Хөдөлгөөн зохицуулж байсан замын цагдааг дайрсан хэрэг гарлаа

2014/05/13
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Хүмүүс:
Хөдөлгөөн зохицуулж байсан замын цагдааг дайрсан хэрэг гарлаа

Замын уулзвар дээр хөдөлгөөн зохицуулж байсан цагдаагийн алба хаагчийг дайрсан хэрэг гарчээ. Тодруулбал: Баянзүрх дүүргийн 14 дүгээр хорооны нутаг дэвсгэр Халдварт өвчин судла­лын үндэсний төвийн зүүн талын уулзар дээр өчигдөр 17.30 цагийн орчимд хөдөлгөөн зохицуулж байсан цагдааг дайрсан байна.



Танд манай нийтлэл таалагдаж байвал LIKE дараарай!
Сэтгэгдэл
bfb ymar aimar ym be bolhoo bjee
IP:202.21.113.170  2014-05-13 09:42:50
SS hohin
IP:202.21.124.133  2014-05-13 09:43:10
zochin Arai ch dee aimar ium ymar teneg n ium bolio
IP:112.72.13.161  2014-05-13 09:46:14
lololo hohiishtee ooroo yaah gj zam deer bainga baij baidag bna ingeed ta nar torgoj baigaarai medvv
IP:103.9.90.229  2014-05-13 09:47:28
Arai l bishee Ajlaa xiij bgaa xun sh dee yaasan myyxai yum boloo ve
IP:103.26.194.6  2014-05-13 09:47:57
lololo xaxaxa :P :) ;) :* :v
IP:103.9.90.229  2014-05-13 09:48:43
bb lololo ta yu bicheed bgan ......hunii ami nas chamd yu ch bish yum bnaldaa
IP:203.194.115.22  2014-05-13 09:50:16
ARAICHDEE Manaihan arai l hvn chanargvi boljee hoh chine bhdaa yahaw dee ajilaa l hiij ywsan hvnshdee hohi chine bhdaa yahaw dee
IP:49.0.153.155  2014-05-13 09:50:45
zochin eoo arai ch dee ajilaa hj bgaa huniig yaaj bgan ingej bolkushdee
IP:202.170.84.16  2014-05-13 09:51:16
hun ss chi muu huniig hohichine bhdaa yahaw de chamd uurt chine hohichine boloh tsag ireh wii dee
IP:103.26.194.5  2014-05-13 09:54:00
Zochin Dairsan Pi-zdaag ni alaach, muusain Pi-zdaanuud dawarch bnaa
IP:202.131.228.51  2014-05-13 09:55:03
Dairii gej dairaagui baih Sonor seremjtei yavj baimaar yumaa jolooch naraa galzuu soliotoi yum yavdag zaluuchuud olon bii shuu.er ni naad nuhur chin dairii gej dairaagui l bhdaa hurdaa taaruulj yavaagui ni buruu shuu de
IP:103.26.195.140  2014-05-13 09:56:13
zochin lololo chi medrel muutai ym bn xvn dairiulchaad bxad teneg nowsh ve
IP:103.23.51.10  2014-05-13 09:56:39
otgoo Hohino gjaga humuus uursduu duremee medehku torguulchad zamiin tsagdaag uzen ydad bgn bnlda ajila hj ywaa huniig dairchad bhd hohino bhda ydiin unen archaagui bodoltoi ymda
IP:112.72.13.244  2014-05-13 09:56:40
Teneg nowshnuud zailaach Ene hohi chin geed bga teneg maluud hohi chin boloh tsag chin irne dee.zamiin tsagdaa zam deer bhgvi tegeed chiniiheer haana bh estoi yum malaa.
IP:103.26.194.10  2014-05-13 09:57:12
11122 araichdeee ene chn ajlaa hiij bgaa hvnshteee buruu yu bhav deeee hvmvvsiin uhamsar gj 00 zaachijee bvvr
IP:202.179.31.242  2014-05-13 09:57:49
zochin tanai site dandaa muu muuhai medee medeelel hund taraahiimaa tooj unshdaggui ch gesen helehgui l bol sanaa amrahguim dandaa surug energi
IP:103.26.194.15  2014-05-13 09:58:28
Yana daa Lololo. SS 2 uursduu estoi vxvvl taarna. Xol ywku sanaatai malnuud bna daa
IP:202.131.242.251  2014-05-13 10:04:55
Zochin HUMUUSIIN UHAMSAR DENDUU DOROI BOLJEE.AJIL UURGEE GUITSETGEJ YVAA HUN INGEED ERUUL MENDEEREE HOHIRLOOSHD.ENE TOMROOD TODROOD BAIGAA YMNUUD COMPUTERIIN TSAANA NEG DOOJOIGUI ULBIISEN TARHINII NAALDANGITAI MALNUUD BAIDAG BHOO,
IP:202.21.100.162  2014-05-13 10:06:06
lololo t1 ene lololo ooroo bsn bol odoo yaj bgaa boldooo t1 nowsh we
IP:112.72.13.73  2014-05-13 10:13:29
zochin yaandaa odor bolgono barag l aimshigt medee chih delseh bolloo doo amid ybahad berh boljee
IP:202.179.26.147  2014-05-13 10:13:58
rgsdf bi l gesen shig peedger alhaad l mashin irj bahd hodolj ogohgui peediigeed l bdag amisgaluud ingeh geed l baij tegj peediitel alhahaa blih heregtei surgamj avag ene toriin huvtsas omsson hongio tolgoitoi garuud
IP:203.91.112.147  2014-05-13 10:14:00
zochin Hohino ged bga humuus amniihaa zorgor hutsahiimaa. Ooriih ni ah duu, hamaatan ni bsan bol yah ingej helj haragdaach.
IP:112.72.13.56  2014-05-13 10:14:01
rgsdf bi l gesen shig peedger alhaad l mashin irj bahd hodolj ogohgui peediigeed l bdag amisgaluud ingeh geed l baij tegj peediitel alhahaa blih heregtei surgamj avag ene toriin huvtsas omsson hongio tolgoitoi garuud
IP:203.91.112.147  2014-05-13 10:14:10
яана даа яанаа арай л биш юмаа
IP:202.21.100.50  2014-05-13 10:14:50
wowka araichde nere ajil vrgee hiij bhadni hvrtel dairchax yumaa nere
IP:202.131.247.23  2014-05-13 10:18:38
суга Дайрна мергене гэдэг 2 уг ондоо шуу. Сэтгуулч ухаантай юм бол наадхаа зев бичээч
IP:202.70.46.203  2014-05-13 10:23:12
teneg hvmvvs bhima. naad hvmvvs chini duranda turiin xuwtsas umsuud har hviten tsasnd hulduh gd zogsoj bhu amidraxiin tuluu l ajillj bga hvn shdeteneg malnuud bhiimaa
IP:103.10.23.63  2014-05-13 10:25:04
яаанаа юу гээд тэнэгтээд хохино эдр гээд байгаан бэ огт цагдаагүй болоод үз л дэ тэр хохино эдр гээд байгаа малнууд ёстой мал байна за
IP:202.126.89.246  2014-05-13 10:27:09
цагдаа hohichine muu erguu dagz nugel nudeeree garch bgaa ym shu de
IP:103.9.90.130  2014-05-13 10:37:03
h manaih shig zam deeree tsagdaagaar duursen gazar bhgui . teged ch tsagdaa nariin ayalgui bdliig ni hangasan shugam talbai gej bdaggui biz dee haa saigui l bj bdag ! uursduu ene tal der bolgoomjtoi bh heregtei shuu de Zamiin gold orchood hour mashin hoorondoo shurgeltseh ni holgui dandaa standart bus zamtaigaa medej bmaar !
IP:103.26.194.5  2014-05-13 10:39:49
UNG Ene hohino geed bgaa humuus uursdiiguu ene humuusiin orond neg taviad uzeerei. Hervee ta iim mergejiltei bgaad humuus taniig ingeed muulaad bval ymar baihuu? Ichihgui yumaa aldchaad tsagdaad handaj bgaa daa ta nar... Mgl chuud yaagaad iim hun chanaraa aldtsan yum be
IP:182.160.1.42  2014-05-13 10:43:29
,,,, ene hvn chini ajil vvrgee bielvvl ywaa hvn peedelzed ene ter ged bitii huwiin talaas ni jijger bodod bai uhaan muutai ymnuud ih baihiinma mongoloor
IP:202.131.235.74  2014-05-13 10:50:50
Нара Энэ улс орон чинь юу болоод байнаа.замбараа
IP:103.26.194.10  2014-05-13 10:51:40
zochin yamar aimaar yum be.yana da yana ene deer teneg setgegdel bichsen hunii orontsoguudiig yaamaar yum be dee.Hun ajlaa l hiij bsan bna sh dee.
IP:202.180.220.81  2014-05-13 10:52:21
Тэрслүү Монгол хүн хүчтэй, хурдтай машин унах болоогүй л байгаа юм даа. Ерөөсөө дэг журам гэдэг юмыг мэддэггүй, тоодоггүй болоод ийм балмад хэрэг гарч байгаа шүү дээ.
IP:103.26.194.34  2014-05-13 10:53:23
Нара Балмад этгээдууд хуссэнээ хийдэг цовуун цаг гэдэг нь энэ байх Бидний ухамсар дэндуу дорой байна хун дайруулчихаад байхад Хохь нь гэж хэлж байгаа хумуус хунуу адгуус уу ! Энэ цагдаа чинь Бидний адил амьдралаа залгуулж ур хуухдээ тэжээх гээд ажлаа хийж Яваа жирийн нэгэн иргэн шуу дээ
IP:103.26.194.13  2014-05-13 10:59:36
dddd Lololo , ss za bar yu ve. Hoorhii hun enchine bas l bidentei adil aav eejiin huuhed bgaa ajlaa HIIJ baihad n ingej helj Bolohgui shuu dee ta nart ene dairuulsan tsagdaa muu ym hiigeegui baihad ingej Bolohgui. Dairsan joloochid harii arga HEMJEE avah yostoi.
IP:103.26.194.11  2014-05-13 11:03:03
b Lololo,Ss ta 2 muu archaagui bodloosoo bolj tamd unaarai za chamd uurt chin iim gai tohioldohoor haramsah.amaa barih tsag irnee muu humuus
IP:112.72.13.92  2014-05-13 11:03:27
багий хүний мөс гэж байхаа больжээ энэ хүн чинь хийх ёстой ажлаал хийж байгаа та нар ингэж хүнийг тавлаж болохгүйш дээ ингээд хүн торгож байж ч гэх шиг өөрийнхөө буруутай үйлдлээс болж торгуулчаад хүнд буруугаа тохох чинь арчаагүй хүнийл арга байх
IP:202.70.46.199  2014-05-13 11:08:14
Eenee Teneg nuxed ix baix ymaa ingeed torgoj bgaaraa ch gex shig. Zamiin tsagdaagui bol ub xudelgeen tag zogsono shu dee.ene uder tsastai buglereetei xetsuu uder baisan, bidnii tulee ajil uurgee guitsetgej yvaad iim baidald orsond tun ix xaramsaj bna.xurdan idgex boltugai.
IP:112.72.13.216  2014-05-13 11:20:50
чччч yмбүүнүүдийн хийсэн хэрэг,
IP:124.158.91.83  2014-05-13 11:27:59
lololo hohineeeee hohin
IP:202.70.44.132  2014-05-13 11:39:01
joy tsaanaa basl ar ger amidralta neg hunii huun l bj taaraashde
IP:202.179.11.178  2014-05-13 11:43:36
Mongol bayn zvrh dvvregt er ni yu l boloodbn daahoer joohon ohiniig heden heseg huwaagaad alchihsanzamiin tsagdaa ni tsohitsuulj bui mashindaa morgvvleel
IP:211.221.154.49  2014-05-13 11:43:37
tsagdaa bas hun Tsagdaa ah duu baihgyi bolhor buhimddag bi biz dee zailuul hun gairuulchihad bhd chini mongolchud iim bolod hujaad deerelhulj bg yum daa
IP:112.72.13.38  2014-05-13 11:48:46
hnnnn lololo hezee neg odor chi yumuu chinii ur huuhed dairuulj uhnedee
IP:202.131.227.133  2014-05-13 11:51:29
uba Zamdeer tsagdaa zogosdog oron bdgiimuu camer bhad teneg maluud
IP:220.120.153.123  2014-05-13 11:55:11
HUN TSAGDAA HUN BISHUU ENE HOHINO GEJ BICHEED BAIGAA HUMUUS OORSDOO ENE ZOVLONG NI UZENE DE HUNIIG HAIRLAJ MEDDEGUI MALNUUD TSAGDAA BAIHGUI BOL ODORT HEDEN 100GAARAA OSOL GARNA MALNUUDAA TA BIDNII TOLOO ZOGSOOD L ENE OROVDOH SETGELGUI OODGUI HUN CHANARGUI MALNUUDDAD
IP:71.189.131.201  2014-05-13 11:56:15
хүний мөс болиочээ та нар ингэж нэгнийхээ болохгүй шдээ цагдаа нарт зарим дургүй ч гэсэн ингэж муухай үгээр хэлж болж бгаму яасан ч их муу энергитэй хүмүүс вэ
IP:202.179.20.165  2014-05-13 11:56:27
haha Ih durguig ni hurgesiin bailguidee
IP:180.149.80.121  2014-05-13 12:02:28
lolo-d лоолойгэдэг чинь гахайн тоорой .чи ч аргагүй л гахай ухаантай юм даа
IP:112.72.13.199  2014-05-13 12:02:51
ViCtoR jiiptei humuus ugaasaa iim ongiroo yvdag hudlaa tomorj bgad l morgoo biz...ene hohino geed bga humuus uchiraa medehgui golognuud l bna shdee
IP:103.10.22.58  2014-05-13 12:04:59
Bi Iim teneg uildel hiij baigaa pizdakuud zugeer jiriin irgediig dairah yiu ch bish
IP:103.26.194.11  2014-05-13 12:05:14
oogii hvniig helbel uurt gej vg bdag baihaa teneg maiuud min ta narin tuluu ajla hiij vbaa hvniig ingej helj baih da vahab dee uhaan muutai mulguu hvn iim zvil bichij bga n uuriiguu vmar gedgig haruulj bnda chabaasda huurhii duu
IP:203.191.56.23  2014-05-13 12:21:07
AJDRA ARGA HEMJEE SAIN ABAH HEREGTEI AJLA HIIJ BGAD DAIRUUIASAN HVN SH DEE
IP:203.191.56.23  2014-05-13 12:25:47
ALDRA HERYYI ZODOON HEREG TOUBUG GARAHAR L TA NART TSAGDAA SHIG HEREGTEI HVN BAIDAGGVI BIZDE AZ JARGALTAI VEDEE TA NAR TSAGDA DUUDAJ VZSEN VV
IP:203.191.56.23  2014-05-13 12:33:47
b.ts nziig min yaj bgn be ehner huuhedtei hun shde arai chdee neere ajilaa hiij yvaa adilhan l irgen hunshdee humuus min neg negnee ingej muuhaigaar bitgi helj bgachde zamin hodolgooniig zohitsuulah gjil zamiin gold daarch horj yvaashde durandaa ochij zogsooguil bh hun buhen ymiig zov talaasni boddogch boloosoi gehdee mijii nz hurdan edgenee sn hun uchiraad
IP:103.11.194.130  2014-05-13 12:34:16
oogii TSagdaa hezee ch zurchil gargayi hvniig torgodoggvi uyma bidnii tuluu ajilladag hvmvvs
IP:203.191.56.23  2014-05-13 12:39:29
zochin Zarim neg ulsuud bichij bga zvilee bodoj bichmeer yum ene hvn bidentei adil amidrah gj zvtgej yavaa mongoliin neg irgen shvv de ene hvnii tsaana heden am bvl bga hechneen hvn tejeej bgag hench med.gvi shde haluund halj hvitend hurj ta bidnii amgaln taiban bdaliin tuluu yabj bga hvniig arai ingej helj bolohgvi bhaa jaahan zam tvgjir.d ireh.r ta bvhen tsagdaa yasan yum bol gd l bdag bizdee tm bj arai ch iim uhamsargvi zan gargaj bolohgvi bhaa
IP:103.26.194.14  2014-05-13 12:45:30
baagii ursdiinhun heg l dairchihaad iim zyil bichij bga baih uurin neg tsohiod abwal vah bolo ariachaagaa aldaad tsagdaa ruu gvihee medehgyi muusain uymnuud maluud
IP:203.191.56.23  2014-05-13 12:51:52
baagii zarim tenegvvd doodhoosoo doloon doloon..........dor uym bichih uym da tenegvded heleh vg danch alga da yag l ilgigtei adilhan yumda.................
IP:203.191.56.23  2014-05-13 12:56:39
xun mongolchuud mini yu l bolood bn da,ene xorvood xumuun zayag olj turnu gedeg zuunii uzuurt budaa togtoxtoi adil gej zuirledeg dee tegxeer ene xovor zayag olj turchuud bie bienee xairlaj yavmaar sanagdxiin...
IP:103.26.194.11  2014-05-13 12:58:25
nmarlaa hoorhiidoo ard irgediinhee toloo yvj bgad dairulchih gej nas barchaagui l bga da ter hohino ged bga nohdud zugeer l mongoloos zail ta nar durem zorchod torguldag bizde archagui golognuud ajil albaa guitsetgej bga tsagdaag ta nar tegj heleh erh bhgui hoorhii tsagdaa
IP:202.179.10.94  2014-05-13 13:02:01
munhuush anzaargatai baij negniigee hairla ldaa manaihaan
IP:202.21.106.109  2014-05-13 13:04:53
oogii tsagda nar bidnig harand svvder haigad borond numur haigad tsacand daarch vbahad hal uund halaj hvitend huruud l ta bidnituiuu ajla hiigeed l zamin goldol zogsood l baj bdag biz de tsagdaa .............
IP:203.191.56.23  2014-05-13 13:05:41
Zochin Ter honino ntr geed bgaa hvmvvs delhiigees zail ta nariin ajil vils yaj bvthiiin archaagui yaduu hooson bolowsrolgui hvniig hairlaj medkv nuhdvvd l tegj helj bgaa bh hvnii ami ervvl mend bvhnees vnetei amiddaa biy biynee l hairlaj amidrah heregteishdee
IP:202.21.106.167  2014-05-13 13:06:35
Aldraa uchra medehgvi uym bicheed bga hvmvvsmongolbatugai delhiigees zailasan ch bagadana
IP:203.191.56.23  2014-05-13 13:20:17
zochin Sonin uhamsartai hvmvvs bas bh yuma te 5alhahgvi barigdan da harajbgaarai
IP:202.126.89.179  2014-05-13 13:29:58
mongol ulsiin irgen Lololo chi udahgui ajil deeree yum uu gertee osold orj uhnee za
IP:103.10.22.37  2014-05-13 13:34:10
wtf ulub dolib geed ybhar tgdiin hohichin manaihan l zamin tsagda gej bhiin busad orond zvger l camer harad suuj bhiin amid cameruudaa zamaas halah tsag bolsonshdee
IP:220.123.107.228  2014-05-13 14:22:52
zulaa sogtuu xun bsiin boluu aimaar in
IP:202.131.228.174  2014-05-13 14:23:21
irgen bolj bolj
IP:202.131.238.115  2014-05-13 14:24:47
Зочин согтуу байсан байлгүй дээ. Эсвэл бүрэн бус техниктэй явсан юм болов уу.Үнэхээр харамсалтай.
IP:202.180.216.8  2014-05-13 14:36:02
тэр чинь үүрэгт ажлаа хийж яваа монголын иргэн Новш. Ямар мал нь дайрав аа. Ялыг нь өгч хатаа.
IP:202.21.106.101  2014-05-13 16:36:29
zochin yamar bolgoomjgui bnaa tsagdaa nart zoriulsan xamgaalaltiin tavtsang uulzvar bolgon deer tavixaar nogoo jolooch nar ny tsagdaa bish tavtsan morgoj uxeed bdiim bolov uu yamaar ch uym dee ajlaa yaj xiixiin bolj bna daa
IP:202.126.91.67  2014-05-13 16:45:07
Зочин SS, lololo нэрээр өөрийгээ нуусан тэнэгүүд байх юм даа. Цагдаа-ажлаа хийж байгаа жирийн л хүн-иргэн. БИд бүгдэээрээ адилхан. Зарим нэг алдаа байдаг л байх. Гэхдээ бид аливаа аюул тулгарахад бүгд л эхлээд цагдаад ханддаг шүү дээ. Дээрх эсрэг байр суурьтай хүмүүс өөрсдөө хууль зөрчдөг, хамгийн бүтэхгүй л хүн байгаа байхдаа. Цагдаа таныг хууль зөрчсөн бол хуулийн дагуу арга хэмжээ авах, хүч хэрэглэх эрхтэй байдаг юм. Та түүнд өртсөн л хүн-хогнуудын нэг л байхдаа.
IP:103.26.195.132  2014-05-13 17:03:45
Зочин Жолооч нарыг 3-5 жилд дахин шалгалтанд оруулж байя. Зарим жолооч эрүүл мэндийн хувьд тэнцэхгүй болсон байдаг юм.
IP:103.26.195.132  2014-05-13 17:06:51
zochin zarimdaa ch tsagdaa nar yg ybah gazaroodoos harchaad holdohgui zogsood baidag shu estoi dairchmar sanagddag l yum gehdee hoorhii ajlaa l hiij bga hunig bolohgui shde
IP:103.26.194.16  2014-05-13 17:08:34
HOHINEEEE!! Hunii muu ih vzeheer ingj bgaam daa!!!
IP:202.179.8.210  2014-05-13 17:34:35
nuust Tagdaa ch gesen hvn sh de. Ene hvmvvs ymar hvn chanar muutai bdag ym de.Ajilaa hj bgaa toriin tolooliig ingej bh ch gj de. Tsagdaa hvn ingej gazar hevtej bhad hvn ni bish ymaa ghed mongol tor gazar hevtej bgaa ni ymar evgui ymde humuusee biy biynee hairla.
IP:202.126.91.159  2014-05-13 18:32:22
зочин төрийн цагдаа дайрч байхаармонголд орж ирсэн хөдөө гадаагүй тэнэж яваа хужаа нарыг дайраач. Наадах чинь хужаа байгаа даа
IP:199.115.117.235  2014-05-13 18:44:42
tamir ЗХУ болон ОХУ, СНГ-д 5 жил суралцаж төгссөн хүмүүс ОХУ-ын Магистрийн гэрчилгээ нөхөн олгож байна. Холбоо барих хаяг:tamir46@bk.ru
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IP:118.219.37.121  2014-05-13 19:24:15
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IP:31.1.222.144  2014-05-13 20:01:05
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IP:112.72.13.11  2014-05-14 00:18:39
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IP:202.170.80.25  2014-05-14 08:06:41
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IP:122.201.20.206  2014-05-14 08:40:26
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IP:202.170.69.196  2014-05-14 10:04:25
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IP:103.26.194.4  2014-05-14 10:16:55
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IP:112.72.13.247  2014-05-14 12:45:36
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IP:202.21.117.230  2014-05-14 15:05:05
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IP:118.216.252.157  2014-10-08 07:54:21
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IP:118.216.252.157  2014-10-08 07:55:54
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IP:188.143.232.22  2015-08-10 06:04:07
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IP:188.143.232.34  2016-02-27 15:36:13
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IP:31.184.238.180  2017-06-17 12:20:22
Danieldrubs Why are Americans so worked up about health care reform? Statements such as ”don”t touch my Medicare” or ”everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system”s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let”s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let”s look at the pros and cons of the Obama administration health care reform proposals and let”s look at the concepts put forth by the Republicans? Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life”s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution. These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better. A recent history of American health care - what has driven the costs so high? Key elements of the Obama health care plan The Republican view of health care - free market competition Universal access to state of the art health care - a worthy goal but not easy to achieve what can we do? First, let”s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher? To begin, let”s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail”s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time! Let”s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a ”wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions. This very basic review of American medical history helps us to understand that until quite recently (around the 1950”s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; ”nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual. What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today. I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor”s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the ”perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying. At this point, let”s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions? The Obama health care plan is complex for sure - I have never seen a health care plan that isn”t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let”s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care. Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance. To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don”t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs. To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans. The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs. The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide ”free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney”s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision. As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to ”give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative. Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don”t generally like these ideas as they tend to characterize them as ”big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction. A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to ”go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn”t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems. OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience”s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don”t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary. I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens - health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don”t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition. Let”s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don”t exercise but we offer a lot of excuses. We don”t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can”t do anything about managing these known to be destructive personal health habits. We don”t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because ”health care is there” and somehow we think we have no responsibility for reducing our demand on it. It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame. There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, ”Google” ”preventive health care strategies”, look up your local hospital”s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America”s health care system now and into the future. I am anxious to hear from you and until then - take charge and increase your chances for good health while making sure that health care is there when we need it.
IP:146.185.223.25  2017-10-14 12:58:31
Williamtog First, let”s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher? To begin, let”s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail”s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time! Let”s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a ”wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions. This very basic review of American medical history helps us to understand that until quite recently (around the 1950”s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; ”nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual. What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today. I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor”s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the ”perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying. At this point, let”s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions? The Obama health care plan is complex for sure - I have never seen a health care plan that isn”t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let”s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care. Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance. To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don”t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs. To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans. The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs. The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide ”free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney”s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision. As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to ”give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative. Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don”t generally like these ideas as they tend to characterize them as ”big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction. A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to ”go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn”t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems. OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience”s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don”t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary. I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens - health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don”t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition. Let”s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don”t exercise but we offer a lot of excuses. We don”t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can”t do anything about managing these known to be destructive personal health habits. We don”t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because ”health care is there” and somehow we think we have no responsibility for reducing our demand on it. It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame. There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, ”Google” ”preventive health care strategies”, look up your local hospital”s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America”s health care system now and into the future. I am anxious to hear from you and until then - take charge and increase your chances for good health while making sure that health care is there when we need it.
IP:146.185.223.25  2017-11-10 00:14:30
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