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View Diary: Nice job you got there ... (129 comments)

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  •  I don't think evidence based medicine (11+ / 0-)

    is inherently bad, although I can see ways in which that methodology can be misused.

    The point of using it in the diary is that, right now, even highly skilled occupations can be de-skilled to use less skilled and/or less expensive employees, even to replacing workers with machines when previously complex tasks become routine. The close of your comment points in that direction.

    While I think doctors and researchers see it as a way to improve treatment when used intelligently, I'd be even more certain that clinic and hospital CEOs and CFOs see it as way to reduce costs and increase profits - and a big segment of the industry i for-profit.

    But suppose the very best happens and diagnosis and treatment become highly automated and drastically improved in quality, and everyone in the country can now afford the very best medical care. What happens to all the people whose jobs have been replaced by machines, when it's happening across nearly every industry?

    I'll grant that the questions I pose in this diary about employment are often at odds with improved cost, quality, or service delivery. That's what makes them so very difficult to solve as problems.

    Modern revolutions have succeeded because of solidarity, not force.

    by badger on Thu Jan 24, 2013 at 03:53:34 PM PST

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    •  It's interesting (6+ / 0-)

      The health care system I belong to seems to on the one hand have ever longer waits to see a doctor, which would suggest they are cutting physician total FTEs, but on the other hand, between the times my two kids were born they got rid of midwives so I had one with my first but not my second because CNMs don't bring in as much reimbursement as MDs do. (Fewer c-sections partly.)

      I can't figure out whether they want to hire or fire the nurse practitioners.

    •  Then people could spend less on medicine (0+ / 0-)

      and spend more on efficient transportation, sustainable food, efficient housing, living close to work...

      Government and laws are the agreement we all make to secure everyone's freedom.

      by Simplify on Thu Jan 24, 2013 at 08:42:39 PM PST

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      •  If the savings were distributed (5+ / 0-)

        But money/wealth only flows upward right now - that's basically what this is all about.

        Modern revolutions have succeeded because of solidarity, not force.

        by badger on Thu Jan 24, 2013 at 08:51:53 PM PST

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        •  Not necessarily true (0+ / 0-)

          Walmart is a good example of lower costs, as much as people hate it.

          You can certainly afford declines in your salary if your costs also decline even more. In fact, deflationary monetary systems like Bitcoin pretty much have to work that way.

          Besides, wealth can only accumulate so much. Natural feedback systems (in my view) will always tend to counter excessive concentration too much. A person who owns all the money in the world is the same as the person who owns none.

          (-5.50,-6.67): Left Libertarian
          Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

          by Sparhawk on Thu Jan 24, 2013 at 09:10:47 PM PST

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          •  Depends (6+ / 0-)

            Maybe Wal-Mart food is cheaper, although I'd be real surprised if shopping there beat careful shopping at a mix of different places, which is what we do. I doubt Wal-Mart's quality is uniformly as good as elsewhere, which also makes the low price illusory, even for commodities.

            But on clothing or hard goods, I think if you take life-cycle costs into account, the wealth still flows upward. You might get socks for 1/2  the price of elsewhere,  but they cost 10% of what other seller's socks cost to make, and you buy them 3 times as often (that's the last thing I bought at Wal-Mart many years ago, and that was pretty much my experience).

            I was going to give an analogy in the other response, but I'll give it here.

            You pay 7.65% SS/Medicare tax on your wages. Your employer also pays 7.65% on your wages. If tomorrow, that tax were abolished (hypothetical - I'm not advocating it), what would happen to your paycheck? Would it be

            a) 15.3% higher, because you no longer pay the tax, and your employer gives his tax payment to you

            b) 7.65% higher, because you keep your share of the tax, and your employer keeps his

            c) The same, because the employer keeps your share of the tax as well as his.

            (I won't add (d) Lower, because I've been cynical enough today).

            I think there's no question the answer in today's environment is (c), and that means your cost to your employer just dropped 15.3% - but he won't be lowering his prices any time soon. That's especially true in a market where unemployment is nearly 8% and not trending downward very fast.

            What you might save by making health care cheaper will evaporate in the same way, IMO.

            Modern revolutions have succeeded because of solidarity, not force.

            by badger on Thu Jan 24, 2013 at 09:30:37 PM PST

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    •  Evidence based medicine & treatments are good, (2+ / 0-)
      Recommended by:
      Brooke In Seattle, badger

      but not for everyone. A medication in a study works for a high percentage but not all. The danger is to misuse such information to railroad patients and practitioners.

      •  Sure (2+ / 0-)
        Recommended by:
        badger, doinaheckuvanutjob

        It depends on how it is used of course. But having the information available is better than having no information. A judicious practitioner can take it into account. That doesn't mean they are going to always make the decision to go in a particular way, only that they have research based information they can take into consideration, instead of just 'we've always done it this way.'

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