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I generally don't like personal ancedotes as a method of convincing people. However, I recently had a conversation with my grandfather about his opinion on health care, what should change, and what should stay the same.

I don't really trust a lot of people's opinions on health care, but my granddad is an exception, namely because:

1. He has been practicing medicine since the 1930s.

2. He's a D.O. vice a M.D.

3. He founded a medical school, served as its first president, and is still on the board of regents.

4. At 104 years old, he still practices medicine as a GP in a very rural, extremely poor part of the United States.

His experience is massive- from being a coal mine doctor, to an army physician during the wars, to starting a medical college, this guy know American health care, especially in areas of extreme economic hardship. He practices in West Virginia, one of the poorest, unhealthiest states of the Union. If there is anywhere in America where health care can make a difference it is West Virginia, and he has been on the front lines of medicine there for more than seven decades.

His observations about why the system is broken:

1. The system was working pretty efficiently until the sixties, then rumbled along OK until the late 80s and early 90s when the wheels fell off.

2. He believes that the health care system is not adapting to advances in medical technology- To see a rise in average lifespan of more than twenty years in 2 or 3 generations is unprecedented in human history. Most of the cost of health care, and the problems with its financial aspect, comes from the inability to deal with cost of the 'new' twenty years of life that the average person can expect.

3. The cost increased simply because you were getting a better product. It was like if every car dealer in America suddenly switched to selling only Ferraris and Lambos. The scope of what medicine could do for you had increased exponentially, and the market is still trying to absorb the shock of change.

4. The rise of heavily government regulated Health Insurance conglomerates in the 80s and 90s put the final shock into the system and knocked it out of control. These new organizations put too many intermediaries between caregiver and patient. The actual cost of care is low- the cost of wheedling money through the patient's employer, government, overarching hospital organizations (like parent companies that own dozens of hospitals), insurance company for the patient, malpractice insurance company for the doctor is what, in addition to the increasing scope of medicine, drove costs through the roof.

He has several suggestions about how to fix this problem.

1. He also farms- raising more than a hundred cattle on his property where he treats people who come by. Often these people can't pay him, so they barter. They might work on his tractor or give him a trunk load of strawberry preserves (that stuff is like crack for him). He thinks this is the way that medicine should be-- the patient honestly tries his BEST to pay the doctor his due. If he can't pay in money, then in something else. Conversely, the doctor must try his BEST to render care to those who ask for it, regardless of whether or not he will be compensated for his effort. This works better for him, because he is a GP, and his procedures are not particularly expensive, but he feels this should inform the medical profession and the populace as a whole.

2. Tort Reform. Malpractice lawsuits are MURDERING the American medical system, as they target the only part of the entire bloated bureaucracy that actually does anything, the nurses, doctors, and PAs. If you are a doctor, you can expect to pay fully a third of your entire yearly income for malpractice insurance. Every single person you treat is a threat to you, as the possible plantiff of a huge lawsuit against you, even when their is NO error on the part of the doctor.

3. In addition to making health care a far less lucrative profession, the rampant nature of lawsuits has another effect: doctors don't trust their patients, and patients don't trust their doctors. According to my grandfather, this is the much bigger problem, as it strikes at the soul of the medical profession. There was a time when people realized that going to the hospital was a risk- and that just because a highly complex surgery went wrong was not grounds for you to be compensated to the tune of hundreds of millions of dollars. Can you expect doctors to make a good faith effort to save you at all costs, when they know that at the first mistake they make, you will completely ruin them financially and professionally?

4. End farm subsidies. The government pays farmers to grow stupid huge amounts of corn and beef. Way more than there is any natural demand for. So we end up with having half of all the products on grocery shelves being made of corn. Forget a tax of fast food, or on fat people or any of that other nonsense, just REMOVE the massive amounts of government money given to farmers for growing really unhealthy crops. Or better yet, just switch the subsidies to only offer incentives for healthy crops, and diversify the entire American agricultural system so that we aren't the country that can feed the entire world twice over, but only if it wants corn.

5. Recruit new doctors and nurses. People not in it for the money (he is a wealthy man, despite not ever really being payed that much, the compound interest of a 104 year old saving account starts to accrue, apparently), people who's first desire is to help people get better. And make sure the public realizes this, and goes to the hospital with the understanding that suing their doctor to hell and back won't fix them, and it won't fix the system.

That is almost all his advice. He's delivered more than 10,000 children, and plans of practicing medicine until he dies, which doesn't appear to be anytime soon. He's got a great sense of humor too: I asked him for a health tip and he said "Avoid hospitals: they are full of sick people"

So you are looking for a barter system almost... sounds interesting and may work in small communities. I also agree with the malpractice bit, but we must keep something if a truly malicious act is done(i.e. stitching an ear to someones forehead).

The doctors that only want to help thing is "unrealistic" to some people.

That's the most important part, the paycheck is just a bonus.


Seeing as though your grandfather sounds like a good man and he is elderly and wise, I will agree with him on this.

Your grandfather sounds like a "mensch'.

He is quite correct that the money spent on healthcare is massively biased towards the elderly. It's the same in the UK, because the older you get the more problems you are liable to.

I agree on Tort Reform. Something needs to be done about it, doctors are really being treated unfairly with regards to it.

It's just as well you've got those Death Panels on the way, they're going to solve so many of your problems in one fell swoop.

Bring in an a larger inheritance tax as well and you'll be balancing the budget in no time.

Can we send our Death Panels after the lawyers?

Lawyers have the "demon" rule which includes the "eternal warrior" rule so it could be awkward.


.... worth a go though.

That's okay,

Lawyer WS BS S T W I A Ld Sv
2 7 3 3 2 4 2 7 3+

Special Rule
-Independent Character
-Demon
-Eternal Warrior
-Stubborn

Special Abilities
-Objection(Lawyer may make leadership test against any wound he receives. If the test is passed then the wound is negated.)

Wargear
- Law Suit(armor)
- Power of Attorney(Counts as Power fist)


Death Panel WS BS S T W I A Ld Sv
4 4 8 8 4 2 10 8 2+

Special Rule
-Monstruos Creature
-Bureaucracy(Player must roll d6 during movement phase. If a 4+ is rolled the Death Panel functions normally. If anything else is rolled, the Death Panel does not function. It will fight normally if assaulted)

Special Abilities
-Euthanasia( Once per game, Death Panel may use injections on a target)
-Accountability( Death Panel must make a leadership test for each wound caused by Euthanasia. If test is failed, Death panel takes a wound. Death Panel may make armor saves against wounds.)

Wargear
-Injections S Type
2 Assault 2, poison(wound on 2+)
-The Panel(armor)

.... are.... are you Jervis Johnson ?


Behold, they come... the four lawyers of the Apocalypse

Lawyers are not mounted units and as such they may not get a trample attack. You'll just have to wait for the new codex for rules changes.

halonachos wrote:Lawyers are not mounted units and as such they may not get a trample attack. You'll just have to wait for the new codex for rules changes.

They dont need mounts, you forget about the Chase Ambulance rule. Lawyers can keep up with any transport. Its nastier because while the passengers might not be able to assault when they disembark but the attached lawyers can.

Thank you for sharing this with us SilverThorne.

I found this part very interesting, especially since we have a very crazy thread on this right now.

4. End farm subsidies. The government pays farmers to grow stupid huge amounts of corn and beef. Way more than there is any natural demand for. So we end up with having half of all the products on grocery shelves being made of corn. Forget a tax of fast food, or on fat people or any of that other nonsense, just REMOVE the massive amounts of government money given to farmers for growing really unhealthy crops. Or better yet, just switch the subsidies to only offer incentives for healthy crops, and diversify the entire American agricultural system so that we aren't the country that can feed the entire world twice over, but only if it wants corn.

I have read about this tactic a few places, and there is a lot of evidence stating that we do eat too much because our food is so heavily subsidized. So instead of having a stable agricultural economy, we have Monsanto and thousands upon thousands of farmers trying to squeeze enormous amounts of food out of the ground. Most of the tactics used by Monsanto are backed up by lobbyists and serious "interests" hell-bent on keeping the farmers on their knees. I think this is where the government need to cut the fat, and quickly. Overall, I think that government subsidies are not quite as bad as some people think, but we definitely had a huge surplus of grain in this country. Companies take this extra grain that costs so little and they just throw it in everything. We see corn syrup in practically every processed food, due to the excess of corn that we produce. By-products seem to be the biggest issue, especially due to the fact that by-products of wheat and corn are the types of food that cattle should be eating, not humans.

We get unhealthy because our bodies simply cannot process all of this excess that we see in all of our food. Serving sizes in the U.S. tend to be twice that of most European countries, which is nice, but you are just getting fatter with all of that "discount". I am pretty sure that food costs considerably more in Europe, but they also seem to balance their budgets quite a bit more efficiently. If people learned to take care of themselves a bit better that extra 20 years we all tend to have would not be anywhere as detrimental to the system, especially if the health care reform focused on making the nation healthier. There will always be people that take poor care of themselves, but most when presented serious alternatives will choose to take it IMHO.

Perhaps the reason it is so hard for Doctors to advise their patients in effective and healthier way due not to the fact that people don't trust their Doctors, but due to the fact that Doctors seem to care less now. I feel sorry for some of the Doctors that get sued for all this crazy stuff, but I think that if anything it would be a signifier of the Doctors lack of a professional approach. Patients are just patients, they do not get paid to go to school, then form and office and charge a hefty chunk of change for their services. All professions have their disadvantages, and it appears being sued often is one that Doctors have to put up with quite regularly. If the system worked better, and more Doctors took the time to spend more than 5 minutes with each patient this type of thing could be kept to a minimum.

How often have you gone into the Doctors office... then waited for an hour, then spent a half hour with a Nurse... then saw the Doctor for five minutes? That has been my experience with nearly every Doctor (Dentists included) for my entire life. I believe when I was a kid our family had a decent doctor, but after that it was a matter of seeing that guy with the shiny stuff. Seriously though, regardless of your Grandfather and many other Doctors being good moral men, I truly feel that many Doctors could care less on most occasions. How irrational is it to sue a Doctor for making you worse? Of course they are not trying to, but seriously seriously though... if a surgeon messes up an operation, the patient should have the right to sue. Perhaps not for hundreds of millions of dollars... because that is just silly most of the time, but most definitely enough to fix the problem, and a bit more for emotional damages. Most of the time I think the responsibility is on the Doctor/Surgeon/Specialist... because blaming a passed out patient is totally insane... on so many levels.

That problem is one with the legal system, not the Health Care system BTW.

No offense, but it's awfully stupid to try and figure out "who's to blame" when extremely complicated surgeries don't go as planned. Making a mistake is not grounds for a lawsuit unless it's due to true incompetence on the part of the doctor.

Of course they are not trying to, but seriously seriously though... if a surgeon messes up an operation, the patient should have the right to sue.

The right to sue does not automatically infer responsibility to the Doctor. More importantly responsibility IS very relevant to this, and your police analogy did not really make sense to me. If a Doctor makes a mistake (intentional or not) that causes someone to die (this does happen) not only would the doctor feel terrible, but I think more often than not they would take the full responsibility for their actions; they by no means meant to hurt someone, but with the amount of experience that they have, and the fact that mistakes can be fatal, they should be taken very seriously.

Of course they're serious, and the operations are usually done for serious reasons, even when they're relatively routine. There are lots of jobs where messing up causes someone to die; in pretty much every case it's a matter of preventing serious harm themselves. Police, firefighters, soldiers, and doctors all fall under that catagory.

"Responsibility" is a buzzword here. Of course they're responsible for the operation they're doing, but that doesn't translate to being legally punished for making common mistakes. Mistakes are inseparable from the medical profession, any time you get an operation you should no full well the risk you're putting yourself into. It's not the same as coming to work drunk.

Some mistakes are the Doctors fault, some are not, I am not trying to say that all Doctors that make mistakes constantly, in fact I would argue the opposite is true.

Regardless of how you want to spin responsibility in this context, the Doctor is professionally responsible to perform at their best. Whether mistakes happen from time to time, their are actions that Doctors should be expected to perform with a relative amount of ease. When you are talking about a very complicated and sometimes experimental procedure the appropriate legal papers are usually accounted for. This is not always true in the more simple procedures, and yet again mistakes that actually merit this type of legal action on the Patient's part are very few and far between.

Just because there are very few instances where a Doctor is actually the cause of a problem, this does not mean that all Patients that are taking Legal action are doing anything inherently wrong.

It's not a matter of the patients treating the doctors unfairly, or the lawyers for that matter. They both cause their problems, but it's the courts that need to be looked at. They're the ones giving out huge awards in situations that often don't warrant any, and it's that kind of money that has lawyers and patients swarming around and greatly increases the expense of practising medicine.

Also, even simple procedures are usually quite complicated. They're only "simple" relative to what else is done.

There is a great deal of problems with the U.S. legal system, I just thank god that the most ludicrous cases usually fail regardless of how the media chooses to present the total picture.

All in all I think we are doing a whole lot better than most people think, if only we could get all of these Bush people together for THEIR court case .

I would argue that if the simple procedures are as complicated as you are trying to make them out to be, you are not talking about simple procedures at all. Attaching a bionic arm is a job for a freaking neuro-surgeon or something along those lines, and I can see no reason why they should not carry hefty insurance at any rate. There are many reasons that their insurance costs so much, and it cannot all be attributed to a handful of ridiculous rulings in the courts. Risk and experience go hand in hand, so more often than not the basic surgeries that people would require are actually quite simple. For an average joe it would seem a lot more complicated than it actually is. On this same note, Doctors (or surgeons more specifically) simply cannot be expected to be miracle workers, although I find that they are in many cases; on the whole they seem to perform more miracles (in part because of the Patients themselves of course) much more often than becoming a part of an utter catastrophe.

This all links back to the insurance companies yet again with a very solid link to the legal system. A hyberbolic over-reaction from Judges is not all that uncommon, but in essence they have to make political decisions from time to time, and that must be a huge pain for them to deal with.

The fact that it requires 8 years of college to get an MD isn't without cause. There's a lot that can go wrong during surgery. There's anesthesia, the chance of infection, the actual cutting, the paperwork that needs to be on file for it begin, etc. A non-professional generally cannot do a "simple procedure". "Simple" doesn't mean that doctors who act responsibly/professionally won't make mistakes, or that something outside of their control won't come up.

Wrexasaur wrote:There is a great deal of problems with the U.S. legal system, I just thank god that the most ludicrous cases usually fail regardless of how the media chooses to present the total picture.

The plaintiff doesnt need to win a lawsuit for it to be horribly damaging. the threat that they could win and the fact that you have to hire lawyers to defend yourself makes all prospects risky, horribly expensive and in many ways random.

This is true Orlanth, and I do not disagree with you on that. How would you make that system work better though?

They tried to overhaul the whole thing, so it blew up in their faces.

'Nuff said. I can't really comment on what I don't know much about but that just doesn't seem like the way to tackle a problem... I won't start on what other proverbial cans of worms have been opened in the past seven months.

The main problem I see with getting things to pass is that the Democrats and Republicans generally hate each other so much that nothing gets done. This is hyperbole from someone with limited knowledge, but with bipartisan work so much could be accomplished. Unfortunately, we're all human. Curses.

Rico...

Orlanth wrote:
The plaintiff doesnt need to win a lawsuit for it to be horribly damaging. the threat that they could win and the fact that you have to hire lawyers to defend yourself makes all prospects risky, horribly expensive and in many ways random.

Which ties into the expense of law degrees. Its amusing (read: not at all) how much of this comes back to the spiraling cost of education.