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Comment: Re:Here I come. (Score 1) 732

Here is an example of what is wrong. My son got hurt and didn't have any money, so he called a hospital to find out what it would cost to xray his ankle to see if it was broken. Because he knew if it was just sprained, there was very little anyone could do other than tell him to 'stay off it'. They hospital refused to quote a price, because there was no way they knew how much it could cost because they didn't know what was wrong. In other words, if all he wanted to get was an xray and have a doctor tell him if the ankle was broken, they wouldn't do it.

There are several reasons this is the case:

  1. 1) Hospitals that are subject to EMTALA (a.k.a. all except the VA) are prevented from telling you the cost of possible services prior to a medical screening exam (MSE) by a physician or a mid-level like an NP or PA. This is to ensure that hospitals don't use cost to dissuade people from seeking care. If a hospital answers that question they can be subject to a fuckton of fines. I am surprised they called back.
  2. 2) The real reason that a MSE is important (other than to avoid fines for violating EMTALA) is that not every sprain needs an X-Ray. The Ottowa Ankle Rules are very useful to eliminate the need for XRay in about 30% of people presenting with acute traumatic ankle pain.
  3. 3) The FDA and states regulate medical treatments and tests for a good reason. If you made medical test/treatments like a vending machine, you would harm way more people than you help. Full body CTs are a good example (though these still required a physician's order, they were essentially provided to anyone with the $ to pay for it.) The brochures showed you the father of 4 who had a stage 1 kidney cancer diagnosed and treated, but not the ten other people who had incidental findings that once discovered had to be followed up... landing people in the hospital, with invasive procedures, and sometimes disabling complications from these unnecessary investigations. If you look at the cost-benefit for tests like this, the cost weigh outweighs the benefit, but that doesn't stop people who have no concept of basic math, much less Bayes Theorem, from getting the test. That's the reason that lotteries are so so popular: tax on those who can't do math.
  4. 4) Without an exam the diagnostic value of an ankle Xray is diminished (also a Bayesian deal). The pre-test probability of disease effects the performance of the test. As an example, think of a test for HIV that has a 1% false positive rate (but for simplicity assume no false negatives). If you do that test in an individual in a population with 0.1% incidence of HIV, and it is positive, 90% of the time the person with the positive result doesn't have HIV. In a population with a 20% incidence, 95% of the time they really do have HIV. So there is an additional negative of testing not directed by history/exam in that its less accurate. (Which is why I am surprised that the Radiologist who volunteered to read it did... the malpractice vulnerability increases with decreased accuracy.)

Finally, if your son wants a cheaper option next time, try a NP staffed clinic. In some states you even will find them in big box stores or pharmacies. They are a better value especially if you have something simple like an ankle injury.

Comment: Re:Here I come. (Score 1) 732

Your 10% figure is correct but misleading. It is correct in that insurance companies take 10% from the total figure we spend on health care in the US. It is misleading in that the total health care spending is a combination of private insurance AND public insurance.

If you look at the percentage that insurers add to the cost of health care FOR INSURED PEOPLE only, the figure is more than double that. In fact, part of Obamacare is limiting the percentage that private insurers take off the top for “profit and administration” to ONLY 15%. If you look at the percentage taken off for administration (obviously 0 profit) taken off VA healthcare, government employee care, straight Medicare (i.e. not Medicare that is administered through private insurers), etc that percentage is in the low single digits (varies between programs a little – the VA is the best bet and most efficient of all dollar for dollar).

Though even if you take your 10% figure at face value, that means that insurance companies are funneling off 1.7% of the total US GDP for doing work slightly less valuable than a wet kleenex. That amounts to 250 BILLION dollars a year.

Lets however compare that to the administrative cost for traditional Medicare plans (the CBO calls it 2% for traditional MediCare plans and 11% for those run through private insurance companies.) Lets even round that 2% up to 5% to account for arguments about whether its really 2% or 4.6 or whatever.

Then lets take your figure of 255 billion – but we will use the correct denominator. Forty-five percent of US expenditures are (prior to Obamacare) are from public programs. So 255billion/(GDP * percent of GDP spent on health care *percent of private insurance) = 255billion/(15trillion * 0.17 *0.55) = 18%. This 18% is (shockingly) quite similar to the percentages quoted by people not wanting to obfuscate the data. Its actually a bit of a low ball figure for that, but again to give you the benefit of the doubt. In addition, that's the reason why the limit on profits/admin of 15% that is part of Obamacare was fought by health insurers. If 15% is less than what they were taking off the top already, why did they fight it?

So lets say the entire US expenditure on health insurance were administered through a MediCare for all plan versus an average private plan. Fifteen trillion*17% of GDP*18% admin/profit = 459 billion is the cost for private companies administering it. Fifteen trillion*17% of GDP*5% admin = 127 billion is the cost for private companies administering it.

That's a lot of zeroes in between those numbers. 332,000,000,000 to be exact. Plus, Medicare is good insurance. Most seniors on Medicare LIKE their insurance – whether or not its traditional Medicare or more expensive Medicare Advantage plans.

So why not just offer that plan to everyone? Its a simple solution: if you like your insurance that you have, fine. If you don't have insurance and make too much for the Medicaid programs, you have a choice: any one of many insurance plans on the exchange, or to buy into Medicare for the average cost of traditional Medicare for existing Medicare recipients. So if Medicare costs $7,000 per person per year, anyone could buy into it for $7,000 per year.

Why do you think the insurers fought that – the Public Option – tooth an nail? Because they knew they could not compete unless they brought their margins down to match Medicare. Its the simplest math in the fucking universe: If you only spend $0.82 for every dollar you take in, you will spend less than if you paid $0.95 for every dollar you take in. And that expenditure – whether 82 or 95 cents is the actual payment for doctors, medicines, hospitals, etc. If you can't understand that, go refresh your algebra on the Kahn Academy.

Comment: Excellent family culture my ass (Score 0, Flamebait) 665

by NIckGorton (#28134705) Attached to: Wikipedia Bans Church of Scientology

Take mormonism..Horrible theology, but an excellent family culture.

Er, no. They have an excellent family culture as long as you adhere to 'Leave it to Beaver' cultural norms.

Kid misbehavin'? Send 'em for some re-edukashun.

Fags next door creeping you out by getting married and adopting unwanted children? Make sure their relationship is prevented from legal recognition and that their kids don't have the legal protections of married parents.

Pro family my ass. If they were truly pro-family then my family would present no threat to them. However as an organization they spent millions last year fighting against the right for myself and my husband's marriage to be recognized. That money could have been spent subsidizing all the kids in CA who will lose their health insurance now that our state budget is circling the drain. Instead of those millions being spent for something good like treating a kids asthma, diabetes, or leukemia, they spent it on divisive PR campaign to keep me a second class citizen. And don't even get me started on how 'pro-family' they are when their kids turn out to be gay.

Comment: Re:Shame they can't do it for other religions (Score 1) 890

by NIckGorton (#28104419) Attached to: Church of Scientology On Trial In France
You assume (wrongly) that I am being an apologist for the CO$. I'm not. I'm an atheist just like you are: we both believe that there is no Xenu, or Odin, or Zeus, or Anu, or Hacha'kyum, or Eagentci, or Vishnu, or any number of the gods of other religions. The difference is that I am an atheist for one more than you are.

Kill yourself.

...and apparently that one extra god I disbelieve in makes me more fun to have at parties. I had heard your god was kind of a buzzkill, but dude, lighten up: http://www.youtube.com/watch?v=MyE5wjc4XOw

Comment: Re:Conspiracy theory alert! (Score 0, Flamebait) 890

by NIckGorton (#28104243) Attached to: Church of Scientology On Trial In France

Oh... you haven't? Why not?

For the same reason that I don't have to read everything published by Kent Hovind and the Answers in Genesis crew to know that Young Earth Creationism is a load of whacknut loony flaming poo. At first glance Hovind's views are nuts so a second glance isn't required unless its morbid curiosity. Taking a first glance at things I have actually read (both during childhood indoctrination as well as during undergrad) in some of your source documents (albeit in translation since Medical Spanish is worth more time for me than Latin, however in what are considered reliable translations)... you believe that a Jewish zombie can make me live in eternity with him if I eat his flesh and telepathically agree to accept him as my master, so he can remove an evil force from my soul that is present in me personally because a woman created solely from the bone of a man's thorax was talked into eating a magical fruit by a talking snake over 6000 years ago.

Seriously. That wouldn't even make for a good acid trip.

Comment: Re:Shame they can't do it for other religions (Score 1) 890

by NIckGorton (#28104059) Attached to: Church of Scientology On Trial In France

FWIW, official Catholic Church doctrine is not Genesis-style creationism. Also, most Catholics I know take "official doctrine" to mean "food for thought".

The Catholic Church only came to (at least somewhat) support Evolution by Natural Selection post Vatican II. And in fact only finally in 1992 did JPII vindicate Galileo and his crazy Heliocentric theories. (Though not until after then Cardinal Ratzi stated in 1990 of the RCC that "Her verdict against Galileo was rational and just".)

Seriously. I ain't making that shit up.

Comment: Re:Shame they can't do it for other religions (Score 1) 890

by NIckGorton (#28103801) Attached to: Church of Scientology On Trial In France

I'm the council president and former treasurer, so I know of what I speak.

So the guy in charge of the money the church gets tells us about how the church practices getting its money. This is sort of like trusting Dick Cheney to tell us what we need to know about Guantanamo or trusting Bill Gates to tell you all the many ways that Windows sucks. (Not to intentionally compare you with two evil characters. I'm an atheist but I still don't think accounting-for-Jesus is quite up there with torture or releasing Vista.)

Comment: Re:The sources are public... the slanders continue (Score 3, Insightful) 890

by NIckGorton (#28103729) Attached to: Church of Scientology On Trial In France

All the source documents for Christian theology are publicly available

Depends on what you call source documents. If you mean the Hebrew scriptures and the NT (including newer archaeological finds), sure. However since you are a dead language fan, three words for you: Archivum Secretum Vaticanum. But then the whole point of a secret archive is that its.... well.... secret. We don't know what source documents may be in it any more than people knew in the 80's about Xenu and the DC-8s.

However you might be one of the ones who argue RCC != Christian. But since they are the oldest school on the block for the most part I'll assume they have some goods the newer kids might not have. (Though as an atheist the goods in question are about as valuable to me as a wet kleenex or Vista.) However my original point was that there is just as much secrecy in Christianity (more now really since the Vatican has done a better job keeping their stuff off of WikiLeaks) than in the CO$.

And its just too unfortunate that you didn't go to school in West Virginia.... the potential for sheep rather than goat jokes would have been enormous. But I'm just not that lucky.

Comment: Re:Shame they can't do it for other religions (Score 0, Troll) 890

by NIckGorton (#28103069) Attached to: Church of Scientology On Trial In France
No, QuantumG has a very valid point. While the Bible may be readily available at the local bookstore for $10, so is Dianetics. However you can't really believe that the Roman Catholic Church doesn't have extremely classified information that is less accessible than NOT-VII (which you can download from Pirate Bay or WikiLeaks in a few minutes.)

In both fairy tale based cults information access is restricted. The difference with the CO$ is that if you have sufficient funds you can read the batshit crazee at some air conditioned Celebrity Center without spending 10 years in a seminary and blowing a goat for some sexually repressed cardinal's entertainment.

Comment: Re:You Can't Fight the Internet (Score 1) 544

1) Spouse doesn't work (or well, he doesn't make income.) He largely takes care of his elderly parents.
2) We do live in a place with very high real estate prices (on par with Princeton, though on the plus side we haven't had a bubble).
3) I work 2 days a week as a volunteer physician at a clinic that serves uninsured and underinsured patients. This costs me all totaled about $1000/month to do so. (Its in SF, so I share an apartment with a friend pretty much in the T-Loin, etc.)
4) I travel to teach medical students about LGBT health care and often pay for part or all of that travel.
5) As I said I donate pretty heavily too.

So its not sucking at money management, its more that we have a different perspective on what's important in life. The most expensive article of clothing I own may be worth less than $100, I bring my lunch to work, and I drive a car with 200k miles on it, but I also am practicing the kind of medicine I went to school to do and I am keeping my husband's parents out of a SNF. Though if we're talking money management skills, I certainly have you beat on the frugality front. I did my entire education in state at one of the cheapest schools in the US. When I started undergrad it was $381/semester and when I finished med school it was $2K/year (in 1998). I was not going to pay a lot for that muffler.

Comment: Re:You Can't Fight the Internet (Score 1) 544

Freedom of speech is not freedom from the repercussions of speech.

Absolutely, but the repercussions by definition should be limited. If you say gay marriage is an abomination. I can call you a homophobic twat. I can even make an awesome video showing precisely how much of a homophobic twat people who believe that are. I can also boycott your business (taking a page from the fundie handbook.) But I can't sue you for a million dollars because I am butthurt about your statement.

If what is said causes harm, then it is entirely valid and correct to punish the offender. That's why we have fraud, libel, harassment and other similar laws.

Fraud, libel, and harassment laws are inappropriate here. For fraud or libel to be operative, the speech must be untrue. If I say Ted Haggard had sex with a drug dealing gay prostitute, that's libel. If I say you did, it is (unless you have.)

Similarly for harassment to be operative, there has to be intended harm to the individual claiming harassment. If you take the report at face value, the idiots who released this were not harassing the family. Others may have taken those pictures and harassed them, but the original leakers and the vast majority of people who posted them have no intent to specifically harass the family.

You are right that there are limits on free speech. However the limits this family would like are not allowable ones.

Comment: Re:You Can't Fight the Internet (Score 5, Interesting) 544

Just because they're well off does not mean their motivations are any different to yours: happiness, family, safety, achievements, fulfilment, etc.

Its not that they are well off that irks people. Its what they choose to do with that wealth.

I'm a physician and make about $250-300k a year. With this I pay off the debt I accrued in medical school (I put myself through undergrad and med school because I am from a very poor background. Poor as in welfare, foodstamps, and housing projects.) I also pay the mortgage on two adjacent (although modest) homes for myself and my partner's elderly parents. My partner and I share a 6 year old civic (hybrid) although he has 2 used motorcycles as well. We donate about 10% of our income, and I volunteer 2 days a week at a free clinic.

If I had ten times the money I wouldn't buy a porche. I also wouldn't spend my money on a quixotic quest for retribution through the legal system.

That said, the parents of this girl have every right to do so. And we have every right to say that their quest, while understandable, is dangerous in that it threatens the freedoms of speech rights of an entire country. And that statement is not from a place of class rivalry, but from an understanding of free speech and the necessity of defending even repulsive free speech.

You can't just say that censorship is OK when applied to douchebags. Arguably the people who post these pictures and link to them are supreme douchebags. However, I also think that Bobby Jindal, Karl Rove, and the entire membership of the KKK are also arguably supreme douchebags. However others would disagree with me. So we can't use douchebaggery as a bar for censorship. In fact its the very speech that repulses us most that we must defend because that's where freedom of speech is most easily chipped away. See Virginia v. Black et al. http://www.firstamendmentcenter.org/analysis.aspx?id=14776

In order for speech to be free, even the most repulsive speech must also be protected.

It was kinda like stuffing the wrong card in a computer, when you're stickin' those artificial stimulants in your arm. -- Dion, noted computer scientist

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