“I completely agree that economic rationing in health care is a fact of life. Health care reform will ultimately address about 30 million who currently are without insurance. It will help close the gap for many but not all.
But in reality, it all comes down to economics. Not just for the haves vs. the have nots. As the baby boomers age, we are going to have to make some very difficult decisions along the line. Medicare cannot take care of all of them without an enormous cash infusion...which isn't coming. It means making hard but objective decisions.....is this new drug REALLY worth the cost? Does this patient being considered for a transplant have a meaningful chance of surviving and living a high quality of life? Decisions will have to be made on an objective basis and not out of a sense of entitlement.”
“Completely agree, but our ideas on end of life issues are not mainstream. Medicare estimates that 80% of a patient's cost of care is spent in the last year of life......trying all means to avoid the inevitable end of life. Is 6 extra months of life meaningful is there is no quality to it at all? For me, personally, if it is accompanied by being bedridden, in pain and unable to eat, then its not for me.”
“I am troubled that Berwick is gone; it leave CMS rudderless in a sea of change. He would have been an effective leader.
As for the article, I think it nails down very nicely some of the issues in health care. We have a schizophrenic approach to care; we want to address costs without impacting our sense of entitlement. Both the UK and Canada have tackled these issues head on. When the US tries to attempt the same thing, we hear cries of "death panels". Until our culture and expectations change regarding meaningful outcomes, health care will remain as it is today. For those who advocate single payer systems (and I do), understand that it comes with the loss of entitlement that so many treasure today.”
megwright on Nov 27, 2011 at 12:46:24
“What it comes down to, Dr. Bob, is that we already have rationing, and it's a form of rationing that far too many Americans are comfortable with: that is, if you can't afford to purhase health insurance, as is the case for 50 million Americans, or if you're one of the 45,000 - 60,000 poor people who die from lack of access to health insurance, then it's a form of rationing that we're used to.
A more sensible form of rationing that makes decisions based on the most good for the largest number of people will include some rationing for those who are dependent on the amount of health care their insurance or assistance programs will cover. Those who have enough money won't find their ability to access the most expensive treatments impacted at all.”
kmc528 on Nov 27, 2011 at 08:31:33
“Being born has a 100% death rate. It's time we realized, as a culture, that death is inevitable; none of us live forever.
When your health insurance attributes everything to pre-existing condition and refuses to pay for anything, you make rational decisions about what you want to pay for yourself. A drug that returns me to functioning/working is worth it to me. A drug that leaves me non-functional is not. Being stuck in bed 24/7 too drugged-up to even watch TV is not "living", and I personally refused to pay for that stuff once I knew what it would do to me (not "for me").”
Nov 14, 2011 at 18:57:21
“A few concerns about this study:
1. It was funded by a drug company. No bias there.
2. Less than 5% of patients enrolled in the study were from North America. A case of mixing apples and oranges?? If the standard of care in other countries is less than what it is in North America, any new drug may look better but not really be meaningful in terms of improved outcomes in the US.
3. Some members of the research team are employees of the drug company. No possibility of bias there.
4. Serious bleeding was FOUR times higher than those who didn't take the drug, including intracerebral bleeding. None died. In my experience, having an intracranial bleed is a life changing event which is usually accompanied by significant and permanent neurologic deficits.
Personally, I would adhere to the current standard of care until better data emerges and avoid the risk of ending up as a permanent nursing home resident.”
“The reform law encompasses approximately 1600 pages. How many people, let alone physicians, have the time to read and digest this?
To say that the doctors did not have input because few in Congress have a medical degree is a bit naive. Lobbyists for various physician groups were clearly in the loop and at the table.
The concern about quality of care is that when we add 30+ million covered lives to the insurance pool, there will not be enough primary care physicians to provide care for these patients. I suspect the negative impact on our practice is really a reflection of more work and less reimbursement per patient. The absence of providers and the impact on income are grounds for cynicism at its finest. One does not need an education in legal terminology to grasp these concepts.”
AMERIKA on Nov 14, 2011 at 19:51:43
“I would agree. I am already booked solid. So how are all these people going to be cared for unless more access is facilitated? But even so, caring for the uninsured is also expensive and difficult...”
“I do a fair amount of public speaking on topics that I am extremely well versed in. Once in awhile, I too get a whoops moment and lose my train of thought and have a hard time getting back on track.
Perry's whoops moment is over blown, it happens to all of us......just not in the middle of a debate on national TV while talking about dismantling government agencies. Personally, I don't like his politics at all.....but he just showed he is human after all. Much ado about nothing.”
john rajah on Nov 11, 2011 at 20:31:06
“Whoops moments happen.But listeners can easily distinguish such moments, as in Obama's 57 states mispeak.
But it is certainly more than an oops moment when someone cannot recall a central piece of his policy(scrapping the Department of Energy when you are Governor of Texas).
This incident clearly indicates Perry is not speaking for himself”
“I find this statement particularly disturbing: 57 percent of military suicides sought help in 2010 compared to 36 percent in 2009. More are seeking help but apparently that assistance is ineffective....the percentage of soldiers who sought help committed suicide more frequently than those that did not.
A nation that sends its youth to fight in distant lands has an obligation to ensure that they are provided the best possible care, both on and off the battlefield. We are failing that obligation in the mental health arena, We can and must do better.”
“"the fact that many of the ills which kill us are self-induced: too much alcohol, too much food, drugs, homosexual unions, cigarettes. They're all known to lead quite often to premature death."
A lot has been inferred by this statement, but if we return to 1989, the largest group afflicted with AIDS were homosexuals. As one of the few physicians who welcomed them into my practice, we knew little of the disease at the time. Preventative measures against certain infections had not been clearly defined. We had but 3 similar drugs to treat the virus, when one failed the others quickly did as well. AIDS was a death sentence. There is nothing in Mr. Rooney's statement that is factually wrong or gives credence to homophobia.
I don't not agree with his other statements regarding homosexuality, but we come from far different generations and backgrounds. At worst, he is guilty of expressing an honest opinion. However, unlike many politicians today, to my knowledge, he never made money trying to train gays to be straight, nor did he ever express a desire to curtail their civil liberties.
His segments on Sunday nights were usually entertaining and thought provoking. A curmudgeon at times, but I never detected a trace of hate mongering.....Archie Bunker he was not. I have more fear of the current presidential candidates and their views on homosexuality than anything that is state in this article. RIP, Andy”
ALSmith68 on Nov 9, 2011 at 18:05:20
“To include the term "homosexual unions" instead of "AIDS" in the list of "self-induced" deadly activities implies much more than mere fact. Don't try to kid us that it was MERELY observatory, and not judgmental. It was an expression of contempt, and it's ridiculous to suggest otherwise.
And expression of contempt is no less damaging than "trying to curtail our civil liberties." Who do you think the people that ARE trying to curtail our civil liberties were listening to and getting their cues from?
His segment was more than just a grumpy old man spouting off about his personal views (which, frankly, I never understood why CBS allowed for so long--it stopped being funny circa 1977). He was a media figure, and therefore afforded lots of exposure, and that carries responsibility, like it or not. If his homophobic comments have been noted by all here, well, dem's de breaks. Part and parcel with the paycheck he received.
You're right, he was no Archie Bunker. Archie Bunker was at least funny (if despicable).”
“Dr. Murray was the final straw that broke the camel's back. Along the way, there were other enablers as well physicians for sure, and perhaps his family as well.
The care of a superstar addict is already fraught with potential hazards, particularly when the doctor is being provided large sums of money sufficient to cloud the physician's judgement. The patient has all of the control. Murray took a bite of the tainted apple and the result was inevitable. Clearly, that does not excuse Murray's prescription of a dangerous drug not intended to be given in a home setting. His actions are well beyond what a reasonable physician would do, and criminal penalty is appropriate.
As a physician, I disagree with many of the points made by the author. I don't see barriers for patients or their families seeking redress for real or imagined injuries. But understand that most harms occur without forethought or malice; they are unintentional or accidental. Criminalizing these circumstances serve no purpose. Juries will award damages and the MD may lose his license, which is their livelihood. I no longer see the MD being held in such high esteem that juries are biased in their favor.”
“I can understand your frustration. We send them to war, but make a political decision about caring for the vets afterward. That is just wrong. If we send them to war we are obligated to take care of them when they return.”
“Sometimes, I think we remain blissfully unaware of the consequences of war, for it is so distant and if you are not connected to the military, it is a matter of out of sight and out of mind. We need stories like this to remind us of the consequences of war.
Many have died, many have returned home with horrendous physical or mental injuries. The politicians send them in harm's way and claim the victory. But let us never forget the human cost, both to the individual and to their families that arise from these decisions.
While I am deeply saddened by this loss and those of countless others, we should support those who fought, served and have returned. We must ensure that the needs of those who returned are addressed in a meaningful way.”
sayers3474 on Oct 27, 2011 at 19:28:30
“And the politicians - Democrat and Republican - compound the tragedy by using medical care for the injured vets as a "trump" card to advance a political agenda. I love my country - but I honestly don't know what to believe in anymore.
Oct 24, 2011 at 05:03:14
“You have accurately described the impact of the disparities in health care and their attendant consequences.
Unfortunately, you did not elucidate a real solution to address these issues. I understand why, as it is very difficult to address the root cause in this politically charged climate. Lack of insurance and access to a medical home fosters dependence on ER care. A great short term fix for some, but completely inadequate to address chronic illness.
If the politicians, who have the best health insurance of anyone in the country, could be forced to give up their Cadillac health plan in favor of Medicaid coverage, change would happen a lot faster.”
“Time to pull the plug on this. Not another dime, not one drop of blood We got Osama; the Afghans should be left to build their own nation in their own fashion. If after 10 years of training, they cannot stabilize then another year of building a corrupt army or police force will not further our interest.
Let's see how long Karzai stays in power without the US. His days are numbered.”
“I completely disagree with the writer. Health care reform is headed to SCOTUS, one way or the other. Just look at the states which have sued in federal court and the conflicting opinions that have been issued. So fast tracking the issue, getting a decision will help all to plan and move on. There is far too much at stake and far too much uncertainty within health care to drag this debate on forever. Both hospitals and health plans have had to drastically change their business model to accomodate the ACA. These changes will and have had impact to the consumer.
One way or another, the sooner the SCOTUS issues a ruling, the faster we can get on with it. Till then, get over it.”
Oct 22, 2011 at 10:44:32
“At one point in my career, I noticed that a disproportionate number of patients with first time mammograms were getting called back for additional testing or needle biopsies. Not one of them had any form of cancer. However, the lack of a baseline study for comparison caused extreme caution in the interpretation of the study. It got to the point that I routinely informed my new to mammogram patients that they would likely be called back. It relieved a lot of unnecessary anxiety.
That said, mammograms are an invaluable tool in the detection of breast cancer and detecting early disease is crucial for women's health.”
“The US should stop playing the role of the world's policeman and holster its gun, turn in its badge. A mere 38k for one Stinger missile? How many homeowners could get bailed out of their personal mortgage crisis for the price of ten missiles?
The Syrians should deal with their own issues, in their own way, by their own hand. Let us not forget they have not even asked for our help, nor do we know what view's a new regime will hold towards this country.
Even of the misguided wars in Muslim countries, let's focus on fixing America.”
nenitaB on Oct 22, 2011 at 12:40:49
“Fanned and Faved! Hope the authorities put a halt on war. More loses than gains. It's never a positve approach but on the contrary.”
fairwayhill on Oct 22, 2011 at 10:23:22
“His main concern is how to destroy Syria on the cheap. That's the isreaIi way of being concerned with the well being of the Syrians.”
Dr Bob on Oct 22, 2011 at 10:18:57
“Sorry, the last line should have read "enough of the misguided wars .....”
“Emeril and others from the Food Network taught me to cook, and for that I am grateful. I was between careers and spent many an afternoon/evening learning new techniques and realizing that you really don't need to be a rocket scientist.
I am happy to see him back on his feet and sharing his passion for cooking great food.”
hp blogger Regina Varolli on Oct 22, 2011 at 17:16:32
“I'm glad to see him doing this kind of cooking show too. Obviously!”