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View Diary: What are some Progressive Solutions to the "Medicare Problem"? (70 comments)

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  •  interesting idea Keith930 (0+ / 0-)

    hadn't heard of that one before.


    Here's how the game is really Rigged.

    by jamess on Sun Jan 20, 2013 at 04:43:08 PM PST

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    •  some...perhaps most, would say "I want it all" (1+ / 0-)
      Recommended by:
      jamess

      BUt I'll bet a not insignificant number would actually give it some thought.  Either way, most people choose not to deal with those questions until it's too late, and the system ends up taking over and making the decisions for them...and then it's all about medical CYA and running up the bill.

      Oregon: Sure...it's cold. But it's a damp cold.

      by Keith930 on Sun Jan 20, 2013 at 04:57:43 PM PST

      [ Parent ]

      •  well I still think (1+ / 0-)
        Recommended by:
        3goldens

        merit compensation based on wellness outcomes,

        not on the number of tests etc,

        has significant incentives to drive costs down, in the long run.

        ie. pay doctors a bonus, when their patients, DON'T need any tests or treatments.


        Here's how the game is really Rigged.

        by jamess on Sun Jan 20, 2013 at 05:01:54 PM PST

        [ Parent ]

        •  Is that like paying teachers (1+ / 0-)
          Recommended by:
          jamess

          according to how well their students do on tests?

          Doctors don't completely control outcomes, just as teachers don't. They can't control how their patients will respond to treatment or how sick their patients are or how well they comply with instructions or the other factors in their lives that affect their health.

          And maybe you want your doctor to have a financial incentive to deny you tests - I don't. I've already seen in HMOs what happens when the insurance company has an incentive to deny them: diagnosis and treatment get delayed for non-medical reasons, and people suffer.

          Creating financial conflicts of interest between doctors and patients is just as bad - or worse - as giving doctors incentives to overtreat. And I certainly don't want to give them an incentive to turn away sicker patients. The answer has to lie elsewhere.

          We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

          by denise b on Sun Jan 20, 2013 at 09:03:51 PM PST

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          •  yes but (1+ / 0-)
            Recommended by:
            Chi

            tests for the sake of tests

            does not usually result in long-term learning.


            Learning is a process, much more than memorization;

            but you raise some good points about HMO's and denial of care ... for dollars, in my "merit system."


            Obviously for a bonus based on wellness to work.

            Wellness would have to be more than an arbitrary pronouncement.  Made by the provider.


            Here's how the game is really Rigged.

            by jamess on Sun Jan 20, 2013 at 11:34:26 PM PST

            [ Parent ]

      •  I started to write an advance directive (1+ / 0-)
        Recommended by:
        Chi

        a year ago, along with two of my friends. It's harder than we thought. I have not been able to complete mine yet.

        One of us already had a disease that she knew would kill her when we started the process, most likely within five years, although she was still doing quite well at the time. Her illness was the impetus for the three of us, all in our 60s, to do this. She has since died. She went downhill very abruptly one day and spent the next month in and out of the ICU, then in hospice for a month. She rescinded her original advance directive and did not complete another until she left for hospice, because, as I said, it's hard to say exactly what you will want before you're faced with concrete choices.

        It bothers me a lot that anyone would suggest that the money spent on her hospital care was wasted because she died anyway. Yes, she had a terminal disease, but no one knew when she would die. Her doctors didn't know exactly what caused her to get worse - whether it was the progression of her disease or a treatable infection. They might have been able to get her well again to live for an indeterminate amount of time, so of course they treated her. I would never want her or anyone else deprived of care in a situation like that. When her doctors determined that they could not get her better, then and only then did they stop treating her. It would have been tantamount to murder to do otherwise.

        And though she did not want her life prolonged if she was in a coma or on a breathing machine, she definitely wanted to live the last weeks or months she had left. I think almost anyone in her situation would have.

        We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

        by denise b on Sun Jan 20, 2013 at 08:50:27 PM PST

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