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The $100 trillion problem
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QuestionSocratic Offline
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Post: #21
RE: The $100 trillion problem
(12-22-2014 02:36 PM)Fo Shizzle Wrote:  
(12-22-2014 02:20 PM)Owl 69/70/75 Wrote:  
(12-22-2014 02:08 PM)Machiavelli Wrote:  You do have to give credit to our health care system. The fact that the two nurses that were infected are still on the right side of the roses speaks volumes. I didn't suspect that from the things I have read.

You mean our "completely dysfunctional" and "hopelessly broken" health care system that was so bad we had to kill it and replace it with Obamacare?

This is where the left's comments are truly exposed for their hypocrisy.

What we had before was not a perfect health care system. But the problems could and should have been addressed in ways that did not lead to the disruptions that are now going on and will intensify in the future.

Bismarck would have taken the best of what we had and added things to address the problem. Obamacare keeps the worst features of what we had and adds the worst features of a single-payer/single-provider system.

Yep. I hope the first thing the new congress does is open up the insurance marketplace to competition across state lines. I should be able to purchase products and services where ever I wish.

The state control issue is actually a states rights issue. About 75 years ago, Congress decided that states would control the insurance markets within their individual states without consideration of anti-trust or the commerce clause. Because of this, it is not legal to offer insurance across state lines. Insurance companies get around this by "filing" in every state in which they wish to sell policies. But each filing must adhere to that state's requirements. That is why here in New York, we have very expensive plans because the state legislators have added all kinds of required coverage (chiropractic, podiatric, shaman).

So here's where the ideology gets involved. Many would want to continue the state control which precludes the purchasing of a cheaper/lower benetir plan.
(This post was last modified: 12-22-2014 02:54 PM by QuestionSocratic.)
12-22-2014 02:53 PM
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Post: #22
RE: The $100 trillion problem
(12-22-2014 02:17 PM)Fo Shizzle Wrote:  As you point out...with YF...Malaria is also transmitted differently. My comment was just in regard to numbers of deaths...not particularly that we should not be concerned with Ebola.

I'll agree with that.

Given the host of diseases transmitted by mosquitoes It IS mind-boggling that we can't control them any better than we do... especially when we've controlled bees to the point where they are are scarce in many farming areas and its causing issues. It's not as if we aren't trying. We spend a fortune in the south on personal products and 'spraying'... just in the US, much less world-wide... and I'm unaware of any specific benefit that we'd lose if we were able to get rid of mosquitoes. I'm aware they eat nectar like bees do, but I don't believe they travel like bees do so their usefulness for pollination is far less. That's obviously not something I know for a fact, but I don't see any 'save the mosquitoes' groups around... yet we can't get rid of them.
12-22-2014 02:56 PM
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Fo Shizzle Offline
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Post: #23
RE: The $100 trillion problem
(12-22-2014 02:56 PM)Hambone10 Wrote:  
(12-22-2014 02:17 PM)Fo Shizzle Wrote:  As you point out...with YF...Malaria is also transmitted differently. My comment was just in regard to numbers of deaths...not particularly that we should not be concerned with Ebola.

I'll agree with that.

Given the host of diseases transmitted by mosquitoes It IS mind-boggling that we can't control them any better than we do... especially when we've controlled bees to the point where they are are scarce in many farming areas and its causing issues. It's not as if we aren't trying. We spend a fortune in the south on personal products and 'spraying'... just in the US, much less world-wide... and I'm unaware of any specific benefit that we'd lose if we were able to get rid of mosquitoes. I'm aware they eat nectar like bees do, but I don't believe they travel like bees do so their usefulness for pollination is far less. That's obviously not something I know for a fact, but I don't see any 'save the mosquitoes' groups around... yet we can't get rid of them.

That report I listened to talked about the fact that a treatment for Malaria is a ten day series of meds that are not very expensive. The problem is availability and supply in the regions where this most occurs.
By the time someone contracts Malaria it can be days before treatment because of the remote locations. This looks like something that the WHO in collaboration with other countries could improve. My guess is that it just is not deemed as not as glamorous as dangerous as Ebola in regard to its spread outside of the regions.

I never thought about before but was brought out that world population would be over a 1/3 larger today...without the 1918 flu. That thing killed close to 50 million people in a couple of years. Is this stuff natures population control?
12-22-2014 03:16 PM
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Post: #24
RE: The $100 trillion problem
(12-22-2014 03:16 PM)Fo Shizzle Wrote:  I never thought about before but was brought out that world population would be over a 1/3 larger today...without the 1918 flu. That thing killed close to 50 million people in a couple of years. Is this stuff natures population control?

Yes, along with war. That it's humans on a global scale versus bacteria in a petri dish doesn't change the basic principles very much.
12-22-2014 03:48 PM
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Post: #25
RE: The $100 trillion problem
(12-22-2014 03:16 PM)Fo Shizzle Wrote:  
(12-22-2014 02:56 PM)Hambone10 Wrote:  
(12-22-2014 02:17 PM)Fo Shizzle Wrote:  As you point out...with YF...Malaria is also transmitted differently. My comment was just in regard to numbers of deaths...not particularly that we should not be concerned with Ebola.

I'll agree with that.

Given the host of diseases transmitted by mosquitoes It IS mind-boggling that we can't control them any better than we do... especially when we've controlled bees to the point where they are are scarce in many farming areas and its causing issues. It's not as if we aren't trying. We spend a fortune in the south on personal products and 'spraying'... just in the US, much less world-wide... and I'm unaware of any specific benefit that we'd lose if we were able to get rid of mosquitoes. I'm aware they eat nectar like bees do, but I don't believe they travel like bees do so their usefulness for pollination is far less. That's obviously not something I know for a fact, but I don't see any 'save the mosquitoes' groups around... yet we can't get rid of them.

That report I listened to talked about the fact that a treatment for Malaria is a ten day series of meds that are not very expensive. The problem is availability and supply in the regions where this most occurs.
By the time someone contracts Malaria it can be days before treatment because of the remote locations. This looks like something that the WHO in collaboration with other countries could improve. My guess is that it just is not deemed as not as glamorous as dangerous as Ebola in regard to its spread outside of the regions.

I never thought about before but was brought out that world population would be over a 1/3 larger today...without the 1918 flu. That thing killed close to 50 million people in a couple of years. Is this stuff natures population control?

it's old hat...that's why....old hat doesn't generate advertising dollars....

to the rest....see post #5....'that' flu pandemic was a godsend in totality....
12-22-2014 04:16 PM
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Post: #26
RE: The $100 trillion problem
i disagree somewhat.

I think there would be billions of dollars in creating some chemical compound that eradicated mosquitoes and while there would certainly be environmental issues, I can't imagine there would be widespread support to 'save the mosquito'.


Because we can't control mosquitoes, we can't control Malaria. We can control 'people', so we CAN control Ebola.
12-22-2014 05:06 PM
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Fo Shizzle Offline
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Post: #27
RE: The $100 trillion problem
(12-22-2014 05:06 PM)Hambone10 Wrote:  i disagree somewhat.

I think there would be billions of dollars in creating some chemical compound that eradicated mosquitoes and while there would certainly be environmental issues, I can't imagine there would be widespread support to 'save the mosquito'.


Because we can't control mosquitoes, we can't control Malaria. We can control 'people', so we CAN control Ebola.

We can't control mosquitoes....We can though provide adequate medications to treat the million Malaria victims each year. The question is? Does anyone really care? I actually found this scary as hell. I would never travel to one of these regions for this reason.
12-22-2014 05:13 PM
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Post: #28
RE: The $100 trillion problem
(12-22-2014 05:13 PM)Fo Shizzle Wrote:  We can't control mosquitoes....We can though provide adequate medications to treat the million Malaria victims each year. The question is? Does anyone really care? I actually found this scary as hell. I would never travel to one of these regions for this reason.

Your comment seems to imply that there isn't a price at which pharmaceutical companies would produce the drug and I just don't buy that. They produce aspirin, for pete's sake.

If the treatment is relatively inexpensive, that usually means that it is off patent and anyone, anywhere in the world (at any labor cost) can produce its chemical mixture. I seriously doubt that we don't have the chemicals in close proximity to these places, but the US (or UN) certainly can't make people use them. They can't make people go to doctors. They can't stop local governments from denying the drugs to people.

Now perhaps if we had enough doctors in this country as it was that 'the best and brightest' from all of these other countries weren't coming to practice medicine here but instead stayed closer to home... but that is pure supposition. I KNOW that groups like the Methodist Church and Doctors without Borders are ALL OVER those places with 'treatment' in hand.
(This post was last modified: 12-22-2014 05:28 PM by Hambone10.)
12-22-2014 05:26 PM
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Post: #29
RE: The $100 trillion problem
(12-22-2014 05:26 PM)Hambone10 Wrote:  
(12-22-2014 05:13 PM)Fo Shizzle Wrote:  We can't control mosquitoes....We can though provide adequate medications to treat the million Malaria victims each year. The question is? Does anyone really care? I actually found this scary as hell. I would never travel to one of these regions for this reason.

Your comment seems to imply that there isn't a price at which pharmaceutical companies would produce the drug and I just don't buy that. They produce aspirin, for pete's sake.

If the treatment is relatively inexpensive, that usually means that it is off patent and anyone, anywhere in the world (at any labor cost) can produce its chemical mixture. I seriously doubt that we don't have the chemicals in close proximity to these places, but the US (or UN) certainly can't make people use them. They can't make people go to doctors. They can't stop local governments from denying the drugs to people.

Now perhaps if we had enough doctors in this country as it was that 'the best and brightest' from all of these other countries weren't coming to practice medicine here but instead stayed closer to home... but that is pure supposition. I KNOW that groups like the Methodist Church and Doctors without Borders are ALL OVER those places with 'treatment' in hand.

Im relaying the report I heard on a recent podcast on this subject. They report that the treatments...while not expensive are not widely distributed in the remote areas that many of the victims die. It has more to do with distribution and access than supply. My guess is that Malaria is most prevalent...at and below the equator. That is probably a very daunting supply challenge.

For clarity... I have no evidence or opinion that big pharma is denying drugs to Malaria victims.07-coffee3
12-22-2014 10:04 PM
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Hambone10 Offline
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Post: #30
RE: The $100 trillion problem
(12-22-2014 10:04 PM)Fo Shizzle Wrote:  Im relaying the report I heard on a recent podcast on this subject. They report that the treatments...while not expensive are not widely distributed in the remote areas that many of the victims die. It has more to do with distribution and access than supply. My guess is that Malaria is most prevalent...at and below the equator. That is probably a very daunting supply challenge.

For clarity... I have no evidence or opinion that big pharma is denying drugs to Malaria victims.07-coffee3

Right... sorry... my intent isn't being clear....

I also don't think the issue is pharma. I think the issue is logistics. I think logistics is often hampered locally because there are so many 'non-financial' groups trying to deliver the care.... but it still isn't getting where it needs to.
12-23-2014 12:10 PM
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Post: #31
RE: The $100 trillion problem
(12-23-2014 12:10 PM)Hambone10 Wrote:  
(12-22-2014 10:04 PM)Fo Shizzle Wrote:  Im relaying the report I heard on a recent podcast on this subject. They report that the treatments...while not expensive are not widely distributed in the remote areas that many of the victims die. It has more to do with distribution and access than supply. My guess is that Malaria is most prevalent...at and below the equator. That is probably a very daunting supply challenge.

For clarity... I have no evidence or opinion that big pharma is denying drugs to Malaria victims.07-coffee3

Right... sorry... my intent isn't being clear....

I also don't think the issue is pharma. I think the issue is logistics. I think logistics is often hampered locally because there are so many 'non-financial' groups trying to deliver the care.... but it still isn't getting where it needs to.

Malaria rates across Africa have plummeted due to wide distribution of mosquito nets. If nets can be distributed, so can pharmaceuticals.
12-23-2014 12:12 PM
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Hambone10 Offline
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Post: #32
RE: The $100 trillion problem
(12-23-2014 12:12 PM)UM2001GRAD Wrote:  Malaria rates across Africa have plummeted due to wide distribution of mosquito nets. If nets can be distributed, so can pharmaceuticals.

So you're saying that it is merely a matter of will? That the Methodist Church, who alone spent hundreds of millions of dollars to distribute mosquito nets and doctors without borders etc etc never considered buying vaccines and/or were thwarted by someone from doing so?

You need to learn more about many remote African tribes. Many of them are happy to accept mosquito nets, but far less so to take pharmaceuticals... and in some cases, the local governments stop them from being delivered. Some won't take ANY outside assistance.
12-23-2014 12:25 PM
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Post: #33
RE: The $100 trillion problem
(12-23-2014 12:12 PM)UM2001GRAD Wrote:  
(12-23-2014 12:10 PM)Hambone10 Wrote:  
(12-22-2014 10:04 PM)Fo Shizzle Wrote:  Im relaying the report I heard on a recent podcast on this subject. They report that the treatments...while not expensive are not widely distributed in the remote areas that many of the victims die. It has more to do with distribution and access than supply. My guess is that Malaria is most prevalent...at and below the equator. That is probably a very daunting supply challenge.

For clarity... I have no evidence or opinion that big pharma is denying drugs to Malaria victims.07-coffee3

Right... sorry... my intent isn't being clear....

I also don't think the issue is pharma. I think the issue is logistics. I think logistics is often hampered locally because there are so many 'non-financial' groups trying to deliver the care.... but it still isn't getting where it needs to.

Malaria rates across Africa have plummeted due to wide distribution of mosquito nets. If nets can be distributed, so can pharmaceuticals.

What was the death rate before?....cause it is stated at close to a million now.
12-23-2014 04:41 PM
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Post: #34
RE: The $100 trillion problem
(12-18-2014 06:11 PM)QuestionSocratic Wrote:  Superbugs could kill millions & cause turmoil

Who is going to mitigate this problem? Well there is only one answer, those greedy pharmaceutical companies.

a huge issue with resistance is docs that don't use abx judiciously or de-escalate.

very common for a patient to come into the ER with community acquired pneumonia and be given levaquin instead of a beta-lactam + macrolide or just a macrolide (depending on severity) because "the guidelines say so" and "they work".

dont need to throw big guns at small infections, because we may need those big guns later.

very common for patients to get admitted and put on a vanc/zosyn drip empirically with no risk factors for MRSA or pseudomonas, and then stay on it when cultures come back with e. coli susceptible to rocephin or bactrim.
(This post was last modified: 12-23-2014 05:10 PM by Tiguar.)
12-23-2014 05:08 PM
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Post: #35
RE: The $100 trillion problem
(12-23-2014 05:08 PM)Tiguar Wrote:  
(12-18-2014 06:11 PM)QuestionSocratic Wrote:  Superbugs could kill millions & cause turmoil

Who is going to mitigate this problem? Well there is only one answer, those greedy pharmaceutical companies.

a huge issue with resistance is docs that don't use abx judiciously or de-escalate.

very common for a patient to come into the ER with community acquired pneumonia and be given levaquin instead of a beta-lactam + macrolide or just a macrolide (depending on severity) because "the guidelines say so" and "they work".

dont need to throw big guns at small infections, because we may need those big guns later.

very common for patients to get admitted and put on a vanc/zosyn drip empirically with no risk factors for MRSA or pseudomonas, and then stay on it when cultures come back with e. coli susceptible to rocephin or bactrim.

You didn't address this so this is more of a +1, not a correction

Also very common for Medicare rules to require/encourage that a patient be discharged before the bacteria can actually grow to determine what the 'best' plan of attack is.

Doctors (at least mine, because of our high percentage of uninsured/poor) are often conscious of the cost of meds and often prescribe the ones on walmart's or walgreens $4 list... meaning the oldest and most common... fist thing out of the shoot. Only if the culture comes back with something that REQUIRES the latest and greatest do they prescribe them. It similarly saves the 'big guns' and as you note, 90% of the time, the tried-and-true works.
12-26-2014 12:02 PM
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Post: #36
RE: The $100 trillion problem
(12-26-2014 12:02 PM)Hambone10 Wrote:  You didn't address this so this is more of a +1, not a correction

Also very common for Medicare rules to require/encourage that a patient be discharged before the bacteria can actually grow to determine what the 'best' plan of attack is.

Doctors (at least mine, because of our high percentage of uninsured/poor) are often conscious of the cost of meds and often prescribe the ones on walmart's or walgreens $4 list... meaning the oldest and most common... fist thing out of the shoot. Only if the culture comes back with something that REQUIRES the latest and greatest do they prescribe them. It similarly saves the 'big guns' and as you note, 90% of the time, the tried-and-true works.

well, with respect to in-patient therapy, I see patients thrown on vanc/zosyn or levaquin almost without any regard.

in a 200 bed hospital, we had FORTY out of fifty CAP patients on levaquin just a couple weeks ago at ID rounds. ridiculous, I watched the antibiogram change over the course of a year. we can't use levaquin anymore for reliable pseudomonas coverage at this particular institution, only 55% of isolates were susceptible 6 months ago.

we're seeing the "tried and true" abx show resistance streaks. ZPaks in my area showed only 60-70% susceptibility for strep pneumoniae- the most common CAP pathogen. disconcerting.
(This post was last modified: 12-28-2014 11:45 PM by Tiguar.)
12-28-2014 11:44 PM
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