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One keeps hearing about how much stimulation to the economy the tax cuts are doing (these tax cuts are really long-term goververnment loans because they add to the Federal deficit). Actually, there is very little evidence of this. Such stimulation as there is, is from the Federal deficits and the low interest rates sparked by the Fed. Why is this the case?

Some time ago I tried to answer this. If you take the case of a revenue neutral tax cut (that is one in which Federal expenditures are decreased to balance a tax cut), the stimulation is decreased because most of the wealthy get most of the tax cut (they pay most of the taxes, remember.). But not all the increase in income the wealthy receive go into productive ventures. They will put a lot of their money into Treasuries (and foreign bonds) and existing stock which is not stimulative. This is not just an idea of mine but was expressed by Alan Greenspan and Paul O'Neill (then Treasury Secretary) when the so-called tax cuts of the Bush Administration were first considered. They will also do such things as buy Swiss chalets, islands in the Bahamas, and buy timeshares in Canadian Bombardier jets. None of these stimulate the U.S. economy though they may help the global economy. In contrast all of Federal spending is productive, even pork is productive to some part of the economy because the Federal government only contracts for services and items or gives money to people who spend it on something in the country ( rent, groceries, automobiles, etc.). In a revenue neutral tax cut, you therefore get less stimulation than if you had left things alone. One thing that you do get is a change in the mix of what money is spent on such as fewer battleships, highways, and low cost housing and more expensive mansions and other homes, more automobiles and home improvements, and, perhaps more groceries. An exception might possibly be a case where the Federal government is running a surplus and is paying down the Federal debt as in the last two years of the Clinton administration.

However, we did not do a revenue neutral tax cut, but added this money to a Federal deficit due to loss of revenue from the recession and the Afghanistan and Iraq wars. Therefore we had the stimulation of the increased Federal deficit plus the exceptionally low interest rates fostered by the Federal reserve. And the high demand for Treasuries as a result of the so-called tax cut lowered the long-term Treasury rates.

A New York Times editorial on August 12 (Painting the Economy Into a Corner) states that the reduction in tax rates provided only 59 cents on the dollar of economic stimulous whereas the tax cuts for dividends and capital gains produced only 9 cents of stimulous for every forgone dollar. "In contrast,the economic bang for a dollar of aid to state governments is $1.24. Yet such assistance accounted for only 3 percent of the total cost of Mr. Bush's fiscal policies." Unfortunately, the editorial does not give a souce for their figures, and, as a scientist, I am always suspicious of such numbers, especially in newspapers, but the trend agrees with the reasoning in the previous paragraph.

Now the worry is, why don't we have a roaring economy and raging inflation (of course, inflation is already rampant in propterty taxes, property insurance, dental costs, and health care insurance)? It seems that business fears that an improving economy is not clearly sustainable? I've noticed some on these boards who even still worry more about deflation than inflation.

brucedoe
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If you take the case of a revenue neutral tax cut (that is one in which Federal expenditures are decreased to balance a tax cut), the stimulation is decreased because most of the wealthy get most of the tax cut (they pay most of the taxes, remember.). But not all the increase in income the wealthy receive go into productive ventures. They will put a lot of their money into Treasuries (and foreign bonds) and existing stock which is not stimulative.

Right, most of "the rich" (those with household incomes over $100k who pay 60%+ of the FIT don't have that efund and are just waiting for a tax break to roll around so they can establish it.

I submit that it is more likely that a large portion of any tax cut for people at this level is very likely to be either spent or invested in assets more profitable than treasuries.

I guess since all you have an undocumented quote that is cited out of context and is to appear authoritative based on it's purported origin and since all I have an opinion, we're at an impasse.


In contrast all of Federal spending is productive, even pork is productive to some part of the economy because the Federal government only contracts for services and items or gives money to people who spend it on something in the country ( rent, groceries, automobiles, etc.). In a revenue neutral tax cut, you therefore get less stimulation than if you had left things alone.

Rhetorical question: where does the moeny to purchase pork come from? The feds can only purchase pork becuase they have either taxed someone else, or laid claim to future taxes (run a deficit). In either case, your example ignores the fact that someone else had the money before it was spent on pork. It was taken from them, so it's not their most economically valuable trade and therefore diminishes it's value to everyone.

The government does not have an economically sound reason to be in the either the "pork" or redistribution (talk about an Orwellian phrase) games.


One thing that you do get is a change in the mix of what money is spent on such as fewer battleships, highways, and low cost housing and more expensive mansions and other homes, more automobiles and home improvements, and, perhaps more groceries.

Novel concept. The government making choices with limited resources (favoring Constitutional mandates over those not so enumerated (and therefore reserved to either the states or individuals)) and letting people pursue life, liberty, and happiness on their own terms.


A New York Times editorial on August 12 (Painting the Economy Into a Corner) states that the reduction in tax rates provided only 59 cents on the dollar of economic stimulous whereas the tax cuts for dividends and capital gains produced only 9 cents of stimulous for every forgone dollar. "In contrast,the economic bang for a dollar of aid to state governments is $1.24. Yet such assistance accounted for only 3 percent of the total cost of Mr. Bush's fiscal policies."

Great!!!! Now, if only we could find someplace in the Constitution where it says it's OK for the federal government to play Sugar Daddy to the states.

The bulk of money that would be paid to the states is derived from income taxes (or worse, SS "surpluses"). It is an affront to liberty to believe that it is proper to take the fruits of a mans life and labor and give them to a state. Take as little as possible, and then let the states duke the proper mix of taxation and spending out on their own.


, inflation is already rampant in propterty taxes, property insurance, dental costs, and health care insurance

Taxes are not properly included in insurance. People choose, collectively, their level of taxation. It is not a production cost (including profit) that is built into prices and passed on to willing consumers.

My property insurance bill hasn't hardly budged. Last year was the first increase in 3, and it was a whopping 2.5%. Anecdote is not statistic, but don't recall seeing a convincing analysis that would lead me to believe that insurance costs (ex-healthcare) are increasing at a high rate.

wrt health insurance, I think there are two options. Either we take out the profit from r&d and content ourselves with the services we have, or we accept that with medical research pushing the envelope and with increasing demand (aging boomers, in patricular, but flippant use of health insurance as an aggravating factor), health insurance is guaranteed to rise. Until the boomers (and older) get individual policies that reflect the true cost of their care and stop depending on subsidies from everyone else (read, individual insurance plans being the norm vs. employer sponsored plans for everyone), everyone else will continue to see their premiums rise.
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Now the worry is, why don't we have a roaring economy and raging inflation (of course, inflation is already rampant in propterty taxes, property insurance, dental costs, and health care insurance)? It seems that business fears that an improving economy is not clearly sustainable? I've noticed some on these boards who even still worry more about deflation than inflation.

Because the tax cut stimulus has worked quite well. It has created a LOT of new jobs.

In India. And China.

Since the barriers are down (and due to technology, not law), we can't assume that the stimulus we provide will stimulate things here, unless that stimulus is targeted in a fashion that compels it (for economic, not legal, reasons) to stay here.

Whether the way the stimulus was applied was efficient has always been a question. That it has worked seems beyond dispute. That the jobs situation in this country continues to be - ummm - "less than good" is also beyond reasonable dispute. My area continues to lose jobs, as it has throughout the last 4 years.

So the stimulus was inefficient under any circumstances and the way it was targeted has created jobs half way around the world, but not here. Third world status, anyone?
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Until the boomers (and older) get individual policies that reflect the true cost of their care and stop depending on subsidies from everyone else (read, individual insurance plans being the norm vs. employer sponsored plans for everyone), everyone else will continue to see their premiums rise.

Until the system is fixed so that everyone can afford insurance, insurance will continue to rise as those who have insurance subsidize those who don't but who of necessity use medical services anyway.

Until we have tort reform, insurance will rise as tort lawyers extract money from the medical community.

Until the medical community undertakes a fundamental overhaul of its own procedures and practices, implementing a complete systems engineering approach to the application of medical care to that system which is the patient, complete with no-fault peer review of care of individuals, and the elimination of the giant egos that most physicians seem to have (which is the biggest stumbling block to fixing their system), and the total elimination of the culture of "hanging together" which protects the bad doctors, insurance will continue to rise and tort reform will be impossible.
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Taxes are not properly included in insurance.

Typo. Taxes are not properly included in a discussion on inflation.

Sorry.
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Until the system is fixed so that everyone can afford insurance, insurance will continue to rise as those who have insurance subsidize those who don't but who of necessity use medical services anyway.

Are you proposing a state funded solution? What is your idea? National solutions may appear a panacea a paper, but 1.) there is that pesky Constitution, and 2.) Britain and Canadas experience don't really give one a great deal of optimism.

I would propose that the employer deduction for employee health plans be revoked. Employers will then be able to get out of the health insurnace game. People then can unleash a tidal wave of competition for individual policies. People could then also make some real choices on health care, such as choosing to pay low premiums for a policy that covers true emergencies, but which has them paying for maintenance (such as routine doctors visits). Portability would be a non sequitur under these circumstances. As it currently is, with the employer picking up part of the costs there is no incentive for consumers to not use health insurance inprudently (when was the last time you used your auto policy for a tune up?).

Until we have tort reform, insurance will rise as tort lawyers extract money from the medical community.

Very good point. Thank you for bringing it up.


and the elimination of the giant egos that most physicians seem to have (which is the biggest stumbling block to fixing their system), and the total elimination of the culture of "hanging together" which protects the bad doctors, insurance will continue to rise and tort reform will be impossible.

A strongly worded assertion without a fig of evidence. Insurance rates rise because of increased demand for the latest and greatest treatment (which are, hélas, expensive) by an aging population and a system in which judicious use of insurance is not necessary. Tort reform is in the hands of Congress, who as a group appear more sympathetic to the lawyers lobby than the physicians, so let's not try to lay that at the feet of the canard of "giant egos" of physicians.
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Sgtjoefriday:

Wow, where do you live that your property taxes rose on 2.5% in three years? It must be in a, well, run down part of the country (forgive me). Our primary residence had property taxes increase by 15% this year and 23% two years ago (northern Virginia). My wife's vacation cottege (in Highlands, North Carolia) had property taxes increase nearly 50% this year plus there was a large increase four years ago (I forget the exact amount). The rise was do to increasing property values and the rates were actually decreased though the end result was much higher taxes. Because of the increased property values, home insurance rates have also soared. Medicare part B rates increased 13.3% this year after increases of 8% for several years before that. Our backup health insurance increased 13.6% this year after an average annual increase of 12.5% for the 7 years before that.

If you think that the wealthy don't put a large part of their fortunes into Treasuries and existing stock, I'm afraid you don't understand the wealthy. Some put a part of their money into new stock issues, corporate bonds, and start ups that may eventually result in corporate growth and stimulative productivity, but that can take many years (for example, more than 10 for amazon.com and how many competitors were ruined while amazon.com was losing money?) and is an iffy proposition for even the most knowledgeable investors.

brucedoe
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Well, if you have a certain amount of income, you might be excused if you count increased property tax as inflation. After all they leave you with less money to spend on other things. On the other hand, improved schools, teacher's salaries, parks, roads and whatever the county spends money on may be worth it.

brucedoe
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Wow, where do you live that your property taxes rose on 2.5% in three years?

My original comment was not that my property taxes had increased only 2.5%, but that my property insurance had, viz:

Taxes are not properly included in insurance. People choose, collectively, their level of taxation. It is not a production cost (including profit) that is built into prices and passed on to willing consumers.

My property insurance bill hasn't hardly budged. Last year was the first increase in 3, and it was a whopping 2.5%



Property taxes leave you with options. Not always attractive ones, but options. You can move to a less expensive house, demand your local reps not spend so much, &c. There are fewer options on say, obtaining food and other items where inflation is measured.

If you think that the wealthy don't put a large part of their fortunes into Treasuries and existing stock, I'm afraid you don't understand the wealthy. Some put a part of their money into new stock issues, corporate bonds, and start ups that may eventually result in corporate growth and stimulative productivity, but that can take many years (for example, more than 10 for amazon.com and how many competitors were ruined while amazon.com was losing money?) and is an iffy proposition for even the most knowledgeable investors.

I didn't dispute that the rich practice asset allocation and that "secure" asset classes play a part in their holdings. My contention is with the assertion that marginal increases in their means, such as from a tax cut, will disproportionately flow into such secure classes over less secure (but more economically stimulative) classes. Particularly when you consider the demographics of, "the rich". Households making in excess of $100k are paying 65% of the taxes. So, a dual-income family where each earner makes approximately the US median income would be included in "the rich". We're not just talking about Richie Rich here (even though the government has no more right to his money that anyone elses), we're talking about people who have families and who are saving for retirement and who might not throw everything into t-bills. Some of the marginal tax savings from tax reductions might indeed flow into treasuries, &c., but I have a hard time believing it constitutes a significant portion.
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Well, if you have a certain amount of income, you might be excused if you count increased property tax as inflation. After all they leave you with less money to spend on other things.

And if it is excessive, you recall the spendthrifts who put the jurisdiction in that position via the political mechanism. Taxes are a product of the political environment, not the market or a monetary phenomenon, and on that ground I disagree with people dragging them into a discussion on inflation. It is disingenuine.

On the other hand, improved schools, teacher's salaries, parks, roads and whatever the county spends money on may be worth it.

Worth it according to who? If it is "worth it" to a citizen, then the "excess" government spending might rightlly be considered consumption for them. For those who disagree with any "excess", it is nothing more than other people gratifying their desires through the public purse.
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Are you proposing a state funded solution?

Nope. But we have to do something.

A strongly worded assertion without a fig of evidence.

I have a lot of social contact with physicians. There are some in my family, and for particular reasons my wife knows a lot of them. So I talk to them a lot, and I talk to them about what they do and how they do it. I also watch the news and read certain medical journals.

I have, over a period of years, based on discussions and observations, formed some definite opinions about what they do that is right, and what they do that is wrong.

Insurance rates rise because of increased demand for the latest and greatest treatment (which are, hélas, expensive)

This demand is seldom driven by the patient, who very often has no clue at all. Much of this demand is from the doctors themselves who have been steered by the marketers who sell the machines and technology. This is not to condemn the "latest and greatest" in a blanket sense, of course, but all too often the latest technique is not the best technique, and costs far, far more than the "traditional technique" while providing only a marginal benefit.

It comes down to doctors not being cost sensitive and often not employing common sense, or more often being afraid to employ common sense because of fear of the lawyers. The system is badly broken, and the place to start is with the doctors.

let's not try to lay that at the feet of the canard of "giant egos" of physicians.

Much of the problem belongs there. Physicians for the most part try to do their best, but they often forget that they are fallible. Their institutional systems are such that there is very little oversight of individual doctors, and almost no no fault peer review of a doctor's work.

Consider, for instance, the case of the bridge designer. He is a highly skilled professional, who designs large and expensive structures to which many people will daily entrust their lives. He works continually under the expectation that his design work will be reviewed, and criticized, and he will often have to make changes to accommodate the reviewers.

In this fashion, bridges get built that meet their design criteria, those criteria are sensible, and it is quite rare for a bridge to fall down.

Similar conditions apply to the entire engineering profession, the software engineering profession, and the scientific community. Peer review keeps everyone sharp and allows multiple viewpoints to be brought to bear, and incidentally is inexorable about weeding out the incompetent.

Compare this to the general way a physician does business. If, for instance, something extremely unusual comes up (separating conjoined twins, for instance) he will go through a design process mapping out how to do the job, with review, input, and coordination from other physicians.

But this is the exception rather than the rule; usually he is on his own, makes his own decisions and his own calls, and patients live or die by whether or not he is right. His professional judgement is no better and no worse than the professional judgement of an engineer or scientist in that individual's area of competence; why, then, is it that the engineer and scientist are trained to expect review while the physician isn't? Very simple. This society practically deifies physicians, and they themselves buy into it. It is most certainly a problem of ego, and of training, and of a systemic defect in the physician's method of practicing.

Whether he is right, or he is wrong, he is seldom reviewed. That he was wrong often never comes to light because his profession shelters him from such review and from "attacks" by outsiders. This trait of the medical community is where the lawyers find their easiest point of attack; they say (with more than a bit of justice) that it is only THEY who are shining the light on the medical community and holding them accountable for their mistakes.

The medical system in this nation is badly broken. The doctors are at the heart of it, and much of the problem is a problem of ego. Clearly the doctors are not the only problem, but I would insist that they are the most important problem - after all, it is THEIR system. Pull on that string, and most of the rest of the problems will unravel.
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I'm not sure how much of the problem belongs to the egos of physicians, but my late brother was a research physician and had a gigantic ego, something that made him difficult to live with. But he did have patients (especially with things like hyper and hypo thyroidism who thought he was the greatest). A humorous story is that after dinner in a restaurant with his family as they walked to the car, he went up to a man in the parking lot and told him that he was ill and should see a doctor. I must say that he had an encyclopedic knowledge of medicine that was widely respected in the medical profession. He was forever telling me that I had 3 (of maybe 5) symptoms of some dread disease or other. I learned not to talk to him about my personal health.

His wife (my sister-in-law) was also a physician (anasthesiologist), but though she knew she was good, she was more restrained and easy to be with. It got to be, however, that she felt she was not earning enough to put up with all the fuss that occurs in her profession and retired at 62 (and never looked back). Her malpractive insurance, for example, was over $50 thousand per year.

brucedoe
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I have a lot of social contact with physicians...I have, over a period of years, based on discussions and observations, formed some definite opinions about what they do that is right, and what they do that is wrong.

If I had to make a concession such as that before beginning my arguement, I'd probably rethink the validity of my arguement.

This demand is seldom driven by the patient, who very often has no clue at all. Much of this demand is from the doctors themselves who have been steered by the marketers who sell the machines and technology.

Right, lemmie make sure I'm getting this. Demand is on the physician side, so no one goes to a doctor because they feel sick or to have a preventative checkup. Only there because the doctors want them there. Also, once people do get into the doctors office, they never pressure them for the newest treatments or for unnecessary procedures (for example, no parent has ever demanded antibioctics for his/her child when they were medically unnecessary).

Get a grip. Patients are the ones demanding medical services. Doctors aren't jockeying for position to force their services down their throat. Whether the doctor elects to use a new treatment or not is a function of patient insistence, professional judgement by the attending physician (which includes such factors as how up to date the doctor keeps his skills, how aggressive he is in integrating the latest technology into his practice, &c.).

The point I was trying to make was that since the employer picks up the tab for the majority of medical costs (in the form of all or some of insurance premiums) then the employee as consumer of medical services has only a nominal cost (often a copay) for expensive medical services. This is effectively a subsidy, and what you subsidize you get more of. Hence, people are using medical insurance for routine office visits. When was the last time you used your auto insurance for an oil change?


But this is the exception rather than the rule; usually he is on his own, makes his own decisions and his own calls, and patients live or die by whether or not he is right.

So, if you're in the ER and dying of a puncture wound, you'd like a team of experts to consult with each other before any services are rendered? Or, as a parent whose child is dehydrated from some variant stomach flu that is going around, you're going to accept a few days wait while a few experts get together and do a peer review on the variant strain and then they'll get back with you?

Now, wrt your engineering analogy. First, the fact that you would compare engineering with medecine is very revealing about your understanding of medecine. Second, correct me if I'm wrong, but bridges are built to maximum specifications, that is, the maximum anticipatde load is determined in advance, and then established mathematical formulae will yield the proper design specifications (gross oversimplification, to be sure, but the point is that the maximum load which, in connection with known quantites, such as the strength of the design material, it's weight, &c. yield a predictable outcome).

With the various permutations of body types & conditions and injuries present a much more squishy predicament. It's presicely becuase comparitively so little is known about human body that major breakthroughs can occur. When was the last significant breakthrough in bridge building? Apples to oranges comparison amigo.


His professional judgement is no better and no worse than the professional judgement of an engineer or scientist in that individual's area of competence; why, then, is it that the engineer and scientist are trained to expect review while the physician isn't? Very simple. This society practically deifies physicians, and they themselves buy
into it.


Thanks for reinforcing your concession above that all you have to operate on is your opinion.


It is most certainly a problem of ego, and of training, and of a systemic defect in the physician's method of practicing.

As long as you're content to focus on opinion, I'll join you. Looking back over my life, I can think of only one physician I, my wife, or our children have been to who truly had ego problems. All the rest were either easily approchable or willing to take time to explain what they were doing and the alternatives. Now, I'm not saying my anecdotes are better than yours, but I'm contesting that your experience is universal.

Also, food for thought for you. I recall hearing a study that concluded doctors learn the equivalent of 2.5 languages in their training. I wonder if you're confusing the understandable frustration of someone who just knows a lot more than you do being questioned by someone who doesn't know as much and then his having to dumb down a highly technical explanation to a layperson.

Incidentally, if your wife is a nurse and that is her "particular" reasons for having insight, I'd discard that out of hand. We had nurses fighting our doctors over med doses (and a few other issues) the last time my wife was hospitalized. Once the nurse got off her "the doctor thinks he's G_d" tangent (which she was not hesitant about sharing with us) and listened to the docs explanation, she realized, to her horror, she was wrong.

You wife might not be a nurse, but some of your extreme positions from her "particular" experience sound a lot like our attending nurse.


Whether he is right, or he is wrong, he is seldom reviewed.

Right, which is why out of control lawsuits (which are clearly not a strong check or review </sarcasm>) have done a lot of damage to ER professionals (those most likely to have to make judgement calls of life and death) and obstetrical practitioners. Let me know when you make your trip back to reality and we can continue this conversation at that time.

Listen, doctors make mistakes all of the time. Do they make them with any more frequency than other professionals in their respective spheres. My gut tells me no, but the negative consequences of the bad exercises of judgement are far more visible than an accountant who blesses an erroneous cash flow statement. Combine this with the american system of litigants paying their own attorney fees and unscrupulus attorneys who are willing to gamble on the hopes of a large payout for a marginal (or worse) case, and I believe there is actually a strong bias built into the system for doctors to be very careful.


This trait of the medical community is where the lawyers find their easiest point of attack; they say (with more than a bit of justice) that it is only THEY who are shining the light on the medical community and holding them accountable for their mistakes.

Ah, the trial lawyer in shining armor. My hero.


The medical system in this nation is badly broken. The doctors are at the heart of it, and much of the problem is a problem of ego. Clearly the doctors are not the only problem, but I would insist that they are the most important problem - after all, it is THEIR system. Pull on that string, and most of the rest of the problems will unravel.

You've proven nothing. You initially attempted an inappropriate appeal to authority (argumentum ad vericundiam) by stating you had contacts in the profession and read their literature, and then proceded with your op-ed. You didn't cite anything but your own opinion, which is fine, but it doesn't prove anything (other than that your mind is made up).
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If I had to make a concession such as that before beginning my arguement, I'd probably rethink the validity of my arguement.

In other words, an argument is more valid if it is based on no knowledge and no contact? Interesting.

Right, lemmie make sure I'm getting this. Demand is on the physician side, so no one goes to a doctor because they feel sick or to have a preventative checkup. Only there because the doctors want them there. Also, once people do get into the doctors office, they never pressure them for the newest treatments or for unnecessary procedures (for example, no parent has ever demanded antibioctics for his/her child when they were medically unnecessary).

Antibiotics have been around for the better part of a century; certainly not a new treatment.

Beyond that, most patients most of the time have absolutely no clue about how they are to be treated, or what is right or best. The patient who is well informed is the rare exception.

So, yes. The treatment regimen demand is virtually all driven by the doctors. The need for treatment isn't, but the means by which it is accomplished most certainly is.

Now, wrt your engineering analogy. First, the fact that you would compare engineering with medecine is very revealing about your understanding of medecine. Second, correct me if I'm wrong, but bridges are built to maximum specifications, that is, the maximum anticipatde load is determined in advance, and then established mathematical formulae will yield the proper design specifications (gross oversimplification, to be sure, but the point is that the maximum load which, in connection with known quantites, such as the strength of the design material, it's weight, &c. yield a predictable outcome).

It was not an analogy, it was a comparison. That the one is unlike the other does not obviate the need for comparable processes and procedures.

Further, I find the attitude you display in your response to be as abyssmal as the spelling you display in the post.

Accordingly, we are done discussing the matter; you are not worth it.
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In other words, an argument is more valid if it is based on no knowledge and no contact? Interesting.

If setting up strawmen make you happy, by all means carry on.

Your original post was prefaced by a disclaimer that you had “social contacts” in healthcare (who doesn't?) and that your wife had undisclosed “particular reasons” to know a lot of them. You then stated that you watch the news and read “certain” (undisclosed) medical journals.

Your argument had all the trappings of an argumentum ad verecundiam, as I pointed out in my last post. Read all about it here:

http://www.fallacyfiles.org/authorit.html

These morsels looked like what you had tried:

We must often rely upon expert opinion when drawing conclusions about technical matters where we lack the time or expertise to form an informed opinion. For instance, those of us who are not physicians usually rely upon those who are when making medical decisions, and we are not wrong to do so. There are, however, four major ways in which such arguments can go wrong:

...The "authority" cited is not an expert on the issue, that is, the person who supplies the opinion is not an expert at all, or is one, but in an unrelated area. The now-classic example is the old television commercial which began: "I'm not a doctor, but I play one on TV...." The actor then proceeded to recommend a brand of medicine.

...The authority is an expert, but is not disinterested. That is, the expert is biased towards one side of the issue, and his opinion is thereby untrustworthy.

...While the authority is an expert, his opinion is unrepresentative of expert opinion on the subject. The fact is that if one looks hard enough, it is possible to find an expert who supports virtually any position that one wishes to take. "Such is human perversity", to quote Lewis Carroll. This is a great boon for debaters, who can easily find expert opinion on their side of a question, whatever that side is, but it is confusing for those of us listening to debates and trying to form an opinion.


Back to you.



Antibiotics have been around for the better part of a century; certainly not a new treatment.

I never stated that they were, so lay off beating on the strawman, OK? I used that as an example to counter your claim that: “This demand is seldom driven by the patient, who very often has no clue at all. Much of this demand is from the doctors themselves who have been steered by the marketers who sell the machines and technology.” It is an ironclad example of the fact that demand for healthcare services is driven by the patient. The best you could do in response was erect a strawman and try to change the subject. Very telling.


Beyond that, most patients most of the time have absolutely no clue about how they are to be treated, or what is right or best. The patient who is well informed is the rare exception.

Lack of information on the part of a patient is a low hurdle. They overcome it all the time by bringing in ideas they got from watching TV, talking to a friend or relative, or any number of unreliable sources.


So, yes. The treatment regimen demand is virtually all driven by the doctors. The need for treatment isn't, but the means by which it is accomplished most certainly is.

If you're saying that the final prescription for treatment is signed off on by the physician, I guess one could hardly argue with you there, but then, that would seem kind of self-evident, wouldn't it? So, the doctor signs off and that's it. There is no way of getting a second opinion, or of opinion shopping among other doctors? Come on.


Now, wrt your engineering analogy. First, the fact that you would compare engineering with medecine is very revealing about your understanding of medecine.

Seriously, you have no memory of your own analogy (“comparison”, whatever) from 2 days ago? (http://boards.fool.com/Message.asp?mid=21163645) : “Consider, for instance, the case of the bridge designer.

My bad if I improperly equated “bridge designer” and “engineer”. Care to elaborate on the distinction?


It was not an analogy, it was a comparison.

http://dictionary.reference.com/search?q=analogy

a•nal•o•gy Pronunciation Key ( -n l -j )
n. pl. a•nal•o•gies
1.
a. Similarity in some respects between things that are otherwise dissimilar.
b. A comparison based on such similarity.



I guess I see the distinction. </sarcasm>



That the one is unlike the other does not obviate the need for comparable processes and procedures.

So, you conceede that they're dissimilar in nature, but that didn't stop you from using them as a "comparison" 2 days ago? Roger.


Further, I find the attitude you display in your response to be as abyssmal as the spelling you display in the post.

You've abandoned arguing the matter on it's merits and resorted to an
argumentum ad hominem. Isn't that tantamount to concession?


Accordingly, we are done discussing the matter; you are not worth it.

Right, I transpose when I type so discussing any idea with me is not “worth it”.

Who can argue with logic like that?
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<Icy looks around to see if he has mistakenly wandered into a 3rd grade classroom ---- and I may have to apologize to third graders for the comparison if ya'll keep this up <smile>>

Now now ... the Sarg's tone left something to be desired, but jim there also might have a little too "self-assured" personal opinion from the extrapolation of his personal anecdotes to very broad conclusions. In fairness to jim, he did warn us readers that he had strong opinions on the matter. In fairness to the sgt, should one expect less than a strong challange when placing one's own strong opinions out there into public cyber ghettos like ours? But ya each made some wonderful points ... can't we discuss them without the other distracting personal nonsense?

jim ... What would you think is the average increase in terms of patient care costs from docs ordering tests / procedures more for avoiding litigation than for reasonable patient care issues? I know a few docs too and I know what they order and why. But beyond my own limited personal contacts and experiences (and other biases)there must have been articles and research on exactly this sort of thing .. do you know what it says? HINT - try googling - its fast, simple, informative, and I get a 10% commission if ya do <mischevious wolven grin>.

From the medical literature there appears to be more than a suggestion that fear of litigation adds significant unnecessary costs to patients (or third party payers). But from the legal professions supportive literature the amounts are lower with the interpretation being different. Both claim no significant bias <smile>. How can one reasonably balance these competing perspectives, or do one or both of you know where there are errors in such reports or misleading representations?

We seem to have somewhat related info from the Insurance/Finance industry regarding the cost of litigation on insurance rates, which I personally found both surprising and compelling ... while big dollar awards sound impressive on the news and get everyone's attention, the number of cases being settled without trial and the average settlements (relative to the total costs and fees etc.)belie the stats suggesting it is primarily responsible for (much less the sole reason for) the rate increases. Moreso, the investment portfolio behaviors of the insurance companies seem to correlate much better with rate changes than settling claims/court awards.

Might this suggest that other criteria might be critical in considering what is driving demand or ... what other factors beyond demand (regardless of its drivers) might be important in terms of medical costs etc.? Or if you're sure there are none, why is that the case here?

On another side of this rubik's cube ... how many docs bother with discovering/knowing the lowest cost reasonable alternatives for their patients, much less recommending it? Me thinks both of you "boyz" might be surprised by the answer to that question ... but then again, I am continually surprised by all sorts of things, so maybe you won't be? <shrug>

What should (and shouldn't) be covered by typical medical insurance? Beyond the psychology of patients' copay effects on their cost consciousness, what about the psychological effects on docs regarding reimbursement rates, etc.? ... There are stats published on the finances (and not from a doc's bias <g>) that show if a doc takes ONLY Medicare/caid patients they can NOT afford to practice medicine in most locales in the US today, UNLESS its without office support and they are willing to have to struggle financially themselves. So should we take into account possible reasons for why more docs seem to be leaving medicine than ever before?

Anyways, maybe I have become more accustomed to the thoughtful insightful (vs inciteful) postings in the TMF forums I regularly visit than I thought? If so, my apologies to you both ... please go on your merry ways ... but its just such an intriguing topic and it seems you both have positive things to contribute to it .. it seems a shame to me that the personal distractions may well inhibit the topic's exploration.

Take care,
IcyWolf



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Jim,
in regard to quality assurance for doctors I have been thinking the exact same thing for years.
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But this is the exception rather than the rule; usually he is on his own, makes his own decisions and his own calls, and patients live or die by whether or not he is right. His professional judgement is no better and no worse than the professional judgement of an engineer or scientist in that individual's area of competence; why, then, is it that the engineer and scientist are trained to expect review while the physician isn't? Very simple. This society practically deifies physicians, and they themselves buy into it. It is most certainly a problem of ego, and of training, and of a systemic defect in the physician's method of practicing.

you right about most of what you say, but there is a lot of peer-review in the system if you know where to look. insurance companies have physicians review things, there are morbidity and mortality conferences at most hospitals (although much of this is in retrospect), and tumor boards where new cases are discussed.

The problem with more peer review that will make it difficult to implement is who will do it? Physicians who already work 10-12 hour days (plus being on call many or most nights and many weekends)? I do stem cell transplantation, and few cities have more than 3 or 4 docs in this field - who is going to peer review our work? someone outside of our specialty?... do we do it over the internet as a videoconference and just sacrifice dinner, or make the 2pm patient wait an extra hour?

The doctors are at the heart of it, and much of the problem is a problem of ego. Clearly the doctors are not the only problem, but I would insist that they are the most important problem - after all, it is THEIR system

I don't feel that the medical system is "MY" system, as you suggest. And I doubt any of our nurses would say that I have an ego problem. Patients email me at 10pm some nights and often get an answer the same night. I can't bill for that advice, and am probably taking on a medical liability by providing that kind of service. is that a part of the problem?

Like a lot of things in life, it's easy to criticize when you don't have to be the one to come with or implement the solution.

email me if you'd like to discuss further, and i'll try to keep me ago from getting in the way.

-hack
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