I can't wait until election-time politcal junkies start flooding vs! With beer talk!

[quote name='Msut77']Are you just going to deny that UHC is cheaper than what we had?

If so, just expect your complete denial of reality to be brought up whenever you post.

Also, it is not literally inconceivable but we do not have a system where you can just create a new more rational system from scratch. I consider it a pretty silly assertion that we have to fix some other random problem before considering any other by the way.[/QUOTE]

IMHO, the error that many people make is assuming that increased access to care will fix our healthcare system. I certainly had that viewpoint prior to practicing medicine. However, the problems are much more deeply rooted than that.

One of the bigwigs from our institution recently gave grand rounds on the changes in healthcare and how they will affect academic medical centers. When describing his research, he indicated that poor access to healthcare was only responsible for about 10% of the overall morbidity/mortality. 40% was attributable to poor behaviors (smoking, poor diet, obesity, substance abuse, lack of exercise, etc.) 30% was due to underlying genetic predispositions, 15% was due to social determinants, such as poverty, and 5% was due to environmental issues.

Currently, in the USA, we practice a rather aggressive brand of medicine that is designed to make people happy and to cover the physician’s ass, while achieving this in about 15 minutes so that you can see more patients and increase your billing. Thus, if you go to an emergency department (BTW, the ED is a dangerous place), you are likely to get a more extensive workup since it is easier and faster to order labs and imaging studies rather than to take a detailed history and examine the patient. So, a person with vague shortness of breath often ends up getting a CT scan of their thorax to rule out a pulmonary embolism even without any other objective signs… this is not an entirely benign procedure as one can (rarely) develop anaphylaxis to the contrast agent, can (more commonly) develop kidney injury due to the contrast material, and can have other incidental findings on CT that then lead to a further workup… plus, there is a small, but measurable increased risk of malignancy associated with studies that use ionizing radiation.

In the outpatient sphere, I see patients all the time with suboptimal medication regimens (usually too many medications)… this is driven both by pharmacological advertising and the fact that it is fast and easy to add-on medications. It takes time to carefully evaluate one’s regimen… in many cases people see numerous specialists and one may not know what the other has prescribed.

There is also a large proportion of patients who are the worried well or conversely, those with suboptimal psychological situations that manifest themselves as physical symptoms. The prototype of such a condition would be fibromyalgia. This has been studied and it was shown that fibromyalgia in an d of itself does not lead to any increase in physical morbidity or mortality, however, treating fibromyagia with pharmacotherapy does harm people. The only things that have been shown to be consistently effective are 1.) exercise and 2.) treatment of the underlying psychological comorbidities… this goes hand in hand with a new paper that came out which showed that patient satisfaction is actually linked to increased mortality (sometimes the physician has to the “bad guy”):
http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.1662

Sorry, that was way too long… in summary, my opinion is that our overall approach to healthcare is so screwed up that universal healthcare will, at most, have minimal effects on outcomes. We would get more bang for the buck with public health to educate people on healthy lifestyles.
 
[quote name='BigT']IMHO, the error that many people make is assuming that increased access to care will fix our healthcare system. I certainly had that viewpoint prior to practicing medicine. However, the problems are much more deeply rooted than that.[/quote]

Depends on how you define "fix", I consider everyone having access to the healthcare system the most important thing.

in summary, my opinion is that our overall approach to healthcare is so screwed up that universal healthcare will, at most, have minimal effects on outcomes. We would get more bang for the buck with public health to educate people on healthy lifestyles.
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A) Your overall point is just silly.

B) You can have both.
 
[quote name='Msut77']Depends on how you define "fix", I consider everyone having access to the healthcare system the most important thing.
[/quote]
Fair enough, but I disagree. Simply having access to healthcare is but a small component. For those under 50 (aside from accidents or self-induced problems), it's not very important to have access to routine care. The efficacy of screening programs is overestimated in general, and largely useless for the young. Prostate cancer screening is useless in people under 50 and of questionable utility in those older than that (a cochrane review has shown that it leads to 50 men getting treated unecessarily in order to save one life). Breast cancer screening is of questionable utility under age 50. From 50-75, it seems to reduce mortality, but still 10 ppl get treated unnecessarily to prevent 1 death (not to mention the DCIS epidemic). Cervical cancer screening has better data... but it is quite rare to start off with and has a long latency... so screening every 3 years is likely reasonable...

I would define "fix" as developing a health care system that provides appropriate healthcare and interventions to those that would benefit from them, such that morbidity and mortality are minimized while quality of life is maximized to the extent possible given our current knowledge base. This would ideally contain a strong component of palliative care, while avoiding unnecessary and often harmful procedures and prescribing practices.

A) Your overall point is just silly.

B) You can have both.
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A.) Based on what data? I challenge you to provide evidence that universal healthcare improves outcomes... I concede that this is very difficult to study with many confounding factors when attempting to compare different populations. Also, when studying this longitudinally, it is very difficult to separate out the effects of medical advancements. To my knowledge, there are no randomized controlled trials that compare universal access to our current system... though, these would be very difficult to do...

B.) Yes, we could, but when resources are limited, we should focus on the best return on our investment.
 
[quote name='BigT']Simply having access to healthcare is but a small component.[/quote]

It is life or death for many people and a huge quality of life issue for millions more.

A.) Based on what data? I challenge you to provide evidence that universal healthcare improves outcomes... I concede that this is very difficult to study with many confounding factors when attempting to compare different populations. Also, when studying this longitudinally, it is very difficult to separate out the effects of medical advancements. To my knowledge, there are no randomized controlled trials that compare universal access to our current system... though, these would be very difficult to do...
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I remember there being roughly a dozen links with stats for countries with UHC in the "obamacare" thread. I am not going to bother proving to you that increasing access to healthcare increases aggregate healthcare outcomes... again.

In a system where your access is tied to employment and only healthy people can obtain insurance people go through periods where they cannot see a doctor.
 
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BigT, I think we desperately need to put the focus back on healthcare instead of profit.

I heard a report on how penalizing hospitals for readmissions led to hospitals actually caring about the patients well-being instead of patching them up until the next ER payday.

If this doesn't make sense to you, read on.

One of the examples was a guy who was trying to commit suicide by smoking himself to death. He would leave the door open and call 911, because he didn't want to die alone.

Anyway after the hospitals started getting penalized for readmissions they were forced to think outside the box. Instead of the tranditional psyche counsel services recommendations that hadn't been working, they got the guy some nontraditional counseling (with a generous activist church lady in his area who shared his background) and it really turned his life around. No more readmissions.The policy worked like a charm.

We need to find these win-wins. The lure of profit only encourages waste like readmissions. The only way to fix the system, the only way to get the focus back on healthcare and away from the balance sheet, is with good policy.
 
I think BigT does see the writing on the wall insomuch as he recognizes how the profit motive of the pharmaceutical industry puts people in his office who don't need to be (but they saw the commercial!) and puts patients at risk because we're fucking overmedicated on the whole, and lord knows what interaction effects our meds are giving us (hypertension!).

It's a matter of recognizing that the profit motive is a source of problem in health care - which you see, BigT, in pharmaceuticals. Just extend it a bit further to the intersection of health insurance companies and care providers (your institution, for example). The two are inseparable, and I most certainly hold insurance far more responsible than care providers. But that does not mean there is a saint in the bunch.

Speaking of which, we do need to recognize that Americans treat themselves like shit in terms of what we consume - tobacco, engineered foods teeming with salt and fat, and massively lethargic activities (playstation!). Our lifestyle does undoubtedly have an impact on the cost of care, and we do need to recognize how we have contributed to that burden. Changing culture is going to be the largest obstacle of them all - but it can't be impossible. The average American did not consume 24oz. of soda per day half a century ago, yet they do today. That's a factor to be considered that we can't legislate away (except in cases like not allowing people to spend their EBT at Burger King and the like, but that's another issue almost entirely separate from health care).
 
[quote name='BigT']Fair enough, but I disagree. Simply having access to healthcare is but a small component. For those under 50 (aside from accidents or self-induced problems), it's not very important to have access to routine care. The efficacy of screening programs is overestimated in general, and largely useless for the young. Prostate cancer screening is useless in people under 50 and of questionable utility in those older than that (a cochrane review has shown that it leads to 50 men getting treated unecessarily in order to save one life). Breast cancer screening is of questionable utility under age 50. From 50-75, it seems to reduce mortality, but still 10 ppl get treated unnecessarily to prevent 1 death (not to mention the DCIS epidemic). Cervical cancer screening has better data... but it is quite rare to start off with and has a long latency... so screening every 3 years is likely reasonable...

I would define "fix" as developing a health care system that provides appropriate healthcare and interventions to those that would benefit from them, such that morbidity and mortality are minimized while quality of life is maximized to the extent possible given our current knowledge base. This would ideally contain a strong component of palliative care, while avoiding unnecessary and often harmful procedures and prescribing practices.

A.) Based on what data? I challenge you to provide evidence that universal healthcare improves outcomes... I concede that this is very difficult to study with many confounding factors when attempting to compare different populations. Also, when studying this longitudinally, it is very difficult to separate out the effects of medical advancements. To my knowledge, there are no randomized controlled trials that compare universal access to our current system... though, these would be very difficult to do...

B.) Yes, we could, but when resources are limited, we should focus on the best return on our investment.[/QUOTE]
You know, it's all fun and games in regards to "limited resourcs" and ROI until you're the one or someone that you love has an aggressive form of cancer that went undiagnosed during that window that you deem redundant or a waste.

I guess I shouldn't be surprised that that you think of someone elses life in terms of monetary value, but it takes a real special kind of person to think that way. And by special, I mean sociopathic.
 
[quote name='mykevermin']Changing culture is going to be the largest obstacle of them all - but it can't be impossible. The average American did not consume 24oz. of soda per day half a century ago, yet they do today. That's a factor to be considered that we can't legislate away (except in cases like not allowing people to spend their EBT at Burger King and the like, but that's another issue almost entirely separate from health care).[/QUOTE]

Americans are positively psychotic about health. We glorify skinny models and actresses, we worship atheletes, and then folks in the middle are proud to be fat. That's psychotic.

I think our consumption of alcohol is also an issue. Historically Americans are way down from what they used to drink in the past and we wonder why everyone is stressed out. Plus crap beer is everywhere.

The only silver lining is that sales of crap beer are on a steep decline and craft beers are coming back. :beer::beer::beer:
 
I'll stand in as the uneducated CAG visitor, since I really only come here to post petty ethical opinions and such. Truth is I'm very uncomfortable speaking about subjects I know very little about. How my peers can rant about war, politics, and the economy without any sense of embarrassment fascinates me. I love debates on subjects I understand, but I hate losing or sounding stupid. This doesn't seem to bother others I know.

So I'll shoot some naive questions and present some stances, albeit uninformed ones. Any information I could learn here would be great:

Health Care:

Most of what I hear about Obama's attempt at changing health care is that it's unconstitutional, as it mandates people who do not have insurance to register with a private insurer. That seems to be where all the "get government out of my life" attitude stemmed from, and the big socialist scare. People also say the plan was hugely expensive and wasteful, and there's a lot of talk of "I don't want to pay for my neighbor's health problems."

I understand the initial plan was much grander in scope, so has this lesser version really been a disaster? I heard it extended coverage to millions, and eased the suffering of many in the system. Exactly how effective was it? Universal health care is in nearly all other developed nations, so what is the primary drawback to their method that makes it so hard to accept in the U.S.? Everyone agrees that what we currently have is prohibitively expensive, so what are the alternatives?

I don't have a stance here, all I know is the mainstream talking points.

Economy:

Really don't know shit on this subject. If you asked me in public I'd shrug my shoulders and if I had to answer, it would be something like "raise taxes, cut spending, isn't that what you do?" All this about taxing corporations, distribution of welfare, and where the jobs come from -- feels like I'd need to read ~30 related books minimum before opening my mouth.

Middle East:

To me it seems like it's a critical region in the world both in terms of the resources it contains, and the instability and potential threat it poses to the rest of the world. To isolate ourselves as the world's leading military power and to not have a presence in the matter, I think would have far more horrible outcomes than what we've done so far. I don't deny the innumerable blunders during the wars there, but I do feel they were unavoidable interventions. It's not that I want conflict, I just don't see a very optimistic alternative where the middle east isn't being closely monitored.

Is that a reasonable stance? Because I don't want to abandon the entire region, but I also don't want to carpet bomb all of Iran.

Gay Marriage/Abortion/Drug Legalization:

I bunch these together because I feel they're so easy to answer.

Gay marriage should of course be legal for reasons no one should have to explain, banning abortion is hugely impractical in a society not prepared for it (so talk about being for or against it seems irrelevant at this point), and I don't see the negatives of legalizing drugs, but I'm unclear on the financial benefits of taxing versus fining criminals in possession.

Ron Paul:

I'd also appreciate a run down on Ron Paul and why he is or isn't the answer. I hear a lot from pro-paul folks in day to day conversation and although they know nothing of what they're talking about, I'm too intimidated to form an opinion of my own at this point. What era is Paul referring back to with going back to the rights of States? Why is this considered impractical?

Right now, the only reason I'm not a huge fan is because he doesn't seem all to concerned with the middle east.








So yeah, I'm one of those wishy washy "I'll just stick with Obama to be safe" guys. Maybe I represent a sizable demographic that doesn't really understand a whole lot, so use this as an opportunity to enlighten. How does the common voter become an educated one? Book recommendation would be fantastic.
 
[quote name='camoor']
The only silver lining is that sales of crap beer are on a steep decline and craft beers are coming back. :beer::beer::beer:[/QUOTE]

I'll drink to that :beer:

It's awesome how quickly the craft beer movement has exploded. America went from having the worst beer scene imaginable to having one of the best in the world after the past 10 years or so.
 
[quote name='dmaul1114']I'll drink to that :beer:

It's awesome how quickly the craft beer movement has exploded. America went from having the worst beer scene imaginable to having one of the best in the world after the past 10 years or so.[/QUOTE]
I blame Michelob and Budweiser.:lol:

And DAMN, Panzerfaust! Do you own damn homework!!;)

I kid...I'll write something up for you later this afternoon.:)
 
[quote name='dohdough']I blame Michelob and Budweiser.:lol:
[/QUOTE]

It was partly that. But also that after Prohibition beer was restricted to 3.2% for a long time. And even after that went away many states had laws capping it at 5-6%. That kept a lot of styles from being made a sold.

The explosion of micro brews is due to those laws losening, as well as brewers/beers like Sam Adams, Sierra Nevada and imports like Guinness catching on and broadening people's palettes for beer, and paving the way for all the microbreweries and brew pubs to burst on to the scene.
 
Prohibition ended with the 21st, but homebrewing was made legal again much later, under Carter.

Then you had to allow time for the market to adapt (i.e., make a market for homebrewing), create distribution chains for goods used in homebrewing, give time for the culture to develop, meet, discuss, grow, and (perhaps most importantly) rediscover styles and recipes that had long been abandoned in the United States.

So it was a decade or so later that we got breweries that were certainly 'craft' at the time, but today are perhaps viewed as poor (or milquetoast) examples of their craft - Pete's Wicked, Sierra Nevada, Brooklyn Brewey, etc. That was regional by the late 80's, but somewhat national by the early-to-mid 90's. 20 years later, and many cities have huge beer scenes of local and regional craft, homebrewers groups, beer snobs, etc. Colorado (too many to mention) is hella well known, as is parts of Michigan (Bells, Founders) and the Northeast (Dogfish Head, Victory, Yards). And I'm sure some of you are thinking "but what about ?" Yeah, you're right. Beer culture has grown and changed that much.

Which is why Miller SAB, InBev are buying up craft breweries (Rolling Rock and Goose Island are the two that come to mind). They don't see Bud or Miller growing their market share, so they might as well sop up the growing market share a tenth of a percent at a time.

This thread rules.
 
Honestly I hated beer until I started drinking Sam Adams and John Harvard's pumpkin spice. I am not a beer connoisseur but I like sampling local brews in rotation at the local bar/restaurant.

There's a good reason the craft and micro brewed beers are taking off, Budweiser and Coors are just awful.
 
[quote name='Spokker']Something must be done because our health care system is in shambles. The direction to go is what's being debated. Very few people are advocating that nothing be done.[/QUOTE]

I don't know man. I think a person can still get better healthcare here than in most places. The problem is the cost and the barriers to access. Face it, you're fucked if you do something as banal as tearing an ACL. If you have a severe medical episode (i.e. potential death, cancer, unexplained rapid anal bleeding, etc...) you're just completely bent over the barrel when it comes time to pay those bills.

The fear mongers will tell you that Universal Care will lead to people going to the doctor when they have a splinter because "hey it's free now!" which is pretty far-fetched. You still have people (like me) who will never go to a doctor unless something is broken or I have a near-death fever thing going. Doctor's are terrible people (no offense BigT) that enjoy poking and prodding.
The fear mongers also think that UHC would mean that you're paying for someone else's care with your tax dollars. Somehow the logical equation of doing the same thing with your current insurance premiums is so utterly beyond their scope of cognitive ability that it doesn't connect. Try explaing to someone that (if) tax dollars are used for healthcare and you get a tax refund you're ahead in the HC cost game (on a personal level) when compared to getting nothing back from your insurer whether you use the care or not. It's really fun to see the reaction. The facial expression is kind of like seeing someone catch wind of a particularly viscious fart.

But then there's those pesky death panels... I love how that buzzword has completely been death paneled.
 
[quote name='panzerfaust']I'll stand in as the uneducated CAG visitor, since I really only come here to post petty ethical opinions and such. Truth is I'm very uncomfortable speaking about subjects I know very little about. How my peers can rant about war, politics, and the economy without any sense of embarrassment fascinates me. I love debates on subjects I understand, but I hate losing or sounding stupid. This doesn't seem to bother others I know.

So I'll shoot some naive questions and present some stances, albeit uninformed ones. Any information I could learn here would be great:[/QUOTE]
You're asking for A LOT of info, so this will be pretty barebones. I'm sure that others and myself will be able to answer follow-ups in more detail.

Health Care:

Most of what I hear about Obama's attempt at changing health care is that it's unconstitutional, as it mandates people who do not have insurance to register with a private insurer. That seems to be where all the "get government out of my life" attitude stemmed from, and the big socialist scare. People also say the plan was hugely expensive and wasteful, and there's a lot of talk of "I don't want to pay for my neighbor's health problems."

I understand the initial plan was much grander in scope, so has this lesser version really been a disaster? I heard it extended coverage to millions, and eased the suffering of many in the system. Exactly how effective was it? Universal health care is in nearly all other developed nations, so what is the primary drawback to their method that makes it so hard to accept in the U.S.? Everyone agrees that what we currently have is prohibitively expensive, so what are the alternatives?

I don't have a stance here, all I know is the mainstream talking points.
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The mandate issue is part of the problem, but also requiring insurance companies to expand coverage to older dependants and pre-existing conditions is problematic for some as well, in regards to telling a business what they can or can't do. Death panels was another, but insurance companies have already been occupying that role for decades and not wanting to cover someone else is the exact opposite of how insurance works because the point is to pool risk.

There were mummerings of a "public option" for people that aren't able to afford private insurance at full cost, but that was quickly sidelined over the whole death panel/"hands off my medicare"/socialism/communism lunacy that had a part to play in what is now affectionately known as Obamacare aka Patient Protection and Affordable Care Act.

The silliest thing about the whole debacle is that almost every part of PPACA is a Republican plan to oppose UHC that was written in the 90's. That mandate that conservatives are pissed about? That was a Republican idea.

Some of the provisions have kicked-in like being able to go under your parent's insurance until you're 25? and not being able to reject people with pre-existing conditions, but most of the big stuff will kick-in in 2014.

Economy:

Really don't know shit on this subject. If you asked me in public I'd shrug my shoulders and if I had to answer, it would be something like "raise taxes, cut spending, isn't that what you do?" All this about taxing corporations, distribution of welfare, and where the jobs come from -- feels like I'd need to read ~30 related books minimum before opening my mouth.
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I'm not sure how much you know, but the simplest I can put it is that there are two schools of thought on this: trickle-up(aka demand-side/Keynesian economics) and trickle-down(supply-side/Austrian economics). I'm going to use a layman's use of terminology to make it easier to understand, so for the people that know more, get off my case!:lol:

Supply-side pretty much says that people with the most money will drive the economy because they hire people to do this or do that and assumes that people are completely rational as to make sure they trickle enough money down the ladder to keep the system going. In a perfect world, supply-side CAN work, but we don't live in a perfect world.

Demand-side says that if more people have money, the better the economy will be driven because more money their is at the bottom would mean more money would trickle to the top. So, when you have massive levels of unemployment and low wages, the economy grinds to a halt. This is exactly what we're seeing now.

When we have an economic crisis, supply-siders will insist that we cut taxes and let the free market do their thing, where as demand-siders will say we need to raise taxes and to exercise more control over the economy to lessen the effects of the boom/bust cycle. Enough proper intervention can actually prevent them, but that's for another discussion.

Middle East:

To me it seems like it's a critical region in the world both in terms of the resources it contains, and the instability and potential threat it poses to the rest of the world. To isolate ourselves as the world's leading military power and to not have a presence in the matter, I think would have far more horrible outcomes than what we've done so far. I don't deny the innumerable blunders during the wars there, but I do feel they were unavoidable interventions. It's not that I want conflict, I just don't see a very optimistic alternative where the middle east isn't being closely monitored.

Is that a reasonable stance? Because I don't want to abandon the entire region, but I also don't want to carpet bomb all of Iran.
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To understand the Middle East, you have to know the history of that region primarily after WW2, especially in regards to foreign influence of both the US and USSR. Long story short, the Middle East was leaning socialist with the USSR backing and the US sent in the Taliban to take over. What we see today is a result of heavy US intervention. It's not so much that we're fighting to spread freedom, but just cleaning up the mess we made.

Gay Marriage/Abortion/Drug Legalization:

I bunch these together because I feel they're so easy to answer.

Gay marriage should of course be legal for reasons no one should have to explain, banning abortion is hugely impractical in a society not prepared for it (so talk about being for or against it seems irrelevant at this point), and I don't see the negatives of legalizing drugs, but I'm unclear on the financial benefits of taxing versus fining criminals in possession.
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Not much to say here except that without proper treatment programs for addicts and even if there were, it's hard to support legalization because of the nature of drug abuse, but it should be decriminalized, but that brings a host of problems with it as well.

Ron Paul:

I'd also appreciate a run down on Ron Paul and why he is or isn't the answer. I hear a lot from pro-paul folks in day to day conversation and although they know nothing of what they're talking about, I'm too intimidated to form an opinion of my own at this point. What era is Paul referring back to with going back to the rights of States? Why is this considered impractical?

Right now, the only reason I'm not a huge fan is because he doesn't seem all to concerned with the middle east.
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Ahhhh yes...Ron Paul...my favorite politician. The problem with Ron Paul is that he is usually the first politician they hear about when they start becoming politically conscious in college because people seem to think that he wants to legalize drugs and end foreign wars. The problem is that he doesn't think any of that at all; just that the federal government shouldn't be able to dictate it. Whereas if a state wanted to throw you in jail for life for being caught with a joint? Welp, state's rights!

As for his fetish with the Constitution, I'd say that he probably stops at the Bill of Rights.

So yeah, I'm one of those wishy washy "I'll just stick with Obama to be safe" guys. Maybe I represent a sizable demographic that doesn't really understand a whole lot, so use this as an opportunity to enlighten. How does the common voter become an educated one? Book recommendation would be fantastic.
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I cannot recommend "Lies My Teacher Told Me" enough as a start. It's actually a pretty neutral view of history and not some liberal screed.

I originally meant for this post to be a little more detailed, but I gotta run an errand.
 
don't forget Surly in your beer list. Hell and Cynicale make me feel happy!

My favourite thing about the constittution weirdos is how averse they are to the changing world. I mean, there's nothing about cell phones in there so they can't be legal right? Then of course you start considering how many times the damn thing has been amended and the realization that it isn't set in stone (or even applicable to most of our daily lives anymore) and the whole deal starts to fall apart.
 
Don't hit me over the head with a Dogfish bottle, but liquor > beer. Specifically, scotch > beer.
 
I've never got much into liquor. I enjoy the occasional bourbon or scotch, and like margaritas (rocks with salt) on a hot summer day. But I just love the taste of a good IPA, stout, porter or barley wine to any type of liquor or wine etc.
 
I've just never had a beer I liked, it all tastes like cardboard to me (don't ask how I know what that tastes like...).
 
IPA is ok, but I really prefer a good Irish Stout. I'm not a huge fan of whisky as I'm more of a cognac fan. Oh, and I HATE wheat beer...especially Blue Moon. fuck that wheat shit!:D
 
^ DON'T YOU GO TALKING SHIT ABOUT IPAS IN HERE.

*cough*

Not sure if we get Surly in the NE. I've had my fair share while in Minneapolis, though.

But we have so much good beer out here it's hard to say I miss it.
 
[quote name='mykevermin']^ DON'T YOU GO TALKING SHIT ABOUT IPAS IN HERE.

*cough*

Not sure if we get Surly in the NE. I've had my fair share while in Minneapolis, though.

But we have so much good beer out here it's hard to say I miss it.[/QUOTE]


Speaking of IPAs, next time your down this way be sure to find the Mug Shot IPA from Jailhouse Brewing. They're a new GA brewery, and it's a pretty kick ass IPA. Their Breakout Stout is pretty damn good too.

They have a double IPA, but I've not been able to find it yet. One place had it on tap but had ran out earlier in the day that I was there.
 
I've honestly forgotten what good beer tastes like myself. Being broker than a joke, mostly only been buying Steel Reserve for the past few years
 
[quote name='mykevermin']^ DON'T YOU GO TALKING SHIT ABOUT IPAS IN HERE.

*cough*

Not sure if we get Surly in the NE. I've had my fair share while in Minneapolis, though.

But we have so much good beer out here it's hard to say I miss it.[/QUOTE]
You know what? I would rather drink some skunky miller lite than drink IPA! WHAT D'YA THINK OF THAT YOU FILTHY COMMIE!
 
I would just like to make a small contribution.

unibroue-la-fin-du-monde.jpg

Don't know about its availability in the US; I have trouble enough getting it in western Canada (with the exception of one bizarre liquor store staffed by a Moira Brown lookalike in a nearly abandoned mining town near the Alberta/BC border that was partially destroyed by a rockslide in the early 1900s). Might be able to find it in northeastern US.
 
[quote name='nasum']I don't know man. I think a person can still get better healthcare here than in most places. The problem is the cost and the barriers to access. Face it, you're fucked if you do something as banal as tearing an ACL. If you have a severe medical episode (i.e. potential death, cancer, unexplained rapid anal bleeding, etc...) you're just completely bent over the barrel when it comes time to pay those bills.

The fear mongers will tell you that Universal Care will lead to people going to the doctor when they have a splinter because "hey it's free now!" which is pretty far-fetched. You still have people (like me) who will never go to a doctor unless something is broken or I have a near-death fever thing going. Doctor's are terrible people (no offense BigT) that enjoy poking and prodding.
[/QUOTE]

I am of the opinion that we should have medical insurance in the true sense of the word... if an emergency occurs or you develop a serious condition, you will be covered. For the routine stuff, people should pay based on their utilization.

And... while I don't agree that doctors are necessarily terrible people, they are dangerous people... I'd probably be the first one to refuse emergency care, to refuse admission, or to leave against medical advice (BTW, there is no insurance penalty for that). You couldn't pay me enough to go to an emergency room unless I were exsanguinating. Also, please don't go to a primary care doctor for a cold (just take some tylenol, benadryl, and sudafed if you are young; if you are elderly, skip the benadryl)...

Another thing is that ppl tend to overestimate the efficacy of medical care, especially in end-of-life situations. Repeat after me: DNR/DNI/Comfort Care! I would never want anyone to resucitate me if I had serious underlying conditions (the chance of meaningful recovery is infinitesimal). Here's a good read:
http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/
 
Unibroue is pretty easy to come by in the US. They regularly collaborate w/ Trader Joe's stores for special brews offered there.

Now, if only PA didn't have puritanical liquor laws (picture "Strange Brew," Crotch), I'd be able to get that and 2 buck 3 buck chuck at their stores.
 
[quote name='camoor']BigT, I think we desperately need to put the focus back on healthcare instead of profit.

I heard a report on how penalizing hospitals for readmissions led to hospitals actually caring about the patients well-being instead of patching them up until the next ER payday.

If this doesn't make sense to you, read on.

One of the examples was a guy who was trying to commit suicide by smoking himself to death. He would leave the door open and call 911, because he didn't want to die alone.

Anyway after the hospitals started getting penalized for readmissions they were forced to think outside the box. Instead of the tranditional psyche counsel services recommendations that hadn't been working, they got the guy some nontraditional counseling (with a generous activist church lady in his area who shared his background) and it really turned his life around. No more readmissions.The policy worked like a charm.

We need to find these win-wins. The lure of profit only encourages waste like readmissions. The only way to fix the system, the only way to get the focus back on healthcare and away from the balance sheet, is with good policy.[/QUOTE]

The whole issue of discharge planning and transitions of care is a big topic in medicine nowadays. Essentially, for a long time the big focus has been on reducing length of stay and avoiding in hospital adverse events... in order to maximize profit based on how medicare reimburses.

Reducing readmissions is a newer focus, and it's more complicated than it seems. Several factors are at play.
* Patients are taken care of by hospitalists who don't follow-up with them after discharge.
* Doctors are expected to see more patients in a given amount of time as this raises RVUs and therefore profit.
* There is poor communication between the patient's hospitalist and primary care doc.
* There is still pressure from case managers and insurance companies to discharge fast.
* To play devil's advocate, hospitals are dangerous places... people pick up highly resistant bacteria, can become delirious and fall quite often...
* Lots of patients have poor habits, or are homeless, or are addicted to various substances, or are unwilling to make changes... i.e., you can lead a horse to water...

-The out of the box examples that you mentioned are currently very difficult to implement... trust me, I've tried... and we work with social workers/case managers all the time. However, usually, the goal ends up turfing the person somewhere else, so that he or she is no longer your problem... sad, but true.

Going along with this threads alcohol theme...another related pet peeve is how we treat patients with addiction... the US is so obsessed with its temperance tradition, that it is nearly impossible to practice harm reduction. If I admit someone who is addicted to heroin and they need some long term care or are homeless, it becomes almost impossible to place them... recovery homes or programs are built on the AA/NA 12-step religion and require abstinence... board and care's often won't take people on opiates used to treat addiction...
 
I like the flying bitch IPA. Come on now - hops never killed noone.

[quote name='HumanSnatcher']I've honestly forgotten what good beer tastes like myself. Being broker than a joke, mostly only been buying Steel Reserve for the past few years[/QUOTE]

Yeow. You might as well punch yourself in the liver

If I was broke I'd hit up that Evan Williams. Not great stuff - but great for the price.
 
they'll send you to the bin for putting a mouse in dad's elsinore....

myke, when did you live in mpls and why didn't we ever cage fight? And why in god's name would you drink that Charles Saw dishwater?
 
[quote name='camoor']I like the flying bitch IPA. Come on now - hops never killed noone.



Yeow. You might as well punch yourself in the liver

If I was broke I'd hit up that Evan Williams. Not great stuff - but great for the price.[/QUOTE]

I think between that and the cheapo vodka I get (try $12 a half gallon), trust me, I'm honestly thinking that I'm starting to feel it. Literally. And I'm only 28 (less than 2 months shy of 29). Basically a borderline functional alcoholic binge drinker here. Thankfully moving back in with my parents has seriously curtailed that
 
[quote name='The Crotch']You always know how to make culturally appropriate references.[/QUOTE]

Whenever I go into a beer distributor in Philly (you can only buy beer by the case unless it's at a bar), I want to ask for a case of Elsinore.

nasum, I never lived in Mpls, but I've been there enough times and have some good friends (bike punks, triple rock cooks and a couple people who are close with the extreme noise crusties) who live up there.

EDIT: oh, I can see how you misread what I said as living in Mpls. Hmm. Well, I'm good friends with people that love to drink and hate to sleep, so I've spent plenty of time up to my neck in cans (craft cans still makes me giggle) of Surly and bottles of Summit (meh).

Speaking of friends, dmaul - my friends had to pack up and move to Seattle. One is still behind trying to sell their house in grant park, but his western move is imminent. Since the WFTDA Championships are in Atlanta this November, I'll probably be there for that, unless ASC is the same week (they've been one week off of each other for three years now, so I have my fingers crossed).

EDIT: Oh, snap. Two weeks apart. So I won't be out of town for 11-14 days straight, save for like 1 night in my own bed. Huzzah. I'm already planning on hitting up Six Feet Under for the tacos.

fuck all y'all politics. Sorry, had to stay on topic somehow.
 
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[quote name='HumanSnatcher']I think between that and the cheapo vodka I get (try $12 a half gallon), trust me, I'm honestly thinking that I'm starting to feel it. Literally. And I'm only 28 (less than 2 months shy of 29). Basically a borderline functional alcoholic binge drinker here. Thankfully moving back in with my parents has seriously curtailed that[/QUOTE]

Yeah I think family living is a good thing. It's how the Europeans do it, and they seem to live a pretty good life.
 
Didn't really want to move back in with my parents. Me and my ex got evicted from our apartment back in mid Nov. Moved in with some dyke (yes I use that term about her because shes the atypical bitch dyke) from his church. I decided to move back in with my parents when it became evident that we were ONLY there to be her house maid service. Literally, she couldn't be bothered to lift a finger to do a damn thing for herself.

I think that this thread has really gotten of its rails now lol
 
[quote name='HumanSnatcher']Didn't really want to move back in with my parents. Me and my ex got evicted from our apartment back in mid Nov. Moved in with some dyke (yes I use that term about her because shes the atypical bitch dyke) from his church. I decided to move back in with my parents when it became evident that we were ONLY there to be her house maid service. Literally, she couldn't be bothered to lift a finger to do a damn thing for herself.

I think that this thread has really gotten of its rails now lol[/QUOTE]
You finding the person detestable doesn't justify it's usage. Fill in any other ethnic slur and think about what you just said. Take more than a few seconds.
 
[quote name='dohdough']You finding the person detestable doesn't justify it's usage. Fill in any other ethnic slur and think about what you just said. Take more than a few seconds.[/QUOTE]

lol

do you always have to play Jesus?
 
Considering she went on a tirade yelling and screaming in my face for literally no damn reason and totally disrespecting me and talking shit about me behind my back...I'll call her whatever I please

She has no respect for me, so thus, I have no respect for her
 
[quote name='HumanSnatcher']Considering she went on a tirade yelling and screaming in my face for literally no damn reason and totally disrespecting me and talking shit about me behind my back...I'll call her whatever I please

She has no respect for me, so thus, I have no respect for her[/QUOTE]
So if the person was a gay man, Asian, or a black person, are you going to call the person a f*g, g**k, or n****r? Is that acceptable speech? Of course not. She might be a bitch, but that's because she's a bitch; not because she's a lesbian.

If you have problem being judged about it, then maybe you should keep shit like that to yourself and not a public forum.
 
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Myke,

I used to hate IPAs (I thought they tasted like India) until I got some proper crystal glasses to use.

It stops them from losing the distinct smell/flavor and turning into what we in the business call "sad beer".

Also, I am going to be in Philadelphia for a month straight on business. Is there any one cheesesteak place you absolutely have to go to?
 
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[quote name='Msut77']Myke,

I used to hate IPAs (I thought they tasted like India) until I got some proper crystal glasses to use.

It stops them from losing the distinct smell/flavor and turning int to what we in the business call "sad beer".

Also, I am going to be in Philadelphia for a month straight on business. Is there any one cheesesteak place you absolutely have to go to?[/QUOTE]
NO!! Stay the fuck away from those cheesesteak places. Pat's and Geno's are tourist traps that have sandwiches that taste like the meat was boiled.

Goto Fogo de Chao or food trucks if you're by Penn instead.
 
[quote name='dohdough']So if the person was a gay man, Asian, or a black person, are you going to call the person a f*g, g**k, or n****r? Is that acceptable speech? Of course not. She might be a bitch, but that's because she's a bitch; not because she's a lesbian.

If you have problem being judged about it, then maybe you should keep shit like that to yourself and not a public forum.[/QUOTE]
Let me preface this by saying I myself am a gay man. Most on here know that I am. Or may not remember off hand as I stopped bothering with CAG around the time you joined.

The term "dyke" has been embraced within the lesbian community. Ever heard the group Dykes on Bikes? They've even gone so far to to legally trademark "Dykes on Bikes". As a gay male myself, do I get offended when someone calls me a $$$? No, I could care less. Have you ever used the term "gay" to refer to something? Such as "that video game/movie/song/idea is so gay"? I'm sure you have. If I were as sensitive as you are about me calling a lesbian a dyke, then I would be offended by such semantics. But, I am not. What DOES offend me are over sensitive people. That and the intergroup getting pissed off by an intragroup using the same slang that they themselves JUST used.

Example, GLAAD gets pissed off when a straight person calls a homosexual a $$$. They even get pissed off when someone says that something "is gay". Yet turn to Logo, they call each other $$$s and queens and dykes, etc, etc. GLAAD doesn't seem too preoccupied with such issues. Heck, in the case of Perez Hilton calling will.i.am a $$$$$$ they jumped on his case. Yet again, I point to the usage not being an issue on Logo.

And dyke and $$$ are not racial/ethnic slurs. So, please think before you react.

On top of that, another use of the term dyke is a woman (not just exclusively lesbians) that hates men. Clearly from her behavior that she has exhibited towards others, not just her shit treatment of me and my ex, she hates men.

Besides, CAG does have an ignore feature.
 
[quote name='Msut77']Myke,

I used to hate IPAs (I thought they tasted like India) until I got some proper crystal glasses to use.

It stops them from losing the distinct smell/flavor and turning into what we in the business call "sad beer".

Also, I am going to be in Philadelphia for a month straight on business. Is there any one cheesesteak place you absolutely have to go to?[/QUOTE]
Honestly, I think the only IPA I've ever had was by some national brand. I forget the name of it. I wanna say Sierra Nevada? But that was about 5 years ago and recall it being a bit much.
 
^ Sierra Nevada Pale Ale is what they're most known for. It's close to an IPA, but underhopped by comparison. They do make an IPA (Tornado), and it's okay.

I think most people despise IPAs because they take huge gulps - and IPAs are so hoppy that (a) they can leave a really dry finish (i.e., it feels like it sucks the moisture out of your mouth), and (b) too much hops can taste really piney or soapy to some (which is odd that I love IPAs since I hate cilantro b/c I think it tastes like dish soap).

If you're one of those people, try the Dogfish Head 60-minute IPA. It's a solid, solid beer - and the hops they use in it (I forget which kind) have a flavor that's much more citrus/grapefruit-y. It's by no means an IPA on training wheels, but it's much more palatable than some of the more pine-y IPAs.

[quote name='Msut77']Myke,

I used to hate IPAs (I thought they tasted like India) until I got some proper crystal glasses to use.

It stops them from losing the distinct smell/flavor and turning into what we in the business call "sad beer".

Also, I am going to be in Philadelphia for a month straight on business. Is there any one cheesesteak place you absolutely have to go to?[/QUOTE]

Many, many moons ago (i.e., before I understood why a British-styled beer was called an "India Pale Ale") I wondered more or less the same thing, I'll admit.

Pat's is no good and Geno's is a racist fuckhole of an establishment. If you want to go to one of "the" places (i.e., one of the places made popular on teevee), I'd recommend Tony Luke's for sure. If you're staying in the city proper, there are a number of places in Old City that look or claim to be "famous" or "authentic," but are shameless shitholes that managed to rent property close enough to Independence Hall so as to absorb unwitting tourist dollars. Unless the place is Jim's Steaks, don't go to a steak place on Market Street.

Also: Reading Terminal Market. Make sure you go.

If you're rally into beer, there are tonnnns of places to go to. Belgian Cafe and Monk's Cafe are highly recommended (even dmaul has been to one or both of those, I think), and you can't go wrong if you end up at a bar in the Northern Liberties or Fishtown areas.

Hit me up when you're in town.
 
Yeah, Monk's Cafe was great, didn't make it to the other one. I second Reading Terminal Market, some great food in there. A good cheesesteak place too (don't recall the name).


As for IPAs, Myke's getting into the general west-coast style (piney) vs. east coast style (citrusy). Though the coastal breakdown doesn't work as well any more since lots of east coast breweries like Southern Tier and Troegs make some piney IPAs.

Anyway, some other good citrusy ones are Bell's Two Hearted Ale and Sweetwater IPA.

In general, IPAs are very much an acquired taste. I hated them the first time I tried them years ago. Just gradually over time as I started drinking some hoppier lagers etc. my tastes shifted and now I love them and find many popular ones not hoppy enough! I prefer the piney west coast style to the citrusy ones myself, though I like those occasionally as well.
 
[quote name='mykevermin']^ Sierra Nevada Pale Ale is what they're most known for. It's close to an IPA, but underhopped by comparison. They do make an IPA (Tornado), and it's okay.

I think most people despise IPAs because they take huge gulps - and IPAs are so hoppy that (a) they can leave a really dry finish (i.e., it feels like it sucks the moisture out of your mouth), and (b) too much hops can taste really piney or soapy to some (which is odd that I love IPAs since I hate cilantro b/c I think it tastes like dish soap).

If you're one of those people, try the Dogfish Head 60-minute IPA. It's a solid, solid beer - and the hops they use in it (I forget which kind) have a flavor that's much more citrus/grapefruit-y. It's by no means an IPA on training wheels, but it's much more palatable than some of the more pine-y IPAs.[/QUOTE]
Then it wasn't Sierra Nevada then, as I specifically remember it was an IPA. Might have been Red Hook Long Hammer. Had to look them up and the label looks familiar. I do remember this was at a Fud Ruckers. I honestly was rather hung over when I had it, so my tastes were a little off when I had it lol. Would love to try it again at least tho, IPA that is. Theres a place here called Total Wine & More that offers making your own 6 packs. Next chance I get, see if they have anything you guys are mentioning

Couple years ago me and my best friend split a 6 pack of Wild Blue Blueberry Lager. That was something interesting.

I'm still kicking myself that I never tried that Monty Python branded beer from several years ago...no idea if its still made
 
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