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bob2356   ignore (1)   2009 Jun 29, 12:51am   ↑ like (1)   ↓ dislike (1)     quote        

My wife is an ob/gyn physician now practicing in New Zealand who would never return to practice in the states again even though the money would be over double and the cost of living much cheaper. Here are some observations from outside the system.

Yes people used to pay for doctors out of pocket. But the life expectancy at the time was something like 55 vs 75 now. Anyone who wants to can certainly return to those utopian days. Just please die quietly when something comes up you cannot afford. Which would be just about every medical advance since 1930. You want those extra 20 years provided by modern medical care then you must pay the cost of modern medical care.

Some doctors are money orientated some aren't. Here's a good article that address the issue http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail

Engineers don't rack up an additional 4 years of medical school at 50k a year after graduating college then another 4 years of residency with 100+ hour work weeks for far below minimum wage while the interest is accumulating on student loans. Not to mention starting your savings for retirement at age 30 instead of age 22. We have physician friends back in the states who will literally pay their last student loan payment with their first social security check.

Doctors don't set prices. Doctors get paid whatever insurance companies decide they will pay for the service.

The average cost of health care per capita in the US is almost double cost per capita for the rest of the industrialized nations. Yet by almost any measure there are no better results. In areas like infant mortality the US is almost in third world range. The system is clearly very badly broken.

Here in NZ doctors are hired by the health district and just see the patients. A doctors office staff consists of a receptionist and a nurse. No billing staff, office manager, accounts receivable person, insurance coders, accounting person, etc., etc.. The average doctor here has less than one third the number of people on staff compared to the states. Who do you think pays for the two thirds of the staff doing medical billing and office management in the states? Santa Claus? Then of course there is the cost on the insurance company side, like lobbying, executive compensation, collecting premiums, paying out claims, profits for investors, marketing, etc.. Not one cent of those dollars goes to actual patient care. Someone remind me again how exactly is it that competition is going to make this all cheaper?

I find no or very little difference in the actual care here. Life expectancy is actually higher. I am of an age where I use health care regularly so I'm not going by anecdotal. I have also used the Canadian and French health care systems. I did not see the horror stories that everyone seems to be able to dredge up about other countries health care. Everything here is done on a strict cost benefit basis. You won't get the latest greatest drug or procedure unless there is some clear benefit. You won't get a hip replacement if you are 90 years old with terminal cancer and 3 months to live. People here don't expect or desire huge amounts of intervention if they are clearly dying. Most would prefer to die at home with family if possible rather than eke out another couple of months in a hospital.

Ditto on the on call thing. Getting called out at midnight and getting home at 6 for a quick breakfast with the family then go to work on a regular basis gets old really fast.

bob2356   ignore (1)   2009 Jun 29, 11:48am   ↑ like (0)   ↓ dislike (1)     quote        

What is it about life expectancy that is not apple to apple pray tell? America ranks down with Bosnia and Albania. Infant mortality is another stat that is pretty foolproof to calculate. America ranks just behind Cuba and depending on whose chart you look at just ahead of the Faroe islands or Croatia.

Not much bang for twice the bucks.

The people throwing out hyperbole like "slavery" or "rationing" are very careful to avoid noting that in the other industrialized countries the public health system provides a basic level of care. You are free to purchase private insurance and see private physicians if you please. This isn't exactly slavery. Private insurance is not very expensive because most people use the public system for the bulk of their health care and use the private system for elective care. No one is in slavery or forced to do anything if they choose not to. I'm not sure how being a slave to health insurance companies in America is any better. Harvard did a study in 2001 that found half of all bankruptcies are precipitated by medical bills and really surprising was that most of these people had health insurance.

In America:
The association of medical colleges accredits medical schools not the ama. They are not related.
The Accreditation Council for Graduate Medical Education (ACGME) accredits residencies not the ama. They are not related.
Us Medical Licensing Examination association is the examining body that administers the 3 step usmle exams for physician licesnsing and is sponsored by the Federation of State Medical Boards not the ama. They are not related.
Physicians are licensed by the individual state medical boards not the ama. They are not related.
Physicians are board certified by their individual specialty boards after several years in practice and additional testing not the ama. They are not related.

Not much monopoly control that I can see. I for one am really glad the guy cutting a hole in my chest has had stringent licensing and certification.

bob2356   ignore (1)   2009 Jun 30, 11:33am   ↑ like (1)   ↓ dislike (1)     quote        

That's why I specifically choose infant mortality and life expectancy. The rest of the industrialized world may be full of a bunch foreigners who don't have American sophistication but I am almost positive they have the necessary knowledge of record keeping and statistics to know how many people died and how old they were as well as being able to count the number of babies born and figure out many of those died. This is pretty hard criteria to differentiate. I would be interested in seeing the research on how these area's are being under reported.

All licensing leads to higher costs. I would not be terribly comfortable flying if my pilot was part of a voluntary association whose membership decides the level of training. Or, as is much more common around the world, the level of bribe to get the job (training, we don't need no stinking training). I think the licensing cost vs safety ratio is pretty reasonable here compared to other places.

All functions of government lead to increased costs. If you feel that government services are slavery then feel free to move to where to there are none. Zimbabwe and Congo come to mind. If you object to the concept of government services where exactly do you personally draw the line on using government services? Do you drive on the government provided roads, fly using the government provided air traffic systems. use the government subsidized internet? If so then it's more than a little hypocritical to object to government services don't you think?

Yes, having government provide health care funding is not ideal, but it would be hard to be worse than the current system in context of society in general. That is the basic question in the whole debate. When does the cost of providing a societal benefit less then the cost of not providing it. I really would like to believe that the free enterprise model of health care would be the best. I would really like to believe that the least government is the best. But the current system just isn't providing health care at a cost that is anywhere close to being in line with the results.

bob2356   ignore (1)   2009 Jul 1, 7:49pm   ↑ like (1)   ↓ dislike (1)     quote        

Hi Patrick,

Actually you have to pull out hispanics and american indians also to get up to the rest of the industrialized world. On the other hand if you pull out asians and pacific islanders (who have much better numbers than whites) the numbers get much much more grim. So your point is what? All this shows is who is poor and uninsured. My only point here is that for close to twice the per capita cost there should be a noticeable positive difference in the results instead of having to quibble statistics so things don't look bad.

I'm not a big fan of universal health care in the US, but what are the other options at this point? The cost projections are not sustainable. Everyone already pays for the uninsured, the medical malpractice (both insurance and defensive medicine), the absurd cost of the entire system of billing (I used to write software for physician billing so I know a lot about what it costs), all the expenses of the insurance companies, etc. through higher taxes and higher insurance premiums. Santa and the tooth fairy aren't paying for er visits. The uninsured rightfully (to them) wait until they are very sick, when they are difficult and expensive to treat then go to the ER which is the most expensive place in the whole system to treat them. It would be much better to treat them in relatively inexpensive clinics (compared to er's) when they are slightly sick and much cheaper and easier to treat. If they are not insured by someone it's not going to happen.

It's actually not that important to me personally in some respects. I have several citizenships and if the tax burden goes off the scale I would very regretfully mail back my US passport. I am happily living and working overseas, perfectly contented with using dreaded government health care.

bob2356   ignore (1)   2009 Jul 15, 9:44pm   ↑ like (0)   ↓ dislike (1)     quote        

Since I can rent for less than 1/3 of what it would cost to buy I will continue to rent and put the difference in the bank. When and if the cost of buying approaches the cost of renting (this will be the housing bottom as sure as the sun will rise in the east) I will put 20% down and take a 15 yr loan.

Say I am buying a house for a $300,000 house with 20% ($60,00) down getting a 30yr 5.25 for $240,000 there will be a total cost of $477,104. Same numbers with 15yr $347,275. However you usually get 15yr at half a point off so 15yr at 4.75 total of $336,000. This is a difference of $141,104. I would be very hard pressed to take the $60,000 down payment and make $141,104 in 15 years with it. That would be about 23% simple return. Should the interest rate get higher, almost a certainty since rates are near historic lows and the federal government is about to borrow huge amounts of money, the spread gets much more dramatic fast.

Then again, I made the foolish mistakes of selling my house in 2006 and getting out of stocks when the dow hit 13,500 despite all the experts saying what a terrible choices I was making, so what do I know?

bob2356   ignore (1)   2009 Jul 18, 7:18am   ↑ like (0)   ↓ dislike (0)     quote        

How do I get some of those tits benefits at my job?
bob2356   ignore (1)   2009 Jul 25, 6:30am   ↑ like (0)   ↓ dislike (1)     quote        

Housing sales always go up in May, June, and July. Year over year is the only valid metric. There is a bar chart that I can't find comparing 2006-2009 month by month. 2009 is below 2008 every month. 2008 is below 2007 every month. 2007 is below 2008 every month. Housing is not at the bottom yet, there is far too many problem mortgages still out there.

Dow at 9000 really doesn't make sense and I am normally a very bullish person. P/E ratio's are terrible. Almost everyone is making their numbers with layoffs in an economy that is 70+% consumer driven. That's called eating your seed corn.

I'm all for good news, but only if it's real, not NAR or wall street spin.

bob2356   ignore (1)   2009 Aug 1, 5:47am   ↑ like (0)   ↓ dislike (0)     quote        

Before I broke out the champagne I would take a look at this chart from calculated risk.

I'm all for good news, but if a statistically meaningless one month bump in 5 years of data is best result we get from all trillions of BORROWED dollars being dumped into the system, not to mention massive political manipulation of the system, then I'm not that impressed. Somewhere the stimulation has to end because we can't continue to borrow unprecedented amounts of money forever. What we have done is shift massive unsustainable borrowing from individuals to the government. No country in history has borrowed it's way to prosperity unless the money was used as an investment in infrastructure, like the US did in the late 1800's.

I agree with Claire, all the garbage has to shake out first. There will be a bottom, there is always a bottom. Some places may even be there now. But a lot of places aren't.

bob2356   ignore (1)   2009 Aug 1, 10:24pm   ↑ like (0)   ↓ dislike (0)     quote        

"I’m guessing there’s a LOT more Equity wealth that was sucked out of the bubble era prices by established buyers than you might think"

There's no guessing involved. Home equity has historically been around 57-59% for decades, never dropping below 57.2%. Somehow the price of homes in most area's rose dramatically (189% nationally according to schiller) between 1996 and 2005 while equity remained flat then started falling and has now reached an astonishing 43%. Think about that. Housing values almost tripled while equity dropped. If you owe 100,000 on a 200,000 home you have 50% equity. Double the house to 400,000 then you have 75% equity. So where did the extra equity go? The housing atm of course. This completely unprecedented increase in debt doesn't even include an equally unprecedented increase in credit card debt during the same period.

Who owes the vast majority of this debt? The baby boomers, who should all theoretically be retiring over the next 20 years. Which means drawing down (as in selling their stocks) and reallocating (as in selling stocks) their retirement accounts. Green shoots? Housing bottom? Dow 14,000? Maybe, maybe not.

bob2356   ignore (1)   2009 Aug 2, 12:31pm   ↑ like (0)   ↓ dislike (0)     quote        

"well in many areas, houses are going for less than the COST OF RAW MATERIALS TO BUILD THEM."

In some places houses cost less than a week at disney. Until there is a shortage of unoccupied houses in those places the cost of building isn't really relevant. Almost half of the houses in the boom years were second homes or investment properties. They weren't built to supply a fundamental need for shelter. When supply and demand and price and income all are in alignment in the majority of the markets then we will see the bottom overall. This will obviously be at different times for different places, but more places are out of sync than in right now.

bob2356   ignore (1)   2009 Aug 6, 2:10am   ↑ like (0)   ↓ dislike (0)     quote        

Some people need to check their facts more carefully before speaking out. No one gets to be a doc in 8 years, the minimum is 11 years for a family practice doc. 4 years to a ba, 4 years of medical school, 3 years of residency. At least during residency you get paid more or less minimum wage. Most family practice docs make in the very, very low 100's. Not bad for racking up a debt of 200-400,000 dollars in tuition and giving up 11 years of your life. Many of our family practice friends joke they will make their last student loan payment with their first social security check. Since the top of the food chain docs make maybe 400k in today's market if they work lots of hours I would be very interested in finding out how someone becomes a serious multimillionaire in less than 10 years practicing medicine. The numbers just don't add. Total malpractice PAYOUTS are less than 1% of medical costs. NOT total malpractice costs. Premiums and defensive medicine (a very real expense but impossible to quantify) add a considerable amount. That being said it is probably no more than 2-4% of total healthcare costs. So malpractice isn't the PRIMARY driving factor in health care costs, but represents a real expense nevertheless. The real cost of malpractice is in the rapidly approaching crises in the specialties that most affected by malpractice rates. Ob's for one are rapidly becoming an extinct species. My wife is an Ob. We are overseas and she will never practice in the states again. We know many Ob's who are going out of the country or leaving medicine altogether. Want your baby delivered, call your lawyer to do it. The AMA has nothing at all to do with the supply of doc's. Medical schools, residencies, USMLE testing, state medical boards all have their own independent accrediting boards and have no association with the AMA at all. To the people who hold this idea the training of docs is being limited by some type of grand unspecified conspiracy, you really need to look into the cost and effort involved in expanding a medical school or a residency program. It's not like a law school where you can throw a couple extra chairs in the back of the room. Despite the extremely high cost, 4 new medical schools have opened in the last 4 years, bringing the total to 131. The first students of these new schools will become practicing docs in 2019. H1B docs? Sure why not. It won't change the cost of medical care one cent. Insurance companies set the reimbursement rates. The only effect will be each Doc will see less patients. The number of patients seen will still be the same, no one will be less sick if there are more docs around. The rates paid by the insurance companies will be the same. Net effect on costs - Zero. Anyone who feels the training level of american docs is excessive to their needs or who desires to save money on their health care is free to go anywhere in the world they would like to get their health care.
bob2356   ignore (1)   2009 Aug 7, 10:01am   ↑ like (0)   ↓ dislike (0)     quote        

"This is hilarious …its like saying ” H1b’s won’t affect cost of software development because its the software companies which set the salaries and cost of software products” Economics 101 : more labor supply reduces labor cost." Economics 102 says that Economics 101 is only true in free market system. The entire health system is far from free market. Remind me again when exactly it was that the health insurers passed cost savings back to consumers rather than increasing profits or investing in the stock market? "If you can afford a Caddy, you get a Caddy — but if you can only afford a ‘72 Pinto, then that is what you get. Why should those who can pay for a Caddy be forced to: A) Buy everyone a Caddy, B) Give up their Caddy and get a Pinto forced upon them, C) Do both and pay for it all." That is EXACTLY what most of the univeral health systems around the world are. You get basic health care with the public system and if you want access to the private system then you buy private insurance. You get ACCESS to use the pinto for basic transportation but can move up to the caddy if you want to pay for it. Anyone who has health insurance is paying for the uninsured in the US anyway through increased premiums and taxes. Economics 103: ass, gas, or grass no one rides free. "HSA’s are the right solution but have come too late in the game" Big weakness in HSA's (which are a very good idea) is the question why would the 30-40% of people who don't pay any or minimal taxes participate. The entire premise of HSA's is that the contributions are tax deductible.
bob2356   ignore (1)   2009 Aug 8, 10:29pm   ↑ like (0)   ↓ dislike (0)     quote        

">> it’s called free market - which made US the most powerful nation economically… I think you’re misguided. The US is the most powerful nation for many entirely different reasons" You missed reason #5 called World War II where we bombed every other industrialized nation flat. Sort of like Goldman Sachs, get rid of the competition then make LOTS of money.
bob2356   ignore (1)   2009 Aug 8, 11:01pm   ↑ like (0)   ↓ dislike (0)     quote        

"You need rule of law and proper regulation for free markets to work. people manipulate the system to thier advantage under the guise of free markets ( when the govt is republican) and under the guise of regulation (when govt is democratic). free markets and regulation are just scape goats.greed and evil don’t have party affiliations/color/creed" This is contradictory. The second you publish the first regulation by definition you don't have a free market. Any regulation manipulates markets to someone's advantage. Who determines proper regulation? I'm all for free markets within the rule of law, but there is no such thing as a totally neutral free market system. All regulations are within the political realm and will always be influenced by someone's political agenda. So I keep hearing about this nebulous free market in health care from rentor. Care to step up to the plate and explain exactly how such a thing would work in the real world? Or give a real life example of a working free market health care system in the world today. If all you need to do is give health care over to a free market system then why hasn't it happened anywhere on earth that I am aware of?
bob2356   ignore (1)   2009 Aug 8, 11:08pm   ↑ like (0)   ↓ dislike (0)     quote        

I'm all for good cheer, but housing have gone up considerably less than the amount of government money thrown into the housing market. This ain't good and that's a fact.
bob2356   ignore (1)   2009 Aug 9, 5:35am   ↑ like (0)   ↓ dislike (0)     quote        

From Price Waterhouse Coopers 2007 report on health care in India: http://www.pwc.com/en_GX/gx/healthcare/pdf/emerging-market-report-hc-in-india.pdf "When it comes to healthcare, there are two Indias: the country with that provides high-quality medical care to middle-class Indians and medical tourists, and the India in which the majority of the population lives—a country whose residents have limited or no access to quality care. Today only 25% of the Indian population has access to Western (allopathic) medicine, which is practiced mainly in urban areas, where two-thirds of India’s hospitals and health centers are located. Many of the rural poor must rely on alternative forms of treatment, such as ayurvedic medicine, unani and acupuncture." or "some communicable diseases once thought to be under control, such as dengue fever, viral hepatitis, tuberculosis, malaria, and pneumonia, have returned in force or have developed a stubborn resistance to drugs. This troubling trend can be attributed in part to substandard housing, inadequate water, sewage and waste management systems, a crumbling public health infrastructure, and increased air travel" or "While the rural poor are underserved, at least they can access the limited number of government-support medical facilities that are available to them. The urban poor fare even worse, because they cannot afford to visit the private facilities that thrive in India’s cities." or "Because so little insurance is available to the population of India, out of- pocket payments for medical care amounted to 98.4% of total health expenditures by households, as of the most recent (2001–02) census. Without insurance, the poor must resort to taking on debt or selling assets to meet the costs of hospital care. It is estimated that 20 million people in India fall below the poverty line each year because of indebtedness due to healthcare needs." Sorry to have to tell you this but Thailand has a public health care system. From Thailand Health Profile 2001 to 2004 published by the Thai government: "The MoPH is the core agency that implements the universal coverage of health care or 30-baht healthcare scheme, beginning on a pilot scale in six provinces in April 2001 and later expanded to another 15 provinces on 1 June 2001, finally to all provinces in January 2002. As a result, in FY 2003, 47.7 million Thai citizens or 74.7% of all 63.8 million people nationwide were covered by the universal healthcare scheme, leaving only 3.2 million people or 5% of total population without any health insurance coverage, while the rest had already been covered by other health insurance schemes" The Indian model certainly represents a bright future for America. After all India ranks 112th in health care according to the WHO. Since America ranks 37th (pretty bad since we rank #1 in costs) this is certainly something we should aspire to. Denying allopathic health care to 75% of the population would certainly cut costs in a big way. Good plan. No politician should have any trouble selling this to the American public. Want to take another stab at it?
bob2356   ignore (1)   2009 Aug 18, 12:38pm   ↑ like (0)   ↓ dislike (1)     quote        

You know I am really sick of hearing about Canadians flocking to the US for medical treatment. Go to Canadian blogs and no one knows of anyone that has done it. Here is a pretty good study from 10 years ago (when the Canadian system had MUCH higher waiting times) that says its pretty much all BS.

http://content.healthaffairs.org/cgi/content/full/21/3/19

The study didn't even try to identify Canadians that were living and traveling in the US and got sick or hurt, so if anything the numbers are under reported.

People do come from all around the world for health care in America. But very few come from the other industrialized countries Those that do mostly come for very specialized treatments at the cutting edge research centers. Why do other people from around the world come here instead of Canada or England or Sweden? Is it the health care in America is so superior (it is very, very good most places) that people don't even consider the rest of the industrialized world (which also has very, very good care, I have lived in several of them)? Not at all. The reason is simply that the rest of the industrialized world has public health care that is only available to the citizens of the country. You can go to some of these countries and pay for treatment with private specialists out of pocket. But only with great difficulty. America is the only first world country you can pay out of pocket easily. Some other countries are starting to cadge onto this. For example New Zealand now offers medical tourism using private specialists with some sort of arrangement for insurance to cover any complications that need access to the public system.

Of course facts don't concern the demagogues anyway, so why bother?

bob2356   ignore (1)   2009 Aug 19, 10:09am   ↑ like (0)   ↓ dislike (1)     quote        

"But the libs want to change this. They want everybody to be “equal” (except for the ruling elites). They believe that a highly educated professional making 6 figures in SV shouldn’t be able to obtain better medical services than the illegal alien that mops his pee off the the floor in the men’s room."

You have no clue what you are talking about. There is private insurance available in all the public health care systems around the world for anyone who wishes to pay for it. Nowhere in Obama's or anyone else's plan does anyone even suggest that private insurance wouldn't be available. Do you read anything other than the NRO. Would you care to document where and how exactly this change will be implemented. Where is the proposed bill? Who said this in what speech? Or are you just some troll throwing meaningless garbage out?

bob2356   ignore (1)   2009 Aug 25, 2:06am   ↑ like (0)   ↓ dislike (1)     quote        

“Eliminate all licensing requirements for medical schools, hospitals, pharmacies, and medical doctors and other health-care personnel. Their supply would almost instantly increase, prices would fall, and a greater variety of health-care services would appear on the market.

Competing voluntary accreditation agencies would take the place of compulsory government licensing — if health-care providers believe that such accreditation would enhance their own reputation, and that their consumers care about reputation, and are willing to pay for it.”

Hey there are places that have ended licensing requirements for professionals. They also let business self regulate. Zimbabwe, Nigeria, and Somalia come to mind. Anybody know how things working out for them health care wise?

What the article manages to overlook is that there is no shortage of doctors in the US. There is a severe maldistribution both geographically and by specialty, not a shortage. When foreign docs come to practice in the US they also tend to choose the same locations and specialties that are overcrowded already. Believe it or not a lot more doctors want to live in Manhattan NY than Manhattan Kansas. So the free market solution would be to have some government agency tell doctors where and what they can practice?

Another fly in this simplistic solution is the unfortunate fact that the highest cost per capita for medical care is in the areas with the highest number of doctors per capita. Should we continue to increase the supply in those area's to further drive down the costs? It's worked so well already.

Medical schools and residencies both have voluntary accreditation already, not licensing. See the AAMC and ACGME websites for more information. As Mark Twain once said "It is better to remain silent and appear to be a fool than to speak out and remove all doubt".

Yet another issue is the fact (I really hate when facts screw up a good demagogue's argument) that the supply of medical school grads is limited by the amount of money the states and federal government are willing to throw into medical education. You didn't realize almost all medical education is subsidized (pretty much everywhere around the world)? Oh my now that's a problem. We will have to cut out that government subsidy stuff right now!! So the first thing that happens in our search of ideological purity is to eliminate roughly 80% medical school grads. Now we're making progress on instantly increasing supply. Although I am a little mystified on how you "instantly" increase supply of people who have to go through 4 years of medical school and 3-7 years of residency training. After we eliminate that awful licensing stuff where people actually have to prove they know what they are doing (although I am pretty sure that knowing the difference between the stomach and liver is a much overrated skill anyway) they will perhaps be able to absorb all this training overnight somehow?

Who accredits the accrediting agencies? This would be like the NAR accredited realtors maybe? That's certainly worked out well.

There are no easy solutions. The cost problems of the US healthcare system are deep and very mutifaceted. Anyone that says the solution lies in a couple simple steps is just a fool.

Obama's plan is not a solution. It does nothing to tackle the cost side. The plan may help by getting uninsured people insured, which means they will seek care in doctor's offices while mildly sick, instead of in very expensive er's after getting very sick. Maybe. Maybe not. Obama should have gotten the plan completely together first, then explained the nuts and bolts of how it would work.

bob2356   ignore (1)   2009 Aug 26, 5:57am   ↑ like (0)   ↓ dislike (1)     quote        

"Ever wonder why doctors do not discuss or recommend alternative therapies such as medical cannabis in place of opoids (and fought tooth and nail to keep it illegal )"

Maybe because the DEA doesn't allow prescriptions of medical cannibis and any doctor prescribing it will lose their license. Big incentive. Ca,Ri,Nm, and Co get around this by allowing doctors to recommend as opposed to prescribe, but this is pretty shaky legal ground where most doctors are unwilling to go. Especially during the Bush administration. The DEA, FDA, Justice Department, and the legal/law enforcement establishment are the ones fighting tooth and nail. Considering how much money goes to the war on drugs this is not surprising.

You don't know what you are talking about. The AMA doesn't oppose medical cannabis. The official position is they would like to see results of controlled, peer reviewed studies before making a recommendation. This is the major paper on the subject from 2001 http://www.ama-assn.org/ama/no-index/about-ama/13625.shtml. Since doctors are the ones who will be sued if anything goes wrong and there is not a peer reviewed study to back them up this is a sensible position. Who says fear malpractice lawsuits doesn't add to the cost of medicine at every level? No one can even begin to calculate how much defensive medicine adds to the cost of health care. Both the Medical Students Society of the AMA and American College of Physicians have recently adopted resolutions calling for rescheduling medical cannabis allowing it to be available for prescription. That is hardly fighting tooth and nail.

It's opioids (the synthetics) and opiates (opium containing) by the way. FYI opiates/opoids and medical cannabis wouldn't be used to treat the same conditions anyway.

"Doctors in the U.S. make more money than in other countries where there is socialized medicine."

They also work a lot more hours. That also doesn't include what doctors in the public systems can make doing private practice. Doctors overseas who wish do private practice can make as much as US physicians if they want to work that hard. Most don't and are very glad to have the option. Of course doctors in socialized medicine countries don't have to pay 100,000 malpractice insurance every year or 300,000 in student loans either.

"The insurance companies are trying to stay in business and make money, but really they are only reacting to something they can’t control."

It's nice to know the insurance companies are benevolent Santa Claus like organizations committed to the public good and supporting girl scouts. They would certainly never lobby congress for laws that stifle competition or raise the cost of health care. You are aware that the insurance companies set the reimbursement rates for doctors aren't you?

Doctors are far from blameless in the cost of health care. Read this article http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande from the New Yorker for some good insight. But to claim insurance companies are helpless pawns of the AMA is so far beyond absurd that I have to assume this is satire.

bob2356   ignore (1)   2009 Aug 26, 11:45am   ↑ like (0)   ↓ dislike (0)     quote        

Home sales always go up in May, June, July. Duh. They did it last year also. Year over year the difference is almost within the tracking error range.

bob2356   ignore (1)   2009 Aug 27, 4:39am   ↑ like (0)   ↓ dislike (0)     quote        

Excellent idea bap. I also think we should return to the good old days of 35 year average life span, 2 months to cross the country by wagon train, and dentistry with a hammer and chisel. It's just wonderful you have enough money in the bank to whip out your debit card for things like chemo or open heart surgery. Like 99.998% of the rest of the people in the country I don't. How much money do you have in the bank set aside for medical treatment by the way? Or would you lay on the hospital bed surrounded by crying wife and children and say "I stand on my principles, I will die now rather than have anyone else pick one dime of my treatment costs that I can't pay for". Bullshit!! What you really mean is you are a selfish greedy bastard who doesn't want to pay for insurance, but if the spam hits the fan you want the rest of us to pay for your treatment. Perfect analogy for life in America today, privatize profits, socialize losses.
bob2356   ignore (1)   2009 Aug 29, 6:26am   ↑ like (0)   ↓ dislike (1)     quote        

I really hope that birthers are just plain old fashioned racists, not people who actually believe this stuff.

Besides birthers are just helpless pawns being manipulated by larger forces, the uberbirthers. Uberbirthers are of course aliens who while time traveling spotted 2008 as an ideal time for a cosmic intergalactic practical joke. First they went back in time to the constitutional convention to make sure that the founding fathers didn't actually define the term "Natural Born Citizen". Then racing back to the 1950's they implanted an alien fetus into the belly of a 17 year white college student married to a black kenyan all the while knowing that this baby would eventually become president of the united states, therefore driving all the right wingnuts to apoplexy. They then cleverly arranged for the couple to secretly fly to Kenya without leaving any written records of the flight so their son would actually be a british citizen (how the hell could a couple of college students afford plane tickets to Kenya at 1950's air travel prices anyway?) in order to further frustrate the birthers . Then the uberbirthers cleverly placed articles in the local newspapers and official documents in the states (yes you idiots Hawaii was a state for 2 years already when Obama was born) archives to cover up for this. See. it's all very simple.

bob2356   ignore (1)   2009 Aug 29, 8:54am   ↑ like (0)   ↓ dislike (1)     quote        

Through the miracle of government intervention in the free market. Va/Hud is the new Fannie/Freddie. Until they blow up also.

bob2356   ignore (1)   2009 Aug 29, 6:05pm   ↑ like (0)   ↓ dislike (1)     quote        

Why should anyone open their records. The state of Hawaii certified it. If this was not within the states normal procedures there would have been lawsuits all over. AP and CNN sent reporters to Indonesia and had no trouble seeing the schools or talking to teachers or former classmates. http://www.cnn.com/2007/POLITICS/01/22/obama.madrassa/

Oh right, CNN and AP are also part of the grand Obama conspiracy. I forgot.

What do you mean his records are sealed? No one's school records are public information. Call up Harvard and ask for Bush's records. I'm sure they will sent them right out to you. I don't see where Obama is any more secretive than anyone else. I really don't remember any past president posting his college records or birth certificate to the press. Please tell me which ones did. Actually could you scan them and post them here, I would be very interested in seeing that.

It wasn't a rant, it was satire, look up what that means. Get a life.

bob2356   ignore (1)   2009 Aug 30, 4:02am   ↑ like (0)   ↓ dislike (1)     quote        

There aren't any perpetual motion machines??? Really??? Next I suppose you're going to try to convince me the world is round.

No need to be paranoid nosf41, we really are laughing at you.

bob2356   ignore (1)   2009 Aug 30, 5:09am   ↑ like (0)   ↓ dislike (0)     quote        

homeowner_for ever_san jose says
I personally know many good doctors from india ( some from top 1% in thier school ) who told me that there is too much red tape in US which prevents them from landing in US as a doctor. it was easy in 80’s and then AMA made it tough. BTW, these are same doctors who treat patients from US who go to india for best in the class treatment. I am pissed off that i can get a world class treatment in india for 1/10 th the cost of US but can’t use the same labor arbitrage (so called globalization) in US.
BS. If they can get a visa (which is a major problem post 9/11 and has nothing at all to do with the AMA), pass the same USMLE exams as American medical grads, and get hired by a residency program they can go through a residency program and practice here. If they are in the top 1% it should be a breeze. Or are you saying that having to actually pass the test is too much red tape? Or are you saying that the entire idea of testing is invalid? Your basic argument seems to be that testing people for competency is some kind of conspiracy to prevent competition. Eliminating it would certainly increase the supply of people like doctors and airline pilots. They could just self certify their skills and we would have some kind of web based satisfaction survey. That should work out nicely for the people that survive to be surveyed. Are you working in India? If not, how is it you are talking to so many Indian doctors who say they wouldn't come to America because there is so much red tape? How could they be from India but didn't come to America? Are they living in Poland? This statement doesn't add up. You sure have a lot of crtiticisms about the system, but don't seem to offer any alternatives except the vague idea of some type of H1B system that somehow attracts qualified docs without some onerous third party actually checking if they are qualified. I have no idea how that would actually work. Are you saying we don't want or need licensing here, but that we should accept licensing from other countries for qualifications? You don't see a little contradiction in this thought? Or should we just accept anyone who claims to be a doctor in another country, let them start operating on people and see how it works out? Hey Bap33, did a doctor rape your sister or something? If you really believe 80% of the people who become doctors are unqualified you are a seriously warped individual. That's one of the stupidest things I've ever seen posted. What exactly do you do for a living (or in life) that makes you so qualified to pass judgment on people who spend 11-15 years and hundreds of thousands of dollars to pursue their profession.
bob2356   ignore (1)   2009 Aug 31, 5:53am   ↑ like (0)   ↓ dislike (0)     quote        

Bap33 "Your post is the stupest thing I’ve sen on the net ever in life — ever. You stupid motherfucker. Actually I am quite bright and used to be a conservative until the religious crazies co opted the term. Now I prefer to be independent with a fiscally conservative outlook. I think the thing you are truly searching for in life is called anger management counseling. You really need to get your meds readjusted. I noticed you never answered my questions by the way, just vilified my response. Typical of what passed for discourse in the far right wing. Why do you consider all American doctors scum and believe Indian doctors walk on water? Especially since lots of Indian doctors were trained in the American system that you so despise. What qualifies you to have this opinion? This should be interesting. FYI. Unlike America where the primary limit on medical students is the amount of funding provided by states and the federal government, in India the medical schools are strictly regulated by the government and there is a strict limit on of 18,000 on licensing (graduation). Since about 36,000 students graduate medical school in India half must go abroad to finish their training. Don't ever let facts interfere with you opinions.
bob2356   ignore (1)   2009 Aug 31, 10:40pm   ↑ like (0)   ↓ dislike (0)     quote        

REGISTRATION OF DOCTORS 2004 21,003 2005 16,634 2006 17,064 2007 15,517 This is information is from the Indian Medical Register at the Medical Council of India website http://www.mciindia.org/ as pulled out of my ass. Registration is what we would call licensing. The Indian Medical Council is the governing body for Indian medical schools. As in (major dirty word) licensing, although they call it recognition. Interesting reading for the intellectually curious. The demagogues can just look at the pretty pictures I guess.
bob2356   ignore (1)   2009 Sep 1, 5:56am   ↑ like (0)   ↓ dislike (0)     quote        

I misspoke, the limits change year to year. You don't become a doctor in India in 5 years. You become a MBBS roughly equivalent to a masters degree. You also have to take 2 years of medical school courses in high school leading into medical school. After your MBBS you go on to post graduate courses. It's an additional 3 year course to an MD degree. If you want to specialize, such as surgery, there is an additional 3 years after that.
bob2356   ignore (1)   2009 Sep 12, 11:24pm   ↑ like (1)   ↓ dislike (1)     quote        

3steve says

I’d like to respond to mjfhorsey@comcast.net.
I agree with you in terms of people modifying their behaviour. They will have no choice. They won’t like it as they watch the American dream slip away. The American Dream to the consumer society is markedly different than the American Dream that the war generation sought. They were prepared to forgo immediate gratification for a stable climb in standard of living. Not so, especially since the recession of early 90’s. Yes we will have to return to the world of delayed gratification……those that lived pre 1990 (i.e.: war, boom and bust generation) will understand. Those that lived post 1990 (The echo generation) will not and for all it will be difficult.
My challenge to all is to ask you will the behavioural changes make the difference. If the problem is in the behaviour alone then yes it will. I mean to say if the basis of the economy is stable and all things being equal and do not change except behaviour then I could buy into the thesis. However, we are talking about fundamental shifts in the basis of the economy that behavioural changes won’t fix. It will help but when the ground shifts, changing your gait won’t help much.
As I’ve stated in other posts, the monumental shifts in the economy will change the way we all live significantly. Behavioural changes will occur no doubt but I believe that the aggregate of these changes will not be able to overcome the problems in the economy. The late adopters will be the victims 70% generally. The early adopters (15%) will survive. Be an early adopter. Cut debt, refuse consumerism and save, save, save,……….
With respect to all

It's a good question, will it be enough. I believe things are in a later stage of decline than they appear to be. America has only the primary player on the world economic stage for about 60 years. From the guilded age to the start of the depression the American economy was strong, but far from dominant. It is not preordained that America will continue to be the largest economy in the world. Many long since forgotten societies throughout history were the the Americas of their time.

We have moved into owing unprecedented levels of debt that might not be payable. Yes people are reducing their personal debt, but public debt is increasing faster. There were large amounts of debt in the late 1800's but almost all was spent building infrastructure. There was a higher level of public debt after WW II but a big part of that debt went to building the largest industrial base ever seen in the world to that date. Not to mention that the rest of the industrialized world was left in smoking ruin. America was in a unique position of advantage never seen before in history. Never to be seen again.

Contrast that to our current debt along with the staggering amounts of future unfunded obligations. These debts have done nothing to increase our infrastructure or industrial base. Previous public debt was an investment in the future. Our current debt is stealing from the future. Can a government that hasn't balanced the books in 30 years not only balance the books, but generate a surplus to repay the debt? It seems, at best, unlikely. Is an entire generation going to repudiate the only lifestyle they have ever known. I really, really hope so. But I also think it unlikely. Ever increasing interest on the debt must be repaid. Missing a debt payment would result in t bills being used for toilet paper. There will be a breaking point where interest on the debt consumes all the money in the federal budget.

It's a long hard road back to a sound fiscal base and I don't hear a single person in a position of responsibility talking about sacrifice of any kind. The only message I hear is that we are somehow going to get back to the unsustainable pre crash status quo. It's very sad and scary state of affairs. Like others here I have been responsible, paid cash, and saved. I also have multiple citizenships. If things go horribly wrong I would reluctantly renounce my citizenship. Still I am worried. My future and my children's future are being mortgaged to pay for the irresponsible, the greedy, and the reckless. I hope I am proven very wrong.

bob2356   ignore (1)   2009 Sep 13, 8:14pm   ↑ like (0)   ↓ dislike (0)     quote        

Last time I checked the constitution and bill of rights are the underlying document for all Americans. So any true conservative, independent, Republican, Libertarian and other hard working, taxpaying, patriotic American defenders of the constitution must by definition defend the rights of the liberals, elitists, socialists, Democrats, whiners and the like to exist and be heard. Ironic isn't it? This is where the rushbots fail to grasp the principle. The words big liberal and government are not synonymies. You can have any combination you want. BTW I am a libertarian who doesn't own a tv.
bob2356   ignore (1)   2009 Sep 17, 6:08am   ↑ like (0)   ↓ dislike (0)     quote        

I'm so glad to be an expat. Surf's up got to go.

bob2356   ignore (1)   2009 Sep 17, 12:03pm   ↑ like (0)   ↓ dislike (0)     quote        

"We have had several USA heatwaves of longer duration and higher temperatures (and some shorter). " This is hardly an accurate comparison. The upper midwest including the dakota's gets very high temps and humidity levels almost every summer. The area's of France affected by the heat wave (I have lived there) almost never get high temps or high humidity. Even if there is a hot day or two the nights are always cool. Having 2 weeks of very high nighttime temps was the biggest factor in the disaster. Only something like 2% of houses in France have air conditioning including the much hotter more humid south. Of course the fact that 90% of the people in Northern France spend August on holiday in the south leaving pretty much no one around to deal with it didn't help at all. I don't exactly see where a natural disaster is a referendum for elder care. I guest the Indonesians must have the worst elder care in the world after the tsunami killed 230,000 people.
bob2356   ignore (1)   2009 Sep 17, 12:06pm   ↑ like (0)   ↓ dislike (0)     quote        

HeadSet says
JboBbo says
French eat lots of good food and have a hard time leaving the kitchen. Most of the French deaths were kitchen related.
I was in France for about 6 months in the 90s flying out of LeTube near Salon de Provence. Salon was a typical beautiful French country town with great food at restaurants, griils, and even street carts. But right in the middle of town, among the very French environment, was a popular McDonalds. Go figure.
Last time I was in France several years ago I noted the French are getting much fatter than they were 20 years ago. McDonalds rules.
bob2356   ignore (1)   2009 Sep 20, 9:52am   ↑ like (0)   ↓ dislike (0)     quote        

1. 20% down, 15 year mortgage, 3:1
2. New Zealand
3. I own cash flow positive rentals in Texas and Oregon. Renting in NZ. Renting a 2.5 million (about 1.75 million us) beachfront house for $2120 nzd a month. Needless to say the market here is in a major bubble.

bob2356   ignore (1)   2009 Sep 20, 9:54pm   ↑ like (0)   ↓ dislike (1)     quote        

The 1950's were not sweetness and light. Racial killings in the south, Korean war, Mccarthyism, red scare, cold war, hydrogen bomb, etc.. There were some pretty ugly chapters of American history written in the 1950's. Joe Mccarthy makes the Glenn Becks of today look like pikers in terms of smear tactics. It is interesting to see revisionist history being written about Joe Mccarthy by a number of conservative hard liners. Ann Coulter actually wrote a book about it. Now that's a ringing endorsement! I wasn't even aware that Coulter could read and write.

bob2356   ignore (1)   2009 Sep 24, 12:46pm   ↑ like (0)   ↓ dislike (0)     quote        

thomas.wong87 says
“I have not seen any reports that a specific provision of the Patriot Act was instrumental in apprehending the suspects” Of course ‘you’ didn’t. I don’t think ‘you’ ever will.
So why don't 'you' fill us in. Awaiting with baited breath.
bob2356   ignore (1)   2009 Sep 25, 6:15am   ↑ like (0)   ↓ dislike (0)     quote        

thomas.wong87 says
“So why don’t ‘you’ fill us in.” And who is ‘us’ ? ‘You’ speak for the rest of ‘us’.
Ok fill ME in. How exactly was it that the patriot act made it possible to arrest these people and why was it impossible under existing laws pre patriot act. I I I I I I am waiting with baited breath.
bob2356   ignore (1)   2009 Sep 26, 6:13am   ↑ like (0)   ↓ dislike (0)     quote        

"How is this BETTER than Anarchy?"

Is this a joke? Do you have a clue what the term Anarchy means? Travel to Nigeria, Somalia, Zimbabwe, or Zaire and find out for yourself. The US is the only country in the world where poor people are fat and have color tv's. Get a grip. Or at least get some perspective.