U.S. Politics: Confirming The Trumpocalypse

[Mexal]

There is nothing more ironic then Trump quoting the Russian spokesperson about the veracity of the accusations. Well, that and asking if we live in Nazi Germany after he's had actual white supremacists nazi salute him or lamenting unverified accusations (secret birther call to his office?). This press conference will be interesting.

[OldGimletEye]

Just now, Ser Scot A Ellison said:

Because a categorical regulation will help in situations that are necessarily individualized?  Medicine varies from patient to patient.  Malpractice is decided on a case by case basis as well, how can regulation, which cannot be individualized, help?

Scot, I thought, you supported singer payer. I don't know how you do that, unless you have some kind of regulatory framework to help to decide which treatments are helpful and which are not.

You've agreed that that the doctor's interest and the insurance company's interest probably will not align with the patient's, I thought.

I don't know what your issue really is here.

And of course, we'll have to keep malpractice litigation as some cases will be very fact dependent.

[Ice Queen]

4 minutes ago, Ser Scot A Ellison said:

Because a categorical regulation will help in situations that are necessarily individualized?  Medicine varies from patient to patient.  Malpractice is decided on a case by case basis as well, how can regulation, which cannot be individualized, help?

So you'd rather have them be allowed to operate carte blanche, to be able to deny people based on, for example, genetic profile? Denying pre-existing conditions was eliminated in ACA for a reason, after all. And as we get better at compiling genetic markers and individualized genetics, people who have those markers could be discriminated against. What's the point in paying for treatment when you know someone is going to develop a disease no matter how much preventive care they have? Do you see what I'm getting at? No regulation is a slippery slope that won't end well for many people. 

[Ser Scot A Ellison]

23 minutes ago, OldGimletEye said:

Scott, I thought, you supported singer payer. I don't know how you do that, unless you have some kind of regulatory framework to help to decide which treatments are helpful and which are not.

You've agreed that that the doctor's interest and the insurance company's interest probably will not align with the patient's, I thought.

I don't know what your issue really is here.

And of course, we'll have to keep malpractice litigation as some cases will be very fact dependent.

I do, with reservations.  

I'm pointing out that regulating practices that are necessarily individualized is incredibly difficult.  Regulation isn't the answer to all problems particularly problems that vary from individual to individual and are time critical.  I absolutely agree that Insurance companies interests do not align with patients, they are actually (in many circumstances) the opposite of the patient.  Insurance has every incentive to refuse to pay for anything.   That maximizes their profit.  

Doctors and patients, less frequently, have misaligned interests.  Doctors have an interest in not being sued and maximizing their profit as well.   That is maximized by doing more work for their patient.  That should, in most cases add up to better care for the patient.  But it costs the patient, or, the insurance carrier money.

We've taken the patient out of the equation with third party insurance.  Insurance isn't going to want to make decisions on an indiviualized basis, nor is there time to wait for insurance to make a decision.  It opens the insurance carrier up to potential malpractice claims as well.  Ideally, the decision would be between the physician and the patient.  

My point is that I don't see how regulation helps in this case.  I think, that at this point, single payer is the least bad option.  

That said I can't help but wonder what would happen if medical practice was deregulated and third party insurance banned.  Force people to bear the direct cost of their medical care and make their own decisions about what the do and do not want done.  

When people either refuse to have expensive treatments, or when they do have expensive treatments can't pay for them will that not necessarily force the hand of physicians and hospitals? They will have to lower the cost of care or they will go out of business.

The problem is the interregnum between deregulation/the end of third party insurance and lower pricing.  That period of time would be incredibly painful.  That is why I think single payer is the least bad option.  It avoids the painful interregnum even if it requires regulation of the practice of medicine, which because of its individualized nature, I think is a very bad idea.    

[Lux]

Will the Kek cult survive Trump's presidency?

[OldGimletEye]

Just now, Ser Scot A Ellison said:

snip

Without going through this all, it seem to me you want to be a socialist with regard to providing healthcare, and then be a complete libertarian with regulation.

You can't make that work.

And if you got rid of insurance, and made people pay out of pocket, some people would simply go without healthcare. The whole point of insurance is to pool risk. You either have private parties provide the insurance or the government do it or a combination of both.

And the reason you have to have regulation is so people can't just get penis enhancement surgeries under their Medicare program anytime they want them.

[Ser Scot A Ellison]

1 minute ago, OldGimletEye said:

Without going through this all, it seem to me you want to be a socialist with regard to providing healthcare, and then be a complete libertarian with regulation.

You can't make that work.

And if you got rid of insurance, and made people pay out of pocket, some people would simply go without healthcare. The whole point of insurance is to pool risk.

I know.  The problem with pool risk is that the insurance carriers care about profit and not keeping patients healthy.  

I understand this is complex and contradictory.  How is regulation helpful for physicians and patients on an individual basis in time critical situations?  Really, how?

[OldGimletEye]

Just now, Ser Scot A Ellison said:

I understand this is complex and contradictory.  How is regulation helpful for physicians and patients on an individual basis in time critical situations?  Really, how?

Scot, I thought I've explained this. You seemed to have acknowledged the point. But, now, it's, "like I don't just don't understand."

[OldGimletEye]

Just now, Ser Scot A Ellison said:

I understand this is complex and contradictory.  How is regulation helpful for physicians and patients on an individual basis in time critical situations?  Really, how?

Because, it could prevent the Doctor from giving treatment with little benefit for the purpose of increasing his paycheck?

[Ser Scot A Ellison]

2 minutes ago, OldGimletEye said:

Because, it could prevent the Doctor from giving treatment with little benefit for the purpose of increasing his paycheck?

How?  A doctor treating a patient in a time critical life threatening situation should stop and check the regs before deciding what individualized treatment their patient needs?

[Tywin et al.]

While it seems like the most salacious parts of Buzzfeed's report are unsubstantiated, it's becoming abundantly clear that the President and the President-elect did in fact receive a two page memo about how Trump is being co-opted by the Russian government.

1 hour ago, Commodore said:

I'm shocked the left's lamentations about fake news were insincere

As others have said, I don't think you understand what fake news is. It would be fake news in Buzzfeed just made it up, but this information has been known to several top ranking Republicans, among other people, for months. It just wasn't reported on. 

[OldGimletEye]

Just now, Ser Scot A Ellison said:

How?  A doctor treating a patient in a time critical life threatening situation should stop and check the regs before deciding what individualized treatment their patient needs?

Yes, he should be knowledgeable about what is considered "best practice" given the situation.

Again, Scot, you can't have it both ways, which you are trying to do here it seems. You can't do single payer and then have no framework that eliminates practices that have high cost, but have little marginal value.

[Jo498]

In countries like Germany, health insurance cannot be denied because of prior conditions, that is, there are companies that have to provide insurance for anyone, no matter how ill. This does not mean that all bills and all kinds of treatments are paid in full (especially untrue for dental care). There is usually a low payment for medicine, e.g. I have to pay 5 Euros for a bunch of higher level painkillers I need a prescription for and they might actually cost 20 and the rest is covered by the insurance. There are quite a few treatments not covered in any case, e.g. homoeopathy (I think, or maybe the homoeopathy lobby has managed to get some of their treatments included).

In any case, everyone can voluntarily pay for treatments not covered by the obligatory programs or buy additional insurance (esp. popular with dental care) if one wants to do so.

Of course there are "losers" as in any system. You usually lose if you are rather healthy, single and an employee earning around 4000 EUR/month before taxes because than you are forced into the mandatory program. If you earn slightly more you can opt out or in any case the payment is capped at the amount you pay around these earnings. You also lose if you have bad luck and the stuff you need is not covered or has high additional payments. e.g. glasses used to be covered at least partly, but not anymore, I think. (It's o.k. that glasses are not being covered but you are still screwed if you pay high premiums because of a decent wage but the stuff you need you have to pay for yourself. This happened to me with glasses, orthopedic soles, dental stuff, so I am very well acquainted with the considerable flaws of the system)

You win if you are earning not well or have a part time job with full health insurance because you pay considerably less than the guy mentioned before and get the same level of healthcare. Also often spouses and children are covered by the breadwinner's insurance (having never been in that situation, I don't know about the details). Also doctors and other people in the "health industry" make less money than in the US (but note that medical school is basically free, except for living costs), nevertheless most jobs in the health sector are decently paid (except probably for the least qualified types of nurse or so).

[Ser Scot A Ellison]

5 minutes ago, OldGimletEye said:

Because, it could prevent the Doctor from giving treatment with little benefit for the purpose of increasing his paycheck?

That might work for calm office practice.  How does that work in a trauma unit where expensive treatment can be needed or th patient dies?  Will such regulation not, necessarily, inhibit innovation and advances in medical treatment because new treatments wouldn't be covered by regulation and thus not something that will be paid for?

[Commodore]

why have any classified information if people can leak with impunity 

 

[OldGimletEye]

Just now, Ser Scot A Ellison said:

That might work for calm office practice.  How does that work in a trauma unit where expensive treatment can be needed or th patient dies?  Will such regulation not, necessarily, inhibit innovation and advances in medical treatment because new treatments wouldn't be covered by regulation and thus not something that will be paid for?

Still wanting to have it both ways, it seems.

Certainly the regulations could be drafted to make allowance for the fact a doctor acting in an emergency situation is different from a calm office situation, could it not? If the expensive treatment is likely to save the patient' life, then do it. But if the treatment is not likely to work, then maybe it shouldn't be provided, unless the patient in question has the additional resources to pay for it. 

Also, if you're worried about innovation, I'd suggest drop the Patent Laws and spend more money on basic research. It would probably save us a lot more money.

[Werthead]

Information on the BBC News now from their Washington correspondent:

1. The information regarding Trump - just the fact that Russia had some kind of intelligence on him, none of the specific details - was known about in late October/early November but because the intelligence services would not comment on them, the media could not report on them (unlike the emails scandal, with the FBI making public statements about it).

2. The information has come from multiple sources. The former MI5 agent in Moscow is considered highly credible by American intelligence because previous information from the same source proved accurate. However, other sources have corroborated the MI5 agent's report. There isn't one single point of communication on this matter.

3. The information relates to multiple events (not just one) in multiple locations in both Moscow and St. Petersburg over a long period of time.

4. The information consists of multiple video and audio files. These files have not been disclosed but their existence has been well-known in Russian intelligence circles for a long time (one of the reasons its has leaked is that it appears the Russians basically gathered it for the lolz starting years before Trump was a serious contender for President and now they're trying to clamp down on it like there's no tomorrow).

5. The information relates to both sexual conduct and also to financial "impropriety."

6. Until the actual files are released (which the reported seemed to find rather nauseating) this is all unproven. However, multiple American and foreign intelligence agencies are involved in the matter as they regard the sources to all be "highly credible".

[Jo498]

A central problem is that a patient is not really a customer. He is ill, in pain etc., he cannot choose if he wants treatment like choosing between fruit loops and cornflakes. There is a huge asymmetry in power and information between doctor and patient. Another is that the healthcare provider (doctor) should strive to make the patient healthy but he might earn more if the patient does not get well asap. So there is a conflict between the essential goal (health) and the economical goal (maximise profits). Then there is a very uneven risk distribution in the populace etc. All these factors show that healthcare is not just another market like cars or cornflakes.

[Commodore]

1 minute ago, Jo498 said:

A central problem is that a patient is not really a customer. He is ill, in pain etc., he cannot choose if he wants treatment like choosing between fruit loops and cornflakes. 

What's inhibiting competition/choice in treatment offerings?

[Mexal]

MSNBC is reporting that the two page annex wasn't handed over to Trump or his team. That it was there for the briefers if they wanted to use an example of unverified intelligence but was never used. As always, more and more stuff that is closer to the truth will come out after the initial blast.