ny_quant

I also suspect that being inside, you're looking at a biased sample. You will simply never see those who never found a way inside the hospital.
I respect the opinion and you may be right in the end. However I don't like socialist solutions. I prefer universal access via vouchers.

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I was just going to say something about the selection bias. In this case it is particularly strong as (it appears) tandem_bike is a specialist, not a general practitioner.

Another point is that many issues are not life-threatening and perhaps have no medical consequences at all. Still, not being able to see a doctor when you are not feeling well or having pain can be very stressful even if those pains later go away on their own.

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Still, not being able to see a doctor when you are not feeling well or having pain can be very stressful even if those pains later go away on their own. """"""""

this is worth posting as a separate entry. i will.

it is a perfect example of 1. idiocy, and 2. entitlement, and 3. an important therapeutic effect which is related to placebo but is beyond it.

so e=despite 1. and 2., where mishab reveals himself again, he is eerily right if you consider 3. more later.

mishab, thank you for the discussion, i no longer am as involved in medical student teaching, but your opinions are priceless and worth preserving for future lectures - as the view of the electorate ( not dzhigurda, but close).

meaning - most of the time, you are maddeningly stupid. but once in a while you strike a note that totally defeats the opponent. that's what you had done with this little comment.

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Perhaps you should first decide on whether it is a "perfect example of idiocy" or an "important therapeutic effect".

But I forget, they don't teach logic in medical schools. So it's ok.

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i don't think you knlw what THEY do teach or do not teach.

it is actually both - an idiocy and an important therapeutic effect. can happen.

your condescension does not work - my PHD in applied math can probably fight yours and win.

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This is grand idea, let's have a Ph.D. fight! I love it!

What are the rules and the stakes?

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first, you go play with your diploma.

but seriously, do't get all uppity on me, the "you silly doctor" thing is quite silly. i am possibly ( conceivably, ahem) smarter and better educated than you are - you don't know, mishab. so don[t give me 'you little idiot don[t know logic 'cause they did not teach that in medschool". makes you look even more idiotic and out of arguments. yeps.

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But as an intelligent person you surely should also consider the possibility that the opposite is true, and that you are less smart and less educated than me?

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it is also possible. but your comments reveal both ignorance and arrogance. of course, your edication and inteligence can be piecewise continuous so to speak. with huge holes in them that you fill with :intuitive: opinions that range from naive to idiotic to just laughable, like this thing about "logic". yes, what you sputtered out is both idiotic and touchingly true - you need hand-holding, and you are reassured by the phantom presence of doctor ajbolit in your life.

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My education and intelligence are piece-wise continuous! So true, this comment made my day, really. It is also very true for all of us.

Still, my point stands. You are are attributing naivite and idiocy to my comments without any real effort or interest in understanding what I have in mind. You make an elementary logical error, assuming that everything I say must apply directly and immediately to myself, even when discussing broad issues. You continue to build some model of me, a person existing only in your imagination, needing "hand-holding" who is reassured by the "phantom presence of doctor ajbolit" in my life.

If that is not arrogance, I don't know what it.

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i am not interested in you and your persona at all. i am judging you on what you are saying - which is arrogant and ignorant, no matter who you are in life. i truly don't care. you have exposed yourself here enough.

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Well, it is you who constructed models of my internal life (which you profess to be totally indifferent to) and brought up doctor ajbolit.

In any case, lets us part at this cheerful note, fully convinced of each other's arrogance. If anything, it was an amusing conversation :)

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it was a waste of time.

Re: ECCO

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misha-b.livejournal.com - Date: 2017-03-13 05:15 pm (UTC) - Expand

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you know, on one hand i am tired of you and ready to use bad language, i have a low threshold for that - on the other hand, it is possible that i misinterpreted you and turned my hearing off, seeing a stupid leftie ignoramus with trivial and misguided ideas and lack of both education and insight.

well, prove me wrong, then. i am willing to start over.

what were you trying to tell me, exactly. i answered to what i THOUGHT you were trying to tell me. i had two independent "readers" go through our threads, neither are flatterers, and both basically said you are an idiot.

i am tempted to agree, but what if you are not? what if this discussion somehow painted you as an idiot that you are not?

i gave you and Q. a fair "4 scenarios for the uninsured". all of these have access to medical care, and all of these are taken care of fully under the current imperfect system, except for group 3, the people with nonthreatening chronic diseases that may teeter on the verge of 4. but not quite become catastrophic. these are the people whom the system fails - a relatively small group, i say confidently, as most of them either get insurance or transition to 4, where it is given to them.

so let's stat from you r initial comment about how care is "unavailable to all here" compared to Canada.

that is - false. i hope i had shown it to you and Q. medical care is available and accessible. for group 3., it may be less affordable than for the others - 1, who don't need it 2, who get it, and 4, who tie up 30% of resources.

so what are we arguing about, other than whose PhD is Phdier?

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Fur what it's worth, I know Misha for many years and while we often disagree he's most certainly not an idiot.

I know you're not an idiot either (there are other reasons why you jump to ring conclusions) but I'd question your independent "readers". Probably they are.

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i doubt it this is a typical 'leftie who is sure of his statement but has no ground' discourse. remember, it all started with "canada" and "access to care". your smart friend Misha knows shit about Canada, misunderstands what "access" means, and is convinced that millions go untreated. when it is explained to him - that it is not true - instead of "thank you, ma-am" he continues to seek bias and wiggle out of saying okay, it is not as i thought it was. that is ... intellectual dishonesty, i don't need to "win" arguing with some unknown and uninteresting misha, but i am at least able to see where i am right or wrong and admit the latter. he - is not. which is, i am sorry, a hallmark not exactly of an idiot, but of a smallish, stubborn mind.
i am also sorry i wasted my time.

have a nice day.

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believe me i had enough relevant education to be aware of bias.

but you are forgetting that i am 55 and have a huge circle of acquaintances, friends, family and... patient stories, outside of my own practice. so i am not speaking as a narrow fourth-level specialist - BTYW in canada access to "me" would have taken a year, Quant.

i am speaking as everything i am, including xabalka Molly. :-) and i do believe i have a better view than the people who insist on "people without insurance don't get care". it really is baloney. i gave you the 1. 2 3 4 cases, and i posted in my blog as well.

out of those, there is only one group , 3, the "chronics", that are not invalids.. yet - who are potentially undertreated - but not for lack of access.

this misha, prostigospody, confuses ACCESS which is AVAILABILITY of care, with PROHIBITIVE COST of care. to group 3, this may somewhat apply in some cases. but to none of others.

io hate talking to people who are convinced of soimehtign - based on nothing. as he freely admits, but it is discouraging anyway, he is probably educated, but not caring to see how flawed his logic is.

i AM right in the end, dear, and i am also right about the socialist solution.

as much as i hate it, i had come around full circle, and believe that without FREE UNIVERSAL MEDICAL PLAN FOR ALL CITIZENS - we will rapidly descend into bancruptcy, chaos and increasingly horrible medical care.

believe me, i tried all views.

"vouchers" are a joke, mostly for two reasons. do you want me to continue?

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Nobody disputes that you’re better positioned than the rest of us but it doesn’t necessarily mean that you’re right*. To wit, you were just as well positioned when you had opposite opinions. Being in the same position, you made a full circle and, conceivably, you’ll make another one or two.

I’m guilty of the same “error” as I speak of access and unaffordability interchangeably. I appreciate the distinction but I’ll laugh if you tell me that Manhattan townhouses are available to me and other members of my economic strata. If I can never afford it, they are as good as unavailable.

My daughter’s BF probably has not seen a doctor in his adult life. If something serious happens he goes straight to bankruptcy, no doubt. Ditto my uninsured friend. You can continue claiming that they have access but I’ll say it’s a rather technical point. Maybe it’s better be alive and bankrupt rather than the other way around but I don’t think this argument supports your view. My view is that they should drink less and buy insurance but they have other preferences, nothing can be done about it. Your solution is for the nanny-state to step in and administer a dose of socialism to compensate for individual responsibility. I’m against it philosophically and (I suspect, pending sound cost estimates) fiscally as well.

Vouchers may be a joke although I don’t see why. It’s not my original idea. Milton Friedman suggested it (maybe he wasn’t the first as well) and he’s not known to be an idiot.

* If you look at ongoing global warming debate, nobody (and I mean it literally) is concerned that the opponent is better positioned and thus may have sounder judgment. I suppose you can just as well get used to it.

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not quite touche.

i changed my mind not about access or availability of care, but about how to make this care less expensive and universal.

i am not sure the manhattan touwnhouse analogy stands, either. please consider 1.2.3.4. again, 1. probably does not need any care, though if a funny-looking mole appears on his back and nobody picks up on it , not so good. the percentage of such cases is unknown to me or anyone else, really. 2. NOBODY ever went with pneumonia untreated or a broken leg unfixed because of money. do they face, in some cases, unpleasant bills and have to argue them down? yes. but this is not a townhouse.... 3. a SOMEWHAT shady group, some members of which probably go without proper care. i can elaborate on them. 4. ALWAYS get standard of care. no matter what.

so, your friend mishab is indeed .. well, let me not kick him anymore. but he is annoying.

as to your boys who won't get ACA or quasi-ACA - i don't call them irresponsible. it is their decision. they made a choice and i respect it.

it would make more sense if they had a "nanny-state" minimal program to fall back on, to avoid the fate of 2. who might need to go into debt, or 3. who might be in bad shape unless cared for adequately.

but you have NO IDEA - you and the milton friedman, for whom i cannot have much respect despite, i am sorry, i have trouble respecting someone because others respect them and nothing else - about the actual daily expenditures.

what VOUCHERS? the care of truly irresponsible people is what is chokiong the system. "vouchers" may help0 a few good citizens, maybe 10 million, okay 20, but there are 335 million of us here, and the most expensive customers won't reach for a voucher.

arbart and his dezhurnye mandavoshki would say "their problem, let them die" - but they are idiots. WE CAN'T LET THEM DIE.

so we need a nanny state and a nanny program.

re poteplenie - what do you mean? i did not get it. there are so many special interests there that it is better not to venture an UNINFORMED opinion. so i don't.

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1. ok
2. Nobody? The same friend of mine worked, for more than a week, thru what was later diagnosed as a "walking pneumonia" and quickly cured by antibiotics. I know him all too well: if his woman didn't kick his ass he'd never go to see a doctor. I'll also mention mention a class-mate who died when we were 18. Whatever went untreated after that strep
3. Imagine someone with asthma or diabetes or something dermatological or back pain that is so bad that requires a surgery. It's either you cough up the money that you don't have or you suffer the rest of your life. Maybe not too long.
4. Maybe but if you're not destitute you'll get a bill that you can't pay.

Voucher as something that can be spent only on medical care. If you don't need it then it's gone but if you do it's there to help w/o destroying the rest of your life. Even an otherwise irresponsible person would use it. My hunch is that it'd be a lot cheaper than universal insurance.

I didn't mean special interests nor you personally. I meant so many bloggers who feel that their opinion is as good as any.

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no cigar. because i had turned around 180% not on 1.2.3.4, but on how to deliver medical care, and the best of the worst is - the universal, single payor system but 1.2.3.4. and the access issue - it stands.

2.... it is very human but misleading to use individual examples. the "walking pneumonia", akak "community-acquired pneumonia", often mycoplasma pneumonia - is okay untreated. says i. a sufferer back in 2013, i worked through it for weeks. not a good idea - people need rest when they are ill. but the miraculous response to macrolides or tetracycline group or quinolones - does not mean that without them your friend would die or be worse for wear. and mark, it was HIS CHOICE to go untreated, unlikely due to his lack of funds. cynically - he was just NOT SICK ENOUGH.

so i reject this argument. 2. is well-served, even if they occasionally have to take out a loan.

3. i cannot imagine someone with asthma who requires a surgery...diabetes - insulin pumps are not recommended for everybody, and SQ insulin still works fine... something dermatological is either a 2. or a 4. if it is psoriasis - it is borderline. kike i said, 3 is the only iffy part of my argument. back pain - like my former friend Ninazino used to say, ne smeshite moi tsapochki.

4. does happen that a catastrophically ill person GETS a bill. i have never seen that person PAY that bill.

the problem with you, milton fr, and vouchers - they will take care of a repsonsibel or kinda responsible 10 million. i shudder to try and estimate the IRRESPONSIBLES.

like i said - we cannot not treat them, and vouchers for them are toilet paper. or worse.

my opinion on? global warming? is NO GOOD. as in. i don't have a right to an opinion. like your mishab, i "feel" there is somethign to it, but i am too shy to voice something i know nothing about.

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Какие тапочки?! Another friend of mine had 2 back surgeries. He's intensely against any medical intervention (so his knee and shoulder will go untreated even though he can't lift his arm more than 90%) but he HAD TO do it b/c his pain level was like 9/10 and he couldn't live like that. So 2 surgeries. 2nd required 2 nights in the hospital. Altogether probably 6 digit amount w/o insurance. By daughter's BF is doing physical work that will eventually ruin his back (he's suffering already). When it comes to his surgeries I wish your slippers paid for it and I were the one laughing.

I agree that completely irresponsible people won't be helped even with vouchers. But universal insurance won't help them either. Both ways they need to go and see a doctor when something is wrong and both ways they don't have to pay out of pocket. Same situation, same outcome.

No, not YOUR opinion, forget it...

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again, anecdotal examples of someone who had back surgery. you are trying to say he maybe needed it. i am trying to hint that back surgery is a gamble and that 8/10 are not needed if you look at community, 5/10 not needed at a University Hospital anywhere ( by expert judgement postfactum, that study has a flaw), and many are so-called "failed backs". that study addressed nonemergent back surgery where the cord was not compromised and where the neurological exam was normal. that's why tapochki.

a LOT of what we ( collective we) do - is stupid, futile, and.. expensive.

just as Yucca suggests a surgery for asthma, you think that back surgery might be an end to one's trivial (myofascial plus discs) back issues, but it is more commonly the beginning. unless the disc is "fresh" or very small, surgery (discectomy) makes sense only if there is impingement on the canal and (not or) neurological impairment such as paralysis. anterior discs that manifest with pain only do worst with surgeries. myofascial back inury (most common) is not amenable to surgery.

thus taochki.

you consumers of medical care have lots of anger but talk like.. "uneducated people", which you are, actually, in those areas. buit so much self=assurance, so much entitlement, it is amazing every time.

as to completely irresponsible people - tehy presently are free customers when they get in trouble. so, universla insurance would provide perhaps nothing to them - htey will be treated either way - but to us as a society. to you, who is now paying out of pocket for those people and the illegals BTW. but that's a different story. as you know i favor legalization and a "path to citizenship" for all but criminals and welfare users. teh reason is not takinetish - the illegals weigh very heavily on medical expenditure, and if legalized, they would be covered with universal insurance which is i am afraid going to remain a fantasy.

Edited Date: 2017-03-11 05:46 pm (UTC)

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No, I'm saying he definitely needed and I don't have any reasons to believe that his story is anything unusual. He is an engineer like millions others and (was) a recreational tennis player like millions others. Back surgery is a gamble when it's a choice. For him it wasn't as I thought I made very clear.

No, nobody thought the surgery would be the end of the pain. The hope was to reduce the pain from unbearable to manageable and that's what ultimately happened. Of course we, the consumers, lack formal medical education. But we compensate by sourcing multiple medical opinions, by reading everything that is available on internet (and that's a lot) and by thinking a lot. We know how to process information and there's nothing so special about medicine that we cannot handle if we try hard enough. And when it comes to life-changing decisions we do.

You keep talking about irresponsible poor (and I don't care too much about them b/c they'll be taken care of, as you say) but I'm concerned about people like my friends who will run out of luck one day.

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