Open Border Tragedies Caused by Visa Lottery System

[Steeleballz 7,550]

Just now, Boiler said:

http://www.denverpost.com/2017/11/13/#######-fighting-charges-evans/

 

Evans police have arrested three men on animal fighting and cruelty charges after authorities discovered several injured roosters and euthanized 28 roosters.

 

Luis Mosquedo-Razo, 31; Pablo Cortez-Diaz, 27; and Gambino Villegas-Delgado, 52, have each been arrested on felony charges of animal fighting and cruelty to animals. Cortez-Diaz was also charged with possession of a controlled substance.

Police were called Friday night on a complaint about an animal running at large, according to a Monday news release by Detective Shawn Holmes.

When a community services officer arrived at the home in the 3700 block of Burlington Avenue he discovered an apparent illegal animal-fighting operation.

Numerous roosters had been physically altered and some were injured, the news release says

 

    Does this pertain to the topic at hand in some way?

[Unlockable 7,315]

1 hour ago, jayjayj said:

A lottery program is a terrible way to pick and choose who can immigrate to America.  We should use that allotment of 50,000 visas to bring 50,000 new doctors into the country and see if that drives down the cost of health care.  Democrats tell us that foreign labor doesn't drive down wages, so let's give it a try and see what happens. 

 

28 minutes ago, bcking said:

I can answer that question before we waste the time.

 

It won't.

 

24 minutes ago, jayjayj said:

Why wouldn't it?  Any reduction in cost to provide health care should be realized at the consumer level.  Increased competition among general practitioners should drive down the cost of a doctors visit for minor illnesses, thus reducing health care costs at a basic level.

 

14 minutes ago, Steeleballz said:

 

   I don't think physicians services are actually a big driver of health care costs. My doctor bills $84 dollars for an office visit. Compare that to the $32000 a surgical suite bills for an hour of time, or the $2000 for a 15 minute MRI at a hospital. 

 

   When you go to a hospital for care, the doctors are not actually involved in negotiating the cost of procedures. It's between the hospital and the insurance providers.  

 

   

 

 

Let me chime in here as this is a field I have worked in for almost 20 years.

 

DOCTORS NO LONGER HAVE ANY SAY IN THE COST OF HEALTHCARE. You can bring in a million doctors in that will not reduce the cost. Now it MAY increase the quality of care as doctors will have more time to focus on patience individually. But it definitely will NOT reduce cost.

 

Back in the day doctors had unlimited control on what brand of products they can use at hospitals. This cause a lot of bribery from drug/medical device companies. Today, the healthcare industry is heavily regulated to where a sales rep can't even buy a doctor a sandwich for lunch. Also, because of the regulations and threat of lawsuits, drug companies are required to an extensive amount of research before launching a product.

 

So the answer to reducing medical cost is not more doctors.

Edited November 14, 2017 by NuestraUnion

[bcking 3,157]

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

 

Most recent highlights on expenditures from CMS.

 

The category including physician salaries has grown, so it is now 20%. That being said, it includes more than just physician salaries and they even comment that the growth in that category has been in non-price factors.

 

I'd gladly add 50,000 GP's to our healthcare system. I just wouldn't expect it to make a huge dent in our healthcare costs without many many other changes occurring concurrently. 

[jayjayj 571]

4 minutes ago, bcking said:

This is a very complex discussion and off topic for this discussion, which seems to be primarily focused on how immigrants are disproportionately killers and criminals.

 

You initially just said bring in more doctors, not specifically GP's. So I think first off we should decide which one we want to discuss.

 

If we wanted to focus on just GP's I could MAYBE see an argument that is several steps removed where increasing GP care would lead to decreased cost. It wouldn't be in the method you describe though. If you added more GP's in the mix and expected "competition" to bring down costs, it wouldn't be sustainable. We have a lack of GP's in the USA because that aspect of healthcare is not profitable, or rewarding. Throwing even more GP's in, without doing anything else to change the system, wouldn't help. Not to mention that GP care is an INCREDIBLY small proportion of our healthcare costs. GP's cost pennies compared to other things so even if you drove down their cost through competition, you'd be remove a couple drops of water out of a very very big bucket.

 

Now if we could promote more GP care (Again - Just more GP's won't do that) we may be able to reduce long term costs by making our people generally healthier, and focusing on preventative medicine. However, again, that won't just magically happen by adding 50,000 more GP's (or 100,000, or 1,000,000). 

 

If, instead, we are talking about just adding 50,000 "doctors" and assume they were made up of a similar distribution that we have now it still wouldn't make much of a difference. Our healthcare spending isn't driven by a lack of specialists or doctors in general. Do we need more? Sure we do, but that isn't going to save us much money in the long run. "Physician services" (Not just GP's but all physicians) account for maybe 15% of our total healthcare expenditures. Competition may reduce that a bit but will make very little overall impact.

 

One third of our healthcare spending is in hospital care. Just having more doctors wouldn't change that. Another 10-15% is in prescription drugs, again something that more doctors won't fix. The other pieces are small and unrelated to physician expenses.

 

We could look at it another way, but addressing the areas of "waste" in our healthcare system (instead of just looking at where we spend money). Several people have done that. Look up Berwick and Hackbarth, they wrote an article about it (https://jamanetwork.com/journals/jama/article-abstract/1148376).  The Institute of Medicine came up with a similar list.

 

Bottom line - The number of physicians, physician compensation/competition - These things are major contributors to what we spend money on, or what we waste money on.

 

Sensible post, as always.  Can you read that article I posted and give some comments?  

[bcking 3,157]

Just now, NuestraUnion said:

 

 

 

 

 

Let me chime in here as this is a field I have worked in for almost 20 years.

 

DOCTORS NO LONGER HAVE ANY SAY IN THE COST OF HEALTHCARE. You can bring in a million doctors that will not reduce the cost. Now it MAY increase the quality of care as doctors will have more time to focus on patience individually. But it definitely will NOT reduce cost.

 

Back in the day doctors had unlimited control on what brand of products they can use at hospitals. This cause a lot of bribery from drug/medical device companies. Today, the healthcare industry is heavily regulated to where a sales rep can't even buy a doctor a sandwich for lunch. Also, because of the regulations and threat of lawsuits, drug companies are required to an extensive amount of research before launching a product.

 

So the answer to reducing medical cost is not more doctors.

We still get lunch from pharmaceutical companies around 3 times/week at my hospital. They just aren't really allowed to talk to us about anything. They'll make a <5 second plug while you are stuck in line and pretending to ignore them.

[Steeleballz 7,550]

1 minute ago, bcking said:

We still get lunch from pharmaceutical companies around 3 times/week at my hospital. They just aren't really allowed to talk to us about anything. They'll make a <5 second plug while you are stuck in line and pretending to ignore them.

 

   We still get free pens, but that's about it.

[Steeleballz 7,550]

3 minutes ago, NuestraUnion said:

 

 

 

 

 

Let me chime in here as this is a field I have worked in for almost 20 years.

 

DOCTORS NO LONGER HAVE ANY SAY IN THE COST OF HEALTHCARE. You can bring in a million doctors in that will not reduce the cost. Now it MAY increase the quality of care as doctors will have more time to focus on patience individually. But it definitely will NOT reduce cost.

 

Back in the day doctors had unlimited control on what brand of products they can use at hospitals. This cause a lot of bribery from drug/medical device companies. Today, the healthcare industry is heavily regulated to where a sales rep can't even buy a doctor a sandwich for lunch. Also, because of the regulations and threat of lawsuits, drug companies are required to an extensive amount of research before launching a product.

 

So the answer to reducing medical cost is not more doctors.

 

   I agree. The only doctors who have direct control of cost are those who work outside the insurance system. Stem cell therapy for example, since it's not covered by most insurance.

[bcking 3,157]

3 minutes ago, jayjayj said:

Sensible post, as always.  Can you read that article I posted and give some comments?  

Ya sure. A few comments directed at the article: (Apologies for some of the font issues when I copy/pasted)

 

1. According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually,on average, because U.S. doctors make twice as much as their OECD peers. And even the poorest in specializations like radiology and surgery routinely rake in around $400,000 annually.

 

This sounds horrible. But do you want to know what percentage of our total health expenditures 58 billion is? 1.8% Our NHE is 3.2 trillion dollars. 

 

2. Doctors--and many Republicans--constantly carp about the costs of "defensive medicine" because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does.

 

Not sure where they get numbers. Experts in the field estimate that the cost of our medical fraud system in the USA is far more. Donald Berwick (former CMS administrator) estimated between 80-200 billion in wasteful spending (actual spending would be higher, since we can assume that at least SOME spending in that area is reasonable, just not the amount we spend now) from medical fraud and abuse.

 

Overall I agree with it though on how the AMA has limited the scope of practice for non-physicians. I also agree that we have a shortage of doctors, I just don't think that increasing our numbers would save us money except in the very long term if it improves our health outcomes. We need more training spots, and a system that supports and promotes physicians becoming GP's. I also am very much in support of a well regulated system to increase the support for non-physician medical providers. Especially midwives, PA's and NP's. Midwives especially have been sadly relegated to the fringes. They then get a bad rap because some of the "fringe" groups that license midwives aren't up to a high enough standard. If they were regulated and supported, it would be amazing.

 

I would very much love to just attach the article from JAMA here, but I believe that would be unethical (since I wouldn't be distributing it for teaching purposes). Berwick and Hackbarth's summary of waste in our healthcare system is quite excellent, and brief. The IOM summary from a couple years earlier was a huge roundtable meeting and it is a brief succinct 800+ pages.

 

12 minutes ago, Steeleballz said:

 

   We still get free pens, but that's about it.

I think I have a pharma pen as well...

 

I found it on the floor in the hallway. It's one of my favorite pens actually.

[bcking 3,157]

I was editing my post and took too long. I wanted to add:

 

Now that doesn't mean I don't think our salaries are a problem - But for me the problem is not in the overall amount that we spend, but in the distribution. There are a number of studies that have looked at the reasons medical students choose high-paying specialties. Medical debt and future earnings are a huge deciding factor (https://www.ncbi.nlm.nih.gov/pubmed/22989132 - Just one study, there are more). There aren't enough places that create incentives for choosing a career in primary care (IM/Pediatrics - WIthout a subsequent fellowship, or FM). The average medical student has something like 150,000 or more in debt. While they may overcome that even as a GP later in life, you can't fault them for looking at specialties that make 4 times more and finding things they like there.

[Amica Nostra 4,803]

This thread used to be about how the legal green card lottery is bad for America (an opinion that I disagree with) How did it get off track onto medicine? 

 

The truth is this: the alt right Bannonites are not in favor of any immigration: Green Card lottery, visas for temporary technical workers, refugees, the opinion piece even targeted family visas.  The reasons they cite are crime and freeloaders if our services. In fact they fear loosing economic and cultural identity. Immigration politics become identity politics.

 

Everyone is entitled to their opinion. I just think those opinions are a bit rich on a site dedicated immigration.

 

Edited November 14, 2017 by Il Mango Dulce

[charmander 692]

48 minutes ago, N-o-l-a said:

In any case, I think most healthcare visits could be accomplished by seeing a PA or a NP and in my county, they area.  So much wasted times and resources on those who visit the doctor with every little cold/flu.   

My wife is an NP. Bigger cities learned what NPs/PAs could offer, how they can contribute, and they're valuing their service. When we lived in upstate NY, she was the first NP hired in her unit, for a while the doctors had no idea what kind of assignments she could do, etc. I think within the next decade PA/NPs involvement in healthcare would erupt.

 

Let's also celebrate the National Nurse Practitioner Week (Nov 12-18) with this opportunity.

 

44 minutes ago, Steeleballz said:

 

      Pet's can be expensive I guess. I saw not long ago that many people buy pet health insurance nowadays.

Oh yeah. You know when you ask a vet how much longer your pet could live, they usually answer it depends how much you're willing to spend.

 

 

 

[bcking 3,157]

10 minutes ago, charmander said:

My wife is an NP. Bigger cities learned what NPs/PAs could offer, how they can contribute, and they're valuing their service. When we lived in upstate NY, she was the first NP hired in her unit, for a while the doctors had no idea what kind of assignments she could do, etc. I think within the next decade PA/NPs involvement in healthcare would erupt.

 

Let's also celebrate the National Nurse Practitioner Week (Nov 12-18) with this opportunity.

 

 

The NICU has had NNP's for a long time. I don't honestly know the historical reasons for why they have been prevalent for longer than other specialties.

 

My hospital actually wants to hire more NNP's, but there aren't enough out there (or there are in increased demand so we have to compete for them). We actually hired some doctors to fill the NNP gaps because doctors were more readily available.

 

When I was doing my Pediatrics training I quickly realized that I could never do primary care. After 11 years of education the majority of my time would be seeing healthy kids, and providing a lot of "reassurance" and "anticipatory guidance". You don't need a doctor to do that.

[The Nature Boy 7,659]

1 hour ago, jayjayj said:

Why wouldn't it?  Any reduction in cost to provide health care should be realized at the consumer level.  Increased competition among general practitioners should drive down the cost of a doctors visit for minor illnesses, thus reducing health care costs at a basic level.

Just a hunch, but I would bet doctors salaries are not the driving factor in our out of control health care costs 

[The Nature Boy 7,659]

1 hour ago, Steeleballz said:

 

   I don't think physicians services are actually a big driver of health care costs. My doctor bills $84 dollars for an office visit. Compare that to the $32000 a surgical suite bills for an hour of time, or the $2000 for a 15 minute MRI at a hospital. 

 

   When you go to a hospital for care, the doctors are not actually involved in negotiating the cost of procedures. It's between the hospital and the insurance providers.  

 

   

My doctor has over 10 years of secondary education.  Gets about 90 bucks for office visit plus co-pay. I wish he could do plumbing. Would save me some $$$

[CaliCat 3,957]