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Author Topic: The right to free speech on healthcare
Adam Masterman
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quote:
I am sure this was the precise reaction of King George III to those colonists who just didn't know their place. I personally prefer people who speak their mind, especially when they put themselves in the line of fire by doing so.

Part of what is irksome about this action is that he didn't put himself in the line of fire. Regardless of legality/constitutionality, his claims that he *would* in fact treat someone who voted for Obama, despite the sign, is a clear attempt to avoid the consequences of his actions. He wants to make his little protest, but doesn't want to suffer any repercussions, so he come up with a transparent and lame qualifier. It may save him from legal ramifications, but it also makes him cowardly and scorn-worthy.

If he had posted a sign against the reform bill, and blamed it on Obama voters, I would staunchly defend his right to free speech. If he had gone further, and refused to treat Obama voters, I would consider it an unethical form of protest, but I would concede that he has the courage of his convictions, and is willing to sacrifice for what he feels is right. As it stands, he's just a petulant malcontent who doesn't really want to sacrifice anything.

I *still* feel that his actions should not be allowed to continue without consequences. He's getting the benefit of being able to turn away a bunch of people he doesn't like, but he isn't taking any responsibility for that. Something as simple as a qualifier on the sign, saying that its rhetorical and not actually his policy (which is what he is claiming) would satisfy this concern.

Adam

[ April 09, 2010, 06:17 PM: Message edited by: Adam Masterman ]

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Michelle
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quote:
I *still* feel that his actions should not be allowed to continue without consequences. He's getting the benefit of being able to turn away a bunch of people he doesn't like, but he isn't taking any responsibility for that. Something as simple as a qualifier on the sign, saying that its rhetorical and not actually his policy (which is what he is claiming) would satisfy this concern.
Fat chance of that happening. I bet his sign has him booked til doomsday with supporters, or at least people who read the bill and are as disgusted and appalled as he is. Too bad I have no need for an urologist.
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OpsanusTau
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quote:
You do realize that implicit, in this provision, is the right to terminate under all non-contracted arrangements, correct?
Um, no, actually it isn't. I suppose it might read that way if it were all by itself, but let me put it back in context (usually, when a sentence begins with "Furthermore...", it's necessary to know what happened in the sentence before to have a clear picture of the meaning).

quote:
A physician may decline to undertake the care of a patient whose medical condition is not within the physician's current competence. However, physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, gender identity, or any other basis that would constitute invidious discrimination. Furthermore, physicians who are obligated under pre-existing contractual arrangements may not decline to accept patients as provided by those arrangements.
As to your statement that "a timely refferral [sic] to another physician satisfies this condition entirely," yes, exactly. That is in fact what some of us are saying. I even quoted the part of the AMA Code of Ethics that says this. This is why it's hard for me to believe you're paying attention to what I'm writing here.
Putting a sign in your place of practice announcing that certain patients are no longer welcome effective immediately does not constitute a timely referral.

quote:
I am sure this was the precise reaction of King George III to those colonists who just didn't know their place.
And it's this kind of "argument" that makes it hard for me to take you seriously either. I support free speech to an extent that many people would call radical, and if this doctor were standing outside city hall (or anywhere else) saying whatever he wanted, I would support his right to do so long past where many people would.

But although we all have a right to free speech, we don't all have a right to practice medicine. The practice of medicine is restricted to those who have met certain criteria; those who have are given a great deal of trust by society, and it is appropriate to require that they continue to be worthy of that trust if they want to continue to practice medicine. Part of that trust is that they will provide care at need and without discrimination. If someone can't do that, someone should not be practicing medicine; fortunately, we have a tool to disallow someone from practicing medicine.

To put it another way - just being a doctor gives someone a ton of authority over their patients - it puts them (us? eek) up on a big pedestal. It is absolutely an abuse of power to stand on that pedestal and attempt to influence patients' politics.

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Greg Davidson
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I can't make a logical case for this, but I have a feeling that civic ethics call for us to be respectful in our political disagreements when we are in environments where people are present for reasons other than debate (such as in a job, or at a doctors).

In thinking about this,I lean pretty far towards there being a broad right of free speech, while simultaneously thinking there is a broad area of speech that is both allowed and wrong. I feel that aggressive advertisement of one's political convictions is inappropriate in many circumstances. When I was a government employee, I felt uncomfortable about having a political bumper sticker (and so I never did) - they drilled the Hatch Act into us pretty firmly.

As a supervisor in private industry, I thought long and hard before putting an Obama bumper sticker on my car because I did not want to have my employees feel pressured in any way about their political choices. I never would bring political materials into the office, but since we all tend to park right outside our building, my preferences were clearly identified. I wound up putting the bumper sticker on, and when several people who worked for me asked for reasons why, I was very careful to phrase things in a way that expressed positives I saw without casting negative aspersions about his opponents. In one staff meeting, an employee mentioned how impressed she was with Sarah Palin after seeing her in a rally in Orange County, and it was not my place to provide a rebuttal.

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Wayward Son
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Once again, as much as some like to praise this guy for practicing free speech, what he is actually doing is trying to limit the free speech of others, by using his position as a doctor to discourage others from voicing an opinion he is opposed to.

He could have voiced his opinion without intimidating others. But not with that sign.

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noel
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Adam,

quote:
Regardless of legality/constitutionality, his claims that he *would* in fact treat someone who voted for Obama, despite the sign, is a clear attempt to avoid the consequences of his actions.
quote:
I *still* feel that his actions should not be allowed to continue without consequences.
Somehow, this comes across to me as wishing for something more specific than "consequences". There are consequences, even as evidenced by this thread. What I think you are really wishing for is punishment.

Represenative Alan Grayson is trying, under the stupidest of pretexts, to transform the notorious sign into an actionable racial issue. I give him credit for having better legal sense than OT, in so far as he understands that neither the State Medical Board, nor the law, will not touch Dr. Cassell as the facts stand. I am curious however; if the law could be distorted to accomplish your desire, would you support the congressman's strategy?

OT,

quote:
To put it another way - just being a doctor gives someone a ton of authority over their patients - it puts them (us? eek) up on a big pedestal.
This does clarify some questions which I had.

Let me be the first to disabuse you of some dillusional impressions. A large number of us went to school with your colleagues prior to the acquisition of a god complex, which some med students eventually fell prey to. We know, firsthand, just how lacking in judgement you can be. There is no serious harm done, in a patient placing you upon a pedestal, unless you begin to actually believe your own press.

It is the same defect which our current Commander in Chief suffers from, in my opinion.

It might be helpful to remember when you were small in your own eyes... if there ever was such a time.

Greg,

quote:
I have a feeling that civic ethics call for us to be respectful in our political disagreements when we are in environments where people are present for reasons other than debate (such as in a job, or at a doctors)... there is a broad area of speech that is both allowed and wrong.
In a general sense, I do not think anyone will disagree with you. The disjuncture enters in the application of personal values. As difficult as it may be to realize, for those who still support Obama's agenda, conservatives identify his tactics as anything but civil, or ethical.

It is time for straight talk... let the chips fall where they may.

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noel
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OT,

quote:
Putting a sign in your place of practice announcing that certain patients are no longer welcome effective immediately does not constitute a timely referral.
Exactly how much time do you believe it takes for a patient to identify themselves as a BFD supporter, cancel their appointment, and obtain a referral... or do you really believe the average American is that much beneath you in basic intelligence?

I meant to ask this earlier, because there seems to be an extremely condescending core to your assumptions.

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Funean
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quote:
Let me be the first to disabuse you of some dillusional [sic] impressions. A large number of us went to school with your colleagues prior to the acquisition of a god complex, which some med students eventually fell prey to. We know, firsthand, just how lacking in judgement you can be. There is no serious harm done, in a patient placing you upon a pedestal, unless you begin to actually believe your own press.

Oh, come on. Not only are you inferring a whole boatload o' motive here, but this isn't about the putative "god complex" some doctors have (and contrary to your suggestions, it's mostly the older ones who suffer from that--particularly surgeons, IME--the younger ones run around in a constant state of terror that they'll screw up in some fatal way). It's about the moral authority we as patients hand over to the people we trust with our bodies and health.

It's well documented that there is an innate power imbalance in our relationships with the people who serve in these capacities--even when we intellectually know that they are, in a sense, our employees. It's why people in all these fields are prohibited from having, for example, sexual relationships with their patients and clients of any age, even former clients/patients in some cases. The interpersonal ethical responsibilities of people in these positions are spelled out as conditions of their entitlements to work in those fields, much more so than engineers, architects, scientists and other highly skilled professionals in highly responsible positions.

quote:
Exactly how much time do you believe it takes for a patient to ... obtain a referral
That's not the point, either. ("Referral," incidently, here means "recommendation of a trustworthy qualified practitioner in the same field," not the thing you have to get to see a specialist when you have an HMO.) The point is that if a physician is compelled to abort the doctor-patient relationship (leaving aside the good/bad reason question), he is required to either give the patient the name or names of other docs he feels are as close a match to himself as he can, OR give the patient sufficient time (and that's probably variably defined from code to code) to research and select a replacement. Putting a sign on the door that you see when you arrive for your appointment satisfies neither of these requirements. Unless it's because he's been arrested or incapacitated, any doctor can do better than that. He simply wasn't thinking about his patients, that's all--and I should think it would be a violation of anyone's standards for a doctor to use his practice as a pulpit for the expression of his views at the expense o his patients.

Again, regardless of what anyone thinks of all these requirements or what's been defined as a doctor's ethical responsiblities by other doctors, the fact remains that they are all part of a voluntary but binding agreement into which all doctors freely enter when they accept their licenses.

I get pretty tired of people agreeing to things when it benefits them, and then trying to find loopholes or argue that "but this (ie ME) is DIFFERENT!!" when it becomes inconvenient for them or when someone holds them accountable when they don't live up to their promises. I'm a bit surprised that some conservative members of this board don't seem to give this angle any weight--it was the first thing I thought of, but maybe that's because my father was a dentist and I know how seriously he took the ethical requirements of his own profession.

[ April 10, 2010, 12:04 PM: Message edited by: Funean ]

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Adam Masterman
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quote:
Somehow, this comes across to me as wishing for something more specific than "consequences". There are consequences, even as evidenced by this thread. What I think you are really wishing for is punishment.
[Roll Eyes] There really isn't any need to imagine any secret desires on my part to have a productive debate, Noel. Especially when my suggestion in that very post contradicts your surmise:

quote:
Something as simple as a qualifier on the sign, saying that its rhetorical and not actually his policy (which is what he is claiming) would satisfy this concern.


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Greg Davidson
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quote:
for those who still support Obama's agenda, conservatives identify his tactics as anything but civil, or ethical
I think this comment shows why we should all bend over backwards to demonstrate civility in political discourse. I believe that your characterization of his tactics is objectively untrue, unless you define "uncivil" and "unethical" such that they characterize almost all major legislation ever passed by Democrats and Republicans alike. Essentially, Obama had Congress vote on legislation after a lengthy debate - this following a very long campaign in which health care was clearly a major policy priority, and then an election where the Democrats won substantial majorities. This is fairly close to the textbook way that legislation is supposed to come to pass in a democracy. If there were stages of the legislative process that you found uncivil or unethical (such as the "Cornhusker compromise", a specialized provision for Nebraska-only that was temporarily in one of the bills), then you should find most major legislation to be uncivil or unethical in the same way.

Even if you find the content of his policies to be odious, that does not make his tactics uncivil or unethical. And just because one strongly believes that the President's policies are wrong, that does not guarantee that one is correct in one's assessment. Even if you are certain that a given President is wrong, you should have some humility and restraint in your prosthelytizing. I was fairly convinced that George W. Bush broke the law (FISA) in a far more important way then Bill Clinton (testimony in the Paula Jones case). It was clear to me that the U.S. government was giving itself powers that would have horrified the founding fathers (to seize any citizen, put them in prison, torture them, and kill them without any recourse as long as the President said the magic words "enemy combatant"). Clearly, these are strong opinions that President Bush was very wrong. However, in my sense of what is appropriate civic and ethical behavior, this level of clarity did not make it right for me to push my political opinions on others in my workplace.

Interesting, I did wind up getting into discussions at synagogue after services (when we usually have lunch as a community). I would never initiate a political topic, but once someone else started a discussion expounding on conservative perspectives, I felt that the floor was open for contrary opinions.

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noel
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Funean,

quote:
Oh, come on. Not only are you inferring a whole boatload o' motive here...
This thread would have ended on the first page absent "inferring a whole boatload" into Cassell's motives.

quote:
... intellectually know that they (physicians) are, in a sense, our employees.
Thankyou for that aknowledgement. If this was made more clear perhaps assertions of physician "power" would not become so exaggerated.

quote:
--------------------------------------------------------------------------------
Exactly how much time do you believe it takes for a patient to ... obtain a referral
--------------------------------------------------------------------------------

That's not the point, either. ("Referral," incidently, here means "recommendation of a trustworthy qualified practitioner in the same field," not the thing you have to get to see a specialist when you have an HMO.)

It is exactly the point, and we are using "referral" in the same way.

quote:
I know this was kind of a joke, inasmuch as he's not actually turning anyone away, but some of his patients will take the sign literally and go away, and that may qualify as de facto patient abandonment.
This is the kind of low-view expectation, of general public intelligence, that I was referring to.

Your hypothetical "de facto patient abandonment" requires;

- A patron reads the sign, and thinks it was a personal note left for him on the office door.

- He does not bother to approach the front desk to cancel his appointment, let alone pick up a referral.

- He walks away without the slightest notion of how to find another urologist... even though he found Cassell in the first place.

Do you have any idea of how patronizing that comes across? Some might "run around in a constant state of terror that they'll screw up in some fatal way", but it is a mistake to project the mind-set onto others.

quote:
It's about the moral authority we as patients hand over to the people we trust with our bodies and health.
... Yet another example of complete hubris. "We", as patients, do not hand over an iota of "moral authority" to physicians. Physicians are not in the morality business.

Adam,

quote:
There really isn't any need to imagine any secret desires on my part to have a productive debate, Noel. Especially when my suggestion in that very post contradicts your surmise:
Feel free to clarify in facilitation of a productive debate. What did you intend by this statement? :

quote:
I *still* feel that his actions should not be allowed to continue without consequences.
Greg,

quote:
Essentially, Obama had Congress vote on legislation after a lengthy debate - this following a very long campaign in which health care was clearly a major policy priority, and then an election where the Democrats won substantial majorities. This is fairly close to the textbook way that legislation is supposed to come to pass in a democracy.
This is an assertion on which you will be hard pressed to find any conservative agreement on a single one of your points. I would be happy to refute it one detail at a time, beginning with the claim that Obama campaigned on this monstrosity. He explicitly diverged from Ms. Rodham/Clinton on this very issue during public debates.

quote:
However, in my sense of what is appropriate civic and ethical behavior, this level of clarity did not make it right for me to push my political opinions on others in my workplace.
I am making conclusions, based on other clues within your posts, that you manage employees as an employee. You are duty bound not to bring politics into your employer's workplace. I appreciate that you honor your obligation to the best of your ability.

Resisting the heavy handed injection of BFD into the employer's workplace against his wishes, is another dynamic altogether.

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Funean
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quote:
This thread would have ended on the first page absent "inferring a whole boatload" into Cassell's motives
No, see, speculation and inferences into the motives of your fellow members is expressly against the rules of the forum. Public figures, politicians, and other folk in the news are fair game (obviously).

You can refer to the "rules" thread stickied at the top of the General Comments page, or see OSC's own standards here.

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Funean
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I've just read the rest of your post, and it's clear there are quite a few words that don't mean what you think they do ("referral" can't take a patient's time when it's something someone else has to do, and "moral authority" doesn't reference "morality," just for starters. And please see a dictionary for the definition of "hubris.").

I've endeavored to give you some credit for thoughtfulness and reasoned examination of the issues at hand, not to mention reading comprehension, but I believe I will save my efforts in future. I don't post often enough to spend that time on the sort of semi-argument you're presenting here.

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noel
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quote:
I've endeavored to give you some credit for thoughtfulness and reasoned examination of the issues at hand, not to mention reading comprehension, but I believe I will save my efforts in future. I don't post often enough to spend that time on the sort of semi-argument you're presenting here.
--------------------------------------------------------------------------------
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... And "hubris" means what again? [Wink]
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yossarian22c
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Actually noel I came to the same conclusion about discussing with you after you read no public option to mean the entire HCR was a public option. You also asserted this piece of nonsense:

quote:
There is only a single provider, and that is the one that has power to regulate.
Literally every industry in this country is regulated. Do you really mean that the government is the provider of every single product and service produced in the US?


I will say Noel that I have generally found you respectful and believe you attempt to engage in well intentioned debate; however you have misread/misinterpreted people's statements and responded to entirely different concerns than they raise.

I also pointed out one example above where you made such a sweeping broad claim to the point of absurdity.

Funean isn't an ideologue and is generally respected around here. Think about what it means about your arguments or at least your writing clarity when this type of person begins to find discussion with you more trouble than it is worth.

P.S. She doesn't post nearly as often as she has in the past. Just because she has a lot of posts to her name (generated over 5 years) doesn't mean she is currently posting a lot.

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LoverOfJoy
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Less than 5000 posts since 2005? That's hardly a ton.

Anyway, regarding the power issue, when you are in pain or your life/health is in jeopardy a specialist can indeed wield a lot of power over their "boss".

It is not always easy to just find another doctor (particularly when that doctor is a specialist). Another doctor may be booked and not accepting new clients (or unable to see them before some long period of time). When you're in pain and you're told that it'll be another 6 months before your new doctor can see you, that's a long 6 months. Imagine those 6 months pass and you come in for your appointment only to see a sign saying you should go find another doctor (and possibly wait another 6 months).

Then, to avoid very costly fees you are going to need to have your previous doctor transfer records. You don't want to have to pay for another MRI before you can have that needed surgery.

It's easy to say, buck up and go inside the building where you've essentially been told to go away and insist on being seen (or at the very least given a referral and gotten your records sent to your new doc. But it's just as easy to say buck up and take down or change the sign instead of misinform with it. Or simply buck up and treat the patient.

I think it's pretty patronizing to think the doctor can't be put upon to make the sign clearer to uphold the agreement he made when accepting a medical license.

Don't want to be bound by the licensing rules? Be an alternative medicine healer and avoid making medical claims. When we go to a doctor we expect a certain bare minimum of competency and professionalism. To post an M.D after your name and not follow the guidelines required to have that M.D. is an issue of false advertising, not free speech.

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Adam Masterman
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quote:
Feel free to clarify in facilitation of a productive debate. What did you intend by this statement? :

I *still* feel that his actions should not be allowed to continue without consequences.

Exactly what I said. I suggested a solution, remember? I could name many more, none of which have anything to do with "punishment", and everything to do with reasonable ethical codes for professional licenses.

I think yossarian may have a point regarding the mis-reading of posts.

Adam

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noel
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Y22,

quote:
The only thing I [Funean] will add (mostly for stayne's benefit, because I would prefer to stay on his good side since there are not so many people with whom I often disagree yet always have civil and friendly discussions)
I am at the disadvantage of not knowing who the "reasonable" members of this site are supposed to be, but these words would appear to be self explanatory, especially in light of her last post.

quote:
Actually noel I came to the same conclusion about discussing with you after you read no public option to mean the entire HCR was a public option. You also asserted this piece of nonsense:


quote:
--------------------------------------------------------------------------------
There is only a single provider, and that is the one that has power to regulate.

Y-22, I do not deal in nonsense, although your criticism of my writing clarity likely has some validity. I would have been pleased to defend the alleged "nonsense", but that is not the issue here.

quote:
I will say Noel that I have generally found you respectful and believe you attempt to engage in well intentioned debate; however you have misread/misinterpreted people's statements and responded to entirely different concerns than they raise.
Examples please...

and thankyou.

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noel
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Adam,

quote:
I could name many more, none of which have anything to do with "punishment", and everything to do with reasonable ethical codes for professional licenses.
So suspension, or penalties, associated with a professional license do not fall into one of your categories of punishment?

[ April 10, 2010, 04:58 PM: Message edited by: noel ]

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noel
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LOJ,

quote:
When you're in pain and you're told that it'll be another 6 months before your new doctor can see you, that's a long 6 months.
There is a member of my family that has had need of extensive medical services throughout her young life. I have never been required to wait for anywhere near six months to get her in... and she has had top-rated specialists in four different fields. What experience are you basing this comment on?

quote:
I think it's pretty patronizing to think the doctor can't be put upon to make the sign clearer to uphold the agreement he made when accepting a medical license.
This begs the question of what those responsibilites actually are.
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Greg Davidson
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noel, could you please explain further how your argument applies given modern patterns of corporate ownership?

quote:
I am making conclusions, based on other clues within your posts, that you manage employees as an employee. You are duty bound not to bring politics into your employer's workplace... Resisting the heavy handed injection of BFD into the employer's workplace against his wishes, is another dynamic altogether.
You are correct that I am not the sole owner of the large aerospace company for which I work. However, I literally am an owner of Northrop Grumman and many other corporations, in the sense that I hold shares of stock. Based on that stock ownership, I am to some degree "the employer". How many shares of stock do I need to own before my wishes regarding not injecting politics into the workplace must be observed? If I own too few, is there are certain minimum amount of shares that constitute ownership (like a majority)? If no own owns that threshold amount, then does the company not have an owner?
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LoverOfJoy
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quote:
There is a member of my family that has had need of extensive medical services throughout her young life. I have never been required to wait for anywhere near six months to get her in... and she has had top-rated specialists in four different fields. What experience are you basing this comment on?
My own personal experience. I, too, have needed extensive medical services throughout my young life (from age 11 until my twenties...though I still try to keep an eye on breakthroughs in case other specialists might be able to help).

Obviously every case is going to be different but I have on more than one occasion had to wait months to see a new specialist for one reason or another and other doctors didn't bat an eye when hearing about it. About 6 months is the highest I've seen personally but it wouldn't surprise me if others have had worse experiences.

Fortunately, during those 6 months I wasn't entirely without care. My referring physician was still available to me for medications and advice and as a contact person when I was taken to the hospital at one point. He simply wasn't able to help me much because I was beyond his expertise. Had he refused to see me or refer I would have been left high and dry, though.

Had the specialists refused me I likely would have been put on another waiting list as there were only 3 hospitals that my doctor was aware of that provided the level of care he recommended and apparently all are pretty well booked.

But the exact length is beside the point. Whether it's months or simply weeks or in some case even days can be a significant burden on someone in extreme pain.


quote:
quote:
I think it's pretty patronizing to think the doctor can't be put upon to make the sign clearer to uphold the agreement he made when accepting a medical license.
This begs the question of what those responsibilites actually are.
Haven't at least some of them been spelled out by other posters previously?
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noel
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Greg,

quote:
How many shares of stock do I need to own before my wishes regarding not injecting politics into the workplace must be observed?
I like that question. When you speak of wishes being observed, the obvious answer is a controlling stock interest... but you are asking something more subtle than that.

I think you are probing around what good business practice would demand, and the answer changes depending on the corporation that you have in mind. Smith&Wesson management made a corporate decision a few years ago, with left-leaning political overtones, that set them on their heels with the public, their employees, and the rest if the industry. From a stock holders standpoint, the move was a disaster, and their option was to sell stock... which many did. The company still has credibility problems with their customer base.

Other corporations, like Boeing, walk a different tight-rope, due to a mix in their product line. Your situation probably resembles this, and politics would be, almost universally, anathema in that setting.

Given that your role as a stockholder, and employee, are entirely seperate, this is a prudent tight-rope to walk in your capacity as a supervisor. It is an obligation that you have to your fellow stock holders.

LOJ,

quote:
But the exact length is beside the point. Whether it's months or simply weeks or in some case even days can be a significant burden on someone in extreme pain.
Unnecesssary pain is never welcome, but I do not believe that you are using the correct measure of someone else's duty to alleviate it. Once a physician agrees to take a patient on, they are obligated do so to the best of their ability... within the constraints of renumeration to treat. This comes with neither a guarantee of results, nor a lifetime committment to continue.

I feel for your experience with the limited resource availablity... but three hospitals are actually more than my daughter had to choose from. Stanford was pretty much our sole option on one occasion. My wife, and I, are fearful that one of these medical crises will come without options. My committment to non-socialized medical care is much more than ideological, as I want her choices maximized. Her life may depend on it.

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stayne
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quote:
Originally posted by Funean:


The only thing I will add (mostly for stayne's benefit, because I would prefer to stay on his good side since there are not so many people with whom I often disagree yet always have civil and friendly discussions) is that my example of the racist dentist was not meant to equivocate between the two situations but to demonstrate the disingenuousness of the claim that the sign doesn't ***really*** exclude patients, with an example of a form of discrimination that is both ethically and legally disallowed.

Why, thank you for that gracious compliment, Fun! [Big Grin] I do see the distinction you make, though I am not firmly on either side of the matter. While I can indeed see how some might view it as an explicit denial of service, I am also aware that language is often imprecise. That's one of the reasons 'legalese' exists.

Often, the only way to be certain we have communicated correctly, especially with the written word, is to ask for clarification. When this was done, the doctor did indeed clarify that he did not intend it as an actual denial of service.

"If you voted for Obama … seek urologic care elsewhere"

On first parse, it does seem like a denial of service. But taken with his clarification, it certainly can be parsed differently, as a gruff statement of preference, or even a very sarcastic joke. Or, also possibly, a backpedal on his original intent. How we take it really comes down to whether or not we are predisposed to think ill of the man. Barring a record of making weasly statements and backpeddling, I think it more practical and decent to accept his clarification. Neither you nor I would like to be pilloried for being misunderstood. We would want people to allow us to clarify our statements, exchange thoughts, and judge us on the deeper issue.

One might still take issue with his views and refuse to do business with him. But I, for one, would prefer we not call him dishonest or disingenuous without further evidence. Such attempts at mind reading are one of the things so very wrong with our political system these days. People are too quick to judge on first impression, without allowing for clarification. I don't think it serves anyone to become so cynical that we lose the ability to communicate except in sound bites.

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G2
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We've got another one:
quote:
While it may be years before most Americans feel the impact of President Obama’s health-care bill, a few patients in Scottsdale, Ariz., got a small taste of life under Obamacare last week when they arrived at their Dermatologist’s office only to see a sign with the following taped to the front door:

“If you voted for Obamacare, be aware these doors will close before it goes into effect.” The note is signed Joseph M. Scherzer M.D. and includes the following addendum: “****Unless Congress or the Courts repeal the BILL.”


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scifibum
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quote:
“If you voted for Obamacare, be aware these doors will close before it goes into effect.” The note is signed Joseph M. Scherzer M.D. and includes the following addendum: “****Unless Congress or the Courts repeal the BILL.”
LOL... so he wants federal legislators, in particular, to be aware that the doors will be closed? I wonder why he doesn't care to give notice to his actual patients.
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G2
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G2 thinks posting that on the front door would serve as notice to anyone visiting the offices. Should he close, no doubt a letter would go out to all patients. What makes you think he would not notify his patients?

[ April 14, 2010, 11:58 AM: Message edited by: G2 ]

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scifibum
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"If you voted for Obamacare, be aware" - so if I didn't vote for Obamacare, I don't need to care? Apparentely only a handful of politicians need to be aware. [Smile] Unless Scottsdale is where a lot of Congressmen take their rashes, this guy seems to have a pretty tenuous grasp of how legislation works, and even who might be affected by shutting down the practice.

Relax, G2, I'm just picking on the guy's sloppy wording. I think it's evidence he's an idiot, not that his patients won't know what he thinks he means. But he did get through medical school, apparently. More reason to screen my own doctors, I guess.

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G2
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quote:
Originally posted by scifibum:
"If you voted for Obamacare, be aware" - so if I didn't vote for Obamacare, I don't need to care? Apparentely only a handful of politicians need to be aware. [Smile] Unless Scottsdale is where a lot of Congressmen take their rashes, this guy seems to have a pretty tenuous grasp of how legislation works, and even who might be affected by shutting down the practice.

Relax, G2, I'm just picking on the guy's sloppy wording. I think it's evidence he's an idiot, not that his patients won't know what he thinks he means. But he did get through medical school, apparently. More reason to screen my own doctors, I guess.

G2 sees what you mean. Opposition to Obamacare can only come from the mentally challenged or, as Adam says, the insane. Is it time for re-education camps yet?
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Wayward Son
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Linkie to G2's latest article.

Interestingly enough, he is considering retiring because the stress of the increased bureaucracy in the bill, specifically the increased fines if you try to rip off the system. He would prefer that Medicare would be more lax about checking for fraud, because the paperwork and the stress of audits is too much for him.

Considering how many millions of dollars are estimated to be lost to fraud each year, making it easier or less costly to commit fraud does not seem to be fiscally responsible. It would be nice to hear his suggestions on how to prevent fraud without inconveniencing doctors.

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scifibum
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quote:
G2 sees what you mean. Opposition to Obamacare can only come from the mentally challenged or, as Adam says, the insane
I actually knew you'd interpret my post that way. You're quite predictable. No, I'm saying that the guy's demonstrated sloppy thinking (in the wording of his sign, not his political alignment) may indicate he's not very bright. That's all.

Adam didn't say "insane", G2. He's repeatedly pointed out that your distortion of what he did say into "insane" is wrong. Why do you keep repeating it?

Why not argue in good faith, dude?

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G2
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quote:
Originally posted by scifibum:
quote:
G2 sees what you mean. Opposition to Obamacare can only come from the mentally challenged or, as Adam says, the insane
I actually knew you'd interpret my post that way. You're quite predictable. No, I'm saying that the guy's demonstrated sloppy thinking (in the wording of his sign, not his political alignment) may indicate he's not very bright. That's all.
If you knew that's the way it would be interpreted then you must have meant to put that message out there. And, based on your last few words you think this guy is "not very bright", i.e. stupid. If you think G2 is misinterpreting, you sure seem bent of confirming G2's interpretation.

quote:
Originally posted by scifibum:
Adam didn't say "insane", G2. He's repeatedly pointed out that your distortion of what he did say into "insane" is wrong. Why do you keep repeating it?

Adam said this was a " a strong indicator of an unbalanced personality" which he later changed to "definitive proof". Once challenged, he tried to moderate back to "maybe" along with the standard ad hominem attack thinking it would be all the logic he needed to prove his point. So what is an "unbalanced personality"? If it's not something to do with a degraded mental state, then what must it be?

[ April 14, 2010, 01:25 PM: Message edited by: G2 ]

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Wayward Son
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quote:
If you knew that's the way it would be interpreted then you must have meant to put that message out there.
How would you have phrased it so as to avoid it being interpreted that way?
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TCB
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quote:
So what is an "unbalanced personality"? If it's not something to do with a degraded mental state, then what must it be?
To me "unbalanced" implies someone with personality problems, but a more or less normal life. "Insane" implies stark, raving madness.
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G2
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quote:
Originally posted by Wayward Son:
Linkie to G2's latest article.

Interestingly enough, he is considering retiring because the stress of the increased bureaucracy in the bill, specifically the increased fines if you try to rip off the system. He would prefer that Medicare would be more lax about checking for fraud, because the paperwork and the stress of audits is too much for him.

Considering how many millions of dollars are estimated to be lost to fraud each year, making it easier or less costly to commit fraud does not seem to be fiscally responsible. It would be nice to hear his suggestions on how to prevent fraud without inconveniencing doctors.

This is artful spin by implying he's retiring because it makes to too difficult for doctors to defraud the system.

Let's see his what he really says:
quote:
Scherzer said the bill’s emphasis on punitive measures for physicians not following government-prescribed treatment methods under Medicare would increase his anxiety level to the point he would no longer be able to practice medicine. The maximum fine was previously $10,000; under the bill it will now be capped at $50,000. Scherzer said the fine system makes seeing a Medicare patients a difficult and stressful exercise.

“Doctors have actually committed suicide over these things. There’s no insurance to cover it,” Scherzer said, calling the fine system “tremendously complicated and Frankensteinian.” “It’s absolutely impossible to be certain you’ve complied. I feel like when I see a Medicare patient I have the Sword of Damocles hanging over my head.”

The system is overwhelmingly complicated and, with another massive layer of bureaucracy laid on top of it, becoming even more complicated. It was virtually impossible to be in compliant before and now it is only going to be worse. Couple that with a quintupling of the fine makes practicing medicine impossibly stressful (to the point of suicides) and too financially risky.

This guy is looking down the road and seeing that he's on the hook for regulations that he is unable to comply with and that makes him vulnerable to financial ruin. Does his unwillingness to take that risk make him stupid or "mentally unbalanced"?

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G2
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quote:
Originally posted by Wayward Son:
quote:
If you knew that's the way it would be interpreted then you must have meant to put that message out there.
How would you have phrased it so as to avoid it being interpreted that way?
G2 would have avoided uses phrases like "it's evidence he's an idiot" and "may indicate he's not very bright".
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G2
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quote:
Originally posted by TCB:
quote:
So what is an "unbalanced personality"? If it's not something to do with a degraded mental state, then what must it be?
To me "unbalanced" implies someone with personality problems, but a more or less normal life. "Insane" implies stark, raving madness.
What is a "personality problem"? Is objection to a political ideology an indicator of a "personality problem"? Should it require treatment so that they have a "balanced personality" ?
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Wayward Son
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quote:
The system is overwhelmingly complicated and, with another massive layer of bureaucracy laid on top of it, becoming even more complicated. It was virtually impossible to be in compliant before and now it is only going to be worse.
From what the article stated, it sounds like they are using the same system as before. How is this adding "another massive layer of bureaucracy laid on top of it?" [Confused]
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scifibum
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G2, knowing that you will twist and misinterpret is not enough motivation to get me to bend over backwards to prevent the possibility. See you re: Adam. You are pretty insistent on your distortions.

Good talkin to ya, though.

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TCB
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quote:
What is a "personality problem"? Is objection to a political ideology an indicator of a "personality problem"? Should it require treatment so that they have a "balanced personality"?
Those last two are oddly off-topic questions. I'm guessing you're leading into your apparent suspicion that people who support health care reform think conservatives should be sent to political re-education camps. (I can't tell if you're joking about that.) Anyway, like scifi, I don't think I'll play this game.
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