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Message
re: Why can't the US have univeral healtcare with the current budget?
Posted on 10/4/23 at 1:06 pm to NC_Tigah
Posted on 10/4/23 at 1:06 pm to NC_Tigah
quote:
You don't understand how medical billing works. With the rare field exception (e.g., plastics), or a cash-basis or concierge model, fees are set based on medicare rates.
I don't think you understand that how it works now doesn't mean thats how it would work in this scenario, or how I would have it work. Why even change it if you're just going to add to current regulations? It would have to be a total overhaul, which is needed even if we don't go to a universal insurance system.
0
Posted on 10/4/23 at 1:06 pm to NC_Tigah
quote:
Medicare heavily influences facility care and billing, across the board. Not just for the >65 group.
I can believe this but to blame the opioid crisis on Medicare and totally absolve Purdue Pharma, who lied to doctors, Congress and everyone else about their drugs as long as they could, and bribed the FDA to approve them is incredibly irresponsible and fanatical.
This post was edited on 10/4/23 at 1:07 pm
Posted on 10/4/23 at 1:20 pm to VolSquatch
quote:So you're the chick who agrees to become a serial philanderer's 6th wife because this time you think he'll be faithful.
Yeah, and in this discussion I'm defending a version of something that I personally would support
quote:I'm just pointing out what you'd be getting into.
attacking a version of it that you don't like
Posted on 10/4/23 at 1:50 pm to 4cubbies
quote:Cubbies, if there was a single doc in this country who was unaware p.o. narcotics were/are addictive, he needs to have his license taken away. The discussion was always framed in terms of relative addictive risk. OxyContin was a slow release formulation to control pain for up to 12 hours. The slow-release lowered addictive potential somewhat.
who lied to doctors
However, within a couple of years of FDA approval in the mid-1990's, addicts found that crushing the tablets produced a recreational high (12hrs of dosing was released in ~1hr). That problem was the subject of a litany of papers, alerts, and texts 15-20 yrs ago. It was very well known.
Nonetheless, when overmedication of pain was pushed by CMS mechanisms in 2009-10, OxyContin remained the least dangerous loaded gun in the armory. Docs pressured to avoid any patient pain-control complaints, prescribed Oxy for that reason, not because there was any question it carried addictive risk.
Posted on 10/4/23 at 4:35 pm to NC_Tigah
quote:The doctor leaders at Purdue swore to them that it wasn’t addictive. Should their licenses be revoked? It seems like you’d say no because you don’t believe they should face any sort of accountability for the havoc they caused.
Cubbies, if there was a single doc in this country who was unaware p.o. narcotics were/are addictive, he needs to have his license taken away.
quote:Purdue pressured their reps to pressure doctors to write more scripts at higher doses so the reps and Purdue could earn more money. Are you disputing that? It’s common knowledge. A whistleblower rep testified to that. I’m not an opioid or narcotic expert but I have a hard time believing that OC was the safest narcotic pain med available for mild pain.
when overmedication of pain was pushed by CMS mechanisms in 2009-10, OxyContin remained the least dangerous loaded gun in the armory.
quote:
not because there was any question it carried addictive risk.
Purdue said it had a less than 1% risk of addiction. They even produced false studies to push that same narrative. But they are the real victims, right? Poor zillionaire Sackler family. They were just telling the truth and Medicare ruined their lives.
This post was edited on 10/4/23 at 4:38 pm
Posted on 10/4/23 at 5:16 pm to RaoulDuke504
What is the budget for an additional "s" and "h"?
Posted on 10/4/23 at 5:31 pm to 4cubbies
quote:YES! ABSOLUTELY! If doctor leaders at Purdue swore Oxy wasn’t addictive, they should lose their licence AND be subject to extensive jailtime.
The doctor leaders at Purdue swore to them that it wasn’t addictive. Should their licenses be revoked?
quote:That would be about like a pedophile colleague "pressuring" you to have Unlawful Carnal Knowledge of a student.
Purdue pressured their reps to pressure doctors
Not a chance in Hell you would take the recommendation! Right?
This post was edited on 10/4/23 at 11:37 pm
Posted on 10/4/23 at 5:32 pm to 4cubbies
quote:Right. You should stop.
Poor zillionaire Sackler family
Posted on 10/4/23 at 7:03 pm to NC_Tigah
quote:
Right. You should stop.
Posted on 10/4/23 at 8:29 pm to VolSquatch
quote:
You're selfish
How so? I’ve opened my home to numerous foster children, I sponsor kids around the world thru Compassion International, regularly volunteer thru my Church, have gone on a few Mission Trips and even if I don’t have foster kids in the house, I still volunteer to coach multiple youth league sports in my rural community. Add to that I served this nation as a soldier, regularly volunteer and participate in my Veterans groups to reduce suicide among us Veterans. What exactly do you do to help others? And how is what I’m doing selfish?
Posted on 10/4/23 at 8:48 pm to VolSquatch
Who are we kidding though, you sound like the type that begrudgingly drags themselves to Church each week, because it expected. Probably volunteer for nothing at the Church, just sit in the pews. Probably spout that you are pro choice but do nothing to provide choice. Probably never served this nation. Definitely don’t volunteer in the community. So how close to the truth am I?
Posted on 10/5/23 at 5:25 am to 4cubbies
quote:I missed this.
Purdue said it had a less than 1% risk of addiction.
I have no love for Big Pharma, no cares for Purdue Pharma, and no feelings of support for the Sacklers. None.
What I do have feelings for is truth in science and medicine, even if that truth goes against popular narrative. Pharma did NOT cause the opiate crisis. It did fuel it. It did profit from it. Causation lies directly at the feet of Washington DC, though. CMS during the Obama Administration (and final months of W's term) concocted and deployed its pain-scale based pay scheme, in an effort to cut reimbursements. Hospitals and medical providers were complicit, albeit basically extorted. All parties are happy to have found a pharma fall guy.
Regarding your "1%" quote, a 1% risk of addiction for treatment of acute moderate to severe pain with oxycodone, as prescribed, is an overestimate of risk.
Now then, that fact comes with a couple of important caveats. (1) The pain level (moderate to severe) warrants opioid intervention. (2) Acute pain is temporary nociceptive discomfort rather than neuropathic (chronic) pain.
But I mention it because if at some point you break a bone, have surgery, etc., and need an opiate pain reliever, you shouldn't dread addiction as a consequence.
There was also independent data in opiate crisis timeframe indicating addiction risk, even for chronic pain ran as low as 0.59%.
IMO 0.59% is low relative to long term opiate use by a factor of 10 or more. But Fishbain et al derived it on their own. So it wasn't just Purdue sponsored stuff.
quote:
What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review
David A. Fishbain, MD, FAPA, Brandly Cole, PsyD, John Lewis, PhD, Hubert L. Rosomoff, MD, DMedSc, FAAPM, R. Steele Rosomoff, BSN, MBA
Pain Medicine, Volume 9, Issue 4, May 2008, Pages 444–459,
For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%.
LINK
Still keep in mind that although these numbers may seem low, if a doc is treating 20 patients/day, 1% amounts to creating an addict per week.
This post was edited on 10/5/23 at 5:26 am
Posted on 10/5/23 at 5:49 am to NC_Tigah
quote:
Regarding your "1%" quote, a 1% risk of addiction for treatment of acute moderate to severe pain with oxycodone, as prescribed, is an overestimate of risk.
Does this take in to account irresponsible prescribing? Like prescribing 100 mg of Oxy for a sprained ankle, for example?
quote:
Pharma did NOT cause the opiate crisis. It did fuel it. It did profit from it. Causation lies directly at the feet of Washington DC, though. CMS during the Obama Administration (and final months of W's term) concocted and deployed its pain-scale based pay scheme, in an effort to cut reimbursements. Hospitals and medical providers were complicit, albeit basically extorted. All parties are happy to have found a pharma fall guy.
Didn’t the first wave of the opioid crisis start in the 90s after the big increase in opioid prescribing? That’s before W or Obama took office. I don’t think Purdue or pharmaceutical companies are 100% solely to blame for creating the epidemic, but they do shoulder a lot of the responsibility for fueling and perpetuating it.
This post was edited on 10/5/23 at 5:50 am
Posted on 10/5/23 at 6:26 am to Azkiger
quote:
Why can't we have a shittier healthcare system for less money?
I mean, I guess we could...
This bears repeating. Compare 5 year cancer survival rates between the US and Britain.
Their universal Healthcare system stays afloat by limiting Healthcare access.
Compare how long it takes to see a specialist. It might be "free" but you'll have to live long enough to enjoy it.
Posted on 10/5/23 at 6:44 am to 4cubbies
quote:
Didn’t the first wave of the opioid crisis start in the 90s after the big increase in opioid prescribing?
quote:So yes, there were two waves, in essence. The first was d/t unanticipated recreational altering. It led to curtailed prescriptions.
Cubbies, if there was a single doc in this country who was unaware p.o. narcotics were/are addictive, he needs to have his license taken away. The discussion was always framed in terms of relative addictive risk. OxyContin was a slow release formulation to control pain for up to 12 hours. The slow-release lowered addictive potential somewhat.
However, within a couple of years of FDA approval in the mid-1990's, addicts found that crushing the tablets produced a recreational high (12hrs of dosing was released in ~1hr). That problem was the subject of a litany of papers, alerts, and texts 15-20 yrs ago. It was very well known.
The second was d/t escalated prescriptions despite known issues, because Oxy was the least bad of bad alternatives.
quote:In an opiate naive patient?
Does this take in to account irresponsible prescribing? Like prescribing 100 mg of Oxy for a sprained ankle, for example?
That wouldn't addict them, but it might kill them. But yes, it's a general population stat. So it takes exceptions into account.
This post was edited on 10/5/23 at 6:52 am
Posted on 10/5/23 at 6:52 am to RaoulDuke504
quote:
I often hear dems yell for universal healthcare as we are one of the few first world nations that don't have it. That we need to tax the rich and raise taxes to afford it. One thing I never see mentioned is that the US spends more of it's GDP on healthcare than any of those countries.
So if Universal healthcare is the answer and we are backwards to be without it. How can we not afford to do it within the current budget that so many other nations can?
Two issues here.
1. Universal HC is the end of treatment choice. You get what the doctor ordered and nothing more unless you pay for it 100% out of pocket. In the UK it is illegal to provide alternative services in many instances. Think of the Covid pandemic.
2. Treatment is scheduled on the most urgent basis and those who take care of themselves and try to nip something in the bud are not urgent enough to be treated.
Posted on 10/5/23 at 6:53 am to AgSGT
You do know you can reply in one comment right?
Oh so you're one of these performative Christians, do all the right things that people can see but you don't actually have Christian values. I get it.
Nope
Another veteran whose whole personality is his time in the military, color me shocked.
More performance. Ever heard "don't let the left hand know what the right hand is doing"?
You also bring up the foster thing a lot. No one made you do that. You seem kind of bitter about it. Wife force you into it and you have to pretend you enjoyed it?
quote:
Who are we kidding though, you sound like the type that begrudgingly drags themselves to Church each week, because it expected. Probably volunteer for nothing at the Church, just sit in the pews
Oh so you're one of these performative Christians, do all the right things that people can see but you don't actually have Christian values. I get it.
quote:
Probably spout that you are pro choice but do nothing to provide choice.
Nope
quote:
Probably never served this nation.
Another veteran whose whole personality is his time in the military, color me shocked.
quote:
Definitely don’t volunteer in the community.
More performance. Ever heard "don't let the left hand know what the right hand is doing"?
You also bring up the foster thing a lot. No one made you do that. You seem kind of bitter about it. Wife force you into it and you have to pretend you enjoyed it?
Posted on 10/5/23 at 7:28 am to VolSquatch
quote:
You also bring up the foster thing a lot. No one made you do that. You seem kind of bitter about it. Wife force you into it and you have to pretend you enjoyed it?
It was actually my idea, thanks for playing
Posted on 10/5/23 at 8:35 am to AgSGT
Sure it was, buddy
Posted on 10/5/23 at 5:56 pm to NC_Tigah
quote:
because Oxy was the least bad of bad alternatives.
Like Tylenol? For palliative care, I can buy that oxy was the safest alternative. But for mild to moderate pain, oxy most certainly was not the safest pain reliever available. You’re saying that every doctor knew that it was addictive despite the FDA claiming it was not. It’s hard for me to accept that so many doctors knowingly and willingly prescribed a medication they knew was addictive for mild or moderate pain. Purdue Pharma and three top executives pleaded guilty to misleading regulators, physicians, and patients about OxyContin's hazards and agreed to pay $600 million in fines and damages. Why would they do that if it wasn’t true? Did they perjure themselves to plead guilty to crimes they didn’t commit? Why would they do that?
In an earlier post, you said that if a doctor saw 20 patients a day, 1 of them would become an addict based on the “less than 1% of patients become addicted” claim by Purdue. Wouldn’t 1 in 20 be 5%? One in 200 would be 0.5% Or is my math off?
This post was edited on 10/5/23 at 5:59 pm
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