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On October 22 2017 16:47 TheYango wrote:Show nested quote +On October 22 2017 15:23 GreenHorizons wrote:
I get the points being made here but you guys do realize in the US we do have drug dealers with doctorates right?
The opiate epidemic is a direct result of said drug dealers pushing opiates onto the masses.
The opiate epidemic is a product of poor oversight and the lack of consensus for prescription practices on painkillers--which are kind of a gray area since they're not actually treating anything and only serve to improve patient "quality of life", making the benefit kind of nebulous and makes a lot of studies less rigorous and subject to interpretation because most patient outcomes are subjective. It's misunderstanding the problem to pin the problems on the healthcare system at large since that's not where most of the problems occur--but rather in places where major healthcare centers lack the reach to oversee issues and manage abuses. There's a reason why the places hit hardest by it are largely rural areas and not major urban centers. That kind of gross over-prescription would be subject to much greater scrutiny at a major urban medical center that would much more quickly result in someone losing their job and/or their license. The chain of accountability and the incentives for rural family practice physicians is totally different than from someone working within a hospital system.
I don't think that's refuting that we have lots of drug dealers pushing prescription drugs for profit. Or that most of the world looks on in disgust at how we advertise prescription medication, or how doctors COMPLETELY LEGALLY profit off of promoting particular prescriptions.
I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point.
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On October 22 2017 17:02 GreenHorizons wrote:Show nested quote +On October 22 2017 16:47 TheYango wrote:On October 22 2017 15:23 GreenHorizons wrote:
I get the points being made here but you guys do realize in the US we do have drug dealers with doctorates right?
The opiate epidemic is a direct result of said drug dealers pushing opiates onto the masses.
The opiate epidemic is a product of poor oversight and the lack of consensus for prescription practices on painkillers--which are kind of a gray area since they're not actually treating anything and only serve to improve patient "quality of life", making the benefit kind of nebulous and makes a lot of studies less rigorous and subject to interpretation because most patient outcomes are subjective. It's misunderstanding the problem to pin the problems on the healthcare system at large since that's not where most of the problems occur--but rather in places where major healthcare centers lack the reach to oversee issues and manage abuses. There's a reason why the places hit hardest by it are largely rural areas and not major urban centers. That kind of gross over-prescription would be subject to much greater scrutiny at a major urban medical center that would much more quickly result in someone losing their job and/or their license. The chain of accountability and the incentives for rural family practice physicians is totally different than from someone working within a hospital system. I don't think that's refuting that we have lots of drug dealers pushing prescription drugs for profit. Or that most of the world looks on in disgust at how we advertise prescription medication, or how doctors COMPLETELY LEGALLY profit off of promoting particular prescriptions. I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point.
As someone from 'the rest of the world' I can confirm this. The way it looks from where I am, the American healthcare system is a mess anyway but the way drugs are promoted and prescribed is the epitome of harmful medical practice.
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Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight. But if this were true, such abuses would be more common in places where healthcare is systematically and rigorously controlled by corporatized healthcare organizations like hospitals. But the fact of the matter is that this isn't the case. The corporatized healthcare environment is less susceptible to these abuses because it's harder for someone to get away with those abuses in a system that has strong oversight and incentives to promote patient health.
At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way.
On October 22 2017 17:02 GreenHorizons wrote:
I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point.
Nobody's saying that it's okay but it's not like a whole lot that anyone can do about it. If misconduct is performed by a physician in a hospital, the guy can lose his job in a day If the same thing happens with a rural provider who doesn't directly work for a hospital, it's hard for the hospital to do anything about it because they aren't directly paying the guy--he's just loosely affiliated with them. They can cut their association with him, but his patients are still going to go to him because he's the doctor they've been going to for their whole lives. They could act to get his license removed but that's a long arduous process involving the state medical licensing board and not easily scalable.
Plus even if the guy loses his license, someone actually has to want to move out there and take his place, otherwise you just put a whole bunch of people out of having a doctor with no alternative, and for whom driving to the nearest hospital every time they need to see a doctor isn't a reasonable option.
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On October 22 2017 17:47 TheYango wrote:Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight. But if this were true, such abuses would be more common in places where healthcare is systematically and rigorously controlled by corporatized healthcare organizations like hospitals. But the fact of the matter is that this isn't the case. The corporatized healthcare environment is less susceptible to these abuses because it's harder for someone to get away with those abuses in a system that has strong oversight and incentives to promote patient health. At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way. Show nested quote +On October 22 2017 17:02 GreenHorizons wrote:
I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point. Nobody's saying that it's okay but it's not like a whole lot that anyone can do about it. If misconduct is performed by a physician in a hospital, the guy can lose his job in a day If the same thing happens with a rural provider who doesn't directly work for a hospital, it's hard for the hospital to do anything about it because they aren't directly paying the guy--he's just loosely affiliated with them. They can cut their association with him, but his patients are still going to go to him because he's the doctor they've been going to for their whole lives. They could act to get his license removed but that's a long arduous process involving the state medical licensing board and not easily scalable. Plus even if the guy loses his license, someone actually has to want to move out there and take his place, otherwise you just put a whole bunch of people out of having a doctor with no alternative, and for whom driving to the nearest hospital every time they need to see a doctor isn't a reasonable option.
Everyone from the manufacturers to the physicians knew they've been over-prescribing for decades. The reason more hasn't been done isn't because of the logistical complications of rural oversight, it's intentional profiteering defended by millions in lobbying.
I'm actually curious by what metrics it is that this is a more rural problem rather than urban anyway? Not saying it isn't, but I often hear this repeated without any explanation as to how we arrive at that conclusion.
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America's severe problem relative to lack of preventative care does all the work of a conspiracy and without the need for intentionality.
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I think it's part of the hyper capitalistic culture in the US.
Lobbying is so massive that it just completely eclipses the ethical framework a health care system should operate in.
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Much of the problem of US healthcare is indeed some sort of fixation on market solutions rather than on "socialism." But markets don't really work for "if you overcharge me, next time I won't be dying in your ER wing!"
Biggest problem with government-funded healthcare is that they tend to be perpetually underfunded but everyone everywhere seems to prefer that to whatever the hell US healthcare is. If you have enough money in the US, then you can get some fantastic care - but tough shit if you're not wealthy.
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On October 22 2017 23:17 LegalLord wrote:
Much of the problem of US healthcare is indeed some sort of fixation on market solutions rather than on "socialism." But markets don't really work for "if you overcharge me, next time I won't be dying in your ER wing!"
Biggest problem with government-funded healthcare is that they tend to be perpetually underfunded but everyone everywhere seems to prefer that to whatever the hell US healthcare is. If you have enough money in the US, then you can get some fantastic care - but tough shit if you're not wealthy.
I get fantastic care from the VA. Cancer free for 3 years thanks to them. And it was completely free to me. LL paid the tab I'm sure.
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On October 22 2017 18:31 GreenHorizons wrote:Show nested quote +On October 22 2017 17:47 TheYango wrote:Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight. But if this were true, such abuses would be more common in places where healthcare is systematically and rigorously controlled by corporatized healthcare organizations like hospitals. But the fact of the matter is that this isn't the case. The corporatized healthcare environment is less susceptible to these abuses because it's harder for someone to get away with those abuses in a system that has strong oversight and incentives to promote patient health. At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way. On October 22 2017 17:02 GreenHorizons wrote:
I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point. Nobody's saying that it's okay but it's not like a whole lot that anyone can do about it. If misconduct is performed by a physician in a hospital, the guy can lose his job in a day If the same thing happens with a rural provider who doesn't directly work for a hospital, it's hard for the hospital to do anything about it because they aren't directly paying the guy--he's just loosely affiliated with them. They can cut their association with him, but his patients are still going to go to him because he's the doctor they've been going to for their whole lives. They could act to get his license removed but that's a long arduous process involving the state medical licensing board and not easily scalable. Plus even if the guy loses his license, someone actually has to want to move out there and take his place, otherwise you just put a whole bunch of people out of having a doctor with no alternative, and for whom driving to the nearest hospital every time they need to see a doctor isn't a reasonable option. Everyone from the manufacturers to the physicians knew they've been over-prescribing for decades. The reason more hasn't been done isn't because of the logistical complications of rural oversight, it's intentional profiteering defended by millions in lobbying. I'm actually curious by what metrics it is that this is a more rural problem rather than urban anyway? Not saying it isn't, but I often hear this repeated without any explanation as to how we arrive at that conclusion. At one point Florida was filling more opioid prescriptions than the rest of the states combined at one point. The lax regulations there definitely contributed more to it than pretty much anywhere else.
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More from Fredrica Wilson :
“John Kelly is almost––I guess you could say he was a puppet of the president and what he was trying to do was divert the attention away from the president on to me, and he basically just lied on me. I don’t like––I don’t appreciate people lying on me. And that’s what he did. I have been in politics a long time and most things don’t bother me, you know, it just rolls off my back. I have been lied on before, but the character assassination that he went through to call me out of my name, an empty barrel and all the work that I’ve done in this community––not only does he owe me an apology, but he owes an apology to the American people, because when he lied on me, he lied to them… Yes, he does owe the American people an apology for lying on one of their congresswomen.”
(on MSNBC to Joy Reid).
www.mediaite.com
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On October 23 2017 01:24 Nevuk wrote:Show nested quote +On October 22 2017 18:31 GreenHorizons wrote:On October 22 2017 17:47 TheYango wrote:Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight. But if this were true, such abuses would be more common in places where healthcare is systematically and rigorously controlled by corporatized healthcare organizations like hospitals. But the fact of the matter is that this isn't the case. The corporatized healthcare environment is less susceptible to these abuses because it's harder for someone to get away with those abuses in a system that has strong oversight and incentives to promote patient health. At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way. On October 22 2017 17:02 GreenHorizons wrote:
I'm sure there is a degree of what your describing contributing to the larger issue, but it's not the main driver by far. Basically the "I didn't know better" excuse from drug pushing doctors has lost most of its credibility at this point. Nobody's saying that it's okay but it's not like a whole lot that anyone can do about it. If misconduct is performed by a physician in a hospital, the guy can lose his job in a day If the same thing happens with a rural provider who doesn't directly work for a hospital, it's hard for the hospital to do anything about it because they aren't directly paying the guy--he's just loosely affiliated with them. They can cut their association with him, but his patients are still going to go to him because he's the doctor they've been going to for their whole lives. They could act to get his license removed but that's a long arduous process involving the state medical licensing board and not easily scalable. Plus even if the guy loses his license, someone actually has to want to move out there and take his place, otherwise you just put a whole bunch of people out of having a doctor with no alternative, and for whom driving to the nearest hospital every time they need to see a doctor isn't a reasonable option. Everyone from the manufacturers to the physicians knew they've been over-prescribing for decades. The reason more hasn't been done isn't because of the logistical complications of rural oversight, it's intentional profiteering defended by millions in lobbying. I'm actually curious by what metrics it is that this is a more rural problem rather than urban anyway? Not saying it isn't, but I often hear this repeated without any explanation as to how we arrive at that conclusion. At one point Florida was filling more opioid prescriptions than the rest of the states combined at one point. The lax regulations there definitely contributed more to it than pretty much anywhere else.
Is it really all about lobbying? I doubt it, as it is an important industry, and even though it is massively overcosted, it still employs a lot of people, and get a lot of actual healtcarework done. You cant just turn around a massive, important strcture like that, no matter how much better if functions elsewhere.
From what I have heard, the monster was born when emplyers were forced to cap salaries, and started to offer health insurance to attract the best workers.
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On October 22 2017 17:47 TheYango wrote:
Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight.
...
At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way.
This makes sense for something like the opioid epidemic, but many of the problems with US healthcare are common symptoms of large organizations (mostly corporations) with skewed incentives and the healthcare organizations themselves are largely the beneficiaries... i.e., too many devices, too many tests, too many administrators, ancient data systems, uniformly higher pay across all positions relative to other industries. I'm uncomfortable when someone tells me the same organizations who played a large part in creating these problems and are benefiting from them that they are aware of them, really have my best interests at heart, are working to fix the issue now, and that I'd really be best off leaving them alone.
It's nothing against healthcare organizations in particular, but large organizations of any kind tend to optimize for self-preservation and profit of its decision-makers. In a competitive market, this usually aligns (at least somewhat) with consumer interests but that's not the case in healthcare for oft-recited reasons.
My experience is that the phrase "only well-intentioned people do job x" is generally worthless as an indicator of how a sufficiently large industry/system/organization behaves. There are various explanatory factors for it: administrators (i.e. the ones making the most impactful decisions) are increasingly abstracted from carrying the core goal of the org as it grows (i.e. working with patients), administrators with experience in running large orgs are often picked from corporations, survivorship bias means those who rise to top positions in large orgs often may not share the good intentions of the founding mission, need to quantify decision-making as scale increases, etc.
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are you commenting? asking for an explanation? or what?
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On October 23 2017 07:48 mozoku wrote:Show nested quote +On October 22 2017 17:47 TheYango wrote:
Most of the conspiracy theory-ing is targeted at the idea that the healthcare *system* is in some sort of cahoots to make money off of sick people and disregarding the idea that abuses that led to things like the opioid epidemic are the outcome of individual bad actors with insufficient oversight.
...
At a systemic level, healthcare organizations in the United States understand the flawed incentives of the US healthcare system and many are doing what they can to correct it. It's just difficult because individual providers are very resistant to change. Chastising those organizations is quite frankly barking up the wrong tree and isn't productive in any way. This makes sense for something like the opioid epidemic, but many of the problems with US healthcare are common symptoms of large organizations (mostly corporations) with skewed incentives and the healthcare organizations themselves are largely the beneficiaries... i.e., too many devices, too many tests, too many administrators, ancient data systems, uniformly higher pay across all positions relative to other industries. I'm uncomfortable when someone tells me the same organizations who played a large part in creating these problems and are benefiting from them that they are aware of them, really have my best interests at heart, are working to fix the issue now, and that I'd really be best off leaving them alone. It's nothing against healthcare organizations in particular, but large organizations of any kind tend to optimize for self-preservation and profit of its decision-makers. In a competitive market, this usually aligns (at least somewhat) with consumer interests but that's not the case in healthcare for oft-recited reasons. My experience is that the phrase "only well-intentioned people do job x" is generally worthless as an indicator of how a sufficiently large industry/system/organization behaves. There are various explanatory factors for it: administrators (i.e. the ones making the most impactful decisions) are increasingly abstracted from carrying the core goal of the org as it grows (i.e. working with patients), administrators with experience in running large orgs are often picked from corporations, survivorship bias means those who rise to top positions in large orgs often may not share the good intentions of the founding mission, need to quantify decision-making as scale increases, etc.
Quite a bit of research and reporting has been done on why our healthcare system is so costly.
A huge amount of the excess cost relative to other countries is administrative bloat, excess costs of diagnostic tests, and drug costs that are inexcusably high.
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Ben Cardin's response is going to be fun.
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On October 23 2017 11:08 zlefin wrote:are you commenting? asking for an explanation? or what?
Given the timing, there are only two logical conclusions you can reach here. So the first is perhaps that the US has some automated system where they revoke visas of anyone who appears on Interpol's wanted list. There is no information pertaining to this anywhere as far as I can tell. It's just a shot in the dark to explain it without jumping to conclusion two, which is that the US state department is collaborating with Russia. Tillerson and Trump are entrenched in opposing and lifting Russian sanctions(and even implementing them at this point), and this is the guy behind it all. He even came and testified in front of the Senate Judiciary Committee in July on the subject. I just can't believe that they would be so obviously blatant in their conspiring. I would love to be wrong, but god damn this looks bad.
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Good luck selling this one, Trump. You're probably not getting tax cuts, almost definitely not getting health insurance reform/ACA repeal. I'm with him on regulation cuts and pipelines, maybe a little on border security if DACA goes away, and I bet Obama would've had this timetable for ISIS too. He's still lacking on legislative agenda and has shown everyone he has no real policy beliefs aside from Trade (and even then vague), so nobody's going to cave at whatever his one-week push for X legislation is. They'll be rewarded for waiting it out and letting the next outrage/overreaction cycle wipe away the pressure.
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What does DACA have to do with border security?
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EPT
