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June 11, 2009

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   Where have all the doctors gone, long time passing?

Fundamentally it enslaves a person for the civil authority to be involved in the most intimate of personal decisions about well-being.

verner

Hooray for the AMA!

Little known secret--most docs are not rolling in the cash. If many family practice physicians didn't employ Nurse Practioners to do every day common colds and routine physicals, they likely could not keep the doors open.

Why? Medicare and Medicaid pay squat. If doctors had to depend on what they paid, they could not keep the doors open.

Personally, I want the best and brightest going into the medical arts. And in order for that to happen, we need to make sure that they can make a decent living for the 10 years of training that it takes to become an MD.

RichatUF

Obama will send out his thugs in "Organizing for America" to take care of the AMA. Greedy doctors...the whole outrage act. Hope the AMA membership has paid up their taxes and isn't on the UBS list.

And in another distraction-the return of "peak oil" and the "sober and serious" $250/bbl oil estimate. Too bad the Obama Administration has decided to eliminate the deep water drilling research program and the Arctic Survey-might have disabused the "peakers" of their "Population Bomb" superstitions.

narciso

That seems to be a 'bug not a feature', Rich, one wonders ruefully, if he was trying
to dismantle this country would he do anything differently

Extraneus

Looks like they might have to use the "reconcilliation" process after all.

Rick Ballard

Rich,

Here's BP's download page for the statistical report. Ya just gotta love the selection of the green theme. I suppose that streetwalkers have to pay close attention to fashion trends in order to maintain custom.

I don't believe that I'll leap into BP's "analysis", given that the IEA "analysis" shows a healthy jump in proven reserves - without adding much of anything in for Tupi. Or Jack II. Or the Caspian plays. Or any revisions for Iraq. The Guardian idiots are using a report which identifies a drop in demand coupled with assurances that the 42 year reserve number is still viable to justify a jump in current pricing.

Ignatz

--Too bad the Obama Administration has decided to eliminate the deep water drilling research program and the Arctic Survey..--

I'm not too convinced by the idea that markets are as easily manipulated as some think, especially one as large as the oil market.
However, markets do anticipate supply and demand expectations very well, so again I'll point out that oil bottomed nearly to the day that Barry confirmed, after he was inaugurated, that "drill, drill, drill" was officially dead.
I'm also a little more convinced I think than many that the "green shoots" (God I'm sick of the term) portend a real recovery. The race seems to me to be between Obama and his spending insanity-giant tax hikes and Obama's new oil shock for which will plunge us into a renewed recession first. The combo is guaranteed to make it another doozy. If he's quick and efficient enough he may eliminate the incipient recovery altogether prior to even getting out of this recession.

RichatUF

narciso-

I try not to think about those things. Also doesn't the "public insurance" option seem to have all the features of Fannie and Freddie-the sort of "public-private partnership" that Obama made a centerpiece of nomination acceptance speech and the DNC made into a platform.

Old Lurker

Those bad bad vigilates captured the 4% level for ten year treasures yesterday with more bad news on the way in that arena. Wonder if anyone in DC is listening or understands or cares? As we here know, 4% is not horrible in historical terms, but it is a stunning runup since the election. Just stunning.

OTOH...jet setting was a lot easier with 5% returns on short term CD's that it has been lately at 1%. :-)

Old Lurker

To be more accurate, I should have said "since December", since the Fed bought the rate down from the high threes in October to the low twos in December. As the rate is now higher than before the buydown, whatever the fed "spent" to get rates down is now gone.

Pofarmer

Ignatz, I tend to agree with you that some sort of recovery might be beginning to possibly start IF Barrack Hussein wasn't ready to tamp on it with his Jack Boot. The combination of higher energy costs, higher interest costs, higher taxes, more regulations, etc, etc, aren't going to be doing anyone any favors.

RichatUF

Ignatz-

I'm not too convinced by the idea that markets are as easily manipulated as some think, especially one as large as the oil market.

I hope my position comes across as more nuanced than outright manipulation-and my apologies for being unclear if it does. When the oil market is controlled by firm-states and national oil companies abroad and US energy policy is dictated by radical environmentalists who have sympathies with the firm-states, prices will go up until demand collapses again because of the energy shock. Since the Obama Administration seems incapable of making the political link, he'll sleepwalk into 70's style energy quagmire as he sees unemployment soar and interest rates climb. His equally destructive policy of ceeding US dollar hegemony to some sort of "Contentinal" arrangement is also disruptive to commodities prices and interest rates.

The problem I have with the "green shoots" recovery is that it is based on a 1980's recovery model. With coming capricious government, restrictive energy policies, and demographics which don't support strong inventory builds, a double dip recessionary environment like what happened in the mid-50's then the late 50's is probably the better model.

Rick Ballard

"I'm not too convinced by the idea that markets are as easily manipulated as some think, especially one as large as the oil market."

You mean, "aside from OPEC curtailing production in order to maintain a wholly artificial price", right?

Everyone can look for a real "green shoot" on the next Fed H.8 release. You'll find it on line 24. When bank deposits stop increasing with monotonous regularity it will mean that consumers have started putting their money where their mouth is. Not quite yet.

Old Lurker

Rich is dead on.

The 80's recovery into the rising sun of the Reagan years will be exactly the reverse of the grey dusk presented by the Obama vision.

Ignatz

--You mean, "aside from OPEC curtailing production in order to maintain a wholly artificial price", right?--

Rick,

They can do that for very short periods until their competing interests take over and they break their quotas. That's one of the reasons their price spikes always blow out.
Even in their case the manipulation is based on anticipation of supply and demand more than their actual effectiveness. In actual long term practice they are often following the larger market forces and are improperly credited with far more power than they have. They spent the last half of 2008 chasing prices down with their production cuts just as they had chased prices up with increases.
And the OPEC angle reinforces my original point. Whatever manipulation can take place can be overwhelmed by the appllication of market forces. As in taxes, it is the marginal production which has the greatest effect. Drill, drill, drill helped spike the spike by promising marginal future production to cover the marginal supposed imbalance in supply and demand. Taking it off the table had the opposite effect.

Rich,

--The problem I have with the "green shoots" recovery is that it is based on a 1980's recovery model.--

Mine isn't. I base mine on the 1930's. We had a crash and a financial meltdown in 29-30. Then Hoover put into place the worst possible policies of large tax increases, protectionism and a tight monetary policy and large spending increases which FDR expanded.
Even with all that, the economy expanded greatly from 1933-1937 until FDR killed it again with even bigger tax hikes.
Even the seventies were not a period of monotonous stagnation. There were fits and starts of growth repeatedly snuffed out by inflation, oil shocks and insanely bad fiscal and monetary policy.
My main point is, free markets and free people have a natural resilience to spring back forcefully, that government must actively move to squelch. My only question is will Barry squelch it first one way or another or both simultaneously. In any case it may blossom for a time before he can knock it back, just as it has historically.

Old Lurker

I'm with you Ignatz. Grandaddy Lurker's fortune survived 1929 but was devastated in 33 and what survived was whacked again in 37. All Lurkers since have been raised with those lessons in mind. I lived through the 69-82 period borrowing big time to launch my own career, so between family lore and personal exposure, those lessons are deeply ingrained.

Me thinks a whole crop of people younger than me are about to learn these lessons first hand. And now with socialism as the backdrop and more voters riding in the wagon than pulling, it's going to be a lesson for the ages.

glasater

......through the 69-82 period borrowing big time

We did too. Got married in that time frame and since my name was on those loan papers--I was helping my better half cross the street for safety:-)

Ignatz

--And now with socialism as the backdrop and more voters riding in the wagon than pulling, it's going to be a lesson for the ages.--

You said a mouthful, OL.
Demographics especially are going to teach the entire world a lesson for the ages over the next fifty years.
Socialism and the welfare state, which blind the left's mind like a schizophrenic's hallucinations are going to run head long into the reality that a shrinking number of working people will not and can not allow the government to steal 70 or 80% of their income to prop up a ballooning generation that consumed when it should have saved.

Danube of Thought

"aside from OPEC curtailing production in order to maintain a wholly artificial price"

Much easier said than done. There's a huge body of scholarship suggesting the limits on the effectiveness of cartel pricing and production decisions, and the principal fly in the ointment is the incentive for each member of the cartel to cheat and thereby profit hugely.

Danube of Thought

This whole debate about both health care and the cap-and-trade theft is pretty fascinating. I have a hunch the latter is doomed, or at least doomed to being watered down to nothing.

On health care, suppose the Dems get, say, 55 votes in the Senate, and proceed via the reconciliation process with zero Republican votes. Would Obama sign such a bill? (Probably.)

The only question then would be how long it would take for the effects to be felt by the very large majority of Americans who are happy with their health care at present. If dissatisfaction arises, it will be 100% attributable to the Democratic party, and might haunt them for a very long time. Not that it could ever be undone...

sylvia

Well if the public /private balance can exist and function well in Germany and France, the haven for socialism wannabes, then why couldn't the balance exist here, in the land of the capitalist? Why would the government take over everything - even if the gov wanted to, it couldn't afford to, it can barely afford to keep up with the programs it has already here, why would it sign up for more? I think it's paranoid fantasies by the AMA.

I think the most thing the AMA is scared about is the knowledge that France and Germany pay their doctors less. However, those countries don't have to pay as much liability and their education is free, so it kind of balances out. Anyway, we can make a choice to pay our doctors more, we don't have to do everything the same, we can come up with a unique American hybrid system.

And today, hearing analysts on TV, again they keep bringing up Canada -but its not equivalent. It's a scare tactic. I would like to hear just ONE analyst talk about Germany and France and try and compare to that, but as I discovered from googling, there is no info on that available on the conservative media circuit, unless someone actually bothers to look it up themselves, because that would undercut their "America has the best system" story. The stats don't always bear that out.

I say lets keep the best of both worlds and make a system maybe 75% like ours and 25% like France's. Let's start with small changes and progress from there.

sylvia

You know after seeing the stats on how our wait times and doctor per patient ratio etc are not as good as some other countries, I think I felt a little like a North Korean defecting to South Korea. My whole life I was brought up to believe our system was "the best", and then when I actually look at someplace else, I see that maybe I wasn't always given the full story.

Jane

We need to get some elected representative to agree that all elected people will be subject to this health care plan - with no exception, as of course evidence to the population at large that it will be fabulous care.

No chance it will be enacted then.

clarice

If you thought your system was best, sylvia, why ever would you as a North Korean risk everything to defect to South Korea?

Take as much time as you feel you need to answer.

sylvia

Jane, I believe Congress is already on some government plan. I remember Obama kept referring to that in the campagin, saying if it's good enough for Congress, it should be good enough for other people.

And good question Clarice. That's an interesting point. I suppose if you risk everything to leave, you must have some sneaking suspicion that all is not as good as you were told. But there is probably a little denial and patriotic pride in you that doesn't want to fully believe it until you see it for yourself.

I suppose that's a fundamental aspect of human nature that allows no-good rulers and bad systems of government all over the world to continue to function and make people defend their own system even though they have some knowledge that people are living better elsewhere. You know better the devil you know. Also the feeling that it might not be a good system, but at least it's OUR system and don't you dare dis it.

Jane

Jane, I believe Congress is already on some government plan.

You are correct Sylvia. It's the government plan that allows Ted Kennedy to go to South Caroline to the best brain surgeon in the country rather than Cape Cod Hospital where the government would have the rest of us treat.

I'm sure that is exactly how it should be, right Sylvia?

(Oh and like the President he believes in public schools too)

Danube of Thought

Yo, Canada.

Tuesday morning I called my orthopedist to tell him there's some kind of problem with my foot. I saw him at 9:00 a.m. today (Thursday); he says first we need an MRI. I get home and in thirty minutes the phone rings and it's the imaging clinic: when would I like to come in?

My MRI is scheduled for 7:30 tomorrow morning. Best system in the world.

Good night, Canada.

daddy

"Surely the North Korean Medical System is the best of all possible worlds."

bad

The chemo currently keeping me alive would not be permitted in a government run program because it is not approved for my cancer. Yet my oncologist and I were willing to try it and my insurance company is willing to pay for it. My life and quality of life have been greatly extended.

I am an experiment. What is learned from my experience will open the door to improved treatment and lives for many others.

In a government program, this success story doesn't happen.

Danube of Thought

Every government program rations care, as it must. The principal rationing tool is delay in service in some cases, and denial in others.

Before extolling the virtues of any government health program, take a close look at the limitations on care that arise with advancing age. Although one of the principal complaints about our "skyrocketing" costs is that we spend too much on people of advanced age, the fact is that we spend it because we choose to.

Example: there's a drug one can take to retard the progress of macular degeneration (my 85-year-old mother-in-law suffers from this condition). In Britain, their 7-member board has determined that if you are over 65, the drug will not be provided to you until you are blind in one eye, after which they will issue it in an effort to preserve the sight in your remaining eye.

MayBee

I am an experiment.

You are a blessing.

MayBee

OK, here's a question.

Medicare makes it illegal for Doctors who do not accept Medicare to take Medicare Patients and charge them directly.
That was designed to keep doctors from overcharging patients. But I wonder if something similar would be enforced in a public option health care insurance.

Would public plan patients be barred from going to a doctor who didn't accept the public plan?

cathyf
I am an experiment. What is learned from my experience will open the door to improved treatment and lives for many others.
And many of those others will be in countries with government health plans -- after years of studies, and the chemo goes generic, because the US private insurance company customers will have paid the full costs of the research and development of the treatments.

The most important thing to understand about British, Canadian, French, German, etc. health plans is that they would get what they paid for if they didn't have us to parasite off of. And if we went to a government plan there would be no one for us to parasite off of.

MayBee

Maybe not illegal. But not acceptable.

Ignatz

--The chemo currently keeping me alive would not be permitted in a government run program because it is not approved for my cancer.--

Precisely, bad.
As I pointed out the other day, my wife was so anemic and hypercalcemic from the cancer in her bones and marrow and because it was stage four throughout her skeleton, she would have died waiting for a decision. And if she got one before her death it probably would have been "no" because stage four is considered incurable.
It's all well and good to talk about controlling costs and rationing and all the other economic terms.
But it comes down to people's lives. People we know and love. Some of them are going to die unnecessarily for compassionate and empathic Barry's idealogy.

Captain Hate

I am an experiment.

Had no idea, bad; your demeanor throughout this is inspirational.

 Ann

bad,

You are a blessing, and we love you!

The day they quit paying for your health care is the day they will see what patriotic conservatives really look like when they are pissed off!

DHS will have to write a whole new book about conservative militia.

sylvia

You all still don't get it. The government would not allow or disallow anything. There would be a public AND a private option. If you are on a private option, you would still get whatever your private option pays for. If your private insurance still wants to pay for cutting edge chemo, it would still do so. You don't need a super large pool for a good private insurance, so even if a large portion of the country signs up for public, you just need to pay a little more that the gov plan and the doctors will flock to you and you will still get the best care.

That kind of makes me wonder why the insurance industry here does so now - what do they get out of it? I don't think it's benevolence. So that made me think the reason the private insurance pays for all these new drugs is the clout of the pharmaceutical indutry here pressuring them to buy the new drugs, which is a good thing for those who need them. The downside are all the unneccesary drugs our doctors are pressured to prescribe. Also lawsuits. So as long as we keep our university and research system and legal system intact, I see no reason why that would change here.

Sue

bad,

Thank God for experiments. You rock our world!

Jane

Sylvia,

The only person who doesn't get it is you.

That's not a problem as long as you don't start to lecture us on what you don't get.

Strawman Cometh

Jane,
Teddy's surgeon is at Duke: here in Duham, NC not SC.

LUN is some un-farging-believable nonsense from Canada via Surber.

Jane

Sorry Strawman, I need to get out more I think. Great surgeon tho.

cathyf

Yeah, Jane, get it right... The joke is that when you cross the border from N. Carolina into S. Carolina you need to set your clock back 20 years.

sbw

... And set your clock back 20 years going into at least 88 sections of Duke, too.

Jane

The joke is that when you cross the border from N. Carolina into S. Carolina you need to set your clock back 20 years.

That's quite funny!

bad

Thanks for the love JOM!

And gee golly gee, Sylvia, thanks for letting me know how litte I understand insurance and the medical system.

Porchlight

We adore you, bad. I'm grateful to learn about the amazing care you've received. Both for your sake and ours I wish I could thank your doctor personally!

Pofarmer

You all still don't get it. The government would not allow or disallow anything. There would be a public AND a private option.

Can sylvia really be that thick?

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