Guest
PostPosted: Fri Aug 04, 2006 8:58 am Post subject:
If I have ever claimed to be "representing" or speaking for anyone other than myself, then I'll need to be refreshed as to the date. Hasn't happened.
You've printed the opinion of one person. Every company in America, if not the world, has disgruntled employees. I sit in a non-profit, welfare hospital and I guarantee I wouldn't have to walk more than 25 feet or take more than 30 seconds to find someone who hates it and would be elsewhere if possible. Chronic dialysis facilities have trouble attracting people for a simple reason....it's near the bottom of the barrel in the healthcare food chain, period. Right down there with nursing homes. There are simply better jobs to be had. Profit or not for profit doesn't matter. What matters is the nature of the patient population (a very difficult patient population), the fact that patients don't get better (and won't even with more dialysis), and many other factors.
God forbid that money should be made in heathcare.
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plugger
Joined: 11 Jan 2003
Posts: 226
PostPosted: Sun Aug 06, 2006 6:56 am Post subject:
[quote:8605789ba4="Anonymous"] Entitlements, entitlements, entitlements provided with someone elses hard-earned dollar. [/quote:8605789ba4]
I hate to bother you with the facts, facts, facts ? but Universal Healthcare is in every industrialized country except ours and they are paying less for it per capita and have better health stats to boot. So do you consider our sick and elderly ?losers and deadbeats?? That is who we seem to be leaving behind. There seem to be a whole lot of people making money for contributing next-to-nothing to the system; I suppose these are what you consider ?winners?.
http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php[quote:8605789ba4="Anonymous"]
You've printed the opinion of one person. Every company in America, if not the world, has disgruntled employees. [/quote:8605789ba4]
Yes, I printed just one. But if you dig far enough back in this site you will find a whole lot of them. One who used to post quite a bit was Shiftworker. I can recall the stories of how what this person would call the ?corp? descending upon a just bought-up clinic and chase off the experienced help then send care skidding down hill. That is just one that comes to mind. But I imagine for you it would be just a bunch of malcontents. But it does add more credence to the picture being painted of a field of medicine that seems more concerned enriching upper management than it does its front-line staff and patients.
Then there are the opinions of such noteworthy people in dialysis as Dr. Kjellstrand and Dr. Belding Scibner. Dr. Kjellstrand?s remarks can be found in the following thread:
http://www.dialysisethics.org/forum/viewtopic.php?t=558Dr. Scibner was only the inventor of the Scibner shunt which helped dialysis become so widespread today; he foresaw the problems with for-profit medicine before they occurred:
?When Medicare began covering chronic dialysis in 1972, for-profit institutions sprung up to offer the treatment. Scribner turned down positions with these organizations, remembers Young. ?Scribner took on the for-profits because he was first and foremost the patient?s advocate,? says Young. ?He really loathed all of what he considered to be the abuse of the technology to make a big profit.? Scribner also became an advocate for more convenient and less costly home dialysis treatments, which he helped develop when a 16-year-old girl was rejected by the advisory committee. ?
http://mednews.stanford.edu/stanmed/2003fall/md-memorial.html?Scribner, who retired in 1990, created the first community dialysis unit, the Seattle Artificial Kidney Center, at Seattle's Swedish Hospital and was an advocate of non-profit dialysis centers.
"Although Belding Scribner is internationally renowned for his innovative clinical research, his motivation came from his role as a physician caring for patients," said Paul Ramsey, vice president for medical affairs and dean of the UW School of Medicine. "Countless people are alive today because of his pioneering innovation."
http://www.washington.edu/alumni/columns/sept03/extras_scribner.html?"Kidney dialysis today has become predominantly a for-profit business," said Joyce Jackson, current director of the Northwest Kidney Center. Watching the profit motive take over health care had been tremendously distressing to Dr. Scribner, Jackson said, and up until his last days he remained active in trying to expand public access to this life-saving treatment.
"The desire for profit in medicine and the desire by medical researchers to capture intellectual property disturbed him," agreed Larson.?
http://seattlepi.nwsource.com/local/127718_scribner21.html(many of the links have expired, but it gives the reader an idea where I got them)
But hey, thanks for giving me an excuse to repost some of this!
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plugger
Joined: 11 Jan 2003
Posts: 226
PostPosted: Sun Aug 06, 2006 7:03 am Post subject: John Hopkins
And who is this John Hopkins fellow and why is he saying such terrible things?
"For-Profit Dialysis Facilities Have Higher Mortality Rates and Lower Transplant Referral Rates Than Not-For-Profit Facilities
Researchers at the Johns Hopkins School of Public Health have found that, on average, patients treated in freestanding for-profit dialysis centers experience poorer survival rates and are less likely to be placed on the transplant waiting list than those who are managed in not-for-profit facilities. The study appeared in the November 25, 1999 issue of The New England Journal of Medicine.
"Our results raise serious concern that provider decision-making may differ within for-profit and not-for-profit organizations, and that the care of patients with end-stage renal disease may be compromised in for-profit dialysis centers, particularly in localities where not-for-profit facilities are absent," said senior author Neil R. Powe, MD, MPH, MBA, professor, Epidemiology and Health Policy and Management, Johns Hopkins School of Public Health; and Medicine, Johns Hopkins School of Medicine.
The authors said that the negative effects seen in for-profit facilities may be due to a greater emphasis on income-generation in those facilities, raising concerns about the current system of payment for dialysis services, which rewards facility efforts to control costs and maintain patient volume but which does not build in incentives to maximize clinical outcomes.
In 1997, 68 percent of dialysis patients were treated in freestanding for-profit units, up from 53 percent in 1990. Medicare pays dialysis facilities a fixed payment per dialysis treatment, a sum that has not increased since 1973. Lead author Pushkal P. Garg, MD, a Robert Wood Johnson Clinical Scholar at the Johns Hopkins School of Medicine at the time of the study, said, "Attempts by dialysis providers to maintain income -- in the face of Medicare reimbursements that are shrinking with inflation -- may lead to cost-cutting that compromises the quality of care."
To assess the impact of facility ownership on patient outcomes, the scientists studied a group of 3,569 patients with new-onset end-stage renal disease (ESRD) who were nationally-representative with regard to age, gender, race, and primary cause of ESRD. National data for the patients and the sites in which they were treated were obtained from medical and administrative records. In order to tease out the impact, if any, of the treating facility on patient survival and access to the transplant waiting list, the researchers adjusted their statistical analysis for age at onset of ESRD, household income, race, gender, education, employment status in first year of ESRD, marital status, primary cause and onset date of ESRD, and geographic region. Besides looking at these demographic variables, they also evaluated the impact of 14 clinical factors that were assessed at ESRD onset. The patients were followed for up to six years.
The 3,569 patients in the study sample were treated by 950 different dialysis providers in the first year of ESRD. Facilities were categorized either as freestanding, for-profit (For-Profit); freestanding, not-for-profit (Not-For-Profit); or hospital-based. Care was taken to correct for the clustering of results by facility, to make sure that any observed effects were not due to results from just a few of the facilities sampled.
The researchers found that mortality rates were 20 percent higher among patients getting dialysis in freestanding, for-profit facilities compared to those of patients who used not-for-profit centers. Treatment in for-profit centers was also associated with a 26 percent lower likelihood that a patient would be put on the waiting list for a kidney transplant. Facility volume and occupancy, urban location, and distance to a transplant center did not affect survival rates Outcomes in hospital-based centers were similar to those for patients treated in
freestanding, not-for-profit facilities.
"Given that approximately 140,000 patients were dialyzed in for-profit centers in 1997, the observed increase in the absolute mortality rate among patients in freestanding, for-profit centers suggests that a considerable number of ESRD deaths may be associated with for-profit treatment," said Dr. Powe. "In addition, we observed that the association between for-profits and poor outcomes was diminished in counties where for-profits operated in proximity to not-for-profit dialysis centers."
The authors cited the results of previous studies, which reveal that for-profit facilities are more likely to provide lower doses of dialysis and reuse dialyzers, practices associated with lower costs but also poorer patient survival. Poorer outcomes could also be attributable to the lower staffing levels seen in for-profit facilities. And lower rates of staffing may mean staff have less time to spend coordinating patients' transplant evaluation process. Finally, it is possible that for-profits may under-refer patients for transplant evaluation in order to maintain patient volumes, and thus income.
The researchers suggested that more rigorous oversight or competing quality controls be put into place to make sure that the cost containment measures of for-profit centers do not jeopardize patient outcomes. In addition, policy makers, when considering converting not-for-profit health care facilities to for-profit facilities, should keep in mind the study's evidence that the presence of a not-for-profit center apparently improves outcomes for patients in nearby for-profit centers.
Other investigators included Kevin Frick, PhD, assistant professor, Health Policy and Management, and Marie Diener-West, PhD, associate professor, Biostatistics, the Johns Hopkins School of Public Health.
This study was supported by the Robert Wood Johnson Foundation Clinical Scholars Program.
Public Affairs Media Contacts:
Ming Tai or Thea Glidden @ 410.955.6878 or paffairs@jhsph.edu"
-http://www.jhsph.edu/Press_Room/Press_Releases/PR_1999/dialysis.html
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plugger
Joined: 11 Jan 2003
Posts: 226
PostPosted: Sun Aug 06, 2006 8:05 am Post subject:
[quote:38c6149bfd="plugger"] ...There seem to be a whole lot of people making money for contributing next-to-nothing to the system; I suppose these are what you consider ?winners?.
http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php[/quote:38c6149bfd]
Hmm, looks like they moved things - try this link:
http://www.pnhp.org/facts/dr_marcia_angell.php****************************************************
Guest
PostPosted: Sun Aug 06, 2006 12:14 pm Post subject:
Every other country has universal healthcare. Good for them...or not good for them....I don't know and I don't care. I guess you subscribe to the "everybody else does it, so it must be the best thing" theory. Well, this isn't every other country champ. This is the USA with the largest underculture of underachievers, deadbeats, and welfare cases than all those other countries put together. Healthcare and healthcare insurance is a commodity. If you want it, go out and buy it. I'll bet none of the uninisured in this country lack for pagers, cell-phones, Ipod, plasma TV, cable TV, SUV's, and......well, you get the picture. Many, if not most, simply have their priorities in other places. I guess you want me to carry their healthcare insurance for them because they don't have it on their own "to do" list. I never called the elderly or the sick deadbeats and losers, you did. What I am saying is this: if you physically qualify for health insurance on the open market and you don't get it, then why in the hell should I subsidize you in your illness?
Plugger, I don't know you and I don't dislike you. We obviously view life and personal responsibility in absolute opposite terms. You appear to believe that bad things just "happen" to people and that as a society we are all responsible for the lowest among us. I happen to believe that, an overwhelming majority of the time, people get caught with their pants down because they had their pants down. I care about number 1 and I ask no one else to pick up my slack. I make my 64K in healthcare and I don't give a bleep who makes more or who makes less and what they do with it. I ended up where I ended up because that's where I ended up.
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plugger
Joined: 11 Jan 2003
Posts: 226
PostPosted: Sun Aug 06, 2006 3:35 pm Post subject:
[quote:063d77ff8b="Anonymous"]
This is the USA with the largest underculture of underachievers, deadbeats, and welfare cases than all those other countries put together.
[/quote:063d77ff8b]
You might also add to that list the biggest underculture of corporate criminals - a group that I sincerely believe does more damage than a whole lot of welfare cheats.
Anyway, if you believe the statement I quoted, I would think it might make you even more in favor of Universal Health Care. At least many of the scalawags you mentioned would have to pay something.
And yes we do see things differently: I think being sick can be punishment enough, you on the other hand would like to see more added on if you feel they haven't paid their fair share into the system. I think it would be too difficult to sort out who deserves what and who doesn't - and it looks like we could be going through a lot of good people to get to those few who you may feel may merit more than illness.
And no, I don't dislike you either, but I sincerely believe a hard-line is already back-firing with people putting off care until they wind up in the emergency room, more and more businesses dropping insurance because they can't afford it, etc... And I don't believe forcing people to buy insurance like Massachusetts is doing is the answer either; these companies get the money and they tend to want to keep it. Believe it or not, Medicare and these foreign governments paying for health care are much more efficient at using the dollars than our private insurance companies.
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swampwitch
Joined: 16 May 2006
Posts: 8
Location: Louisiana
PostPosted: Mon Aug 14, 2006 4:49 pm Post subject:
Slackers & Deadbeats indeed...
NY hubby put in his time as a fully productine member of the work force, saves his money fed, clothed & sent to college his kids, retired with savings , Pension & social sewcurity. I also worked & still do. Unfotunuately, he had a hgeart attack , needed a bypass, pacemaker & went into kidny failure of the only kidney he was born with (also needed a fistula) ; all three months before medicare age. His cobra had run out and insurance didn't come close to covering the cost so there went the savings, three years to pay off what was left (and my retirement plans). Thank goodness that medicare pays for dialysis from the get go or he would be dead. I hope that your 64K a year doesn't end up that way too. It can happen to any one.
We had plans but oh well, thats life and we still have a life & each other so IT AINT TOO BAD! :wink:
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plugger
Joined: 11 Jan 2003
Posts: 226
PostPosted: Tue Aug 15, 2006 3:41 am Post subject: lack of insurance
Swampwitch,
You and your husband seem to be another story of people falling through the cracks when it comes to insurance - but I'm glad you can still appreciate being together.
It seems that sort of thing that is happening more and more, with more and more small businesses dropping insurance due to the rising costs; and people dropping insurance when they are laid-off - cobra is pretty expensive when you are trying to make the money stretch.
And according to the following quote the lack of insurance is not only driving a lot of people to bankruptcy, it is killing them:
"The Institute of Medicine, part of the National Academy of Sciences, estimates that lack of health insurance leads to 18,000 unnecessary American deaths - the equivalent of six 9/11?s - each year."
http://www.pnhp.org/news/2006/may/krugman_death_by_i.phpAnyway, I wish you luck with all this - you and your husband seem like good people who don't need what has happened.
