# House passes "repeal and replace" **URL:** \ **Category:** Great Debates\ **Created:** [May 4, 2017, 8:53pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871 "2017-05-04T20:53:38Z")\ **Posts on this page:** 20\ **Page:** 32
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 8, 2017, 2:46pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/621 "2017-05-08T14:46:29Z")
> [@Bricker](#): > > There can be, in my opinion, little doubt that we as a country do much right with healthcare, and do much wrong. The U.S. has twice as many MRI scanners, per capita, as Canada does. More than twice as many CT scanners, per capita, are in the U.S. than are in the United Kingdom, another oft-presented champion of national medicine. > > Those are good metrics. Uh, nope. > **[MRI overuse is widespread, and dangerous to patients](https://www.kevinmd.com/2011/06/mri-overuse-widespread-dangerous-patients.html)** > > MRI needs to be judicious and scrutinized by the physician who ordered it. > [@](#): > > Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows. > > MRI is unnecessarily overused. In a study of 221 patients who had MRIs, the results showed that only 5.9% actually needed to have an MRI done. The remaining 94.1% of the patients sacrificed their time and money. What’s worse is that the use of MRI for screening isn’t as effective as other methods. ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [May 8, 2017, 3:02pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/622 "2017-05-08T15:02:00Z")
> [@GIGObuster](#): > > Uh, nope. > > [http://www.kevinmd.com/blog/2011/06/mri-overuse-widespread-dangerous-patients.html](http://www.kevinmd.com/blog/2011/06/mri-overuse-widespread-dangerous-patients.html) Dude, that’s not a cite. It’s merely one person’s opinion. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 8, 2017, 3:19pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/623 "2017-05-08T15:19:35Z")
> [@D\_Anconia](#): > > Dude, that’s not a cite. It’s merely one person’s opinion. Well, he is “social media’s leading physician voice.” But I still agree. That’s an opinion, not a study. Of course, mine is an opinion as well, so we’ve established that I disagree with social media’s leading physician voice. It’s frightening. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 8, 2017, 3:25pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/624 "2017-05-08T15:25:00Z")
[Here’s a CT study.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672242/) > [@](#): > > In actuality, there is abundant evidence demonstrating the considerable benefit of CT in managing emergency department (ED) patients, substantially outweighing its risks. This study was peer-reviewed (West J Emerg Med. 2008 May; 9(2): 120–122.), but admittedly not reviewed by social media’s leading physician voice. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [May 8, 2017, 3:36pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/625 "2017-05-08T15:36:25Z")
That’s not a study. It’s an op-ed. And it doesn’t claim that CTs aren’t overused. It acknowledges the possibility, but says the data used by the authors he’s criticizing is insufficient. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [May 8, 2017, 3:39pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/626 "2017-05-08T15:39:12Z")
> [@Bricker](#): > > Then couldn’t other states partner with California? Couldn’t California impose residency requirements? [No](https://supreme.justia.com/cases/federal/us/526/489/case.html), to the latter. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 8, 2017, 3:39pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/627 "2017-05-08T15:39:58Z")
> [@Richard\_Parker](#): > > That’s not a study. It’s an op-ed. > > And it doesn’t claim that CTs aren’t overused. It acknowledges the possibility, but says the data used by the authors he’s criticizing is insufficient. Oops. You’re right. I withdraw the claim that was a peer-reviewed study, or a study at all. And do you have a comment about GIGOBuster’s link? ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 8, 2017, 3:42pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/628 "2017-05-08T15:42:34Z")
> [@Really\_Not\_All\_That\_Bright](#): > > [No](https://supreme.justia.com/cases/federal/us/526/489/case.html), to the latter. OK, take residency requirements off the table. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [May 8, 2017, 3:48pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/629 "2017-05-08T15:48:32Z")
> [@Bricker](#): > > And do you have a comment about GIGOBuster’s link? Sure. I’m glad the linked doctor cited an actual [study](https://www.ncbi.nlm.nih.gov/pubmed/17296133). ISTM, the thing that should be debated is the merit of that study. I doubt I have the expertise to debate that subject, personally. Beyond that, I’d say that if you’re willing to spend some hours of your life posting on a message board about health policy (and here I mean the generic “you”), you should also consider reading what experts have to say on the subject. Like, in books. You should know how Singapore’s health system works before you roll into a GD thread brimming with knowledge about how to fix healthcare in the US, or full of confidence that if only you could turn this policy knob or that economic lever that you’d solve the problem of having a country spend 2x-4x what other countries spend with worse health outcomes overall. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 8, 2017, 3:49pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/630 "2017-05-08T15:49:39Z")
> [@D\_Anconia](#): > > Dude, that’s not a cite. It’s merely one person’s opinion. Not really, he is looking at the research that was done indeed. [http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html](http://www.nytimes.com/2011/10/29/health/mris-often-overused-often-mislead-doctors-warn.html) > [@](#): > > Dr. DiGiovanni did a similar study with foot and ankle patients, looking back at 221 consecutive patients over a three-month period, 201 of whom did not have fractures. More than 15 percent arrived with M.R.I.’s obtained by doctors they had seen before coming to Dr. DiGiovanni. Nearly 90 percent of those scans were unnecessary and half had interpretations that either made no difference to the patient’s diagnosis or were at odds with the diagnosis. > > “Patients often feel like they are getting better care if people are ordering fancy tests, and there are some patients who come in demanding an M.R.I. — that’s part of the problem,” he said. Link to study: > **[The diagnostic value of MRI in foot and ankle surgery - PubMed](https://pubmed.ncbi.nlm.nih.gov/17296133/)** > > This study suggests that many of the pre-referral foot or ankle MRI scans obtained before evaluation by a foot and ankle specialist are not necessary. Further studies need to be performed to determine the role of MRI in the screening of foot and... BTW there are people that have looked more recently and also see a problem with over testing: > **[America’s Epidemic of Unnecessary Care](https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande)** > > Millions of people get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions. > [@](#): > > The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste. > > The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments. > > Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive. BTW \*\*Bricker \*\*I actually did check before hand if the issue was seen by others, so this has been 2 times already that you are accusing me of being the only one with the power to make a judgement about an issue. As Richard Parker noted what you linked too was indeed just an opinion. You should had known already that yes, I do look at experts before letting others know. So give it up. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [May 8, 2017, 4:03pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/631 "2017-05-08T16:03:20Z")
Number of MRI machines can only be a good metric if we have defined an optimal number. If we decided to include MRI machines in every bathroom would we suddenly be a world health champion? The blindingly obvious most useful metrics are actual health measurements. Life expectancy, infant mortality, cancer/serious ailment survival rates, etc. ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [May 8, 2017, 4:08pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/632 "2017-05-08T16:08:53Z")
> [@GIGObuster](#): > > Not really, he is looking at the research that was done indeed. Maybe I missed it, but where in the link you posted in #621 does the social media guru provide a cite for where he’s getting his information from? ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [May 8, 2017, 4:15pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/633 "2017-05-08T16:15:41Z")
> [@D\_Anconia](#): > > Maybe I missed it, but where in the link you posted in #621 does the social media guru provide a cite for where he’s getting his information from? [The diagnostic value of MRI in foot and ankle surgery.](https://www.ncbi.nlm.nih.gov/pubmed/17296133) ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [May 8, 2017, 4:29pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/634 "2017-05-08T16:29:16Z")
> [@Bricker](#): > > Then couldn’t other states partner with California? Couldn’t California impose residency requirements? 1. Why would they bother-California is relieving them of a problem. 2. How hard is it to become a citizen of California, really? By the way, once the poor move in and those who can afford it and don’t want to participate move out, what keeps this scheme afloat? edited to add: And what stops the participating insurance company from moving out? ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [May 8, 2017, 5:27pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/635 "2017-05-08T17:27:38Z")
> [@running\_coach](#): > > [The diagnostic value of MRI in foot and ankle surgery.](https://www.ncbi.nlm.nih.gov/pubmed/17296133) Yes, but where is that in the link Gigo posted? ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [May 8, 2017, 5:29pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/636 "2017-05-08T17:29:41Z")
Do we wish to start carving on tombstones “Died to preserve federalism”? I think there is a difference between respecting the Constitution and treating it as a suicide pact. I admit that the founders were pretty sharp guys, for wealthy slaveowners. Back then, even the poor could give a doctor a chicken to set a broken bone. So the concept of healthcare as a right was never thought of then. Things are different now. Health care is so expensive now that any accident or severe chronic illness could bankrupt the average guy. We claim that all men are created equal, but do we really mean all men who can afford to stay alive? Except for the very elite, we’re all just getting by. For most of us, paying for as little as an appendectomy would consume most of our disposable cash for years if not decades. A lot of people have conditions that require a lot of money to treat. Without that treatment, they die. Without the ACA, often they couldn’t get insurance at any price. Now, the AHCA threatens to take that away and condemn millions of people to death. Why do Republicans want to kill all these people? To make more tax cuts for the rich. They don’t care about some theoretical principle of federalism, they want to reward their donors with untold riches. If some people die to make it happen, that’s a feature, not a bug. Those people don’t vote for them anyway. Specific quotes of interest: > [@](#): > > I don’t agree that providing everyone with health care is a proper role of government. 50 years ago, a valid point. Today, not so much. > [@](#): > > You don’t have to pay the government a penalty any more if you’re not buying insurance. Not a good idea. EVERYBODY will consume health care at some point, EVERYBODY should buy insurance else be a burden to the rest of us. Hard to believe the party of personal responsibility is in favor of people becoming slackers. > [@](#): > > Roads are built by states with the federal government’s involvement limited to its spending power. Not really, there are standards and specifications for highway and bridge design and construction, regardless of who funds the project. > [@](#): > > Yes I object to compulsory vaccinations. I think vaccinations are the absolute right thing to do though. I don’t think vaccinations are compulsory though, This is the unscientific viewpoint. For the safety of all of us and to conserve finite health care resources, they must be mandatory. > [@](#): > > I think if we really wanted a compassionate society we’d ban abortion, since aborting an unborn child represents an extraordinary lack of compassion towards the unborn child. Reasonable people disagree on whether or not the fetus has achieved personhood. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [May 8, 2017, 5:38pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/637 "2017-05-08T17:38:42Z")
> [@D\_Anconia](#): > > Yes, but where is that in the link Gigo posted? I seemed to have found it easily enough. Also, posts 629 and 630. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 8, 2017, 6:37pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/638 "2017-05-08T18:37:02Z")
> [@BobLibDem](#): > > Reasonable people disagree on whether or not the fetus has achieved personhood. Quite true. And: > [@BobLibDem](#): > > 50 years ago, a valid point. Today, not so much. Reasonable people disagree on this point, also. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [May 8, 2017, 6:45pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/639 "2017-05-08T18:45:40Z")
> [@BobLibDem](#): > > I think there is a difference between respecting the Constitution and treating it as a suicide pact This seems to be a very strange thing to say. I’m actually astonished that someone would say this. It’s too bad there wasn’t a way to change, or amend the Constitution to specifically call out rights that the people of the US feel are needed. Following the Constitution is a suicide pact??? Still can’t believe someone would say that. 😕😕 ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [May 8, 2017, 7:01pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/640 "2017-05-08T19:01:28Z")
> [@running\_coach](#): > > I seemed to have found it easily enough. > > Also, posts 629 and 630. That’s nice. Why didn’t GIGO post a link to the NIH or similar, instead of a link to the so-called “social media’s leading physician voice”? What’s next? A thread about legal issues with a link to a Judge Judy video? [Previous page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=31) [Next page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=33)