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(Bloomberg)   Doctors are preparing for the massive influx of patients once Obamacare goes into full effect. "It's like we're handing out bus tickets and the bus is already full"   (bloomberg.com) divider line 319
    More: Obvious, obamacare, American Academy of Family Physicians, Holy Cross, Medicine study, San Francisco General Hospital, Commonwealth Fund, George Washington University in Washington, health law  
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3859 clicks; posted to Main » on 24 Sep 2013 at 9:34 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-09-24 10:26:58 AM  

Kit Fister: The more you eat the more you fart: Pay staff better = more nurses and doctors will work there.

Bet its one of those places that tries to pay a new LPN $12.50 an hour...and wonders why they can get enough staff.

Nurses there start, far as I know, around $20/hr.


That's sub-par for an RN.

So..its exactly what i thought: the wont pay staff what they are worth, and are surprised when nobody wants to work there...forcing them to limit their patient load.

They did it to themselves.

For the record..to be competitive, lpns should be starting at about $17-20 and RNs at $30-50

Your local facility is a joke
 
2013-09-24 10:27:52 AM  

TNel: Oh so you can have more of the pie.


Can't make mid six-figures if every kid coming out of high school also wants to be an anesthesiologist.
 
2013-09-24 10:28:28 AM  

nobodycaneatfiftyeggs: randomjsa: I know things like "reality" are really hard for some of you to accept but the consequences of saying "screw the reality, we're moving forward no matter what" are going to be pretty significant.

What you think "is fair" and what "will actually give the best results" are not always the same thing.

Okay. Educate me.  What will actually give the best results?


eugenics.
 
2013-09-24 10:28:41 AM  
Sarah Palin warned you all about bus ticket panels but you just wouldn't listen.
 
2013-09-24 10:30:01 AM  

netcentric: It not really funny funny... but it is humorous to find that some folks in my state are thrilled to find out they can get an Obamacare policy for $150 a month.     But when I look up for them the cost of a policy last year through thier 'Blues'.   It ends up being cheaper.

They are going to pay more, and have no clue.

They may get max's eliminated,  but they also sacrifice (or have less) choices and options.
(in my state the Blues were the Insurer of last resort so they were required for decades to cover preexisting)

Now you are finding out there are hidden costs ??    Hahahahahahaha...


You can not get healthcare for $150 a month in the wild without REALLY good employer contribution.  Stop lying.
 
2013-09-24 10:30:36 AM  

TNel: Seriously stop, why would you do that? If someone wants to help people and the country needs them why the hell would you do that? Oh so you can have more of the pie.


mmm. Blue waffle pie. Yah, he totally wants that. I'm sure that he would do that because dealing with malpractice shiat, patients, and all the BS that goes along with being a doctor is one giant steaming pile of shiat and not worth the trouble.
 
2013-09-24 10:30:47 AM  

TNel: netcentric: It not really funny funny... but it is humorous to find that some folks in my state are thrilled to find out they can get an Obamacare policy for $150 a month.     But when I look up for them the cost of a policy last year through thier 'Blues'.   It ends up being cheaper.

They are going to pay more, and have no clue.

They may get max's eliminated,  but they also sacrifice (or have less) choices and options.
(in my state the Blues were the Insurer of last resort so they were required for decades to cover preexisting)

Now you are finding out there are hidden costs ??    Hahahahahahaha...

You can not get healthcare for $150 a month in the wild without REALLY good employer contribution.  Stop lying.


I do.
 
2013-09-24 10:31:48 AM  

The more you eat the more you fart: So..its exactly what i thought: the wont pay staff what they are worth, and are surprised when nobody wants to work there...forcing them to limit their patient load.

They did it to themselves.

For the record..to be competitive, lpns should be starting at about $17-20 and RNs at $30-50

Your local facility is a joke


Yes, that must be it. That doesn't change the fact that it serves a very poor area and is not a well-funded facility like you must be blessed with.
 
2013-09-24 10:32:52 AM  

Weaver95: gretzkyscores: randomjsa: I know things like "reality" are really hard for some of you to accept but the consequences of saying "screw the reality, we're moving forward no matter what" are going to be pretty significant.

This is exactly why I laugh when I hear leftists and liberals describe themselves as "reality-based". Reading through these comments here, none of them appear to be concerned in the least with the reality that is coming and utterly fail to comprehend what the law of unintended consequences has in store for all of us because of this abomination of a health care law.

But hey, how about a few more snarky and unfunny comments mocking republican/christian stereotypes - that ought to show everyone how smrt you leftists all are! I'm sure everything will work out just fine and the poorest people in our society will receive a never-ending supply of Mayo-clinic-levels of healthcare for free! Economics be damned!

You haven't studied this out yet, have you?


What in Seven Hells had that got to do with being given healthcare? It insures rights pertaining to living your life, not extending it.
 
2013-09-24 10:33:45 AM  

Capo Del Bandito: Weaver95: gretzkyscores: randomjsa: I know things like "reality" are really hard for some of you to accept but the consequences of saying "screw the reality, we're moving forward no matter what" are going to be pretty significant.

This is exactly why I laugh when I hear leftists and liberals describe themselves as "reality-based". Reading through these comments here, none of them appear to be concerned in the least with the reality that is coming and utterly fail to comprehend what the law of unintended consequences has in store for all of us because of this abomination of a health care law.

But hey, how about a few more snarky and unfunny comments mocking republican/christian stereotypes - that ought to show everyone how smrt you leftists all are! I'm sure everything will work out just fine and the poorest people in our society will receive a never-ending supply of Mayo-clinic-levels of healthcare for free! Economics be damned!

You haven't studied this out yet, have you?

What in Seven Hells had that got to do with being given healthcare? It insures rights pertaining to living your life, not extending it.


Um, technically it's nine Hells, not seven. Nobody reads the classics anymore...
 
2013-09-24 10:33:46 AM  

Weaver95: One thing I haven't checked on is what the evangelicals are preaching about obamacare. Anyone know if Joel Osteen has said anything on point about this?


I'd like to know Joel's position as well, but I'm guessing he wouldn't touch on such a controversial subject for fear of losing half his audience. I hope he's not a sellout, but sadly I'm a heathen with little faith in humans.
 
2013-09-24 10:34:15 AM  

Kit Fister: doyner: Kit Fister: No one does anything out of the good of their hearts.

I guess we should allow pre-existing conditions to force people into poverty then.  Just human nature, huh?

Didn't say that. But, if people are going to go through the trouble to become doctors and nurses, then they need an incentive to do so. Good pay, grants towards medical school/nursing school, and tax breaks for hospitals to incentiveise them to hire more people.  Then you keep up with demand. As it stands, no one wants to deal with the sick and the dying and handling blue waffles all day for shiat pay. I'd rather be a garbage collector, then at least the smell is somewhat contained and I don't have to handle some other person's diseased junk.

Doctors who do it out of the good of their hearts are few and far between. Most of them get into the job for the pay. And again, with the cost of education, it's not worth it for most people.


So which country's system do you think works best?
 
2013-09-24 10:34:18 AM  

The more you eat the more you fart: TNel: netcentric: It not really funny funny... but it is humorous to find that some folks in my state are thrilled to find out they can get an Obamacare policy for $150 a month.     But when I look up for them the cost of a policy last year through thier 'Blues'.   It ends up being cheaper.

They are going to pay more, and have no clue.

They may get max's eliminated,  but they also sacrifice (or have less) choices and options.
(in my state the Blues were the Insurer of last resort so they were required for decades to cover preexisting)

Now you are finding out there are hidden costs ??    Hahahahahahaha...

You can not get healthcare for $150 a month in the wild without REALLY good employer contribution.  Stop lying.

I do.


Same here.
 
2013-09-24 10:35:05 AM  

Weaver95: Um, technically it's nine Hells, not seven. Nobody reads the classics anymore...


I was quoting A Song of Ice and Fire so NYAH!
 
2013-09-24 10:35:13 AM  

doyner: So which do you want, your well-being, or someone else's idea of your well-being?

Now consider that most people are like farkers.

Which is why we have moderators...for everyone's well being. Obamacare is turning our system into Fark. What we had was 4chan.


Now consider that our moderators unsubmit greenlit threads so they can cherry-pick their own headline. Then banhammer the original submitter.

The moderators don't work for you, buddy. =)
 
2013-09-24 10:35:37 AM  

doyner: So which country's system do you think works best?


I don't know, from my experience every country's healthcare system has snafus that affect care.
 
2013-09-24 10:35:50 AM  

jjwars1: Weaver95: One thing I haven't checked on is what the evangelicals are preaching about obamacare. Anyone know if Joel Osteen has said anything on point about this?

I'd like to know Joel's position as well, but I'm guessing he wouldn't touch on such a controversial subject for fear of losing half his audience. I hope he's not a sellout, but sadly I'm a heathen with little faith in humans.


I suspect he is vaguely against it but I really don't know for sure.
 
2013-09-24 10:36:29 AM  

Kit Fister: The more you eat the more you fart: So..its exactly what i thought: the wont pay staff what they are worth, and are surprised when nobody wants to work there...forcing them to limit their patient load.

They did it to themselves.

For the record..to be competitive, lpns should be starting at about $17-20 and RNs at $30-50

Your local facility is a joke

Yes, that must be it. That doesn't change the fact that it serves a very poor area and is not a well-funded facility like you must be blessed with.


Doesnt matter..nice strawman though.

Why should a highly educated medical professional..who has people's very lives in their hands...accept $15/hr?

Even an LPN makes life and death decisions on a daily basis.

I dunno about you...but id kind of prefer those people making those decisions about me or my family be paid fairly for their level of expertise.
 
2013-09-24 10:37:00 AM  

Capo Del Bandito: Weaver95: Um, technically it's nine Hells, not seven. Nobody reads the classics anymore...

I was quoting A Song of Ice and Fire so NYAH!


nine hells? I think I missed something. If you're referencing norse lore, there's Niflheimr, the land of the straw dead, Helheim, and Nastrondr.
 
2013-09-24 10:37:42 AM  

The more you eat the more you fart: Doesnt matter..nice strawman though.

Why should a highly educated medical professional..who has people's very lives in their hands...accept $15/hr?

Even an LPN makes life and death decisions on a daily basis.

I dunno about you...but id kind of prefer those people making those decisions about me or my family be paid fairly for their level of expertise.


I agree. But, you don't have to be a dick.
 
2013-09-24 10:38:06 AM  

QueenMamaBee: Direct quote from my Dear Leader:
Jackson said the Affordable Care Act, or "Obamacare," which he said he had nicknamed "the Unaffordable Care Act," had greatly impacted the ability of hospitals, including KDMC, to earn a profit, and that he expected that to continue.

He said the ACAhad taken away billions of dollars from mostly hospitals to be set aside to pay for health insurance for the estimated 30 million Americans who are currently uninsured, with the promise hospitals will be "made whole" once health care reform is fully implemented because those without insurance will have some form of coverage.

"We don't believe that. No one in health care believes that,"Jackson said.


What?  How does that make any sense?  Now I've never overseen the entire financial picture of a hospital before, but i have for private practices and smaller facilities, and I don't think there is any place where a hospital is forced to put money aside so insurance companies can insure the uninsured through the affordable care act.  The only thing I can think of where he's going with that, is that insurance companies have decreased their reimbursement rates so much that it costs the hospitals billions of dollars in revenue.  The insurance companies are doing this to prepare for the influx of the uninsured, and expecting to have to write out more than the premiums bring in.  That makes sense, except for one thing.  None of the contracts i have through major commercial insurance companies had a decrease in reimbursement rates for services provided.

Here's how i see the Affordable Care Act affecting our businesses.  One, we will have an increase in the medical benefits we must pay out to employees.  Currently, depending on position and department, we pay out 50 - 100% of policy premiums for employees.  The majority of our employees are at the 50% rate.  Since they will be required to get health insurance, we will see quite the jump in participation, so our cost of doing business is going to go up.  Many businesses may be forced to pass that increase down to the consumer by increasing the costs of our goods and services.

Now being on the health care side, we will certainly get more patients.  That will bring us an increase in business which will help offset those insurance costs we put in for our employees.  I foresee that our health insurance rates are going to go up in 2014 and 2015 (then again, insurance costs never go down anyways), but hopefully the increase in business will balance it off.  At least for two years until our medicaid rates get reestablished based on the increase in costs.

Bottom line,  i predict an increase in the health care industry because of the Affordable Care Act.
 
2013-09-24 10:38:19 AM  

doyner: Doctors who do it out of the good of their hearts are few and far between. Most of them get into the job for the pay. And again, with the cost of education, it's not worth it for most people.

So which country's system do you think works best?


Works best for what?
 
2013-09-24 10:40:25 AM  

Kit Fister: Capo Del Bandito: Weaver95: Um, technically it's nine Hells, not seven. Nobody reads the classics anymore...

I was quoting A Song of Ice and Fire so NYAH!

nine hells? I think I missed something. If you're referencing norse lore, there's Niflheimr, the land of the straw dead, Helheim, and Nastrondr.


The divine comedy by Dante defined hell has having 9 levels. Most pagan belief systems of course didn't have the same concept of hel as the Christian version....and then there is the Chinese who seem to have a passion for very specific and organized mini hellscapes tailored to every imaginable vice in existence.

Personally I don't believe in hell. Not the Christian version anyways. It's a bit too useful as a system of societal control to be an actual afterlife.
 
2013-09-24 10:40:28 AM  

Kit Fister: nine hells? I think I missed something. If you're referencing norse lore, there's Niflheimr, the land of the straw dead, Helheim, and Nastrondr


Dante's Inferno
 
2013-09-24 10:40:37 AM  

Kit Fister: doyner: So which country's system do you think works best?

I don't know, from my experience every country's healthcare system has snafus that affect care.


Wow.  Nice dodge.  I guess if nothing can be perfect we shouldn't fix anything.
 
2013-09-24 10:40:40 AM  
Quick!  Somebody expand the H1B pool!

STAT!
 
2013-09-24 10:42:13 AM  

Kit Fister: HotWingConspiracy: Isn't this a good problem to have?

No. When you have a massive increase in number of patients vs. doctors, you have two problems: 1. The wait time for care gets longer. 2. The amount of time the doctor has to spend with each patient to properly diagnose an issue decreases.

As a subset of item 2, you also increase the workload and the chance of mistaken diagnosis, improper prescription of medication, and unnecessary medical procedures that result in issues for patients.

I want people to have health care, but we need to also help get more doctors into the system to offset the increased load.


Fine -

how about regulating the costs of medical schools or we could just keep sucking the university systems dick and subsidize MD loans - that way the college can afford to spend more on their administrative salaries and sports programs.
 
2013-09-24 10:42:37 AM  

Weaver95: James!: Sounds like a good time to go to medical school.

Or get into the claims processing bidness.


The winners in this are the LPNs and such.  The middle ground between no care and real doctors.  Insurance will push people to them as a cheaper alternative.  the Minute Clinics etc... are going to be booming even more now.  I wish I had stock in them.
 
2013-09-24 10:42:56 AM  

This text is now purple: doyner: Doctors who do it out of the good of their hearts are few and far between. Most of them get into the job for the pay. And again, with the cost of education, it's not worth it for most people.

So which country's system do you think works best?

Works best for what?


Maximizing public health while minimizing individual cost. (I know, I know, that's crazy talk, but work with me here.)
 
2013-09-24 10:42:57 AM  

Kit Fister: The more you eat the more you fart: Doesnt matter..nice strawman though.

Why should a highly educated medical professional..who has people's very lives in their hands...accept $15/hr?

Even an LPN makes life and death decisions on a daily basis.

I dunno about you...but id kind of prefer those people making those decisions about me or my family be paid fairly for their level of expertise.

I agree. But, you don't have to be a dick.


But at least I...unlike you...work in the medical field...and actually know wtf im talking about when it comes to the real-world impact "obamacare" will have.

I never claimed to not be a dick. I claimed i know more about such things than you...and i do.

You..on the other hand..are possibly less of a dick...but are also much less informed of the truth than I, but yet you keep pretending like u know wtf you're talking about while you clearly do not.
 
2013-09-24 10:43:21 AM  

TNel: netcentric: It not really funny funny... but it is humorous to find that some folks in my state are thrilled to find out they can get an Obamacare policy for $150 a month.     But when I look up for them the cost of a policy last year through thier 'Blues'.   It ends up being cheaper.

They are going to pay more, and have no clue.

They may get max's eliminated,  but they also sacrifice (or have less) choices and options.
(in my state the Blues were the Insurer of last resort so they were required for decades to cover preexisting)

Now you are finding out there are hidden costs ??    Hahahahahahaha...

You can not get healthcare for $150 a month in the wild without REALLY good employer contribution.  Stop lying.


Our individual polices to employees are right around $380 a month, and we contribute 50% at least.  So pretty close to that.  But the cost will be going up.
 
2013-09-24 10:43:58 AM  

Kit Fister: doyner: So which country's system do you think works best?

I don't know, from my experience every country's healthcare system has snafus that affect care.


Plus in other countries all the doctors hung it up and became garbage men.
 
2013-09-24 10:44:23 AM  

lovefirststool: Kuroshin: Sounds to me like there's market for more Doctors.

Why is it we don't have enough Doctors to handle all these sick people?

Hmmm....

Because, speaking as a physician, it isn't worth it. I routinely encourage high school and college students to do something else.


So you went into it solely for the money? Are you a supporter of this little gem of a policy?  http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage _ x.htm
 
2013-09-24 10:44:40 AM  

jfivealive: QueenMamaBee: Direct quote from my Dear Leader:
Jackson said the Affordable Care Act, or "Obamacare," which he said he had nicknamed "the Unaffordable Care Act," had greatly impacted the ability of hospitals, including KDMC, to earn a profit, and that he expected that to continue.

He said the ACAhad taken away billions of dollars from mostly hospitals to be set aside to pay for health insurance for the estimated 30 million Americans who are currently uninsured, with the promise hospitals will be "made whole" once health care reform is fully implemented because those without insurance will have some form of coverage.

"We don't believe that. No one in health care believes that,"Jackson said.

What?  How does that make any sense?  Now I've never overseen the entire financial picture of a hospital before, but i have for private practices and smaller facilities, and I don't think there is any place where a hospital is forced to put money aside so insurance companies can insure the uninsured through the affordable care act.  The only thing I can think of where he's going with that, is that insurance companies have decreased their reimbursement rates so much that it costs the hospitals billions of dollars in revenue.  The insurance companies are doing this to prepare for the influx of the uninsured, and expecting to have to write out more than the premiums bring in.  That makes sense, except for one thing.  None of the contracts i have through major commercial insurance companies had a decrease in reimbursement rates for services provided.

Here's how i see the Affordable Care Act affecting our businesses.  One, we will have an increase in the medical benefits we must pay out to employees.  Currently, depending on position and department, we pay out 50 - 100% of policy premiums for employees.  The majority of our employees are at the 50% rate.  Since they will be required to get health insurance, we will see quite the jump in participation, so our cost of doing business ...


Because he's a Republican and any Democratic idea is ooooooh scarrrrrrrry.

Also, why we HAD to keep all hospital TVs on Fox News, til last summer where he finally lightened up and allowed HGTV, Travel Channel and The Weather Channel.
 
2013-09-24 10:45:09 AM  

This text is now purple: Highroller48: Oh, I forgot. For-Profit essential medical care can regulate itself and will fix all its own problems!

Seriously, imagine if the fire department and police worked the same way as health care in the U.S.

On the short term, it sort of does work like the police.

Consider Houston -- Houston had a police force arguable adequate for its population and number of criminals. It was at capacity, but could handle its load. Then Katrina happens. Suddenly, Houston absorbs an extra 100,000 of New Orleans' criminals. The police can still only work at 100% capacity, so all of those extra crimes result in reduced police coverage across the board. Net crime increases.


A 100,000 criminals huh? Interesting. You're basing that on what exactly?
 
2013-09-24 10:45:22 AM  

doyner: Wow. Nice dodge. I guess if nothing can be perfect we shouldn't fix anything.


Uhm, I didn't say that. But so far we've put a bandaid on a sawn-off limb. You want to fix this? it's going to take a farkload more work than what we've done.
 
2013-09-24 10:46:26 AM  

The more you eat the more you fart: But at least I...unlike you...work in the medical field...and actually know wtf im talking about when it comes to the real-world impact "obamacare" will have.

I never claimed to not be a dick. I claimed i know more about such things than you...and i do.

You..on the other hand..are possibly less of a dick...but are also much less informed of the truth than I, but yet you keep pretending like u know wtf you're talking about while you clearly do not.


Fair enough.
 
2013-09-24 10:47:05 AM  

HotWingConspiracy: Kit Fister: doyner: So which country's system do you think works best?

I don't know, from my experience every country's healthcare system has snafus that affect care.

Plus in other countries all the doctors hung it up and became garbage men.


Just like you, buddy.

/garbage men, I learned, make a surprisingly good salary.
 
2013-09-24 10:50:39 AM  

Kit Fister: HotWingConspiracy: Kit Fister: doyner: So which country's system do you think works best?

I don't know, from my experience every country's healthcare system has snafus that affect care.

Plus in other countries all the doctors hung it up and became garbage men.

Just like you, buddy.


What?

/garbage men, I learned, make a surprisingly good salary.

They're unionized, of course they do. Not exactly a growth industry though, I really doubt many will stop to consider sanitation over medical school.
 
2013-09-24 10:51:58 AM  

doyner: Thank you for boiling this down to its essence. The Obamacare "debate" is essentialy money vs. humanity. Good to know where people stand on these things.


You can't legislate humanity.
 
2013-09-24 10:52:01 AM  

grinding_journalist: James!: Sounds like a good time to go to medical school.

Did you miss the part in all the articles discussing the rollout where they say doctor fees are going to be a percentage of what they are for medicare patients? And the part where medicare pays about 25-50% of private insurance?

So, sure go to med school if you want to be a "government doctor" and be in debt till you're 50.


Well if we lived in a reasonable country that was not driven by the profit motive educating a doctor would not cost so much that one of the top earning salaried workers are in debt until their 50. Want to lower the cost of education? Lets create a five trillion dollar Federal University system that is free to all applicants who meet the standards. Of course that University only offers education no sports.
 
2013-09-24 10:52:07 AM  

HotWingConspiracy: They're unionized, of course they do. Not exactly a growth industry though, I really doubt many will stop to consider sanitation over medical school.


For about $75k/year? And never having to look at or deal with anyone's diseased crap? I would.
 
2013-09-24 10:52:54 AM  
Obamaphone!
 
2013-09-24 10:52:57 AM  
Steve McQueen's Motorcycle:

I do.

Same here.


Good thing your employer is nice, I pay $100 a month for family coverage because my employer cares about it's people.  My wife's work wanted like $400 for single person and like $750 for family.
 
2013-09-24 10:53:49 AM  
Okay...
But there is literally one doctor in the city that is taking new patients.  And he's almost full.
Soooooooo... yeah.

Woo.
 
2013-09-24 10:54:00 AM  

Kit Fister: doyner: Wow. Nice dodge. I guess if nothing can be perfect we shouldn't fix anything.

Uhm, I didn't say that. But so far we've put a bandaid on a sawn-off limb. You want to fix this? it's going to take a farkload more work than what we've done.


I'd rather get a bandaid on a sawn-off limb than bleed to death while someone steals my wallet.

I don't like it.  I want single-payer.
 
2013-09-24 10:54:01 AM  

TNel: You can not get healthcare for $150 a month in the wild without REALLY good employer contribution.  Stop lying.


I just pulled this quote online. There were options for under $90 a month but with a large deductible. In this case I can get a great PPO for under $150 and for $28 more I could get dental and vision.


dl.dropboxusercontent.com
 
2013-09-24 10:54:33 AM  

Kit Fister: HotWingConspiracy: Isn't this a good problem to have?

No. When you have a massive increase in number of patients vs. doctors, you have two problems: 1. The wait time for care gets longer. 2. The amount of time the doctor has to spend with each patient to properly diagnose an issue decreases.

As a subset of item 2, you also increase the workload and the chance of mistaken diagnosis, improper prescription of medication, and unnecessary medical procedures that result in issues for patients.

I want people to have health care, but we need to also help get more doctors into the system to offset the increased load.


I have an issue with your number 2.  Most doctors (even up here in our Great Frozen Socialist Paradise) already spend as little time as necessary with their patients because they can bill more patients that way.   So don't expect a big change in the way most doctors operate.
 
2013-09-24 10:54:52 AM  
image.patriotpost.us
 
2013-09-24 10:55:20 AM  

Kit Fister: Uhm, I didn't say that. But so far we've put a bandaid on a sawn-off limb. You want to fix this? it's going to take a farkload more work than what we've done.


Logically wouldn't it make more sense to completely restructure it instead of tagging on an extra burden?

Not like we could put everything on hold, hence logically not realistically, while a completely new system is engaged?
 
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