3M stopping retiree medical

[Emeritus]

It depends. Change is easy to accept if it is clearly better than the status quo. I could give numerous examples, one being the fact that you are posting this rather than handwriting a snail-mail letter-to-the-editor.

If this change was clearly better, resistance would be minimal. I agree we need change.

-ERD50

Clearly better to WHOM? If you have control of a key node in any network so that you can extract monopoly profits, You hate change and its worth a lot of money to You to stop it. voila you buy some polticians and it's stopped.

There is more "heat " in a swimming pool than in a match, but only a match can start a fire. It is the structure of power and the existence of a vulnerable node that allows change, good or bad. "Clearly better" means nothing if the people who want change are diffuse and it requires concentrated action.

Take radiology and the use of state licensing laws to eliminte the cost saving of Teleradiology. A few wealthy radiologists can buy enough legislators to defeat the shift.

 

[Richard8655]

This is why I applied for (and got) residence in Canada. Guaranteed health coverage at minimal or no charge, regardless of age or employment status.

 

[samclem]

. . . However, I see a lot less debate about the supply side which has (potentially) at least two pieces of low hanging fruit:

1. recognise a wider range of over seas medical and nursing qualifications and encourage people with those qualifications to immigrate;

2. better tax breaks and other incentives for providing medical facilities and equipment.

I do not know enough about the industry to comment on how realistic these are?

I'm not sure how much would need to be done to increase supply. There are indications that there is excess supply right now (many communities have excess hospital bed capacity, the wait times for sophisticated diagnostics is short and frequently high-capital-cost equipment is only used during "normal" business hours, etc). We deliberately limit the number of med school slots to help keep the wages of physicians higher (thanks AMA).

Still, just because we have enough health care providers now doesn't mean we'll have enough if insurance is expanded and demand increases. But, at least by some indicators, there's no shortage right now.

Regarding tax breaks for medical equipment--it's interesting that the present "reform" does exactly opposite, applying a tax to various bits of medical equipment.

 

[ERD50]

RE: easy to accept "clearly better" change:

Clearly better to WHOM? If you have control of a key node in any network so that you can extract monopoly profits, You hate change and its worth a lot of money to You to stop it. voila you buy some polticians and it's stopped.

There is more "heat " in a swimming pool than in a match, but only a match can start a fire. It is the structure of power and the existence of a vulnerable node that allows change, good or bad. "Clearly better" means nothing if the people who want change are diffuse and it requires concentrated action.

Agreed. But this Gallup poll asks -

Taking everything into account, do you think in the long run the new healthcare bill will make the U.S. healthcare system [ROTATED: better, would it not make much difference, (or make it) worse] -- than it is now?


Healthcare System

2010 Mar 26-28


Better - 42%

Not much difference - 11%

Worse - 45%

No opinion - 2%

edit/add: So, regardless of any powerful monopolies, the American public does not see Health Care Reform as "clearly better". That was my point regarding "acceptance".

further edit/add: I just scrolled down to the detail of that Gallup poll - when they ask specifics, the "Worse" tally is far greater than the "Better" in almost every case - cost, quality, "coverage".


-ERD50

 

[Emeritus]

RE: easy to accept "clearly better" change:



Agreed. But this Gallup poll asks -

Taking everything into account, do you think in the long run the new healthcare bill will make the U.S. healthcare system [ROTATED: better, would it not make much difference, (or make it) worse] -- than it is now?


Healthcare System



edit/add: So, regardless of any powerful monopolies, the American public does not see Health Care Reform as "clearly better". That was my point regarding "acceptance".

further edit/add: I just scrolled down to the detail of that Gallup poll - when they ask specifics, the "Worse" tally is far greater than the "Better" in almost every case - cost, quality, "coverage".


-ERD50

Oh for goodness sake
How the hell would they know?


Supposed they were asked

Do you approve of the Death panels enacted into the new health care law?

Etc
CBS) Most Americans do not accept the theory of evolution. Instead, 51 percent of Americans say God created humans in their present form, and another three in 10 say that while humans evolved, God guided the process. Just 15 percent say humans evolved, and that God was not involved.
Poll: Majority Reject Evolution - CBS News
The world is full of people who will believe ANYTHING

 

[REWahoo]

The world is full of people who will believe ANYTHING

...and a few that will post expansively on EVERYTHING.

 

[ERD50]

RE - Gallup poll showing the % who think things will be worse after the HC 'reform' bill is enacted.

Oh for goodness sake
How the hell would they know?

Supposed they were asked ...

But that is not what they were asked. The questions are there in the poll.

You are now diverting the discussion away from what the public believes to what you think they should believe. That wasn't the question. Let's look back at the post I responded to:

Yes... there are people and businesses who want status quo. But the status quo is not working so well and looking unsustainable.

Change is hard to accept.

And I said people are very willing to accept change that they perceive as positive. Admittedly, their perceptions may or may not be accurate. But that doesn't change the fact that the Gallup poll says people are skeptical of this Health Care Reform. So it should come as no surprise that they are finding it hard to accept the bill positively. It is the bill they find hard to accept, not "change".

And I do find it aggravatingly offensive to be lumped into a group that finds change "hard to accept". The technology business is all about change, I embraced change. It's like telling me that I couldn't have possibly rubbed two brain cells together and come up with an informed opinion on the subject - nope, it involves change, and I just don't like change - end of story, there are no rebuttals, the substance/content makes no never-mind, I just don't like change and that's that. Convenient.

-ERD50

 

[Emeritus]

And I do find it aggravatingly offensive to be lumped into a group that finds change "hard to accept". The technology business is all about change, I embraced change. It's like telling me that I couldn't have possibly rubbed two brain cells together and come up with an informed opinion on the subject - nope, it involves change, and I just don't like change - end of story, there are no rebuttals, the substance/content makes no never-mind, I just don't like change and that's that. Convenient.

-ERD50

Actually, without the slightest intent of any kind to be personal, the technology world is one which often resists change mightily when they have a vested interest in the status quo. The QWERTY keyboard is a classical example of resistance.

I'm lecturing today on Icing and aircraft and how the airplane industry resisted any change in 40 year old icing standards as new scientific understanding developed

In my work on medical information systems we find all kinds of resistance to change AMONG THE TECHNOLOGISTS, not to mention the medical types.

KUHN's the "Structure of Scientific Revolutions" is all about resistance to change and how scientists strenuously resist giving up a pet theory.

So you may be the most flexible and change oriented person in the world. The system we work in is not flexible or change oriented.

 

[ziggy29]

The world is full of people who will believe ANYTHING

"ANYTHING" being derisively defined here as "whatever I don't believe"?

 

[ERD50]

Actually, without the slightest intent of any kind to be personal, the technology world is one which often resists change mightily when they have a vested interest in the status quo. The QWERTY keyboard is a classical example of resistance.
...

No problem - and in this case, once again, the change was not "clearly better" to those it affected. Typists measured the benefits of the new against losing their current skill set. And they decided to stick with the old (designed to reduce jams on old typewriter mechanisms, not to be ergonomic). The people spoke. Maybe they chose poorly (though some studies show little improvement in performance with alternate layouts, so maybe not), but they did not perceive it as "clearly better". That is my point.

So the question is still (and we've debated it so much here in the past, I'll try to refrain from a re-hash of the details) - why doesn't the public perceive the HC Reform bill as "clearly better"?

So you may be the most flexible and change oriented person in the world. The system we work in is not flexible or change oriented.

That all depends on your viewpoint and what you pick in an attempt to make your point. People all over the world have embraced perceived positive changes, far too many examples that we all can think of to even waste time typing them on my old QWERTY keyboard.

-ERD50

 

[MichaelB]

So the question is still (and we've debated it so much here in the past, I'll try to refrain from a re-hash of the details) - why doesn't the public perceive the HC Reform bill as "clearly better"?

Because it isn’t. It may be in the future, and is likely to be in some aspects, but the leadership of this reform effort has not shown, in simple, easy and credible ways to understand, how it is better.

OTOH, FUD (fear, uncertainty and doubt) has worked brilliantly and is likely to continue as long as people fear their collective economic future and there is no measurable improvement in health care availability or delivery.

 

[Texas Proud]

I'm sure that is so. But since we never will get control of costs, waiting for universal access until we do would just mean we never would get universal access. So the statement of a truism becomes a code meaning `Forget about universal access'.

And therein was the problem with what was passed.... they kept telling everybody it was to control costs... but REALLY it was to pass a law for universal access... and to increase taxes by a lot and also spend a lot of money to get this done...

As others have mentioned... cost control will be very hard to do... without rationing or just saying we will not do this because the cost/benefits are just not there... (but, if you want it done, you pay your own money to get it done)... this IMO can save a lot of money.... but then we have people screaming of 'death panels' etc. etc....

 

[Texas Proud]

I'm not sure how much would need to be done to increase supply. There are indications that there is excess supply right now (many communities have excess hospital bed capacity, the wait times for sophisticated diagnostics is short and frequently high-capital-cost equipment is only used during "normal" business hours, etc). We deliberately limit the number of med school slots to help keep the wages of physicians higher (thanks AMA).

Still, just because we have enough health care providers now doesn't mean we'll have enough if insurance is expanded and demand increases. But, at least by some indicators, there's no shortage right now.

Regarding tax breaks for medical equipment--it's interesting that the present "reform" does exactly opposite, applying a tax to various bits of medical equipment.

From what my sister (who is an RN) is telling me.... there will be a big shortage of RNs soon... most are older... they are being replaced by LVNs or someone else with less knowledge...

The other thing she complains about is the work ethic of the 'younger' workers... they go out of their way to try and find ways to 'not work'...

I just talked to her recently and she will be out of a job in 2013... she has worked for a hospital for 30 years.... but she does not have a 4 year degree (even though she is an RN)... they are requiring everybody to have a 4 year degree if you want to work there... no exceptions...

 

[GregLee]

... but REALLY it was to pass a law for universal access... and to increase taxes by a lot and also spend a lot of money to get this done...

I agree this will be the real effect. But while I found the campaign deplorably dishonest, I think we must get universal access. It will cost a lot, but we're a rich society. We can afford it.

 

[Texas Proud]

Actually, without the slightest intent of any kind to be personal, the technology world is one which often resists change mightily when they have a vested interest in the status quo. The QWERTY keyboard is a classical example of resistance.

I'm lecturing today on Icing and aircraft and how the airplane industry resisted any change in 40 year old icing standards as new scientific understanding developed

In my work on medical information systems we find all kinds of resistance to change AMONG THE TECHNOLOGISTS, not to mention the medical types.

KUHN's the "Structure of Scientific Revolutions" is all about resistance to change and how scientists strenuously resist giving up a pet theory.

So you may be the most flexible and change oriented person in the world. The system we work in is not flexible or change oriented.

+1 on what ERD said about the QWERTY keyboard.... if you read history about keyboards... there were many different kinds when typewrites first came out... (and I did read that the QWERTY was not designed to prevent the keys from hitting each other as some have said).... and IF the newer ones were a lot better... I am sure that everybody would make the change... but I can type over 60 WPM on this old one... I doubt that I could improve my spead much with any new layout...


Another thing that most people don't mention when they talk about 'change'... a lot of it is sold as a 'big deal'.... but in reality it is a very small change and in fact might be worse off then what you had. As an example... back when I was a trust officer they wanted to impliment a document retention program where everything was scanned and we would not have to keep our trust docs in paper form. It did not work... when reading a big legal doc, you have to flip back and forth a LOT... and it was not easy on the screen... there were many other problems with the system which I will not go into here... but I said from the beginning that it would not work... I was told I did not embrace 'change'... after two years they got rid of the system because IT DID NOT WORK... did someone say 'gee, the TP was smart and knew that this would not work'... nope, I did not embrace change and was labled as such... (PS.. I did more change than anyone else on my own...)....

 

[Texas Proud]

I agree this will be the real effect. But while I found the campaign deplorably dishonest, I think we must get universal access. It will cost a lot, but we're a rich society. We can afford it.

And there is the fundamental problem... we were sold one thing and got another... to me this is why so many people do not like it...

and I do not think that we are rich enough to afford all that is being promissed... at least at the cost level and inflation rate of our current health care system...

 

[samclem]

I just talked to her recently and she will be out of a job in 2013... she has worked for a hospital for 30 years.... but she does not have a 4 year degree (even though she is an RN)... they are requiring everybody to have a 4 year degree if you want to work there... no exceptions...

This sure seems to indicate that we've got plenty of "supply"--if there are no other factors at work and if RNs were in short supply, they'd be loosening requirements, not tightening them.
But, there may be other factors (insurance or liability concerns, some sort of hospital report card that credits the hospital if they have more RNs with BS degrees, etc). Still, this points to a system that is not trying to wring out costs.

If we going to provide the same quantity of service (hip replacements, checkups, etc), then the only way overall costs can be contained is by doing the same things at lower cost. There are only two models for achieving that: Top-down price controls or market-driven efficiencies. In the US, in nearly every other aspect of our lives we depend on market forces to give us goods and services at the best price. In every case in which we've tried top-down price controls the result has been scarcity, reduced quality of service, increased bureaucracy, and suboptimal resource allocation.

Yes, there are unique aspects to this particular "service", but there are ways to harness these same market forces while addressing those differences.

 

[ziggy29]

From what my sister (who is an RN) is telling me.... there will be a big shortage of RNs soon... most are older... they are being replaced by LVNs or someone else with less knowledge...

The other thing she complains about is the work ethic of the 'younger' workers... they go out of their way to try and find ways to 'not work'...

Given the nursing shortage and the lack of facilities to train a sufficient number of new nurses, they are one of the few occupations who can still dictate terms to their employers to some degree. I'm not surprised they are using the current situation to insist on working conditions more to their benefit.

 

[GregLee]

KUHN's the "Structure of Scientific Revolutions" is all about resistance to change and how scientists strenuously resist giving up a pet theory.

Yes, but they don't resist because they just love the old theories, they resist because they think the new theories are wrong. And for revolutionary ideas, it's always arguable. I've seen it argued that, in retrospect, geologists were right to reject Wegener's Continental Drift theory, because he could give no physical mechanism to explain why continents should drift. I think this is a good example of conservative thinking in science. Even though we now know Wegener was right and he had quite a lot of evidence on his side at the time he proposed his theory, there are still scientists around prepared to argue against him.

 

[samclem]

Regarding change, QWERTY, and arrogance:

The best example is MS Office. I've been using Office 2007 for over a year now and still can't do manythings as quickly as I could do them in Office 2003. If MSFT cared about their customers (or market share) there would be an option on installation that gave users two options:
1." Make Office 2007 look and feel as close to Office 2003 as possible. Pull-down menus and tabs will generally be in the same places I already know."
2. "Optimize Office 2007 to put everything where the brilliant folks at Microsoft wanted to move them. I'll need to re-learn a lot of shortcuts, but things will work better."

I'd like to know how much productivity (in dollars) was lost with the introduction of Office 2007.

 

[Texas Proud]

Regarding change, QWERTY, and arrogance:

The best example is MS Office. I've been using Office 2007 for over a year now and still can't do manythings as quickly as I could do them in Office 2003. If MSFT cared about their customers (or market share) there would be an option on installation that gave users two options:
1." Make Office 2007 look and feel as close to Office 2003 as possible. Pull-down menus and tabs will generally be in the same places I already know."
2. "Optimize Office 2007 to put everything where the brilliant folks at Microsoft wanted to move them. I'll need to re-learn a lot of shortcuts, but things will work better."

I'd like to know how much productivity (in dollars) was lost with the introduction of Office 2007.

This can be another thread.... but I agree about 2007 being worse than before... BTW, most people don't use even close to everything that is available...

 

[Emeritus]

Yes, but they don't resist because they just love the old theories, they resist because they think the new theories are wrong. And for revolutionary ideas, it's always arguable. I've seen it argued that, in retrospect, geologists were right to reject Wegener's Continental Drift theory, because he could give no physical mechanism to explain why continents should drift. I think this is a good example of conservative thinking in science. Even though we now know Wegener was right and he had quite a lot of evidence on his side at the time he proposed his theory, there are still scientists around prepared to argue against him.

You are confusing a hypothesis and a theory. Wegener proposed a hypothesis. You don't need to provide a functional mechanism for a hypothesis. All you need to provide is a method of testing the key hypothesis. You can test whether a drug works without knowing how or why it works.

Requiring a mechanism or explanation is a knee jerk reaction to put an unsettling hypothesis "off the table" WITHOUT testing.

 

[GregLee]

Requiring a mechanism or explanation is a knee jerk reaction to put an unsettling hypothesis "off the table" WITHOUT testing.

Yes, that's so. I tend to think that Wegener's theory should have been accepted at the time he proposed it, regardless of the apparent absence of a physical mechanism. But that's just me -- I don't happen to be a physicalist or an empiricist. Some are, though. I gave the example only to show that there is generally a serious argument to be made on the conservative side, when novel theories are proposed. Think of cold fusion. Think of global warming.

 

[Texas Proud]

Talked to my sister this weekend... her DH was recently retired from 3M... so he is getting kicked off since they are getting rid of their plan...

The interesting info I got from her... she said 3M is planning on eliminating health insurance to all workers!!! They will get $300 some odd per month to go out and buy their own, but nothing offered by 3M...

Now, if this is true, it seems like a lot of megas are going to be following suit...