U.S. Politics: Confirming The Trumpocalypse

[aceluby]

23 minutes ago, Notone said:

Oh boy, I am watching the Trump Press Conference on youtube, well more listening to it. That one is really bizarre. Now that's somewhat of a contrast to an Obama Press conference.

Anyway, you have to put the axe to the costs (obvious, I know). The question is how to do it. I would argue giving the insurance providers more negotiating power would be one step. (Btw. wasn't there another US health care thread?). Part of the problem is, that it's simply not a perfect market (if there's any such thing).

Insurance providers have a ton of negotiating power.  They can pay as little as 10% of the total cost of the bill.

[Ser Scot A Ellison]

19 minutes ago, OldGimletEye said:

Once again, if their is an informational issue between a supplier and buyer, then your standard micro 101 model probably doesn't apply. And then you have barriers to entry in the practice of medicine that probably undermines that model too. 

And then when you decide to provide healthcare to people with pre-existing conditions, then regulations become necessary.

And, again, regulating a market that is moved by cases that are highly individualize is a long damn way from ideal.  Regulations want to work in batches.  Medicine doesn't work that way much of the time.  

Nevertheless I recognize regulation is necessary for Single payer.  I just think its a poor fit in this situation.

[TheKitttenGuard]

That the news related to CNN and Buzzfeed's is getting the main play confirms many of my concern that this was going to distract from Trump's Business conflicts.

In addition the acceptance from the Press of Trump's attack on CNN shows a lot of them are quite spineless.

[OldGimletEye]

7 minutes ago, Ser Scot A Ellison said:

And, again, regulating a market that is move by cases that are highly individualize is a long damn way from ideal.  Regulations want to work in batches.  Medicine doesn't work that way much of the time.  

And why are doctors overcharging there patients for services they might not want, if they had a full set of information ideal?

And how is it ideal if the insurance company is able to give less than what the consumer would want, under a full set of information ideal?

And why would we consider it ideal to allow people with pre-existing conditions to just plain old die.

The problem here, Scot, is I think you assume that we can have a health insurance market where no regulations would produce ideal outcomes. And that seemingly just isn't the case.

I get that when it comes to individuals cases, doctors will have to often make individual determinations based on the facts before them. But, that isn't exactly a great argument that, "hey no regulations required!!"

[MerenthaClone]

1 hour ago, Crazy Cat Lady in Training said:

I understand that Medicare works differently than other insurance, which is why I was so angry that she was diagnosed by her doctor as pre-diabetic with an A1C of 5.1 and FBG of 90, which is well below the threshold by any standard. My impression was that the doctor was attempting to get reimbursed through Medicare for unnecessary tests--effectively committing Medicare fraud and potentially harming my mother's health in the process. She'd been his patient for years, yet he didn't seem to care about ordering that battery of tests until she turned 65 and got Medicare; then it was a whole new ballgame. The nurse on call at UPMC agreed with me and if I remember right the doctor was warned. 

You mention the hospital not being reimbursed for anything sepsis related if that bolus isn't given within the stated time frame. What's to stop a doctor or nurse from charting that it was given even if it wasn't, or would that show up in a pharmacy audit?

One of my neighbors died last year from urosepsis--an undiagnosed UTI while she was in an in-patient skilled nursing facility. I'm sure you see that kind of thing a lot. 

Edit: As I understand it, the rates of HAI are decreasing for a lot of states, except in ICU which really is understandable. So the situation is improving, though still not fabulous. 

Yeah, those lab values are weird and I'm not sure why those would lead to a pre-diabetic diagnosis.  Plus side for your argument, there's a decent chance that CMS saw that A1c value and went "yeah no not paying".  It sucks that they were ordered in the first place though.  

And nothing prevents us from that kind of fraud besides the fact that its illegal.  With fluids specifically there wouldn't be any kind of way to check if they were given, but that kind of outright lying on a chart would get reported immediately if it was discovered by another nurse or doctor. There's never been any kind of pressure on me or anyone else to do that that I know of, mostly because the tremendous fucking shitstorm the hospital would be in if that ever got discovered is in no way worth the benefit to them.  The other aspect is that if I did chart that I gave an aggressive fluid bolus to someone with advanced heart failure I'd have my attending and senior nursing staff yelling at me for being a goddamned negligent idiot, so either way I'm kind of fucked.  If there was pressure from the admin to start lying on charts, all of the doctors and nursing staff would have to be in on it too.  I'm of the opinion that a conspiracy that requires that many people to keep quiet isn't practical, especially since nobody in the hospital has any reason to actually side with the administration anyway.    

And yeah, HAIs are way down in part because CMS stopped reimbursing for them, leading to crackdowns across hospital systems to improve CVC care.  

[A Horse Named Stranger]

Well, Clown News Network deserves a lot of scorn though.

I mean it takes a special kind of news network, to hire a campaign manager that was fired over the assault of a reporter. 

I am sure they are so obsessed with that missing Malaysian Airlines Plane, because their Journalist Integrity was onboard. But nothing to worry about, Wolf Blitzer will find it, eventually.

[Ser Scot A Ellison]

8 minutes ago, OldGimletEye said:

And why are doctors overcharging there patients for services they might not want, if they had a full set of information ideal?

And how is it ideal if the insurance company is able to give less than what the consumer would want, under a full set of information ideal?

And why would we consider it ideal to allow people with pre-existing conditions to just plain old die.

The problem here, Scot, is I think you assume that we can have a health insurance market where no regulations would produce ideal outcomes. And that seemingly just isn't the case.

I get that when it comes to individuals cases, doctors will have to often make individual determinations based on the facts before them. But, that isn't exactly a great argument that, "hey no regulations required!!"

This is what I said before, it still holds:
 

Quote

Nevertheless I recognize regulation is necessary for Single payer.  I just think its a poor fit in this situation.

 

I'm not now saying no regulation is necessary.  I'm saying regulation doesn't fit well in this context.  That is not, and has never been "hey no regulations required!!"

There is no system that can always produce "ideal outcomes".

[OldGimletEye]

3 minutes ago, Ser Scot A Ellison said:

I'm not now saying no regulation is necessary.  I'm saying regulation doesn't fit well in this context.  That is not, and has never been "hey no regulations required!!"

Which context was that again? 

[Ser Scot A Ellison]

1 minute ago, OldGimletEye said:

Which context was that again? 

Where the circumstances regulated are highly individualized.

[TrackerNeil]

42 minutes ago, Tywin et al. said:

No. Our only hope is that the 10 or so Republican Senators I laid out a few weeks ago stand up and oppose Trump. Otherwise, @Kalbear's nightmare scenario is all but inevitable. 

I don't know what that scenario was, but I am sure I put no faith in Republicans--any Republicans. They've demonstrated time and time again that although they may not much care for Donald Trump, they'll do nothing to hinder him. Unless the American people turn strongly and severely against The Donald, the GOP will back him at every turn.

[Lany Freelove Cassandra]

that was an interesting press conference.  Why can't the man state what he's doing without all the extra bullshit?  Why does he always have to either insult someone or point out the losers?

I'd paraphrase it like this: "there's no law that says I have to do this, but you people have bitched so much about it, that I'll do it, but not the taxes. I don't have to that either."

"those states that voted for me will do all right"  and the states that didn't vote for you? what will happen to them?

"we could just let the people [on Obamacare] suffer..  we could. it would be the democrats fault. we could just let it implode and wait for people to come begging us for help.  but we'll fix it first. and it'll be great."

 

Not that I was expecting anything else, really.

 

[OldGimletEye]

5 minutes ago, Ser Scot A Ellison said:

Where the circumstances regulated are highly individualized.

Okay, let's think about this.

You're saying,"I'm all good with regulations, except when the circumstances are 'highly individualized', then anything goes". But, you know, determining when a circumstance is or is not "highly individualized" might require a law or regulation.

And you act is if regulations can't take into account the individual facts of a particular case. That isn't true.

[TrackerNeil]

6 minutes ago, Lany Freelove Cassandra said:

that was an interesting press conference.  Why can't the man state what he's doing without all the extra bullshit?  Why does he always have to either insult someone or point out the losers?

Because he's an egomaniacal asshole?

[Ser Scot A Ellison]

1 minute ago, OldGimletEye said:

Okay, let's think about this.

You're saying,"I'm all good with regulations, except when the circumstances are 'highly individualized', then anything goes". But, you know, determining when a circumstance is or is not "highly individualized" might require a law or regulation.

And you act is if regulations can't take into account the individual facts of a particular case. That isn't true.

OGE,

They can, but not well.  Regulations, by their nature assume generalized facts.  They have too to be effective that or they are so fricking extensive that no one looks at them because they are impossible to properly internalize.  

I, for one, don't want my ER doc worrying about whether the treatment they choose for me if I'm in a serious accident is worrying more about whether they are complying with regulations than treating my highly individualized injuries.

[Kalbear]

52 minutes ago, Tywin et al. said:

No. Our only hope is that the 10 or so Republican Senators I laid out a few weeks ago stand up and oppose Trump. Otherwise, @Kalbear's nightmare scenario is all but inevitable. 

Doesn't seem all that far-fetched, does it? 

[TrackerNeil]

1 minute ago, Kalbear said:

Doesn't seem all that far-fetched, does it? 

What's this scenario? I am intrigued.

[OldGimletEye]

2 minutes ago, Ser Scot A Ellison said:

I, for one, don't want my ER doc worrying about whether the treatment they choose for me if I'm in a serious accident is worrying more about whether they are complying with regulations than treating my highly individualized injuries.

Okay you see your ER doctor after an accident. Things are not looking good. You are insured by a public healthcare plan. The ER doctor suggest that you get some treatment that has about a 5% chance of working and cost about 2 million dollars. Should the public healthcare pay for it?

Probably not.

You're free of course to pay for it out of your own pocket though.

[Ser Scot A Ellison]

1 minute ago, OldGimletEye said:

Okay you see your ER doctor after an accident. Things are not looking good. You are insured by a public healthcare plan. The ER doctor suggest that you get some treatment that has about a 5% chance of working and cost about 2 million dollars. Should the public healthcare pay for it?

Probably not.

You're free of course to pay for it out of your own pocket though.

Right, because if I'm incapacitated due to a serious accident I'll be confiring closely with my ER phyisian.

[Jaxom 1974]

Can you guys take the Healthcare discussion to another thread?  It seems to have moved beyond politics...

And I'm not remembering Kal's nightmare now either...

[aceluby]

22 minutes ago, OldGimletEye said:

I get that when it comes to individuals cases, doctors will have to often make individual determinations based on the facts before them. But, that isn't exactly a great argument that, "hey no regulations required!!"

I understand that we want doctors to be altruistic and only want what is best for their patients, but that is just not the case.  I've had plenty of experiences of surgeons recommending unnecessary surgeries; especially neck, back, and wrist issues.  Some doctors that are very good a performing surgery are very bad at exhausting all avenues before surgery.  

Doctors are people too and it's ridiculous to think that the workforce isn't the same as any other workforce.  Some are good.  A few are very good.  But most are average or below.  So we shouldn't be basing policy thinking that agreed upon doctor and patient solutions are infallible.  The non-regulatory approach has to assume that, and it's wrong.