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« The fine art of failing upward | Main | The Fecund Stench lawsuit »

May 08, 2014


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In my view Ed, this is who you are representing here;

"Dr. Scott MacDiarmid, a urologist with Alliance Urology Specialists was paid nearly $609,000 between 2009 and 2012. His fees came from Allergan, Johnson & Johnson, and Pfizer. During that same period, Dr. Stephen Smith and Dr. Richard Aronson, both with Guilford Medical Associates, made $383,000 and $263,000 respectively from Eli Lilly, Merck, Forest, and Glaxo Smith Kline. There were plenty of other doctors receiving six figures for consulting, giving speeches, and, by implication, endorsing a particular brand of drug. Those included physicians from Eagle Family Medicine, Cone Health Cancer Center, and LeBauer Healthcare, among others."

You appear to be supporting a system that is parasitical, even though I expect you to say you don't.

How about talking about how to fix it, instead of defending it?


Here's a look up tool;


Type in Greensboro.

How many of the doctors on the list work for Cone Health?

This is just Medicare, which doesn't cover private insurance payments.

Does this seem right to you?

Does it seem like everything is ok with these folks making so much that is borrowed from our kids?

Same goes for the 35% increase in higher public education costs since 2008 Andrew.

This looks like a lot of government enabled theft to me.

This is what Kay Hagan appears to be defending, along with one Ed Cone.

Andrew Brod

Ignore the troll, ignore the troll...

I was very happy to see Hagan take on NC's rejection of Medicaid expansion, which I see as one of the most boneheaded moves this state has taken in... well, a few months anyway.


For some reason, it appears to be OK for those with employer sponsored heath insurance to have other taxpayers subsidize their health insurance since it is a tax deductible business expense but it is wrong to put the burden on our children and grandchildren to expand Medicaid. I do believe both of these situations put the burden on our children and grandchildren. This strikes me as welfare program for those with employer sponsored health insurance. If you don't want to expand Medicaid you should either tax the health insurance benefits through employer sponsored health insurance plans or eliminate the business expense deduction for employer sponsored health insurance plans.

To me, the rejection of the Medicaid expansion is a horrible injustice and sentences a portion of our population to an early death.


We are already paying for the ACA.

Who pays for Medicaid expansion?

Ed Cone

George, there are many aspects of the healthcare system that I find worthy of scrutiny and perhaps repair. I agree that the relationship between physicians and pharma is one of those areas.

But your comments on the subject are reductive to the point of meaninglessness. You are pointing at problems within a vast and multifaceted industry, and saying...what, exactly? Burn the whole thing down, because these problems exist? Pillory anyone who works within the system, because the system has flaws?

Your game of selective citation and guilt by association is pernicious, but not terribly effective. If I as a trustee of a healthcare system represent to you some things that need fixing, why don't I also represent the good things? What about the hundreds of millions of dollars in care our local system provides to families who lack the means to pay for it, or the thousands of nurses and doctors who bring their skills and compassion to a difficult job, day after day? And so on.

I'm not claiming to represent all those good things, just making the shopworn point that you are not making a hell of a lot of sense.


Who pays for the employer provided health insurance business expenses deduction?


"Who pays for the employer provided health insurance business expenses deduction?"

It's left as debt to our children to pay for.

Who would pay for the Medicaid expansion?

Our kids.

Who paid all those doctors all that money?

Our kids.

Who pays for QE?

our kids future income.

The health care and education industries helped steal our children's future living standards.

Any of my Yes Weekly articles not make sense?

I didn't see a refutation of the doc fix accounting issues.

So if an editor says it's right, you don't object, but if I say it as an individual I don't make sense?

Your epidermis is showing gentlemen.

john hayes

Someone connect the dots for me, what does drug companies paying MDs for consulting, research, speaking, etc have to do with medicaid expansion?


Well, we'll see. A single utterance does not a fight make. Her website still doesn't have a word about the ACA. If this is sustained, we'll call it a fight. For now, it's more like a burp.


"Who pays for Medicaid expansion?"

Who pays for people whose access to medical care is the emergency room?

And what PFKNC asked: "Who pays for the employer provided health insurance business expenses deduction?"

The costs borne by others are there, one way or another. The question is of outcomes. Is public support best spent on those better able to afford health care (health insurance deduction) or on those less able to afford health care on their own (medicaid, sliding scale ACA subsidies)? Is it better spent on expensive emergency care or on preventive care and treatment?

It's ideology versus pragmatism.

Andrew Brod

Right, Roch. Those costs are paid now through a combination of higher premiums and taxes (because the state and federal governments help hospitals pay to treat the uninsured). Under the ACA, it'll be paid through the taxes introduced by the law. And because the ACA expands insurance coverage (though it could do more along those lines if not for the boneheadedly partisan decisions of some states to reject Medicaid expansion), the cost of treating the previously uninsured will fall.

A few years ago, a colleague and I did a study for the Moses Cone Etc. Etc. Foundation, in which we looked at patient-level data throughout the Cone Health system and saw how the big costs of uncompensated care are generated. It wasn't in the ER, per se, but the process does indeed start in the ER. When people who don't get primary health care show up in the ER, they often have multiple ailments. That increases the likelihood of being admitted to in-patient care, and THAT'S where the big costs are.

So expanding insurance will reduce costs, as Roch suggests. Even if the previously uninsured just go to the ER more often, it'll reduce the frequency of these in-patient admissions. This is why academic studies project that the ACA will (slightly) reduce the country's aggregate spending on health care.

(I realize that everything I say will all be declared irrelevant by the troll, because I once did research for Cone for which UNCG was paid.)

Andrew Brod

Beyond that, the obsessive claim that "our kids" will pay for all this is quite bogus. As I've noted many times, the best nonpartisan projection we have is by the CBO, which holds that the ACA (including Medicaid expansion) will reduce, not increase, the federal deficit over the next two decades. This isn't changed by the apparently intentional misunderstanding of that projection by some.

(Cue the rants about the "doc fix" and projections of individual portions of the program.)

Now, it's quite true that this is a projection, not a fact. But it's only fair to note that the CBO has never underestimated the cost of medical policies, precisely because it chooses not to address changes in incentives. It views them as controversial and it doesn't want to risk its nonpartisan standing with Congress. So the CBO pretends they don't exist when it scores a law like the ACA. But the ACA certainly includes such provisions, like changes in reimbursement formulae. If the CBO projection is qualitatively wrong, it'll most likely be in the good direction.

It's also true that someone will pay. I noted above that the law will reduce costs, but it also relies on a series of taxes, including on the rich. There is a strong whiff of income redistribution in the ACA. Arguing against that is perfectly valid. Pretending that "our kids" will be worse off because of the ACA is not.

Ed Cone

Roch, I agree that Hagan's strategy around ACA is not yet clear. But given that her "single utterance" was in a highly-visible Senate hearing, and that it was aimed in large part at Tillis and his role in Raleigh, I'd say it's a promising first step.

Interesting to note the contrast with Burr at the same forum -- he didn't mention ACA at all. This is the trap Tillis faces: If he veers from the Repeal This Abomination orthodoxy, he enrages his base...yet that orthodoxy is eroding fast elsewhere along the political spectrum.

Andrew Brod

Others have noticed.


Just guessing, but I suspect that Medicaid expansion would be paid, at least in part, with that $2500 we are all now saving as a result of ACA efficiency.

But none of us have seen that $2500 in savings... and while a paltry few have benefited from the ACA, the majority have seen an increase in health-care costs as well as health-care insurance costs, loss of their current insurance, loss of their doctor, loss of access to quality hospitals, demotion to part-time work under 30 hours, or the loss of their job entirely.

And now we are told we need to pay for Medicaid expansion because the ACA is not living up the the promises of ACA ideologues?

You people need to get beck into the real world.

I am glad Hagan is embracing the ACA...I see a conservative Senate from my house.

Andrew Brod

I agree. Glenn Beck should get into the real world.


Is Glen Back here? No.

Brod seems to think/feel otherwise real world be damned.

So yeah, "You people need to get beck into the real world."

The ACA is hurting America and Americans alike.


In my view, Brod, Cone and Craft represent the parasites of our local government and national economy, with meritocracy based conclusions, ridicule of other opinions with support from their rentier constituents.

I believe these folks have done a great disservice to our community and are actively advocating the bankruptcy of our nation.

Andrew Brod

Bwa ha ha ha ha!

Tim Moreland

It's all to often the people that are all set with most of what they need in life that proclaim we can't afford to nanny the poor. I would submit the perhaps radical notion that we don't live in a world where everyone lives in the circumstances that they deserve. To proclaim such is a convenient little tool to justify the world that we have and pacify those who believe that it is a work in progress.

My family and I, all four of us, were uninsured this time last year. I am happy to report that we are all covered as of May 1st thanks to the ACA. My family and I are lucky enough to benefit from the law as it stands in North Carolina. It breaks my heart that those who likely need basic preventive care and coverage the most have become political pawns.

Hagan's stance is bold given what she is up against this year. Still, I can't help but think that my story is not unique. She's got my support.

Ed Cone

George, complaining about "ridicule of other opinions" in a comment where you call people "parasites" doesn't really track in a way I can follow. And ignoring substantive responses -- even agreement -- with your own comments in favor of just lobbing insults does seem like trolling. Let's not do that here. Thanks.


Tim, I am glad you have managed to benefit off the misery of others.

It saddens me, however, that you are comfortable with it.

Andrew Brod

Ignore the other troll, ignore the other troll...


Under the ACA most suffer via limited choice, limited job choice, penalties, etc. for the handful that do not.

It is not trolling to note that observation.

Neither is it trolling to observe the shift in society that has made it not only permissible, but, in fact, a place of honor to life off the efforts of others as long as it occurs through the grace of governance.

And lastly, denigration is not an argument, Brod.


What insult?

Describing what I think you and others do isn't an insult.

It's my view of who you are,what you do and who you do it for.

I am saying you are a lobbyist for our nation's status quo of taking from the poor and giving to the rich via the government and its cronies.

I believe that's what you do.

It's not an insult, it's an observation.

Maybe if you took it for what is was, you may change a little from the criticism, but I doubt it.

To me, along with most of the for profit press, you are the bad guys.

Nothing personal.


"Ignore the other troll, ignore the other troll..."

Great example Ed.

You rarely if ever tell Andrew not to insult as far as I can recall, which points to your partisanship of criticism.

Seems like you are ok with denigrating your opponents, but object to less when directed at your ends.

"Parasites" isn't an insult, as it accurately describes what you support, in my view.

How many families did Cone Health drive into bankruptcy last year?

What is the average take home comp for Cone's physicians?

Why didn't Cone ever release the info before they were made to?


What's the comparable pay in Canada and other single payer systems?

Our system is a rip off, you represent it, and support politicians who enable it.

Our system is a parasitic rip off of uninformed, intimidated patients, many of whom rely on government debt to pay over-sized incomes to our nation's healthcare industry.

And you and your buds support that system.

I call it a form of fascism.

I don't see how it could be called free market capitalism, because it's not free. Competition is stifled by lack of price transparency etc...

You represent a local monopoly.

Ed Cone

George, I have on occasion asked Andrew to refrain, or to temper his approach to keeping threads on track. But I do think you should take some responsibility for your own behavior.

Of course it's an insult to call someone a parasite. You can express your opinion in a less disparaging way.

What I find vexing is not that you disagree with people, it's that you don't really engage with people. Responses to your questions, and questions to you, are ignored. You ascribe negative motives to people and judge their behavior in ways I see as unsupported by argument or evidence, and you use innuendo and leading questions but offer few facts in context.

I asked you a direct question upthread: If by your logic I represent the bad things about a system, why don't I also represent the good things it does? (I have problems with that whole frame, but if you're going to use it you should be consistent. I think you misunderstand or misrepresent what it means to be involved in an organization and work for change from within, or to support a candidate or policy as the best option on the table while at the same time recognizing and working for better ideas).

Finally, I'm confused by your question that seems to compare single-payer systems favorably with our own, while in the same comment you seem to be championing vague notions of competition and capitalism. Which one is it that you are holding out as the ideal?


A system that doesn't charge a society's kids the cost of their parent's healthcare and retirement income.

Unfortunately, neither single payer for all or our overwhelmingly corrupt system seems to apply.

Ed Cone

So what is your solution?

What system would be your preference for the US? What incremental steps should be taken to move us closer to that preferred system?

What outcomes would you like to see in terms of health insurance coverage and healthcare delivery across the population?

What level of cost is reasonable, who should bear those costs, and how do we deal with people your plan leaves uncovered?

What parts of our existing national system work well and how can we preserve them and extend them? What does our local system do better than others in the region and nation, and how can we extend that?

What candidates and policies do you support, however tepidly, as the best realistic forces for change you see in the near future?


The outcomes are pretty set in stone I fear.

Currency debasement, war and attrition.

At some point, some kind of cap on how much everyone else has to pay for our elders will be put in place, via bankruptcy or forced austerity after confidence collapses.

I believe we have already passed the tipping point.

"Sooner than later a high enough proportion of a younger, underemployed, underpaid, educated and overly indebted generation will discover the betrayal.

I fear global standards of living for many may get much worse before getting better, and very few running for office want to say so. I believe we are somewhere near Peak Ponzi. The longer our children take to figure it out, the worse the likely outcomes before recovery."


Ed Cone

Seems like the healthcare system is the least of your worries, but as long as we still have one, how would you answer the questions I just asked you about it?


"some kind of cap on how much everyone else has to pay for our elders"

OK Clarice;

What is the average take home comp for Cone's physicians, including Pharma kickbacks, both private insurance, Medicare and Medicare supplement insurance?

I believe you would violate your fiduciary responsibility as a Cone Health Board Member if you answered the question.

You are who you are.

This has been a relative waste of my time.

Andrew Brod

Then please spend it elsewhere.

Hartzman is less oriented to capitalism vs. socialism than he is to his theory of debt and intergenerational equity. Debt is the hammer that makes everything look like a nail. Unfortunately, Hartzman misunderstands the implications of his own orientation. If he were to apply his signature analysis to himself, he'd say that his orientation serves the interests of the "rentiers" and therefore he's the one whose advocacy serves the elite and screws the poor and the middle. But he can't see that because he's blinded by his debt theory.

He's Polifrog with a calculator.

Hartzman can't even apply his own theory correctly. You'd think that a program that pays for itself and doesn't increase deficit spending would pass muster in the Hartzman mind. But not if it's the ACA. The law's potential to reduce the federal deficit is misinterpreted and ultimately dismissed by him. The result is that he's against a program that pays for itself in significant measure by taxing the rich and redistributing to the poor, and if anything improves the lot of our children and grandchildren.

Hartzman may be an ethical person, because after all he says he is. But I have no earthly idea what he stands for.

It's not off-topic to talk about or even insult Hartzman, because he injects himself into the issues he publicizes. His Wells Fargo whistle-blowing is always in the background. I happened upon a video he posted of his brother telling city council what a great guy he is. Hartzman is a brand and he doesn't take it lightly when that brand is criticized.

The fact that he's a reflexive innuendo-monger makes his contribution to intellectual discourse both poisonous and infantile. Not everything he says is wrong, but on those occasions when he says something important, I often ignore it because he's said so much that's not just wrong, but mean and irrelevant.

Hey, just an observation.

George, I have on occasion asked Andrew to refrain, or to temper his approach to keeping threads on track.

I has always assumed that was the intent behind tolerating Andrew's other less professional "voice".

Billy Jones

Ed Cone, as a board member of Cone Hospital perhaps you can explain why a recent Public Information Request I received from the City of Greensboro shows hundreds of thousands of dollars in payments to Cone Health on top of payments to the Cone Foundation?

Don't believe me? Call Jeffery Sykes, I gave him a copy.

Ed Cone

George, your vague suggestion about caps on coverage sounds a lot like Sarah Palin's "death panels." Even if this rationing were implemented, what impact would it have on overall costs and the system at large? If you want to replace the whole system and damn anyone working within it, what serious alternatives do you propose? Also, I agreed with you in this thread that the relationship between pharma and doctors merits close scrutiny, but you continue to write as if I'm a vocal advocate of pharma payments to doctors.

Also, don't parasites take things out of systems? Not sure how my involvement qualifies me as such.

Finally, I will see if I can find average MD salary info, but I'd guess that such employee information is not made public. In any case, it seems that more relevant queries would address different areas of medical practice, as an average of all physicians would obscure the sizable variations between them; salaries of system-employed docs vs non-employee MDs; salaries of local MDs vs others across the region; % of MD cost to total cost of care; and so on.

Billy, can you share more info with me? A system of Cone's size and scope has many touchpoints with the community. Thanks.

Andrew Brod

Hagan's website still doesn't feature health care in her Issues drop-down menu. But as of this morning, the home page has a link to her Medicaid remarks.

Fred Gregory

This blog post should be called Saving Private Hagan.

Okay bring on the denigration but overlooked in this discussion is the harbinger that is in plain sight.

Ed asks George " So what is your solution? "

Lets see how about a UK styled NHS ?

Millions wait a week to see GP

"Patients waited more than a week to see their GP on almost 50 million occasions last year, according to figures that illustrate the delays people face when accessing basic NHS care.
An analysis by the Royal College of GPs found that 47 million GP appointments in 2013 – one in six of all consultations – involved a wait of at least seven days to see a doctor or nurse.
In 2012, the figure was 40 million – suggesting a rise of 17 per cent, year on year. If the trend continues, projections suggest that next year 57 million GP appointments will involve a wait of a week or more.
Senior doctors last night warned GPs were buckling under the demands of an ageing population, and that too often only those who “shouted the loudest” were able to secure help quickly. Experts said some patients were forced to wait even longer than a week, with delays of up to a month for appointments at some surgeries."

Well it's not just a British run nightmare. We have our own inefficient government run health care system.

A fatal wait: Veterans languish and die on a VA hospital's secret list

"(CNN) -- At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.
The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources.
For six months, CNN has been reporting on extended delays in health care appointments suffered by veterans across the country and who died while waiting for appointments and care. But the new revelations about the Phoenix VA are perhaps the most disturbing and striking to come to light thus far."

From PolitFact:

"The nonpartisan Congressional Budget Office estimates that tens of millions will gain insurance, but the ACA was never expected to cover everyone. CBO says there will be 25 million fewer uninsured because of the law, as early as 2016. That leaves 31 million still uninsured .

New legislation would have to be passed to get to universal coverage. Despite expressing support back in 2003 for a “single-payer” health system, in which everyone has health insurance through the government, Obama hasn’t embraced the idea as a presidential candidate or while in office. Advocates for a single-payer system have been critical of the president for excluding them from discussions on overhauling the health care system."

Would you be among those, Ed ?

Ed Cone

It's not clear to me from your comment, Fred, what system you would prefer, and how you would address the failings in our current system. I do assume that your distaste for gubmint healthcare has caused you to reject Medicare.

I think the most realistic option for the US is probably something like the multi-payer, universal coverage approach used in Germany and other healthy, wealthy countries.

Andrew Brod

One thing is clear from the link on the UK's waiting times: It's not good to underfund a health system. The waiting-time problems appear to be a function of funding controversies under the Cameron government's austerity programs rather than the inherent problems of socialized medicine.

Of course, as soon as one reads "socialized medicine," one realizes that this link is utterly irrelevant to the U.S. discussion. The UK's NHS is socialized medicine, and not even the never-in-our-lifetimes option of single-payer goes that far. Socialized medicine isn't part of the debate here.

Andrew Brod

Nor is it relevant to note that the ACA won't generate universal coverage when, as the link itself says, it was expected to do so.

Fred Gregory

Ed ,

I was compelled to pay into Medicare while working and now my wife and I both pay monthly premiums , retired. Same as the ponzi scheme Social Security.

So what's your point ?

Oh, and since the 1990s, Germans eligible for statutory health insurance have been free to choose their insurer and can switch provider once every 12 months

" If you like your plan you can keep it " LIE OF THE YEAR !!

Ed Cone

Thanks, Fred, I'll mark you down as a fellow supporter of the German model.

Ian McDowell

I won't quite say the AFA has saved my life; Wake Baptist Cancer would have had to treat me even without insurance, although some of my meds, which retail for more than $5,000, would have been an issue. But it's sure made things easier.

Was diagnosed with leukemia last Summer. FMLA only protects your job for 12 weeks, and I'd already been out on leave from January to April of 2013, after my kidneys temporarily failed in December of 2012 due to a bad reaction to Zithromax (probably, although I was unable to interest a lawyer in going after my doc's PA for prescribing it, even though it seems to have a history of causing kidney problems). My employer actually put me on FMLA leave again although they didn't legally have to, but it expired on December 31st of last year and so did my job and my insurance.

So this year, without the AFA, I would have been faced with either getting insurance with a pre-existing condition or going through chemo without insurance. At the Exchange, I got a premium of $19 a month, although if I had it to do over again, I'd have gone for the $55 a month Blue Cross plan instead.

When the Hell did this blog come back?

Ian McDowell

Good to see George is still posting unreadable blank verse.


Kaddish for Ian;

I don't give much credence to the actual meaning,
but the way it sounds means a lot,
if some of the circumcised have been saying it for a few thousand years.

Yit•ga•dal ve•yit•ka•dash she•mei ra•ba
be•al•ma di•ve•ra chi•re•u•tei, ve•yam•lich mal•chu•tei
be•cha•yei•chon u•ve•yo•mei•chon u•ve•cha•yei de•chol beit Yis•ra•eil,
ba•a•ga•la u•vi•ze•man ka•riv, ve•i•me•ru: a•mein.
Ye•hei she•mei ra•ba me•va•rach le•a•lam u•le•al•mei al•ma•ya.
Yit•ba•rach ve•yish•ta•bach, ve•yit•pa•ar ve•yit•ro•mam ve•yit•na•sei,
ve•yit•ha•dar ve•yit•a•leh ve•yit•ha•lal she•mei de•ku•de•sha, be•rich hu,
le•ei•la min kol bi•re•cha•ta ve•shi•ra•ta,
tush•be•cha•ta ve•ne•che•ma•ta da•a•mi•ran be•alma, ve•i•me•ru: a•mein.

It’s kind of like talking to your great x 20 grandparents:

Forget what you give, value what you get,
return what you borrow, replace what you break,
and forgive quickly.

Do the right thing when no one’s looking,
leave others better off for having known you,
and the world a better place than you found it.

Give your family a better chance to succeed
than your forefathers gave your parents
and your parents gave you.

Do the most good, in the best way,
with as many people for as long as possible.

Hope everything happens the way it does.

Sing, laugh, cry, don’t worry, let go, feel good, love,
and have as much fun as soon as possible
with the least amount of risk for as long as you can.

Fred Gregory


As long as you are " marking " put me down for limited, small , little or no burdensome regulatory, pro 2nd amendment. strong national defense, low tax, non-intrusive, pro privacy
government !

From Scott Johnson:

" The incredible waste of money involved in Obamacare may not be the most important aspect of the wreckage it causes. Its tyrannical heart is surely the most important. Yet the waste is staggering, and this happens to be only one of its visible elements: “$474M for 4 failed Obamacare exchanges” (Massachusetts, Oregon, Nevada and Maryland).

If we can waste money like this, we must be rich. Rich beyond compare. Rich beyond the dreams of avarice, to borrow Samuel Johnson’s formulation. In any event, you may recall that in 2008 Obama promised to be all over waste like the failed Obamacare exchanges . When it comes to complete and utter BS, the man is an artist."

Ian McDowell

But not the Kaddish Yasom, at least not yet. Bone marrow biopsy came back with no leukemia cells. No more chemo or weekly labs.

Still need a job, though.


Ian, glad to hear you've recovered. Good luck on the job front.

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