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CBO: Obamacare to cost twice what we were told.

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The private engineering firm running the project focked up pretty good.

http://www.boston.com/globe/metro/packages/bechtel/

Engineers create designs, contractors are responsible for means and methods of construction. They neglect to inform you that there were govt layers of project management that was supposed to oversee Bechtel asleep at the wheel, in this case it should have been the Department of Capital Asset Management.

 

No engineering or architectural plan is 100% complete...there are always requests for clarification, requests for information and subsequent follow up drawings.

 

Contractors own the drawings, so when there is need for additional drawings or scope outside the original contract it is called a change order. this happens on every construction job. The goal is to minimize them as you can control cost alot easier through a competitive bid process than being stuck with a single contractor you are forced to use putting together the estimate.

 

Bechtel may be at fault for missing obvious things or may not, there isn't enough information given to deduce one way or another.

 

Those change orders in theory should have been included in the original drawings and would have had cost anyways, so the only increase in cost through the change order is the difference in pricing between what would have been included in the bid, vs the cost put together on the fly.

 

Depending on the contract between .gov and Bechtel how change orders and scope is handled would be laid out. The fact they were never held to the fire means .gov had no recourse due to their own bumblings... In certain situations you can stick a contractor with a change order that they should have had the foresight to avoid. Engineers can sometimes be stuck with the cost for new drawings if it was something that should have been included in their original contract scope.

 

the bottom line is that while your article provides some nice history of some of the issues, it doesnt provide the information to make any sort of placement of blame. It also completely ignores the role of .gov in the process. Not how reality works.

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Those would be the ones who actually got into medicine for the right reasons, namely helping people, not being some big shot dooshbag.

 

Yes, but most that are crying how bad they have it will still be docs if this does all come to pass. Well, unless they really want to make more money being ranchers.

 

The private engineering firm running the project focked up pretty good.

 

Heard plenty more stories of the private companies "screwing" the project. I knew a few engineering students that did some intern type work on it - they said companies were not honoring their quotes based on some bs, or nothing at all other than holding the project hostage. Things like dumping where original called for $1 per yard, but would then only haul at $3 per yard. Just never really heard about cost overruns caused by the govt - other than Danks bringing up not adjusting for inflation.

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Yes, but most that are crying how bad they have it will still be docs if this does all come to pass. Well, unless they really want to make more money being ranchers.

 

 

True because they have already invested in the profession. The problem will be attracting new talented doctors.

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I give him a pass on most things because of that.

 

Others who are out of school/training/residency/etc. and have been working for some time are the true focking retards.

Don't want to go too far on a limb, but I'm guessing you mean me.

 

To cut to the chase, I don't support the ACA (and welcome you finding any evidence otherwise), although it is not a total disaster that some like to portray. The construct of centralized, often government-sponsored healthcare works better in other countries than the current mess we employ. I don't want to rehash too much, as obviously you weren't listening the first time, but I'll refer you to this excellent resource which discusses healthcare reform, including a comparison of international healthcare systems: My link There also is a series of editorial opinion pieces from the New England Journal which intelligently examines the challenges of healthcare reform. My link

 

If you can change the channel from FoxNews or talk radio, I suggest you check both of them out.

 

The main problem with the ACA is it primarily addresses expanding access without containing costs - clearly both need a lot of work. Private industry can help to an extent, but I expect they will fail to remedy the entire problem as their many of their potential customers cannot afford the product/service they provide. Costs can only be cut so much before quality is impacted, the consequences of which are arguably worse than almost any other bad product or service. So either government or charity needs to step up to help.

 

Very few physicians support the ACA entirely, but nearly 100% desire meaningful healthcare reform. There is no single answer to the problem, but I'm happy to share my thoughts (again) on where to start.

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Things like dumping where original called for $1 per yard, but would then only haul at $3 per yard.

Dumping fill can be tricky as the type and level of contaminants in the soil dictate the process and type of landfill the material can go to.. Obviously the more hazardous or onerous it is to dump it, the pricier it can get.

 

They may have anticipated certain types of contaminants based on testing that proved worse in reality...it happens.

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From whom?

 

 

Not that this really needs and explanation but, I guess you weren't around during the endless Obamacare debate we had around here?

 

Use the search function, you can easily obtain the "whom" on your own.

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I'd give him a pass to, if he wasn't so arrogant about thinking he knows more than anyone else here when it comes to this stuff. For that, he doesn't get a pass. Not that he will nut up and admit he was wrong........

 

 

And I'm here to tell ya, those in the profession hate this turd of a bill. My wife has been calling on Docs for 13 years, and she has watched a ton of them get out of seeing medicare patients because of losing money on low reimbursements. And there have been several of her Docs who have opted out of medicine altogether. In this area they can run cattle and make as much, or more money, without all the headaches.

What would you like me to admit? And who on the board has more first-hand experience in healthcare? Do you think you have more intimate, practical knowledge concerning your career than those outside your field relying on internet blogs?

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Those would be the ones who actually got into medicine for the right reasons, namely helping people, not being some big shot dooshbag.

 

:lol: You really are too much. :overhead:

 

I would rather have a good surgeon who is in it for the money than an average Joe who wants to help me. HTH

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Don't want to go too far on a limb, but I'm guessing you mean me.

 

Don't take this personal but, I have no clue who you are.

 

You make a lot of assumptions. Good for you.

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What would you like me to admit? And who on the board has more first-hand experience in healthcare? Do you think you have more intimate, practical knowledge concerning your career than those outside your field relying on internet blogs?

 

I was referencing Medstoopid. I hope your reading comprehension skills are better if and when patients rely on that ability.

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Whoda thunk those greedy c0cksuckers wouldn't support a bill that limits their ridiculous charges? :rolleyes:

It's obvious you don't like doctors, but I suspect you have no idea how much those "c0cksuckers" collect from the bills they submit. It's a moving target shell game controlled by insurers, where collections are 50% at best. For those in primary care this amounts to less than a decent lawyer's hourly rate, or a plumber's. To attract intelligent, hard-working individuals to medicine, which costs ~100K+ in educational expense and deferred income, what pay scale is reasonable?

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I would rather have a good surgeon who is in it for the money than an average Joe who wants to help me. HTH

 

I'm very lucky in that I have a good cosmetic surgeon. ~ Sharon Osbourne

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Don't take this personal but, I have no clue who you are.

 

You make a lot of assumptions. Good for you.

Great - you mentioned "others" who had completed residency, of which I am the only poster on this board about whom this can be said, I think. I guess you meant non-FF poster in the medical field.

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:lol: You really are too much. :overhead:

 

I would rather have a good surgeon who is in it for the money than an average Joe who wants to help me. HTH

 

Would you rather have the surgeon who was in it for the money who eeked thru med school with the help of dad being friendly with the administration, or the excellent doctor Joe who wants to help people? :overhead:

 

Dumping fill can be tricky as the type and level of contaminants in the soil dictate the process and type of landfill the material can go to.. Obviously the more hazardous or onerous it is to dump it, the pricier it can get.

 

They may have anticipated certain types of contaminants based on testing that proved worse in reality...it happens.

 

I hear you. Where does the fault in this overrun lie?

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I was referencing Medstoopid. I hope your reading comprehension skills are better if and when patients rely on that ability.

I see. You had already excused him, so I thought you were moving on. I agree that he seems pretty naive, but he also has a lot of insight you will never have by virtue of his training. There are so many people involved in healthcare - healthcare providers, hospital admin, insurers, lawmakers, pharmaceutical industry, lawyers, and the patients, that nobody can legitimately be an expert on the 'best' reform.

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Not that this really needs and explanation but, I guess you weren't around during the endless Obamacare debate we had around here?

 

Use the search function, you can easily obtain the "whom" on your own.

RP and others spew "Obamacare" about as often as any other right-wing neologism. I don't really want to search pages of drivel.

 

You obviously have someone (or more than one) in mind. Why so coy?

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I see. You had already excused him, so I thought you were moving on. I agree that he seems pretty naive, but he also has a lot of insight you will never have by virtue of his training. There are so many people involved in healthcare - healthcare providers, hospital admin, insurers, lawmakers, pharmaceutical industry, lawyers, and the patients, that nobody can legitimately be an expert on the 'best' reform.

 

He has been in school. My wife has been in the medical field for over 13 years and talks to multiple doctors on a daily basis. I think I have a fair amount of insight into their thought processes when it comes to this subject. Once he gets into the real world he will learn he doesn't know it all.

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I hear you. Where does the fault in this overrun lie?

There may not be any fault, when they do testing they drill test pits and analyze the samples, if they don't put a test pit in the right spot to see the contamination they won't properly estimate the cost...

 

The contract determines how this is handled.

 

Stuff like this happens in constuction which is why a typical budget will include a contingency number equal to 10-20% of the cost to cover these types of unforeseen conditions.

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He has been in school. My wife has been in the medical field for over 13 years and talks to multiple doctors on a daily basis. I think I have a fair amount of insight into their thought processes when it comes to this subject. Once he gets into the real world he will learn he doesn't know it all.

OK. Admittedly the ivory tower view of medicine is different than the private world.

 

Out of curiosity, what does your wife do? With what type of doctors does she interact?

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OK. Admittedly the ivory tower view of medicine is different than the private world.

 

Out of curiosity, what does your wife do? With what type of doctors does she interact?

 

She is a pharmaceutical rep that promotes 4 drugs for 4 different conditions, so she calls on a variety of fields.

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It's obvious you don't like doctors, but I suspect you have no idea how much those "######" collect from the bills they submit. It's a moving target shell game controlled by insurers, where collections are 50% at best. For those in primary care this amounts to less than a decent lawyer's hourly rate, or a plumber's. To attract intelligent, hard-working individuals to medicine, which costs ~100K+ in educational expense and deferred income, what pay scale is reasonable?

 

Oh, I will agree, doctors are a small part of the problem.

 

See doctors are facing the same comeuppance lawyers took 20 years ago. The days of working 5 hours a day 4 days a week and being butt-stupid rich are coming to an end.

 

The insurance, drug, and hospital companies are the big problem, and they need to be squashed. Unfortunately, they own our government, so that ain't gonna happen.

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She is a pharmaceutical rep that promotes 4 drugs for 4 different conditions, so she calls on a variety of fields.

Congrats! She must be a hottie :wub: Never met an ugly female pharm rep. What drugs does she promote?

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The insurance, drug, and hospital companies are the big problem, and they need to be squashed.

 

So, to fix the healthcare system your plan is to get rid of insurance, drugs, and hospitals.

 

Brilliant!

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Congrats! She must be a hottie :wub: Never met an ugly female pharm rep. What drugs does she promote?

 

Right now an SSRI, a Hypertensive, a COPD, and an alzheimer's drug. And yes, the company christmas party has plenty of eye candy.

 

Her company is one of the few who have not had layoffs, in fact when she started with them they had about 450 reps. They now have about 2400 and are looking to add more.

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Well, you found $1.1 Billion of the $15 Billion in cost overruns. Good job.

 

Keep digging (no pun intended)

 

 

 

Private firms were responsible for the design, construction and management of the project. They are the ones who did the cost estimates. They are the ones who had to redesign their own mistakes and they are the ones who tried to skimp on material specifications. There is enough blame for the state of Massachusetts and the private firms. I don't know where dank gets off saying the project would have been better off handled by private firms. It was handled by private firms.

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Oh, I will agree, doctors are a small part of the problem.

 

See doctors are facing the same comeuppance lawyers took 20 years ago. The days of working 5 hours a day 4 days a week and being butt-stupid rich are coming to an end.

 

The insurance, drug, and hospital companies are the big problem, and they need to be squashed. Unfortunately, they own our government, so that ain't gonna happen.

Physician pay (before overhead) is ~20% of our healthcare expenditures. Insurers have deflected attention at the "rich doctor" stereotype to avoid scrutiny of the tiers of unnecessary middlemen created by the industry. By reducing reimbursement and increasing documentation standards, they force doctors to squeeze patients into shorter visits, which understandably upsets them. Then the doctors are accused of not caring/listening too.

 

While there certainly have been physicians who abuse the system and are lazy, the average doctor comes no where close to this description. Most are very hard working and well-intentioned, and few are filthy rich without working their a$$es off. Not on the golf course or whatever other stupid stereotype. At least not in the 17 years I've been involved with medicine.

 

Oh yeah, you conveniently left lawyers off the sh!tlist of medicine. Don't underestimate the impact of defensive (bad) medicine of the cost of healthcare.

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Private firms were responsible for the design, construction and management of the project. They are the ones who did the cost estimates. They are the ones who had to redesign their own mistakes and they are the ones who tried to skimp on material specifications. There is enough blame for the state of Massachusetts and the private firms. I don't know where dank gets off saying the project would have been better off handled by private firms. It was handled by private firms.

Unions.

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I have met a few docs who do support the bill.

 

According to this survey, 60% of doctors think that it will hurt patient care (vs. 22% help), and 90% would not recommend the medical field to others. Lots of other interesting stuff in the survey; it is a quick read. Doesn't paint a rosy opinion from the medical field.

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According to this survey, 60% of doctors think that it will hurt patient care (vs. 22% help), and 90% would not recommend the medical field to others. Lots of other interesting stuff in the survey; it is a quick read. Doesn't paint a rosy opinion from the medical field.

Mostly older docs in the survey, who have tasted several flavors of medicine as it has evolved. I didn't read all the stats, but am among those that would be reluctant to suggest medicine as a career choice. My main reason for this has nothing to do with money, but rather the loss of autonomy that comes with greater control of the medical machine. Then again, I distrust the private insurance industry more than the government in this process, so I can't predict whether it will get better or worse if government takes the reigns.

 

The best answer for doctors is elimination of both insurers and government intervention in medicine. Unfortunately, most can't afford to pay for their care without the middlemen. I know doctors that have partial cash (less insurance) concierge practices that seem content with that model. This caters to the wealthy, of course, which is fundamentally wrong IMO, but perhaps a combination concierge + charity practice could work.

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Private firms were responsible for the design, construction and management of the project. They are the ones who did the cost estimates. They are the ones who had to redesign their own mistakes and they are the ones who tried to skimp on material specifications. There is enough blame for the state of Massachusetts and the private firms. I don't know where dank gets off saying the project would have been better off handled by private firms. It was handled by private firms.

If the project was conceived, financed, and executed by private firms it would have been substantially more successful. You neglect to acknowledge the role of project management of which .gov was the major player as they were the ultimate owner

 

The concrete fiasco was its own animal, but you don't properly vet your contractors you are likely to get some schiesters.

 

Overly complicated project management while dealing with .gov typical retardedness made the process that much more difficult

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Unions.

Sure that tacked on 30%+ to the price, but it wasn't an unknown. Not building anything within city limits that's nonunion

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According to this survey, 60% of doctors think that it will hurt patient care (vs. 22% help), and 90% would not recommend the medical field to others. Lots of other interesting stuff in the survey; it is a quick read. Doesn't paint a rosy opinion from the medical field.

 

Good post Jerry. Not confrontational to you, but I do think most of this is crap. Doctors will still be paid very well, and it is a good thing that measures are being put in place for eprescribing, physician ordering, and ehr's.

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Engineers create designs, contractors are responsible for means and methods of construction. They neglect to inform you that there were govt layers of project management that was supposed to oversee Bechtel asleep at the wheel, in this case it should have been the Department of Capital Asset Management.

 

No engineering or architectural plan is 100% complete...there are always requests for clarification, requests for information and subsequent follow up drawings.

 

Contractors own the drawings, so when there is need for additional drawings or scope outside the original contract it is called a change order. this happens on every construction job. The goal is to minimize them as you can control cost alot easier through a competitive bid process than being stuck with a single contractor you are forced to use putting together the estimate.

 

Bechtel may be at fault for missing obvious things or may not, there isn't enough information given to deduce one way or another.

 

Those change orders in theory should have been included in the original drawings and would have had cost anyways, so the only increase in cost through the change order is the difference in pricing between what would have been included in the bid, vs the cost put together on the fly.

 

Depending on the contract between .gov and Bechtel how change orders and scope is handled would be laid out. The fact they were never held to the fire means .gov had no recourse due to their own bumblings... In certain situations you can stick a contractor with a change order that they should have had the foresight to avoid. Engineers can sometimes be stuck with the cost for new drawings if it was something that should have been included in their original contract scope.

 

the bottom line is that while your article provides some nice history of some of the issues, it doesnt provide the information to make any sort of placement of blame. It also completely ignores the role of .gov in the process. Not how reality works.

 

 

I am a civil engineer who has worked on some pretty big projects. I am currently working on the O'Hare expansion project (known as the O'Hare Modernization Program) which is about an 8 Billion dollar project. You are leaving out a layer of private project management. Bechtel and Parsons Brinkerhoff were the Project Managers of this project. They oversaw the design and Construction. As the project manager they would have produced preliminary engineering drawings. Other engineering firms would take the preliminary plans (30%) and take them to a final bid set of plans. Change orders would have run through Bechtel and Parsons Brinkerhoff.

 

In my experience, cost overruns are the result of poor initial estimates, additions to the project, or undiscovered conditions. I don't know how these cost over runs came about but Bechtel/Parsons Brinkerhoff were the ones who were responsible for managing the costs. Government involvement on these projects is usually limited to Lawyers and Media spokes people. I always get a kick out of seeing one of these spokes people try to explain the progress of a project I am working on knowing they don't have a clue. Some of the construction mistakes made on the job sound like the worst mistakes. The final engineer would be responsible for checking that the materials met the specifications and and ufortunately one of those mistakes led to a couple of deaths.

 

In fairness to the engineers and contractors on this project, this was a very complex project where new and unique solutions were used to solve some difficult conditions. The government was taken for a ride and when costs started to rise they were probably too far along to turn back. I am not sure if the PMO was upfront with these cost escalations or not but they are the ones who should have been warning the State about the costs as early as possible.

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I am a civil engineer who has worked on some pretty big projects. I am currently working on the O'Hare expansion project (known as the O'Hare Modernization Program) which is about an 8 Billion dollar project. You are leaving out a layer of private project management. Bechtel and Parsons Brinkerhoff were the Project Managers of this project. They oversaw the design and Construction. As the project manager they would have produced preliminary engineering drawings. Other engineering firms would take the preliminary plans (30%) and take them to a final bid set of plans. Change orders would have run through Bechtel and Parsons Brinkerhoff.

 

In my experience, cost overruns are the result of poor initial estimates, additions to the project, or undiscovered conditions. I don't know how these cost over runs came about but Bechtel/Parsons Brinkerhoff were the ones who were responsible for managing the costs. Government involvement on these projects is usually limited to Lawyers and Media spokes people. I always get a kick out of seeing one of these spokes people try to explain the progress of a project I am working on knowing they don't have a clue. Some of the construction mistakes made on the job sound like the worst mistakes. The final engineer would be responsible for checking that the materials met the specifications and and ufortunately one of those mistakes led to a couple of deaths.

 

In fairness to the engineers and contractors on this project, this was a very complex project where new and unique solutions were used to solve some difficult conditions. The government was taken for a ride and when costs started to rise they were probably too far along to turn back. I am not sure if the PMO was upfront with these cost escalations or not but they are the ones who should have been warning the State about the costs as early as possible.

 

Very interesting.

 

 

Thanks for posting this :thumbsup:

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Would you rather have the surgeon who was in it for the money who eeked thru med school with the help of dad being friendly with the administration, or the excellent doctor Joe who wants to help people? :overhead:

 

 

 

 

I want a good surgeon and I don't care if he wants to help people or not. I was responding to the moronic premise that only people who want to help others should be doctors.

 

 

Actually it is the Affirmative Action Doctors I worry about.

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I am a civil engineer who has worked on some pretty big projects. I am currently working on the O'Hare expansion project (known as the O'Hare Modernization Program) which is about an 8 Billion dollar project. You are leaving out a layer of private project management. Bechtel and Parsons Brinkerhoff were the Project Managers of this project. They oversaw the design and Construction. As the project manager they would have produced preliminary engineering drawings. Other engineering firms would take the preliminary plans (30%) and take them to a final bid set of plans. Change orders would have run through Bechtel and Parsons Brinkerhoff.

 

In my experience, cost overruns are the result of poor initial estimates, additions to the project, or undiscovered conditions. I don't know how these cost over runs came about but Bechtel/Parsons Brinkerhoff were the ones who were responsible for managing the costs. Government involvement on these projects is usually limited to Lawyers and Media spokes people. I always get a kick out of seeing one of these spokes people try to explain the progress of a project I am working on knowing they don't have a clue. Some of the construction mistakes made on the job sound like the worst mistakes. The final engineer would be responsible for checking that the materials met the specifications and and ufortunately one of those mistakes led to a couple of deaths.

 

In fairness to the engineers and contractors on this project, this was a very complex project where new and unique solutions were used to solve some difficult conditions. The government was taken for a ride and when costs started to rise they were probably too far along to turn back. I am not sure if the PMO was upfront with these cost escalations or not but they are the ones who should have been warning the State about the costs as early as possible.

That's cool you do civil work. There are most definitely state project managers that are at all those design and construction meetings who sign off on all those change orders. I believe during the big dig the jurisdiction fell between a few agencies, DCAM, DOT etc. since they have combined all real estate and transportation maintenance under DCAM. They believed in splitting up the contracts and having a collective decision making process which I am sure was agonizing to deal with.

 

Bechtel had no authority to grant themselves change orders. That's not how the system works. The state has their lawyers who review the contracts, but the point is that they are involved in the process throughout.

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I want a good surgeon and I don't care if he wants to help people or not. I was responding to the moronic premise that only people who want to help others should be doctors.

 

 

Actually it is the Affirmative Action Doctors I worry about.

 

Still funny you used a "do you want something good or do you want something not good" arguement.

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Good post Jerry. Not confrontational to you, but I do think most of this is crap. Doctors will still be paid very well, and it is a good thing that measures are being put in place for eprescribing, physician ordering, and ehr's.

 

No offense taken. Not sure what you mean by "crap" though. It is what it is. :dunno:

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Let's look at how well the Govt has estimated future costs of a few of their Healthcare programs.

 

 

•In 1965, the House Ways and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.

 

 

 

•In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion.

 

 

But hey, they will get this one right and it will save us money. :doh:

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