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Old 12-21-2009, 01:53 PM   #41
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We're all going in tomorrow morning. DW is coming with me to help restrain comfort the children while they receive their shots. We will see if they relent on DW getting a shot from the nurse. I'm definitely going to confront them as to whether the issue is medical in nature or financial. I may even offer them a crisp $20 in exchange for immediate service for the DW.
Your logic for insisting that you go out of your way to have your shots in the Dr office escapes me. Why not simply stop at one of the Walgreens or CVS stores you'll pass along the way and get the shots there?

Our doc (for the past 28 yrs) offered regular flu shots at his office but is not offering H1N1 shots unless you have reason for concern and insist on a consultation regarding them vs your personal health situation. I'm guessing he doesn't want to assume the implied responsibility that since you're in your own doc's office for the shot, doc or his staff is reviewing your file to assure the shot is right for you.......for no charge.

DW and I are heading over to CVS for the shots right now. They charge a $15 "administrative" fee and you fill out and sign a form indicating you know what you're doing and have read and understood the information CVS provided you regarding risks involved.

If you're happy with your doc and his/her practice other than this issue, why not go and get the shots in a more appropriate setting (you're saying you DON'T want doc involved, just the nurse) like a retail pharmacy or quickie clinic?
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Old 12-21-2009, 02:06 PM   #42
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- When prices go up, we can expect that higher supplies wil soon follow (as suppliers respond to the higher prices). This tremendously beneficial mechanism does not exist with administrative rationing-what is in short supply (doctors, medicines, etc) tends to remain in short supply.
Yes, but the other side of that equation is that demand is pushed down as people get priced out of the market. Which is perfectly fine when we're talking about sirloin and dresses, but it's something entirely different with health care.

The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.
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Old 12-21-2009, 02:11 PM   #43
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why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?
The middle ground, as indicated in my post above, is to take the flu shot business elsewhere but decide whether to change family docs based on overall performance of doc and his office. Flu shots, for people like the Fuego family who difinitely don't want a doc overview, are more appropriately done in a mass clinic setting.

If the Fuego family is unhappy with this doc and his/her staff, including but not limited to this flu shot situation, they should simply establish a relationship with another doc or practice. But moving based only on doc's office not competing well with Walgreens and CVS for flu shots would be silly. Doc's office isn't the best place to get the shots given Fuego's criteria of fast, cheap, no overview.
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Old 12-21-2009, 02:15 PM   #44
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The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.
A good place to see rationing in action is American specialty clinics where wealthy Canadians compete with American citizens for places in line.
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Old 12-21-2009, 03:31 PM   #45
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The demand curve for a heart transplant is a vertical line that ends at an individual's ability to pay. Once the top of that line is reached, there are no economic choices and health care is rationed.
The argument usually comes to this. But the demand curve for the insurance which would pay for a heart transplant is not vertical. Many people can afford it, and do. There are all kinds of catastrophic events for which we buy insurance.
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Old 12-21-2009, 04:22 PM   #46
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Your logic for insisting that you go out of your way to have your shots in the Dr office escapes me. Why not simply stop at one of the Walgreens or CVS stores you'll pass along the way and get the shots there?

I'm guessing he doesn't want to assume the implied responsibility that since you're in your own doc's office for the shot, doc or his staff is reviewing your file to assure the shot is right for you.......for no charge.

DW and I are heading over to CVS for the shots right now. They charge a $15 "administrative" fee and you fill out and sign a form indicating you know what you're doing and have read and understood the information CVS provided you regarding risks involved.

If you're happy with your doc and his/her practice other than this issue, why not go and get the shots in a more appropriate setting (you're saying you DON'T want doc involved, just the nurse) like a retail pharmacy or quickie clinic?
I never said he should give us the shot for no charge. They charge an administrative fee that retails at $21 or so, and my insurance pays them $10. The h1n1 vaccine itself is free. $10 for a nurse-administered shot seems pretty fair given that a simple sick visit with an actual doctor plus nurse only costs us $60 or so typically (insurance negotiated rate, out of pocket of course).

As I said, the doc didn't need to review any of our charts for the other 3 members of the family. I don't think their insistence on a full doctor visit for DW had anything to do with medical purposes. Strictly financial - they wanted to make $60 from her. They don't have any real medical tort liability since they are protected by a federal law that provides immunity to tort claims arising from administration of the h1n1 vaccine.

In this case, it wouldn't have taken more than 2 extra minutes to administer the shot to DW after the other 3 of us got the shot.

And I don't necessarily know if a quick clinic visit would be covered by our insurance. The public clinics were free, but had long wait times for a while. Not sure what the wait is like now. I guess we're down to the canadian system now - wait in line for a while, or pay a premium for quick service.

I guess our Family Practitioner doc is our Primary Care Physician except when it comes to things like immunizations sometimes. It just seemed logical to expect our Primary Care Physician to administer annual regular vaccinations to members of our family who are existing patients. I wouldn't run to the public health clinic or CVS if I needed a booster shot for tetanus or some other vaccine. I don't take my kids to the public health clinic or CVS for simple DPT or MMR vaccines although the administrative burdens are similar.
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Old 12-21-2009, 05:40 PM   #47
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The argument usually comes to this. But the demand curve for the insurance which would pay for a heart transplant is not vertical. Many people can afford it, and do. There are all kinds of catastrophic events for which we buy insurance.
So the answer to a broken health insurance system that excludes people with pre-existing conditions (like heart disease, for example) and forces more and more people each year into the ranks of the uninsured is for people to buy health insurance?
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Old 12-21-2009, 05:40 PM   #48
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Old 12-21-2009, 07:52 PM   #49
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I never said he should give us the shot for no charge.
And I didn't say that you did. I've been reading your posts a long time and, based on those, I'd never expect you'd make medical choices for your family based on a couple of bux one way or the other.
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And I don't necessarily know if a quick clinic visit would be covered by our insurance.
They commonly are but you need to check with your provider, especially if you're in a PPO plan. DW and I are each with a different insurer, one through private and one through public employment, and they do cover quick clinics.
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The public clinics were free, but had long wait times for a while. Not sure what the wait is like now. I guess we're down to the canadian system now - wait in line for a while, or pay a premium for quick service.
And just wait for what the future brings!
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I guess our Family Practitioner doc is our Primary Care Physician except when it comes to things like immunizations sometimes. It just seemed logical to expect our Primary Care Physician to administer annual regular vaccinations to members of our family who are existing patients.
I guess we didn't look at the H1N1 "pandemic" (name per the current administration) and the resulting vaccination as an "annual regular vaccination." This seemed to be something under the control of the public sector.

We got our H1N1 shots at a local CVS Minute Clinic this afternoon. No issues. No dissatisfaction with our family doc for deciding not to provide these but rather directing us to use either the county health department or one of these clinics.

You've expressed a great deal of dissatisfaction with your family doc. I'd think you owe it to your family to go out and find one you prefer. Health issues can pop up without warning and needing to depend on a doc and staff you dislike and have lost confidence in would be a bad thing. There may come a time when we have less choice about selecting docs, but for now your doc is your doc because that is your choice.
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Old 12-21-2009, 11:34 PM   #50
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So the answer to a broken health insurance system that excludes people with pre-existing conditions (like heart disease, for example) and forces more and more people each year into the ranks of the uninsured is for people to buy health insurance?
I don't think it's a simple problem, and I know you don't either. I'm fairly sure that oversimplifying the problem will not lead us to either a solution or to greater understanding of the problem. So, let's not do that.

Yes, I think insurance can play an important role in helping people pay for unexpected medical expenses, just as it plays a role in helping them pay for non-medical unexpected expenses. And, while I personally would like to see a different answer, I believe (based on what our present society demands) that the most constructive, least damaging role our government can play is to:
1) Require that individuals buy insurance (eliminating adverse selection)
2) Provide the outlines for the minimum standard required policy. It would provide "free" preventative care, meaningful co-pays, and no lifetime cap. No-frills care: no private rooms in the hospital, etc.
3) Establish rules that insurers must take all comers without underwriting and charge them all same rate for the standard policy..
4) Provide additional outlines for standardized optional supplemental policies (to foster efficient price competition in these policies).
5) Allow cross-state competition
6) Provide a clearinghouse for medical cost information and objective measures of medical care quality to better inform consumers
7) Provide subsidies to pay for medical insurance and care. But before any American is forced to pay for the care of another, the recipient must have spent a substantial portion of either their annual income or total assets on their own care.

Market based and without rationing. And get everyone used to the fact that good medical care costs money, and that, like food and shelter, they are responsible for providing for themselves unless they truly can't.

Sometimes I think the folks most afraid of the government takeover of
US medical care are Canadians. Hopefully they and US citizens will still have some place to go to get timely quality care in the future.
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Old 12-22-2009, 07:15 AM   #51
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If the safety valve of market based healthcare is eliminated in the US, Canada will likely loosen the screws a bit more and move more decisively to two tier.

As with all policy change, these things are decided by a handful of super-rich guys over drinks (not that there is anything wrong with that), and once the opportunity to fly to Boston or the Mayo and pay top dollar for the best health care is eliminated, these same rich guys and privaleged politicians will insist on "best health care" being available in Canada.

Also start looking for clinics opening up just across the border in Mexico, Grand Bahama, Bermuda, and in floating clinics just outside the national boundry at sea.
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Old 12-22-2009, 09:30 AM   #52
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Also start looking for clinics opening up just across the border in Mexico, Grand Bahama, Bermuda, and in floating clinics just outside the national boundary at sea.
While all the senators are busy raking in pork in exchange for their vote on the present bill, I wouldn't be surprised if at least one state sees the opportunity to become the "medical destination for North America." Let docs and hospitals know that they'll get favorable tax treatment and be allowed to treat any patient they choose, and put out the welcome mat for new customers. If this new scheme goes the way of almost every govt health care system, they'll soon have plenty of business.
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Old 12-22-2009, 09:36 AM   #53
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yes, Nevada and the Native Reservations will want to get in on this.
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Old 12-22-2009, 10:17 AM   #54
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You've expressed a great deal of dissatisfaction with your family doc. I'd think you owe it to your family to go out and find one you prefer. Health issues can pop up without warning and needing to depend on a doc and staff you dislike and have lost confidence in would be a bad thing. There may come a time when we have less choice about selecting docs, but for now your doc is your doc because that is your choice.
I think "frustration" would be a better way to put it. I'm not sure that a new doctor would be better in most respects though. The truth is that we just don't consume a lot of medical services in a given year. I think we average roughly 2-3 visits per year total for our family, roughly half of which are to this doctor (other than annual physicals).

However just yesterday I had a very pleasant experience with this doc's office. Got immunization records for my daughter's kindergarten enrollment. A little phone tag, but they got back to me quickly, faxed authorization forms, and promised to mail me the records (hence saving me an errand to their office).

I would guess that a large part of my frustration arises from general BS that every doc's office has - byzantine insurance policies/claims/filing, forms to fill in, paperwork, authorization sheets, etc. That's a criticism of the health insurance and HIPAA more than the doc though.

We'll stick with the doc for now. Odds are our insurance will change, we'll have to switch docs anyway, or we'll have a spiffy new govt insurance of sorts that may necessitate changes anyway.
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Old 12-22-2009, 11:45 AM   #55
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I think your points 1-7 would offer a great starting point for healthcare insurance "reform". Too bad special interests and politics takes over instead of logic and compromise...Thanks...TomCat

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Originally Posted by samclem View Post
I don't think it's a simple problem, and I know you don't either. I'm fairly sure that oversimplifying the problem will not lead us to either a solution or to greater understanding of the problem. So, let's not do that.

Yes, I think insurance can play an important role in helping people pay for unexpected medical expenses, just as it plays a role in helping them pay for non-medical unexpected expenses. And, while I personally would like to see a different answer, I believe (based on what our present society demands) that the most constructive, least damaging role our government can play is to:
1) Require that individuals buy insurance (eliminating adverse selection)
2) Provide the outlines for the minimum standard required policy. It would provide "free" preventative care, meaningful co-pays, and no lifetime cap. No-frills care: no private rooms in the hospital, etc.
3) Establish rules that insurers must take all comers without underwriting and charge them all same rate for the standard policy..
4) Provide additional outlines for standardized optional supplemental policies (to foster efficient price competition in these policies).
5) Allow cross-state competition
6) Provide a clearinghouse for medical cost information and objective measures of medical care quality to better inform consumers
7) Provide subsidies to pay for medical insurance and care. But before any American is forced to pay for the care of another, the recipient must have spent a substantial portion of either their annual income or total assets on their own care.

Market based and without rationing. And get everyone used to the fact that good medical care costs money, and that, like food and shelter, they are responsible for providing for themselves unless they truly can't.

Sometimes I think the folks most afraid of the government takeover of
US medical care are Canadians. Hopefully they and US citizens will still have some place to go to get timely quality care in the future.
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Old 12-22-2009, 12:20 PM   #56
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Too bad special interests and politics takes over instead of logic and compromise.
This is my area of expertise professionally, so listen up.

Indeed, after a few years, you figure out that it is not about a shortage of ideas or logic, but rather, its all about who decides, and who has the ear and influence over the "decider", and then what is their particular self interest.

As a general rule, any policy issue has several "levels of truth".

The first level of truth is how the issue is perceived by the beneficial or entitled clients of a program or participant under a regulatory regime, which is normally the pov expressed in the mass media.

The second level of truth is how the issue is perceived by the university academics or professional research staff in a department, who do not have a personal stake in the game and are trained to see the big picture. This is the pov expressed in ignored academic papers and in shelved internal research documents, and is as close to true "truth" as you are going to get.

The third level of truth is how the issue is perceived by the deliverers of the program or overseers of the regulatory regime, who have a stake in the jobs and power associated with the policy. Guess what happens when they are given control of the performance measurement and policy development process?

The fourth level of truth is how the issue is perceived by the man on the street who has no direct stake in the issue, and how that particular program or policy plays into their emotional needs, irrational fears and prejudices (think, immigration, energy, abortion, health policy..oh hell, I guess all of them).

The Fifth level of truth is how the program or policy is valued or plays into a substantive issue which is not part of the ground level policy debate - ie. the positive impact of illegal immigration and the grey labour market on the cost structure of US service, construction and manufacturing industry

The sixth level of truth is how a program or policy is used as a card in the international trade negotiation multilateral and bilateral poker game that is played between national leaders in high stakes tit for tat.

I have seen odd and unexplainable offsetting events happen on opposite sides of an international border, and the only explanation is that a call was made the night before.
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Old 12-22-2009, 10:46 PM   #57
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This is my area of expertise professionally, so listen up.
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I have seen odd and unexplainable offsetting events happen on opposite sides of an international border, and the only explanation is that a call was made the night before.
Good evening Mr. Ignatieff!
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Old 12-23-2009, 07:35 AM   #58
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Ha! you are of course speaking of the greatest asset of the non-naturally governing party!

I have a retired friend who's core purpose in life is to write scathing letters to the editor against Iggy, and he is way to good at it....I told him to lay off...Iggy is far too valuable to Stevey.

that being said, I personally support whoever is good for the Country from either side of the black rod, and I believe Canada has been blessed over time with good leaders for the particular challenges of each era.

in 100 years we are all going to prostrate before the image of Johnny for outlawing corporate and union donations to political parties.

and it was Paul who sent the troops into the south....funny how the border started opening to cattle that very same week.
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