constructive dialogue.

I believe there is tremendous misunderstanding of the medical panels (I don’t know if they’re actually called panels in the House bill) Obama has talked about. They make perfect sense to me and they deal with a subject physicians have long known about. In some areas of the country, for example, the overwhelming percentage of children have their tonsils removed. In other areas, almost no children have their tonsils removed. Yet there is no difference in the health of the children.

Obama has given different examples in different speeches, but here’s one from June 9: That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That’s how we can achieve reform that preserves and strengthens what’s best about our health care system, while fixing what is broken.

I would have to do much more research to find concrete examples, but I recall Obama gave some at a town hall meeting some months ago. He compared the costs and outcomes of very specific conditions at two healthcare centers in the U.S. The first center spent about one-half as much per patient as the second, yet had better outcomes than the center that spent twice as much. Because I worked in healthcare administration for so long, I know this “waste” exists. Sometimes it’s just a case of what some physicians are used to doing, so they keep doing.

Medical researchers have been studying the efficacy of specific treatments for a long time. This is not a political issue at all. The research is there and it’s been shared and adopted in specific areas, but not on a nationwide level as Obama is suggesting. It’s ironic that going back to Nixon, presidents have been saying they will work to control rising healthcare costs, and yet costs have not been controlled. In fact, healthcare costs are literally out of control right now, with growth in spending far outpacing every other segment of society, including inflation, wages, etc., with no improvement in overall health of population.

So the sharing of “best practices” is a win/win situation. One, it can help spread information about the best practices as proved by research and help achieve better outcomes. Two, it can help control costs if expensive tests, treatments, etc., that do not improve outcomes are no longer routinely practiced.

As I see it, the medical review panels are a very good way to prevent rationing and save wasted dollars within the system. It’s not about death panels, and it was never about pulling the plug on grandma.

I know this post is long but I’ve tried to explain it more fully, since I think this provision is so misunderstood.

Let’s say an expensive cancer treatment has a 50% chance of working, does the pt get it? What about a 10% chance? 5%? 1%? .5%? etc. What it by working we mean it prolongs life yrs? 1 yr? 6 mos? Currently the people that try to answer these questions are the insurance companies (and no one likes it when they say no). Who is going to make these decisions when there is only 1 party payer? No matter how you spin it, it is rationing. and until you can answer these questions good luck controlling the costs.

This toon has generated some well thought out well articulated comments. An interactive discussion is ensuing.

Here is a quote I posted elsewhere

”. With cancer care, it’s more severe—Medicare is dismantling the delivery system. Medicare has decreased payments for the administration of lifesaving cancer drugs by over 25% since 2004 and is now planning to cut them by another 38%. Additionally, payments next year will be severely cut for diagnostic imaging and radiation treatment. Cancer clinics are increasingly struggling to treat patients while remaining viable.

Based on documented five-year survival rates, the U.S. has the best cancer-care delivery system in the world. However, Medicare is a threat to that record and needs to be fixed in health-care reform; extending its influence—for example, by basing a public plan on it—would have catastrophic implications for cancer care.

Ted Okon

Executive Director

Community Oncology Alliance”

I’m including transcript of the remarks by Dr. Jim Yong Kim, a medical doctor, anthropologist and scientist, now president of Dartmouth University.

_ re tonsil study _: *”Why is there variation, for example, in the number of children who get their tonsils taken out, between one county in Vermont versus another? ‘Cause one of his children was in school at one place. Another of his children were in the school in another place.” *

”And in one place, almost everyone had their tonsils out. And in another place, almost no one did. And of course, he found that there happened to be a doctor there who liked to take tonsils out and benefited from it. And he kept asking this question, you know, outcome variation. He called it the evaluative clinical sciences. And I think that’s really the forerunner to what we’re talking about in terms of the science of healthcare delivery.”

The latter part of this quote explains the type of medical research that I referred to. It’s neither partisan nor political, it’s led by physicians, scientists and researchers. Here’s another explanation he offered :

*”It means how do you evaluate clinical outcomes? How do you understand variation in doctors’ practices, for example? And ultimately, how do you fix the problems? So the group at Dartmouth Institute does all of that. We look at variation. You know, why is a Medicare reimbursement rate, you know, almost a third in the Mayo Clinic area, as opposed to Miami?” *

”It’s around 6,000 and around 15,000, huge differentials. And they simply ask that question. That’s the Dartmouth Atlas, that looks at variation in health care expenditures from one place to the other. And we keep asking the question. “Why does this happen?”

”So not only do we study the problem and try to understand why there’s variation and why there’s poor outcomes in one place, but we also work very hard in the kinds of interventions that will change the tide. I think that’s the science of health care delivery.”

I’ve offered his own words rather than my paraphrasing them because when you read them (or hear them) it’s clear he’s talking about improving cost and quality, exactly what we MUST do as a nation to control our out-of-control healthcare costs. And the tonsil discrepancy was not due to parental choices, but to physician habits. I felt like I learned from listening to him. to read the complete transcript go here:

http://www.pbs.org/moyers/journal/09112009/transcript3.html

charlie: ”You seem to be saying that you would find it acceptable for an anonymous government panel to over-ride decisions made by doctors and parents who actually know and love their patient and child.”

I trust experts like Dr. Kim to research patterns, inefficiencies and outcomes. It would not be an anonymous panel of government bureaucrats. It is something we have to do or we will be crushed by healthcare costs and our ‘system’ will implode to the disadvantage of all except the very wealthy who could afford to pay independent of insurance.

I was a consultant to a physicians’ group in the ’90s so I know first-hand that physicians are aware other physicians habitually have abnormal practice patterns which cannot be justified by medical facts. It exists.

And, back to your statement I quoted above, right now insurers routinely over-ride medical decisions. I’ve shared details on my sister, so just to recap: Her private insurer refused to authorize a procedure for clogged neck artery, her doctor fought for it to no avail. Shortly thereafter she had a stroke and was never able to return to work, too much damage.

My sister’s neighbor, a man in his late 50s, took himself to an ER with chest pains. His doctor, who knew the patient well, wanted the hospital to keep him overnight. The hospital wanted to keep him overnight. The insurer said no, he was discharged and died of a heart attack in his sleep that very night.. These two examples are not aberrations. I most definitely do not trust insurers who overrule doctors constantly. I trust the methodical, scientific research described in this post can help us achieve goals for cost and quality.

This is a good dialogue.

i think i’m in love! so much right brain brilliance around here.

parker, why is this right brain? (I thought left brain was linear and right brain emotional, is that not right?)

I agree with oldlegodad. Acorn sucks. How helpless do you have to be if you can’t go to city hall or other voter registration location, produce your id or proof of residence, and register. If you don’t know where to go, get to your local library and use one of their computers, look up your town, and search on voter registration. Geez!

charlie555, Life is full of unknowns, without a doubt. What I hoped would be informative to people is that in each case, it was an insurance call center that interfered with patient care. As I’m sure you know, one of claims from the opposition to healthcare reform is that it will put government between you and your doctor. But the reality today is that a for-profit insurer sits smack dab in the middle between you and your doctor, frequently, and for no good medical reason. The primary priority for a private health insurer is to return profits to shareholders, to please Wall St. with its medical loss ratios so its stock prices will do well. I’m not ranting, that is their #1 goal.

Of course my sister could have opted to have and pay for surgery out of pocket (or any other patient whose insurer denies care) but I would assert that very few, if any, people do that. They’ve been paying for health insurance, why should they have to now pay for the actual medical care their insurance was supposed to cover?

I don’t consider my sister’s case rationing of care, to me, it was an abuse of my sister’s rights by the insurer. Rationing, to me, means that not every person is going to be entitled to a liver transplant, or a heart transplant, or undergoing intrusive extraordinary measures when their condition is terminal. (Just a personal aside, if I reach that point myself, I will not opt for continuing extraordinary measures.)

If I leave with you any information learned from these posts, I hope it is that private insurers frequently become the deciding factor, rather than the doctor, or even the patient, about the course and quality of care we receive. They are insurers, they are not clinicians, but they substitute their policies and protocols for the judgment of physicians who know the patient and the patient’s history.

Do I think insurers are evil? I think I’d say they are now occupying an improper role in the health of the American people. Thanks for responding.