Not OBAMACARE god forbid a democrat actually pass what the republicans couldn't in 8 years of Bush. And yes we should listen to the doctors cry about how they would be forced to stop massive overbilling people who could not afford a health insurance provider that would negotiate massive discounted rates for its insured. How dare the poor be entitled to the same fee schedule that an insurance company would pay the same doctor for the same services? How dare the poor even think they are entitled to health coverage....good point Ray Polidoro Republican Chairman of GT aka GTWatchdog.
I blame both parties in this one though. The answer is too easy and will never raise campaign contributions for either side. Just like in a motor vehicle accident they have medical fee schedules, doctors are not allowed to over bill or increase or decrease a bill based on insurance companies negotiated rates. Cash payments are the same as insurance payments for the same services. Make a fee schedule for all to abide by if a doctor is willing to wait to get a check for $35 because an insurance company has a contract with him why should he be able to bill $350 for the same service to a cash paying patient just because he/she does not have insurance? That is the biggest flaw in the medical profession. Obamacare guarantees patients rights to access affordable medical coverage and how dare the poor demand the same rates as the wealthy pay!!

If it's such a good step in the right direction how come there has been so much push-back on it? NJ is not the first state to turn it down and it's already run up to the Supreme Court...so, what's so great about it?
I know...
LIE #1: if you like your current healthcare plan, no problem, you can keep it.
LIE #2: Healthcare costs will go down.
LIE #3: ObamaCare will cost $900 Billion over 10 years.
LIE #4: The Healthcare Bill will reduce the deficit.
LIE #5: Healthcare premiums will go down.
LIE #6: The Healthcare Bill will control health care costs.
LIE #7: The Healthcare Bill and economic growth are inexorably linked together.
LIE #8: The Healthcare Bill will not grow government intrusion in our lives.
The lies are legion so you can add all of your own to this short list. Bottom line on ObamaCare: the majority of Americans who will be forced to pay for it don't want it!

Thank you, Governor Christie.

Like Christie or not, he's at least smart enough to know that VP is the most useless position in all of Washington. If he aspires to be President, being the VP is not the way to do it.

Paul, show is where any one of your statements were true....or should line 9 read LIE #9 everything you read in lines 1-8 is true.

Well, Not Applicable, you finally popped her little head up. Here you go, N/A, the Washington Post, usually found in Obama's back pocket, even took umbrage with the $900 billion price tag and states it will probably cost twice as much as advertised or around $2 trillion.
http://www.washingtonpost.com/blogs/fact-checker/post/obamacare-twice-as-much-as-estimated/2012/03/26/gIQACSZncS_blog.html
I hope that helps.

Paul no it doesn’t help, your argument at least. It fails to say what inaction costs us every year. It just goes on to say what the price tag could be instead it should say is the real facts then maybe people like you would not jump to conclusions every time the president wants to do something good for the nation. Did you know people with health insurance are 75% less likely to file bankruptcy and default on their home mortgage.
Making mortgage and loan rates lower and more easily accessible is as simple in many cases as helping people attain health coverage they can afford. Currently over 50% of mortgage applications that are denied were denied due to medical collections on credit profiles. 75% of medical collections that hamper a mortgage application are from homeowners that have no medical coverage and therefore nobody to negotiate fair medical billings. Allowing people to attain medical coverage at rates that are affordable is proven to strengthen our economy because it strengthens people’s ability to attain credit therefore strengthens our banking system.
.............(1of 2 ...continued).......

( Continued...2 of 2)
Paul,
I wouldn’t expect you to understand that especially since by grasping that small fact your Republican leadership keeps from you, your opinion surly would be swayed but, Boehner’s blunder in the budget deal last year cost the US over a trillion dollars in loan debt and crushed the European and Chinese economies and that was just on the threat of defaulting loans. You have no problem with that, yet you expect the economy to rebound when people can’t get loans many due to medical collection accounts. Yet god forbid the president gives every American access to health coverage for the next 10 years at a cost far less then Boehner’s threats did and you have issues. If Boehner was a Democrat you would be hanging him for what he did to our economy and the world economy instead you crucify the President because he is insuring the people of his own country get access to affordable health insurance. The same healthcare that Bush promised us for 8 years but instead gave us $4 a gallon gas and warfronts all over the world. The same warfronts that Bush and Chaney rake in the profits from.

Paul, By the way again I just want to point out the article you quote as being from the Washington Post actually was not it is a blog with no more credibility or truthfulness the your blog here on Patch. It is one person’s opinion not factual in any way he even goes on to say it is his opinion and refers to comments made as his “Pinocchio Test.” This Blog you refer to is not a news article as you portrayed it to be and it is hardly factual at all and infect the author Glenn Kessler is very openly a Republican Backer and shared the “BLOG” as “HIS OPINION.” Please stop attempting to mislead people. Are you that derailed to the real world that you truly only see things the way Republican bloggers tell you to?

Your point is well taken, Joe. Unfortunately, from memory and a quick search on the Internet, I don't think that nullification has ever been upheld by the courts or used in defiance of the courts and taken all the way out to its logical end. While it exists in theory, I'm not sure of how it has fared in actual practice. I am not familiar with the specific incidents you make reference to but would like to follow up. I would be greatly interested if you could supply some references to the incidents you mention so I could cut through to the meat of the matter and not get bogged down in the search.

Wow, up there "will be when" should read "where." Lousy typo.

I believe uninsured refers to people who aren't on private insurance or state/federal aid. Where's your data? 49 million is from Kaiser, and they tend to be reliable.

I thank you for providing the numbers, Chris, but I suspect my question is more related to the framing of the response here. I don't understand how excluding immigrants or the self-selectively uninsured out of the figures somehow means that we won't have to care for them if they fall ill. When people don't have medical coverage, they still go to hospitals and they still require emergency care for conditions that may otherwise be regulated with regular preventive care. We pay for people on the fringes of the system in higher premiums anyway.

Why do we ( or I) have to pay for someone else's medical care ?

Especially considering most Americans really aren't interested ( or willing to do what it takes) to be healthy.

Were are the fatest, laziest, worst eating people on the planet.
And we question why our medical care costs are so high ?

As for your question.

When an illegal shows up for care. Find out who they work for, and send them the bill. Then deport the illegal.

Self selected uninsured. Send them the bill. Decisions have consequences.
Live with it.

Chris Welch, I feel the same way about school taxes. Why should I pay to educate your kids as well as everyone else when I have no children attending schools? Especially since so many of the kids attending school do not even want to learn.

You don't *have* to pay for anyone else's anything, I'm just telling you that you *do* already in the form of higher taxes and higher premiums, which, if you carry private insurance, happens every year. The costs of your premiums go up and the list of stuff they cover shrinks to keep the company profitable.

Sending a bill to someone you know will never (or can never) pay--i.e., the uninsured or the undocumented--doesn't mean that the cost of that service disappeared. The care is still administered, which means the healthcare staff who delivered it were paid to do so. Who foots the bill? The system.

The argument here is that we ask our doctors to consider the value of human life; that we do not legally allow anyone in need of aid to be turned away. How this strays into politics is when it boils down to what your neighbors think your life or mine is worth if we can't bear the financial burden of catastrophic illness.

It's because healthcare is an ethical good before it is a financial good. It's the same reason we all pay for roads, emergency services, the public library, etc....and I believe John Donne said why better than I ever could, a long time ago.

Ric - did you ever have kids attend public schools ? If so, did you feel the same way then ?

Paul, I do not like Obama but you are so rabid that you wouldn't give the man credit if he saved a drowning man. The president has done some good things although I do not want him reelected. Unfortunately republicans are running Mormon Romney and the rhetoric of the far right. The far right are the fools that got us to invade Iraq at the same time we were fighting a war in Afghanistan. Afghanistan would be a whole different story if we just went in there. The only reward America got for the double invasions is turning a surplus into a massive deficit. Now that was dumb.

Okay, Ric, "The president has done some good things..."
You've got my attention...

Paul, he did not send our troops to Iraq and Afghanistan. He did not blow a surplus into a deficit just to fatten up the far right's pockets.

He is not a Mormon - isn't that religion, if it is a religion, an offshot of Scientology?. They are both based in science fiction.

So close and yet so far away, Ric. Mormonism, regardless of my opinion of it, has nothing to do with Scientology and existed way before Scientology was ever thought of. Remember, engage brain before putting mouth in gear.
The only reason Obama didn't blow a surplus is because he had none to blow. Bush ran up the debt $5 trillion dollars in eight years during which time he dealt with 9/11 and prosecuted two wars (fact, I'm not injecting my opinion on any of it here). Obama has run up the debt $5 trillion dollars in 3.5 years. Hmmmmm, now who's running up the debt.
Bush went to war (fact again, no opinion), no ifs, ands. or buts. Obama said he would close Gitmo - ERROR! Obama said he would immediately end the Iraq War - ERROR! Obama still has us in Afghanistan and increased the troop presence there and that is now his war. Obama, the man of peace.
Okay, now what were you saying, Ric?
Obama's religion? My guess is he's an atheist or possibly a deist. He is definitely not a Christian if that's what you're looking for. Listen to a few of Reverend Wright's sermons whose church Obama attended for twenty years, where I believe he was married, and definitely where both of his daughters baptized.
BTW, what are we electing a president or a pastor?
One other thing, we've had debt for quite some time now so any surplus that Clinton passed on, which was more about congress than Clinton anyway, is to me a smokescreen when you have trillions of dollars of debt hanging over your head.

Paul, I sincerely apologize, I wrote too far above your level of understanding. Everyone and their brother know Mormonism was founded in the 19th century by failed science fiction writer Joseph Smith. Science Fiction L Ron Hubbard came along a hundred years later. Both faiths, of course, are baseless – unless you are Tom Cruise or John Travolta.
It is a shame that Dubya was one tenth of the president that his father proved to be. Dubya, a far-righter, used 9/11 to extract revenge on Saddam Hussein’s earlier failed assassination attempt on the elder Bush. The war in Iraq wasted the lives of many thousands of good American men and women. That is on top of wasting hundreds of billions of dollars. There was no cause for that war. And Iraq today is more unstable. Sorry buddy, but Dubya left that nightmare for Obama to clear up.
The elder Bush knew when to cut out, he could have gone on to Baghdad but he did not. The Middle Easterners have been killing each other for thousands of years and they will continue to kill each other for ten thousands of years. The troops should have gone only to Afghanistan. Now we will lose both wars – and no president could fix the mess Dubya got us in. Thank you far-righters.

Hey Ric, if you're really worried about my understanding, work on your grammar a little. As far as Obama clearing up Bush's nightmare...how'd that work out?
BTW, you wrote: "He is not a Mormon - isn't that religion, if it is a religion, an offshoot of Scientology?" You didn't like my answer so I'll clarify...No, Mormonism is not an offshoot of Scientology. Even you know that, Ric. You wrote it, remember? I never commented on the similarities, if they exist, just pointed out that Mormonism could have nothing to do with a philosophy, Scientology, that didn't even exist when it started. Now maybe the other way around might work but that's not what you wrote and not what I answered. Please, give me a little bit of credit for at least reading what you wrote and holding you to it.
So, Ric, I hate to be so picky but this continuing to open up loop after loop without ever attempting to close the original loop is extremely tiring and circular. You did not like what I wrote and replied: "The president has done some good things..."
Remember that? Than I replied with: "You've got my attention..."
Remember that? Focus, Ric, what are those good things? Let's at least close this loop before we start more.

PLH,

Is it safe to say, you have no coverage?

PLH- Our country should provide health care ? Please explain how a "country" does this.

And who will pay for it? Remember, all the European countries that we are so proud of because of all their socialist programs are bankrupt, defaulting, rioting in the streets, and in danger of pulling the rest of the world down with them.

I do have coverage Dave. My concern is for those who do not have coverage. The U.S is supposed to be such a wealthy country, yet some many are left behind.

Shame on those who are ignorant!

AMEN! Instead of critizing and being envious of what others have, people need to ask themselves what they can do to get there! I am sick and tired of the left lecturing and saying people who are already working hard and paying their taxes and EARNING what they have that we should give MORE to OTHERS. I agree with Matilda, let them go out, get a job, save their money and BUY what they want THEMSELVES!

Look to thyself, Peace-loving Hippy.

I am THRILLED that Governor Christie did the RESPONSIBLE thing and vetoed this! I made sure I sent an email thanking him since I called his office on Wednesday asking him to VETO the Obamacare Healthcare Exchange! Thank God we have a Governor who listens to his consitutents!

Don't give up on us yet, Hippy. This is a place where everyone has a right to his opinion.

A couple of things for you to consider. You self identified yourself as a "Peace-loving Hippy", incidentally, not something a supposed person in a "medical profession" would describe themselves as. But putting that aside, what exactly is "social justice"? It sounds like something a person claims gives them a superior view to others selfishly trying to do what is right for themselves, their family and their nation. And as far as your mother's smile, everyone had a mother and most in this country have done wonderfully for their children. But you seem to feel that your particular mother and her "smile" have earned you the right have an unrealistic expectation of others.

Hey, hippie...life ain't always easy. Learn to depend on yourself the best you are able. Be a good person, work hard and apply yourself but stop expecting everyone to act in a way that you and your supposedly self righteous socially conscious father say they should. And get your mother some flowers this weekend...and pay for them yourself.

Better look up the word "Hippy" before you go throwing it around as your name and then try to criticize those who don't think like you as ignorant and uncaring.
I suggest you read "Hippies" (April 1, 1968), written by Burton H. Wolfe. I read it in 1968 as a high school junior and it opened my eyes. You, my friend, are sadly misinformed.

Paul, again with the misinformation you are just a pillar of lies today, why? How about this try learning about what you pretend you know and start telling the truth.

A July, 1967 Time Magazine study on hippie philosophy credited the foundation of the hippie movement with historical precedent as far back as the counterculture of the Ancient Greeks, espoused by philosophers like Diogenes of Sinope and the Cynics also as early forms of hippie culture. It also named as notable influences the religious and spiritual teachings of Henry David Thoreau, Hillel the Elder, Jesus, Buddha, St. Francis of Assisi, Gandhi, and J.R.R. Tolkien.

The hippie movement in the United States began as a youth movement. Composed mostly of white teenagers and young adults between 15 and 25 years old, hippies inherited a tradition of cultural dissent from bohemians and beatniks of the Beat Generation in the late 1950s.Beats like Allen Ginsberg crossed-over from the beat movement and became fixtures of the burgeoning hippie and anti-war movements. By 1965, hippies had become an established social group in the U.S., and the movement eventually expanded to other countries, extending as far as the United Kingdom and Europe, Australia, Canada, New Zealand, Japan, Mexico, and Brazil.

Self-described hippies had become a significant minority by 1968, representing just under 0.2% of the U.S. population before declining in the mid-1970s

Hippies rejected established institutions, criticized middle class values, opposed nuclear weapons and the Vietnam War, embraced aspects of Eastern philosophy,[19] championed sexual liberation, were often vegetarian and eco-friendly, promoted the use of psychedelic drugs which they believed expanded one's consciousness, and created intentional communities or communes. They used alternative arts, street theatre, folk music, and psychedelic rock as a part of their lifestyle and as a way of expressing their feelings, their protests and their vision of the world and life. Hippies opposed political and social orthodoxy, choosing a gentle and nondoctrinaire ideology that favored peace, love and personal freedom.

The book you refer to from Wolfe only explored the antics of one group of bus riding dopers not the hippie movement as a whole. Please don't mislead and misinform people it's degrading to people who actually have intelligence to have to read your dreck and correct you over and over again.

Have you been bored, N/A? What did you do, find out how to use Wikipedia in your time off?
The book you mistakenly refer to is "The Electric Kool-Aid Acid Test" and was written by Tom Wolfe and published in 1968. I read it as well. You must have been so excited thinking I was mistaken that you didn't even read the info you Googled. I'll write it again, "The Hippies" was a book written by Burton H. Wolfe and published in 1968. It had nothing to do with the events occurring on a bus with Ken Kesey and his Merry Pranksters that were documented in "The Electric Kool-Aid Acid Test."
It is obvious now to everyone that you have no real intent of participating in open discussion because you would rather just attack and call names. The fact is you have no idea what you are talking about and I just proved it. Your screech reads like a copy and paste for a Google search. Next time read what you intend to copy, paste and send.
Now that you been outed what do you plan on doing about it?

I take it back, Hippy. Run quickly.

This is exactly the type of response one would expect to see from someone who is running scared that the middle class and poor actually could have what the rich take for granted. Way to be a pillar of society will Chris Christie donate to your council race again?

@David Vaccaro: Patch is an AOL company. We have outstanding health coverage, for which we contribute a bi-weekly, pre-tax amount comparable to that required by most private sector employers these days.

Hi David,

I can tell you my own personal feelings on the subject, but as I see it, I have a few roles here as the editor:

1. To make sure there's a free flow of ideas in a non-harrassing environment.
2. To infuse some facts into a discussion when I see a lot of shooting from the hip.
3. To spark conversation and occasionally introduce my own ideas because I, like you, am a human being, with a collection of perceptions and feelings.

In the course of this discussion, I've seen lots of yelling and some high emotions. You (or anyone here) telling me that I want something to be the way I want it to be rather than accepting how "things really are" does not add to the substance of a conversation. It's a way of brushing off whatever the content of the discussion is. I can say the same thing to you, and how does that help us understand one another? Being dismissive of an idea doesn't lend to its explanation.

When I see in forums like this that there are some participants who seem most interested in hammering out their own perspectives without any engagement short of name-calling or condescension, it leads me to think there isn't much interest in a dialogue, and that's what I, as an editor, am after.

Point to one place in my comments where I did the things you said: called someone stupid, spoke of the "wonders" of Obamcare specifically, etc. You can't. (continuing below)

As my colleague below writes, we contribute to our benefits, like most Americans whose healthcare is tied to their employment. Personally, I have worked multiple jobs almost throughout my entire life--including right now--since I was 15 years old. I've gone without health coverage, paid exorbitant COBRA prices to maintain it, and paid into other premiums of varying quality at different jobs along the way.

But that's an irrelevant point. You're inventing these straw man opponents for the sake of the discussion--that I don't pay for my own health insurance, that I'm extolling the virtues of the Affordable Care Act, that I'm part of the faceless "media" EVERYONE dislikes--because you are trying to construct a scenario that would justify your own worldview, not learn something about me or where I come from. You want it to be easy to dismiss me as a person so that you can be confident in your own perspective, whatever I may be in truth.

And that's really my issue here. I sense that a lot of people don't have a healthy forum to discuss these ideas and so they take to the Internet to fire off some intense screed that they would never in a million years think of laying down to a perfect stranger on the bus or in a coffee shop, etc. When you participate in a discussion like this, you have to remember that there are other human beings on the other side of the keyboard, and you have to provide some base level of respect for that.

Joe, I know what 'nullification' is and generally agree with the idea. My question revolved around whether is was ever successfully used. You mentioned a couple of incidents where you suggested that nullification was successful. Can you point me to articles that specifically address those incidents? I'm not up to reading a book on nullification when I am only looking for its successful implementation in history.

David, the fact of the matter is this:

If you show up at a hospital and you ask for care, it will be given to you regardless of your ability to pay. The cost of that is born, in one form or another, by everyone with health insurance and everyone who pays taxes. This is a fact.

Regardless of your semantic argument that we would add or not add people to the rolls of the insured, the basic principle of healthcare is this: if you're sick and you go to the ER, someone there has to treat you. That's their job as doctors. What we are talking about is how that's going to be paid for.

You're trying to offer some slippery slope nonsense about how if we let these so-called freeloaders away with not paying for healthcare that somehow they will steal every resource imaginable. That's fine if that's your viewpoint. But I'm telling you that the fact is that your idea of what is just has no bearing on the professional ethic that guides a healthcare professional. And if you're going to come out and say that certain people have a right to continue living and others do not based on some financial merit, then you're going to have to take it up with the Hippocratic oath. All else is noise.

Matt- "If you show up at a hospital and you ask for care, it will be given to you regardless of your ability to pay. "

You need to clarify your idea of "care".
We are only required to care for true emergency patients. If that's what you're implying, you need to rewrite your thoughts.

Sure, you can walk in the ER and complain you don't feel good. Nobody will throw you out.
You''ll just sit for hours until they get around to you.

Me: 17 years Thomas Jefferson University Hospital - Philadelphia.

Chris, my only point is that when people enter the ER in need of care, they get it. I'm not saying it's optimal, and if you have worked in or around triage for 17 years, you also know that it's cheaper and faster to provide solid preventive primary care than to have emergency bypass surgeries, etc.

(If you're interested in some research being done right in our backyard on the impact of this type of inefficiency in the current system, Dr. David Brenner of the Camden Coalition of Healthcare Providers has some fascinating data on the ways in which a significant portion of the healthcare services in the city are used by a handful of repeat visitors: http://www.camdenhealth.org/data-research/camden-health-database/)

In short, you can sum it up like this:

1. Delivery of care is not contingent on the patient's ability to pay.
2. When charity care is administered ($41 billion annually by some estimates - http://www.kff.org/uninsured/7451.cfm), the insured, the taxpayers, the hospitals, etc., bear the costs--in higher premiums, higher taxes, etc.
3. I don't know that the Affordable Care Act is necessarily the answer, but my point way back at the beginning is that it doesn't make sense to lie to ourselves that we don't already assume some of these costs under the current system.

Matt- first, I don't work in the ER. Sorry, should have been more clear. Biomedical.

I'm not denying people can come into the ER and ask for care.

"you also know that it's cheaper and faster to provide solid preventive primary care than to have emergency bypass surgeries, etc. "

Um, let's keep this discussion within the realms of reality. Someone doesn't go from a patient requiring faster cheaper primary care, to emergency bypass surgery in a day.
Unfortunately most people that need emergency bypass surgery (something not provided in the ER) bring that upon themselves after years of self abuse. It would be much cheaper if people would take a real interest in their health ( IE: diet and exercise) to begin with.
And the people ( with no insurance) running to the ER for "non- emergency " care are not really the kinds of people that are out exercising and or going to doctors for well visits.

"The cost of that is born, in one form or another, by everyone with health insurance and everyone who pays taxes. This is a fact."

And how will Obamacare change that ?
Let's just focus on the 20 million people with no insurance at all. 10 million illegals and 10 million US citizens.

How does Obamacare make it cheaper for tax payers to fund the cost of providing care for them ?

Right on, Chris--if you're a biomed, you of all people would know where some of the biggest cost drivers are. Service contracts? OEM-supplied parts that go for three and four times their true cost? What about having to pay extra for access codes to unlock a CT scanner that you've already bought just so you can do PMs?

(Here's a good, recent read, too, on how patients who have private insurance can't even get access to the scans they're covered for, even with patient advocates working on their behalf: http://bit.ly/J2mTNn)

Again: I'm not convinced that the Affordable Care Act is the best way to do things. What I do know is that we as a nation are already paying for charity care in one way or another. We don't have any way to make people not get sick. We don't have any right to turn them away in need. And you and others here have touched on the feeling that there is an innate sense of fairness that must be met here in order for people who contribute to get out what they're putting back into the system. How we do that, I don't know. But we're at the threshold of so many important medical discoveries--genomics, targeted imaging therapies, nanomedicine--that we will eventually have to find a way to distribute them.

Matt - yes service contracts are very expensive. One of the reasons we have such a large biomed department. There are very few items in this hospital ( we also cover Einstein, Frankford- Aria, & Methodist hospitals) that we don't cover in-house. Huge cost savings to the hospital, and in the end patients.
OEM parts pricing - no arguement there. They gouge for sure. But there are third party vendors that help with that. Big part of our job is outsourcing parts and or doing bench repairs on the part itself.

Purchasing codes to PM CT's ? Not sure where you got that info. I know we've never had to do it.

Matt - On your article concerning imaging denials . You wrote it's about patients with private insurance. Less then 40% of the cases sited in the article were private insurance patients. 35% were uninsured and the rest were all on government insurance plans. I don't see that as being a case study in what's wrong with private insurance. If you were showing it just to point out that there are abuses in the private insurance industry ? Again, no argument there. Plenty of rotten private insurances companies that will use every trick, even illegal ones, to save a buck.

What's the governments excuse for doing the same thing ?

Interesting to see the majority of the cases involved cancer patients. I work in the Cancer Treatment Center. CT scans are a routine part of patient treatment planning. Wish I could read more on why they were denied. Can only think the scans were performed and then some bean counter thought it was not needed so denied payment.

You're right. We don't have any way to keep people from getting sick or injured.
But we ( or I should say individuals) have penty of ways to work to keep themselves as healthy as possible. This country fails miserably at that.
It would go a long way towards saving money, in regards to healthcare, if people would step up and take some responsibilty for thier own well being.

We don't have a right to turn them away ?
As long as we get paid. I do have a right to earn a living for what I do.
As does my wife , a nurse.

Chris - re: access codes, there's an issue with that leverage being used by OEMs to lock shops into service contracts--i.e., you can't adjust the PM schedule or checklist without the vendor say-so because they allege it conflicts with standard operation of the device.

Even if you haven't experienced it, there are plenty of tales about how hard it is to get access to a manual or device passwords--which also, by the way, keeps institutions from being able to buy cheaper parts and devices on the pre-owned market. It's particularly hitting ISOs, as you mention, because it keeps service deals from being farmed out.

Nice to work for a big place like Jeff but what happens at these rural centers and places farther removed from the subscriber base of the jam-packed Northeast and its teaching hospitals?

As far as the study: another thing to consider is that it's only a small selection of people who sought advocacy help over a period of four years. Why should it take any case manager an average of 15 contacts with an insurer to deliver necessary care?

I digress. Of course you or your wife or any professional deserves to be paid for the work that's done. I'm not arguing that. I'm just saying that the costs are already in the system whether we acknowledge them or not.

Matt - about access codes being used to lock shops into service contracts. In 17 years I've never heard that being done. We are considered an in-house shop by vendors. GE, Philips, HP, Elekta, Varian, Siemens, we deal with them all.

"you can't adjust the PM schedule or checklist without the vendor say-so because they allege it conflicts with standard operation of the device. "
If something goes wrong and a patient is hurt, you can bet the OEM will be named in the law suit.
Don't you think they have a right to make sure the equipment with thier name on it is being maintained properly ?

Nice to work for a big place like Jeff but what happens at these rural centers and places farther removed from the subscriber base of the jam-packed Northeast and its teaching hospitals?
Not sure what you're asking me here.

"As far as the study: another thing to consider is that it's only a small selection of people who sought advocacy help over a period of four years. Why should it take any case manager an average of 15 contacts with an insurer to deliver necessary care?" Can't answer that. Maybe someone could contact President Obama and ask him why the government is denying treatments to people. ;)

Hi Chris--the access codes issue is top-of-mind for me because I circulate on the medical device beat as well and just wrapped a piece on the subject. As you well know, most of that stuff is an issue of control--half the guys and gals in the ISO world were 25-year OEM techs before they set up their own shingles anyway. You can bet that this kind of thing is going on nationwide; I've spoken with a guy who's shopping a whitepaper on the subject. E-mail me and I'll shoot you over a link or two if you want to read more.

My only point about Jeff being a top-notch academic institution is that it's not typically hamstrung by the challenges that other, more far-flung areas served primarily by ISOs must meet. Talk to some biomeds down South or in Appalachia and see how much money they have for staff training, or how many people they can keep in-house to do their own repairs, etc.--those dollars are always the first to go, and as equipment lifecycles lengthen, the knowledge gap gets bigger while the need for repairs increases, too. And hey, how about the GE-Alphasource deal--setting up an exclusive third-party provider for *only* your aftermarket parts stuff? Fishy, fishy.

Matt - would definitely like to read what you have. I understand the issues that small hospitals and clinics deal with. Been at training schools with guys that work them.
Actually spent 3 weeks with a guy from Cuba. He was the only service engineer in the country for 12 machines. It's tough and expensive,no doubt.
Just spent $5300 for a cover that is made from about $25 of composite material. But it can't make one, and I can't pick one up at Home Depot. So not much choice.

One of the worries for the stand alone clinics, even those affiliated with hospitals, was the reimbursement rates. Obama was talking about reducing them. So you have places that are just barely staying afloat. Many of them are only able to do it because of the funds coming from the hospital, and he wants to cut reimbursement rates. Those places would close. And the patients they would normally treat would now have to travel further to reach the major hosptials.
http://www.acr.org/HomePageCategories/News/ACRNewsCenter/Imaging-Cuts-in-2012-Medicare-Final-Rule.aspx

Another problem with this imaging reduction plan is they are classifying linear accelerators as Diagnostic Imaging devices. Which they clearly are not.

Clearly they are not, but they're setting themselves up for another isotope shortage while NIH dumps $10M here and there into home-based manufacturing systems.

The standalone thing is interesting because for a while there, standalone clinics were getting all the financial breaks, and now it's the hospitals that are scooping up rads because they can get more significant reimbursements there. Meanwhile, there's just widespread consolidation in that industry as people look for ways to monetize their roll-up investments from buying up freestanding imaging centers...so even as imaging becomes a greater part of our specialty and subspecialty modalities, the message that's being reinforced is how it's the most expensive service and rads are the ones who command the highest salaries.

I'll send you a few links. Good chat.

Well said, and thank you.

Who is the First Kenyan? Why are you bringing up Kenya? Are you making a lame attempt to point out the president has some black ancestry? Did you know he also has some white ancestry? Why do you feel the president's ancestry is pertinent to a discussion about healthcare?
I do not like Obama but I do not see why you feel it necessary to remind everyone of his race. I also did not like Bush Junior, like most Americans- then and now, and yet I do not recall anyone calling him First German or First WASP. Your arguments could be taken seriously if you had dropped the irrelevant racial reference. Have a great day.

No one has to bother spending the time to remind people of Obama's race; he's quite capable of doing that himself when it suits his agenda.
Consider that he thought it wise to interject himself into the middle of a fracas in Sanford, Florida, that still has not convinced many that it was a racially motivated incident, by telling us the if he had a son he could have looked like Trayvon.
On the other hand, as you say, he is half white but did not feel compelled to remind us that Matthew Owens, a young white man beaten brutally by twenty other individuals in a racially motivated attack to within an inch of his life in Atlanta, could have looked like his cousin if he had one.

David, at Jerry Falwell’s Liberty College, did Romney really say marriage is an institution between a man, a woman, another woman, another woman, another woman and another woman? Do Mormons still practice polygamy?

No Linda Musser you were the Gloucester Township Republican Council candidate who took money from the governors party and now "write letters to thank him" for voting against allowing NJ Residents attaining health insurance at rates they could afford. You cowardly praise him because he demands it of you since he gave you contributions to bail out your election fund.

You should be ashamed of yourself for bragging about your bought and paid for position but then again you would need to have self respect to be ashamed of your own cowardly actions. Too think you wanted to run municipal government? An attitude like yours that is an embarrassment to the Republican Party for having so carelessly chosen a candidate with such a foul mouth. Your an insult to their screening committee. A republican council candidate calling a constituent "a gutless coward" like you called me for not divulging my name is nothing less than a disgrace. My name is irrelevant, a distraction tactic by you, but it does not change the fact that your misleading into believing you wrote your letter (if you actually did) for anything other than to make sure he knew his donation bought your support.

Linda Musser It's not hard to see why the voters choose against you 3x now, even with the governor’s contributions and support. You’re clueless when it comes to having respect for constituent’s opinions when they differ from your bought and paid for opinion. As to why I don’t divulge my real name here? Well? It's because of your obscenity and name calling toward anyone who opposes your bought and paid for views. Your disgraceful conduct is exactly my reasoning for not divulging my real name.

Your actions are nothing less than cowardly and I stand by my comment that you are "running scared" but not just of the middle class and poor attaining the same medical coverage you and the rest of the rich Republican politicians and your fellow business owners have, your truly "running scared" that if you don't openly praise the governor for abusing those classes of people that you would lose your future contributions and support from the governor. FYI, you are not the governor you could not even win a council seat in your town despite his money and support, stop being a cyber bully. Stop making people hate you and turn against your party more than they already did.

Oh, right, Rasmussen. The poll that blew a race in Hawaii by 40 points and had an average margin of error of nearly 6 percent two years ago. That sounds reliable.

http://fivethirtyeight.blogs.nytimes.com/2010/11/04/rasmussen-polls-were-biased-and-inaccurate-quinnipiac-surveyusa-performed-strongly/

How 'bout you check in with Quinnipiac or pretty much any other poll that might be able to hit the broad side of a barn, chief?

My reality? How about any reality? Let's take three that were more accurate than Rasmussen two years ago:

Gallup: http://www.gallup.com/home.aspx
SurveyUSA: http://www.surveyusa.com/electionpolls.aspx
PPP: http://www.publicpolicypolling.com/main/polls/

Cherry-pick, as you did with Rasmussen?

And of course, looking at the national polling is pretty meaningless. What really matters is that link a couple clicks down from the overall poll:

http://www.realclearpolitics.com/epolls/2012/president/2012_elections_electoral_college_map.html

And that electoral map doesn't look so hot for Mr. Romney right now.

Also, seriously, I know you think you're being funny with the Kenyan garbage, but it makes you come off like a nutbar and undermines any salient point you're trying to make.

David, do not get your hope up. Mitt Witt's current lead is statistical nil.