President Has The 'Rona

[Cideous]

3 hours ago, FiremedicMike said:

Can you please qualify this statement?
 

Sure,

Trump's administration along with several Republicans state's attorney general lead by Texas is set to argue that the ACA should be removed in totality.  Pre-exsisting condition protections: Gone.  Kids able to stay on insurance until 26:  Gone.  Medicaid expansion for poor adults:  Gone.  Lifetime caps:  Gone.

The case will be heard a few days after the election and the new justice is already on the record coming out against the ACA and it's protections.  

This is being carried out by 100% Republicans.

Edited October 9, 2020 by Cideous

[Boatswain2PA]

Of course that ignores the reasons Republicans want to get rid of the ACA.

The ACA has vastly increased costs for nearly everyone and reduced insurance options almost everywhere.  

Republicans arent evil for wanting limited government, and Dems arent evil for wanting birth-to-death government care.

[FiremedicMike]

10 minutes ago, Cideous said:

Sure,

Trump's administration along with several Republicans state's attorney general lead by Texas is set to argue that the ACA should be removed in totality.  Pre-exsisting condition protections: Gone.  Kids able to stay on insurance until 26:  Gone.  Medicaid expansion for poor adults:  Gone.  Lifetime caps:  Gone.

The case will be heard a few days after the election and the new justice is already on the record coming out against the ACA and it's protections.  

This is being carried out by 100% Republicans.

Three questions:

1. Didn't we hear widespread rumors that Trump would immediately repeal the ACA as soon as he took office after the first election?  Yet he's made no push that I'm aware of to change healthcare.

2. Do you have evidence this is being run by Trump?  For that matter, can you link some unbiased sources that this is even happening (your post is the first I've heard of it)

3. In comparing healthcare before the ACA to healthcare since the enactment of the ACA, can you quantitively demonstrate that the ACA is a success or a failure?

Edited October 9, 2020 by FiremedicMike

[ventana]

5 minutes ago, Boatswain2PA said:

Of course that ignores the reasons Republicans want to get rid of the ACA.

The ACA has vastly increased costs for nearly everyone and reduced insurance options almost everywhere.  

Republicans arent evil for wanting limited government, and Dems arent evil for wanting birth-to-death government care.

untrue

how can you say it is decreased options when there are MILLIONS of people insured that previously were not- and that they will LOOSE insurance if ACA is repealed.   The only options that have been eliminated are the cheap policies that basically underinsured your for less money - I have a few friends with these policies in the early 2000's and they were awful when they got hurt.  They didn't really cover anything.

as for costs - you have to look at the total spent on health care

USA leads the world by a staggering amount on spending per capita on health care

due to not having a universal health care and the insurance companies wanting to make money we spend FAR more for FAR less then any other country....

 

ACA is not responsible for increasing costs, it is shifting costs to a more universal system.  

 

The issue the republicans have is preserving the profits of the insurance companies under the guise of "personal responsibility" instead of society has the responsibility to protect it's citizens.  

 

If we look and realize that something like 70% of health care is already paid for by public/gov't entities (Medicare, medicaid, VA, disability and the like....) then the only thing that seems reasonable is to have a universal health care program.  As tRump has only want to repeal ACA, and has not offered anything to replace it - he is indeed trying to take insurance away from millions. 

[FiremedicMike]

@mcclanenot sure why the thumbs down, I'm legitimately trying to hear opposing viewpoints.

 

[Boatswain2PA]

20 minutes ago, ventana said:

how can you say it is decreased options

By reading https://www.google.com/amp/s/www.usnews.com/news/articles/2016-08-17/health-insurers-exit-from-obamacare-leaves-little-insurance-choice%3fcontext=amp

[Boatswain2PA]

10 minutes ago, FiremedicMike said:

@mcclanenot sure why the thumbs down, I'm legitimately trying to hear opposing viewpoints.

 

There are a couple of posters here who bring nothing to any discussion but hatred.  Better to just block/ignore them.

[FiremedicMike]

2 minutes ago, Boatswain2PA said:

There are a couple of posters here who bring nothing to any discussion but hatred.  Better to just block/ignore them.

That's the frustrating reality of discussing politics and religion these days, it seems.. 

 

[MediMike]

1 hour ago, FiremedicMike said:

Three questions:

1. Didn't we hear widespread rumors that Trump would immediately repeal the ACA as soon as he took office after the first election?  Yet he's made no push that I'm aware of to change healthcare.

2. Do you have evidence this is being run by Trump?  For that matter, can you link some unbiased sources that this is even happening (your post is the first I've heard of it)

3. In comparing healthcare before the ACA to healthcare since the enactment of the ACA, can you quantitively demonstrate that the ACA is a success or a failure?

1) Trump has been attempting to disband the ACA for the entirety of his term.

https://www.ajmc.com/view/republican-attorneys-general-file-briefs-to-repeal-aca

2) Are you asking for specific quotes from Trump? 

https://www.fiercehealthcare.com/payer/back-to-future-trump-s-history-promising-a-health-plan-never-comes

3) What metrics are you asking for here? We can quantitatively show that more Americans are insured. Not sure that a healthcare program that's been in place for such a short period of time (and has been getting gutted for most of it) can be qualitatively shown to have an effect.

[Boatswain2PA]

Democrat lefties are pushing everyone toward a single payer system.  It has been the goal of virtually every healthcare policy they make.  Obamacare was a big step in that direction.  The "public option" is the next big step as it will continue to kill private insurance policies.

Republican righties want people to pay for their own stuff, so therefore fight back against the Dem encroachments.

Both arguments have their benefits, but neither will provide the panacea promised by their acolytes.  But only the Dem plan will break the nation's bank (not that we are not already broke).

 

[Cideous]

1 hour ago, FiremedicMike said:

Three questions:

1. Didn't we hear widespread rumors that Trump would immediately repeal the ACA as soon as he took office after the first election?  Yet he's made no push that I'm aware of to change healthcare.

2. Do you have evidence this is being run by Trump?  For that matter, can you link some unbiased sources that this is even happening (your post is the first I've heard of it)

3. In comparing healthcare before the ACA to healthcare since the enactment of the ACA, can you quantitively demonstrate that the ACA is a success or a failure?

1.  I don't mean to sound like a jerk, but....really?  Trump with a Republican majority house AND senate came 1 (ONE) senate vote away from repealing the ACA and replacing it with complete crap.  John McCain was the final no vote which saved the ACA, all of its benefits which many people now take for granted.  This was in Trumps first year in office and was 100% of the news cycle.  Thank you John McCain and may he Rest In Peace.

2.  Evidence?  It's the Trump administration who joined the republican states attorneys general in the lawsuit!  From the article I will link: 

 

The Trump Administration and 18 Republican state attorneys general are asking the Supreme Court to strike down the entire Affordable Care Act (ACA) as unconstitutional.Oral arguments are scheduled for November 10, with a decision likely next spring. The ACA remains the law of the land for now, and legal experts across the political spectrum view the case against it as extremely weak. But if the courts “terminate” the ACA, as President Trump again urged in May, some 20 million people would become uninsured — likely many more when accounting for COVID-19’s effects on ACA participation. In addition, if the Administration prevails, millions more could be charged more or denied coverage altogether because they have a pre-existing condition or would lose other important protections.

 

Read it here:  https://www.cbpp.org/research/health/suit-challenging-aca-legally-suspect-but-threatens-loss-of-coverage-for-tens-of

 

3.  I don't have enough time to list all of the benefits that the ACA has provided, the 10's of millions of people who were finally able to get health insurance, the removal of lifetime caps, the illegality to deny someone coverage because they have a pre-exsisting condition, letting your kids stay on your insurance until they are 26, mandatory coverage for vaccines and preventive care, Medicaid expansion for poor adults in every state except a few Republican hold outs...on and on and on.

I am an advocate for my patients and I lived and worked through the "Sorry but your patient Mr. Smith has been denied, it has been determined he had a "Pre-exsisting condition".  It was a a nightmare.  HTN?  DM?  Previous injury?  DENIED.  I saw it happen literally hundreds of times.  The ACA fixed that.

 

 

[FiremedicMike]

14 minutes ago, MediMike said:

1) Trump has been attempting to disband the ACA for the entirety of his term.

https://www.ajmc.com/view/republican-attorneys-general-file-briefs-to-repeal-aca

2) Are you asking for specific quotes from Trump? 

https://www.fiercehealthcare.com/payer/back-to-future-trump-s-history-promising-a-health-plan-never-comes

3) What metrics are you asking for here? We can quantitatively show that more Americans are insured. Not sure that a healthcare program that's been in place for such a short period of time (and has been getting gutted for most of it) can be qualitatively shown to have an effect.

I'll stipulate that the Trump administration may be trying to undo ACA with this caveat: It was literally one of his main campaign points.  The Americans elected him, in part, because they wanted that repealed.

Here's some quantitative metrics that should be observable by now

1. Increase in primary care doctors in underserved areas

2. Increase in PCP visits

3. Decrease in ER visits

4. Increase in prenatal care visits

 

[MediMike]

3 minutes ago, FiremedicMike said:

I'll stipulate that the Trump administration may be trying to undo ACA with this caveat: It was literally one of his main campaign points.  The Americans elected him, in part, because they wanted that repealed.

Here's some quantitative metrics that should be observable by now

1. Increase in primary care doctors in underserved areas

2. Increase in PCP visits

3. Decrease in ER visits

4. Increase in prenatal care visits

 

Why say you haven't heard anything about this/Trump driving this if you knew it was his campaign platform? Are you saying that you haven't heard that he's done anything regarding it in the past 4 years? Want to make sure I'm understanding where you're coming from.

Increased private insurance payments for prenatal care, associated with a decrease in preterm births. -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838787/

Increase in the number of PCP visits, vaccinations - https://www.ajmc.com/view/improvements-in-access-and-care-through-the-affordable-care-act

Number of uninsured visits to PCP decreased - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593726/

Number of uninsured visits to ED/Hospital decreased -https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730788

These are all pretty straightforward answers to find.  Although I'm not sure why you'd expect to see an increase in rural healthcare providers with an expansion of insurance.  If someone doesn't want to live rural they aren't going to move rural, regardless of the insurance of that population.

Wouldn't expect to see an increase in total # of PCP visits or decrease in total # of ED visits at this point either, while having insurance certainly improves ease of and access to care it doesn't create more providers.  The reasons to NOT go into PC/FM remain pretty high for many people.

[FiremedicMike]

3 minutes ago, MediMike said:

Why say you haven't heard anything about this/Trump driving this if you knew it was his campaign platform? Are you saying that you haven't heard that he's done anything regarding it in the past 4 years? Want to make sure I'm understanding where you're coming from.

Increased private insurance payments for prenatal care, associated with a decrease in preterm births. -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838787/

Increase in the number of PCP visits, vaccinations - https://www.ajmc.com/view/improvements-in-access-and-care-through-the-affordable-care-act

Number of uninsured visits to PCP decreased - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593726/

Number of uninsured visits to ED/Hospital decreased -https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730788

These are all pretty straightforward answers to find.  Although I'm not sure why you'd expect to see an increase in rural healthcare providers with an expansion of insurance.  If someone doesn't want to live rural they aren't going to move rural, regardless of the insurance of that population.

Wouldn't expect to see an increase in total # of PCP visits or decrease in total # of ED visits at this point either, while having insurance certainly improves ease of and access to care it doesn't create more providers.  The reasons to NOT go into PC/FM remain pretty high for many people.

I didn't know he was driving anything current, I only knew it was one of his campaign promises.  That is what I meant.

I will check through those datapoints, thank you.

Underserved is not exclusive to rural.  

[CAAdmission]

I don't think there is anyone in the country - healthcare provider, politician, anyone - who sits around thinking having less insured people around is a good idea. One way or another we are going to wind up paying for care they can't afford whether through charity care, subsidies, whatever. 

I'm not sure I have heard someone come up with a plan that I think is economically feasible in the long term. Granted, I'm not an economist, and there are intricate relationships at work (a big one being sick people can't work). The biggest thing that stuck in my craw was imposing financial penalties to coerce people into participating in the ACA. I didn't think it was a good route to go down.  

 

[MediMike]

11 minutes ago, CJAdmission said:

I don't think there is anyone in the country - healthcare provider, politician, anyone - who sits around thinking having less insured people around is a good idea. One way or another we are going to wind up paying for care they can't afford whether through charity care, subsidies, whatever. 

I'm not sure I have heard someone come up with a plan that I think is economically feasible in the long term. Granted, I'm not an economist, and there are intricate relationships at work (a big one being sick people can't work). The biggest thing that stuck in my craw was imposing financial penalties to coerce people into participating in the ACA. I didn't think it was a good route to go down.  

 

I can totally see your point. Takes back to the mention of seatbelts/motorcycle helmets, how do you enforce a law or requirement which is instituted for the good of the individual as well as to protect my wallet without some kind of punitive approach?

Whether it's a ticket for a seatbelt not being worn or a penalty for not having insurance it ends up being the same thing.

Completely agree it's not ideal, guessing they just hit a wall thinking of options.

[FiremedicMike]

34 minutes ago, MediMike said:

I can totally see your point. Takes back to the mention of seatbelts/motorcycle helmets, how do you enforce a law or requirement which is instituted for the good of the individual as well as to protect my wallet without some kind of punitive approach?

Whether it's a ticket for a seatbelt not being worn or a penalty for not having insurance it ends up being the same thing.

Completely agree it's not ideal, guessing they just hit a wall thinking of options.

They tried that with outlawing giant pops somewhere.. New York?  I understand what they were trying to do, but it was predictably a huge failure.

IMHO it has to go back to step 1.  More focus on physical fitness and proper nutrition from preschool.. Find a way to discourage obesity without coming across as body shaming..

[FiremedicMike]

Pop = soda for those of you who are weird...

 

lol

[ventana]

4 hours ago, Boatswain2PA said:

 
Both arguments have their benefits, but neither will provide the panacea promised by their acolytes.  But only the Dem plan will break the nation's bank (not that we are not already broke).

 

nope not true

 

please review the $ on actual monies spent for a single payer system (overall monies spent, not just gov't or private spending) and the data/facts paint a different picture - employer taxes, individual taxes (but never having to pay health insurance premiums - I paid just under 20k last year is the trade off.)  Yes my taxes might go up by $5,000 but my health insurance bill goes from 20k to ZERO

See this is the the thing the republicans fail to mention -the money is already there being spent (highest per capita in the world) but the greedy insurance companies and the lack of negotiation power shifts creates more costs and shifts cost to the consumer.  

[EMEDPA]

1 hour ago, ventana said:

please review the $ on actual monies spent for a single payer system (overall monies spent, not just gov't or private spending) and the data/facts paint a different picture - employer taxes, individual taxes (but never having to pay health insurance premiums - I paid just under 20k last year is the trade off.)  Yes my taxes might go up by $5,000 but my health insurance bill goes from 20k to ZERO

 

Agree- I have one per diem job to pay for health care for myself and my family. It is slightly more than 20k/yr for 3 of us. Would I be willing to pay more taxes to not have to pay 20k for health insurance? You bet. Would that also assure that everyone I see in the ER can afford their antibiotics, etc? Yup. Win/win. 

The US is the only industrialized nation without a universal health care system. Our outcomes for most issues are not as good as many of these nations. Yes, we have cutting-edge medications and procedures here, but at the cost of worse outcomes for routine stuff like 1st year childhood mortality.

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start

[ohiovolffemtp]

In PA school part of our pharmacology was taught by a pharmacist who'd worked for the VA.  He said that when the VA looked at medication compliance for patients who received their meds for free from the VA it was only about 60%.  So, while cost is a factor, I've seen major compliance issues in the ED who just don't take even their low cost medications, e.g. meds in the $5-10/month range.

[MediMike]

19 minutes ago, ohiovolffemtp said:

In PA school part of our pharmacology was taught by a pharmacist who'd worked for the VA.  He said that when the VA looked at medication compliance for patients who received their meds for free from the VA it was only about 60%.  So, while cost is a factor, I've seen major compliance issues in the ED who just don't take even their low cost medications, e.g. meds in the $5-10/month range.

I'd be interested to see if that was explicitly for the VA demographic alone.

Nice JAMA article here detailing the opposite, higher compliance with free meds:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2752366

[ANESMCR]

Talk about EBM. How about the editors of EBM? We all know about Scientific American’s recent condemnation of the current administrations response to Covid, and practical endorsement of Biden; now even the NEJM....

https://www.nejm.org/doi/full/10.1056/NEJMe2029812?query=featured_coronavirus

[ANESMCR]

23 hours ago, FiremedicMike said:

That's the frustrating reality of discussing politics and religion these days, it seems.. 

 

I’m not here to disparage other posters but this is RICH coming from Boats. The guy that dismisses everyone’s view that challenge his own. Baits and gaslights others. Dismisses newer posters in a creepy ‘Internet forum-like’ “elite status” manner similar to the huddle mentality-as if his longstanding history makes him better than others and his opinions more worthwhile. The questioning of those who haven’t been PA’s as long as he has. The blatant plagiarism/copy and pasting of far right talking points, almost like watching fox and friends in the morning. Like talking to a brick wall, literally. I answered his questions and was blocked immediately. 

Edited October 10, 2020 by ANESMCR

[ventana]

On 10/9/2020 at 4:57 PM, EMEDPA said:

Agree- I have one per diem job to pay for health care for myself and my family. It is slightly more than 20k/yr for 3 of us. Would I be willing to pay more taxes to not have to pay 20k for health insurance? You bet. Would that also assure that everyone I see in the ER can afford their antibiotics, etc? Yup. Win/win. 

The US is the only industrialized nation without a universal health care system. Our outcomes for most issues are not as good as many of these nations. Yes, we have cutting-edge medications and procedures here, but at the cost of worse outcomes for routine stuff like 1st year childhood mortality.

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start

This is the winning post!!!