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Reik posted:If it turns out your issue is actually more serious, you'll probably actually see a doctor faster than if you went to the ER Peven Stan posted:They worked hard to prioritize the people with real problems like gunshot wounds first and the commercial insurance holders after that. Medicaid/uninsured got shafted. Dead Reckoning posted:I'm talking about taking steps to limit defensive medicine. Also, if we loving paid primary care physicians enough so there were more of them and I could guarantee rapid follow up, I'd discharge a lot more people without comprehensive workups. Same goes with ensuring more immediate access to specialists. You know what would help? Socialized loving medicine.
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May 8, 2018 12:47
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Dead Reckoning posted:I think everyone in the business knows that there are people who end up at the ED who shouldn't be there, but the question is how we identify those cases in advance and divert them. I’m an ED doctor and I completely understand your sentiment. The problem is that there really isn’t any way to do that, because even the people who come in with a complaint that sounds inappropriate for the ED can have bad disease. For example, I had a patient who came in for STD treatment, which is definitely something that could be handled by a PCP or Urgent Care and doesn’t need an ED. But he also ended up having a collapsed lung requiring a chest tube placed to reinflate it. Or another patient who had a cough and multiple family members with the flu, but his cough was from fluid in his lungs due to his heart attack. Unless we as a society ethically and legally become accepting of preventable disease and death, you have to unfortunately start with the assumption that every patient that comes to the ED is actively trying to die on you, and by your history / exam / workup prove that they either are or aren’t.
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May 8, 2018 13:02
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This is also why analogies to car insurance fall apart. Every part of a car is a known quantity while complicated biochemical pathways can go wrong in a number of ways. Sometimes a headache is a headache and sometimes it’s brain cancer.
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May 8, 2018 13:59
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Kloaked00 posted:Unless we as a society ethically and legally become accepting of preventable disease and death, you have to unfortunately start with the assumption that every patient that comes to the ED is actively trying to die on you, and by your history / exam / workup prove that they either are or aren’t.
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May 8, 2018 15:55
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Peven Stan posted:This is also why analogies to car insurance fall apart. Every part of a car is a known quantity while complicated biochemical pathways can go wrong in a number of ways. Sometimes a headache is a headache and sometimes it’s brain cancer. Also, your car can completely stop working for a week and then be repaired and no worse for wear. Humans cannot.
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May 8, 2018 16:21
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Dirk the Average posted:Also, your car can completely stop working for a week and then be repaired and no worse for wear. Humans cannot.
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May 8, 2018 16:48
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Dead Reckoning posted:"Good news! Your insurance covers a rental husband while yours is in the hospital." However, the only covered options are Danny DeVito or Charlie Sheen.
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May 8, 2018 17:31
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Dead Reckoning posted:I think everyone in the business knows that there are people who end up at the ED who shouldn't be there, but the question is how we identify those cases in advance and divert them. There's some progress that can be made here. Yeah, a lot of people can't really be diverted from the ED because of the liability involved. Flu-like symptoms? Well that might just be a severe cold or it might be the start of meningitis. Severe stomach pain? Maybe it's gas, maybe your appendix is about to explode. And then you have symptoms where people don't know how serious they are, like if you suddenly start experiencing double vision. But minor trauma that's common in worksite accidents can be diverted. We get a lot of contractors come fix their ouchies in the ED for some reason. As long as it doesn't require surgery (and for worksite accidents it, honestly, is usually pretty easy to tell) then that can be dealt with in urgent care. Got a fish hook stuck in you? Urgent care. The flipside is that we get a lot of people who just decide to walk it off and come in to the ED later once they have some horrifying infection because they never had it treated or decided to superglue their laceration shut (this is so common among contractors...I don't even know.) And then the other thing is drug-seeking behavior in the ED, which is really bad around here. This increases costs because a lot of them don't have anything wrong with them and practically none even bother to pay, so everyone's ED bills go up as a result. Drug seeking is why WA state's Medicaid program started cracking down on unnecessary ED visits. Beefing up the state-level opiate registries is something that needs to be done. A whopping TWO PERCENT of providers in this state even bother to check it, because it took until this year for providers to even be "required" to report to the registry -- but there aren't any penalties for failing to report or failing to check it, so...nobody still bothers with it since ED staff is busy as hell anyway and don't have time to mess around with the broken-rear end system the state uses for the registry. It should probably be made federal and shunted off to retail pharmacies to deal with.
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May 8, 2018 17:52
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KillHour posted:However, the only covered options are Danny DeVito or Charlie Sheen. I would live with Danny DeVito for a week 
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May 8, 2018 18:45
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Not sure if it's the right thread for it, but I had to go to a hospital in Beijing for a severe anxiety attack the other day. Queued up, did registration, got to see a doctor, did blood tests, left with a first prescription for an anti-depressant and anti-anxiety medication. All said and done, took about three hours. Final bill paid going out the door was 650RMB (~110USD). What was particularly unusual to me was seeing flat standard prices for different procedures on the wall, the conveyor line style to blood draws, the airport terminal type queues with ticket numbers, and paying things immediately rather than waiting for a nebulous bill in the mail later or not worrying if an office or hospital was in or out-of-network. Seems way less stressful than back in America when a few years ago I did a simple EKG scan on my heart to check my heart pain and got billed like $3k. The small clinic building was standalone, nothing resembling a hospital near by, but insurance marked it as a hospital stay and thus severely increased the final cost for a simple healthcheck. Teriyaki Koinku fucked around with this message at 00:14 on May 10, 2018 |
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May 10, 2018 00:11
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Potato Salad posted:I would live with Danny DeVito for a week Would you sleep in the same bed though?
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May 10, 2018 04:22
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Teriyaki Koinku posted:Not sure if it's the right thread for it, but I had to go to a hospital in Beijing for a severe anxiety attack the other day. Yeah China has a good system for general access to medical professionals and prescription drugs. Do you look Chinese? Often doctors are looking for/expecting payment directly from patients because everybody knows that doctors' salaries are too low. You could call it a bribe but really medical professionals' pay is a major problem in China so it's hard to feel like it's wrong. On the other hand can you imagine the wasted productivity of doctors collecting payment?
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May 11, 2018 06:08
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From what I understand from goons living in china, medicine there is get a giant bag of antibiotics and other pills tossed at you for any ailment or you get some bogus TCM cocktail that does nothing. I was always under the impression if you had a medical emergency you got out of china asap and get to a place with real doctors. You’re literally the first goon i’ve seen praise chinese healthcare. Edit: talking some more with china goons, if you can find a decent doctor it isn’t too bad, but the TCM bullshit is hard to get past. They still recommend for anything major to get out of country for treatment, though. Mr. Nice! fucked around with this message at 13:03 on May 11, 2018 |
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May 11, 2018 12:19
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EugeneJ posted:drug pricing Is there anyone on the right that sincerely thinks this will make a difference? You can just look at the NBI from this morning and see investors see this as absolutely nothing.
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May 12, 2018 01:46
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Trump voters on medicare seem to loving love it.
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May 12, 2018 02:12
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But then Trump could gently caress a puppy to death live on stage and then unhinge his jaw and swallow it whole and they'd loving love that, too, so...
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May 12, 2018 02:13
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good news, everybody: because it is important to move slowly, and patiently, and not take any radical steps, the next conservative health care plan has come out, and it is a paean to moderation! https://twitter.com/TopherSpiro/status/996759810648498179 and by moderation I do of course mean "the stated goal of the exercise is destroying medicaid and handing the money to the rich" goals we can all get behind
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May 16, 2018 16:53
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There were a few more relevant tweets in that thread. Here’s a link to a CSPAM post that collects them:* https://forums.somethingawful.com/showthread.php?threadid=3853186&pagenumber=1511&perpage=40#post484150824 *eta: For whatever they’re worth; not familiar with Tropher Spiro and not sure whether he is a reliable source on this. Red Dad Redemption fucked around with this message at 17:09 on May 16, 2018 |
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May 16, 2018 17:03
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LOL HSAs Basically pay a ridiculous amount of money for the privilege of having a bank account and call it insurance.
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May 16, 2018 19:08
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HSAs usually don't cost money to set up and maintain (and if yours does switch). They're great for people like me who never use their insurance now but know in the future they will (retirement for me). The trap would be getting a really lovely plan to qualify for one then having to eat a lot of out of pocket costs. That said the proposal here is absurd and HSAs do jack poo poo to make health care affordable especially for those who can least afford premiums.
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May 16, 2018 19:12
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Raldikuk posted:HSAs usually don't cost money to set up and maintain (and if yours does switch). They're great for people like me who never use their insurance now but know in the future they will (retirement for me). The trap would be getting a really lovely plan to qualify for one then having to eat a lot of out of pocket costs. I used to work a state government job for a very very red state where the pay was miserable but the benefits were out of this world. The state would give me something around $800 a month to spend on health, dental, and vision premiums while the rest went into an HSA. I did not pay a single penny in medical costs while I worked there except for OTC medications because every co-pay or deductible came out of money given to me by the state and placed into an HSA after paying monthly premiums; I was even given a debit card to use for this very purpose. I hate even the idea of for-profit health care right down to the taint hairs, but I am astonished to this day how well the state government of Republicanvania took care of me. Needless to say, I took care of every problem I had and went to see very specialist I could while I was there. Having said all that, HSAs are only useful for people who are already doing fairly well and Raldikuk is absolutely correct in saying that they do somewhere between gently caress and all for the most needy people. Poor people cannot save money, even for the most important things. Also, health care costs for anything not covered by excellent insurance are so ludicrous that the first problem more severe than a slight cough will wipe out anyone's carefully garnished wages.
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May 16, 2018 19:24
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Arglebargle III posted:Yeah China has a good system for general access to medical professionals and prescription drugs. Do you look Chinese? Often doctors are looking for/expecting payment directly from patients because everybody knows that doctors' salaries are too low. You could call it a bribe but really medical professionals' pay is a major problem in China so it's hard to feel like it's wrong. On the other hand can you imagine the wasted productivity of doctors collecting payment? Nope, I'm Whitey McLaowai as gently caress. And I got the meds at a major local Beijing hospital, got to saw a doctor right away just by strolling into his office. Didn't have to pay or bribe the doctor directly, just got the script stamped at the registration desk then passed it over to the main building pharmaceutical pick-up window with quick mechanical efficiency. No TCM, just Lexapro and Lorazepam.  E: side question, not sure if anyone can answer this, but there's a lot of 'military professional' seating and windows at the hospital explicitly for use by active-duty Chinese soldiers, but it's all rolled right in the middle of civilian wings and floors of the hospital (maybe for propaganda effect to glorify the military?). Do they not separate hospitals for military veterans in China like with the VA in America? Teriyaki Koinku fucked around with this message at 03:41 on May 17, 2018 |
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May 17, 2018 03:30
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Annual Prophet posted:
Dude legit cares about good healthcare but is so poisoned by centrism that he refuses to get on the universal healthcare train because his wonkbrain won't allow him to consider that all that work he did drafting "reasonable" policy was a fool's errand at best
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May 18, 2018 03:56
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Defenestration posted:Spiro is a largely reliable if often alarmist source. He's an Obama flunky who helped draft the ACA and now works at CAP so you can derive his general deal from that. I see your point and like what you have to say, but I can't even call being well-meaning but avoiding universal care "centrism". When you see something that has worked massively better than the status quo in dozens of places, avoiding the thing that provably works is just stupidity, and here probably massive ego too, moreso than centrism. There aren't many people who hate capitalism more than I do, but given how it's been done historically I can't blame people who have grave concerns about socialism and communism. This isn't that, though, and anyone now who denies that UHC is the better option is either a motivated by pure idiocy, pure ideology or pure selfishness. In the former two cases it's like talking to someone who denies climate change, refutes evolution or thinks that the Earth is flat; it's inexcusable in this modern age. In the latter case, the person in question probably realises that it is the better option for most people, but doesn't care because they want to make money. In that case, the only cure is a swiftly falling guillotine.
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May 18, 2018 05:02
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JustJeff88 posted:In that case, the only cure is a swiftly falling guillotine. This right here is WHY Socialism has a bad reputation and didn't do so well in the past.
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May 18, 2018 05:08
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KillHour posted:This right here is WHY Socialism has a bad reputation and didn't do so well in the past. bad reputation with whom, the bougies and their goons or the average person?
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May 18, 2018 06:27
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Defenestration posted:Spiro is a largely reliable if often alarmist source. He's an Obama flunky who helped draft the ACA and now works at CAP so you can derive his general deal from that. His alarmism isn't really useful because the GOP blew their chance at healthcare legislation and don't have the opportunity to pass anything until after midterms...when the Democrats are likely to take the House anyway. There's not much point in pulling out the  unless it's something Trump can accomplish with an executive order, which isn't much.
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May 18, 2018 11:41
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Peven Stan posted:bad reputation with whom, the bougies and their goons or the average person? Most people don't think of the French revolution as a good thing that happened.
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May 18, 2018 15:49
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KillHour posted:Most people don't think of the French revolution as a good thing that happened. Good thing the French Revolution wasn’t an example of socialism
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May 18, 2018 16:07
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Famously uncelebrated historical event, the French Revolution.
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May 18, 2018 17:45
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KillHour posted:Most people don't think of the French revolution as a good thing that happened. Bastile Day is a celebration in honor of Louis XV's favorite prostitute right?
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May 18, 2018 21:00
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KillHour posted:Most people don't think of the French revolution as a good thing that happened. the French Revolution was the first great liberal revolution though?
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May 18, 2018 21:26
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Defenestration posted:Dude legit cares about good healthcare but is so poisoned by centrism that he refuses to get on the universal healthcare train because his wonkbrain won't allow him to consider that all that work he did drafting "reasonable" policy was a fool's errand at best JustJeff88 posted:I see your point and like what you have to say, but I can't even call being well-meaning but avoiding universal care "centrism". We should avoid confusing opposition to (or, more accurately, concern about elements of) Single Payer with opposition to UHC. CAP/Spiro's "Medicare Extra For All" has a number of warts (including branding!) but is a proposal for UHC--and one that appears designed with a potential transition to Single Payer in mind. Kaiser has found that Medicare for All (single payer) enjoys majority support in their polling. There are two important points to note: 1. Medicare For All where people have an option to keep their current coverage (multipayer UHC) polls markedly better, including 64% of Republicans. 2. The support for Medicare For All (single payer) is inflated, as nearly half of Dems incorrectly believe they can keep their coverage.
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May 18, 2018 21:26
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Stepping off of my pedantic soapbox, it's been very interesting to look at the responses to Cali's AB3087--All Payer Rate Setting. It's broader, but roughly akin to Maryland's setup. CNA/NNU, the biggest Single Payer/UHC backers in Cali, have been somewhere between lukewarm and opposed. The cynic in me notes that while the rhetoric centers around insufficiency and incrementalism, bringing private rates in line with Medi-Cal and other government programs would result in lower compensation for the union's members. That's a totally valid reason to oppose the bill, but it strikes me as a bit disingenuous to frame the concerns as philosophical when there's a clear and heavy practical component.
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May 18, 2018 21:44
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CAPs medicare XXXtra plan institutionalizes 80AV plans as the new normal, a standard of benefit that’s much lower than most employer paid plans. For example, a 80AV plan in my state usually has a $1500 deductible and $5000 OOP max. Hardly “affordable”
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May 18, 2018 21:45
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Paracaidas posted:*Pushes up glasses wonkishly* If I recall most people didn't support desegregation in the US but we did it anyway. And it was hard. But it was the right thing to do. This is what kills me most about a certain kind of centrist democrat. That will support right thing when it becomes overwhelmingly politically convenient and not a second before. That will do nothing to generate support for social programs that have proven time and again to be wildly popular everywhere else. "Medicare for All Extra" is nothing but a coward's dodge dressed up to look respectable to exactly the kind of people that work at CAP. JustJeff88 posted:I see your point and like what you have to say, but I can't even call being well-meaning but avoiding universal care "centrism". When you see something that has worked massively better than the status quo in dozens of places, avoiding the thing that provably works is just stupidity, and here probably massive ego too, moreso than centrism. Yadoppsi posted:the French Revolution was the first great liberal revolution though?
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May 18, 2018 22:21
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Paracaidas posted:We should avoid confusing opposition to (or, more accurately, concern about elements of) Single Payer with opposition to UHC. CAP/Spiro's "Medicare Extra For All" has a number of warts (including branding!) but is a proposal for UHC--and one that appears designed with a potential transition to Single Payer in mind. There's no reason to trust that it would actually transition to single payer, particularly given that it's being offered in response to an actual-single-payer bill and can very easily be sabotaged through limiting how competitive the public option is. Paracaidas posted:Kaiser has found that Medicare for All (single payer) enjoys majority support in their polling. There are two important points to note: There are a couple problems with this logic: - The polls that yield these results never provide a full understanding of what the net result in terms of quality of care and impact on finances would be (largely because that would be impossible to do for a generalized poll). In reality, if most people knew they'd be paying significantly less for a similar (if not superior for working class Americans) quality of care, they'd obviously say "same quality for lower price? sure!" In practice you can't (accurately anyways) put that in a poll because there's a minority of Americans who would be paying more than they're currently paying and you wouldn't know the specifics of every poll recipient's medical circumstances (etc). - As a result of the former, you just shouldn't care and pass the policy regardless (unless running on it is having a noticeable negative impact on people supporting the politician, and you can't use support for the policy as a proxy for whether people will vote for the politician who supports it). If a politician who supports MfA manages to get elected, they should just try to pass it because it's the right thing to do. It's not like the people making arguments like yours apply this same level of "IT MUST BE ABSOLUTELY APPROVED BY A MAJORITY AS DEMONSTRATED BY POLLS" to literally every bill the government passes. I never saw these arguments coming from the same liberals regarding the ACA, for example. And I think we'd all agree that the people who hem-hawed about polls when it came to stuff like gay marriage were also shitheads, right? The only legitimate concern, and something that I think should be addressed alongside something like MfA, is that many employers would likely just cut employees' pay for the amount of money they no longer had to pay as health insurance. In this situation, someone could end up paying more, since the increase in taxes (assuming it was drawn from almost everyone to some degree) wouldn't be offset by an increase in earnings due to their employer no longer covering health care. Even then, it would still be a net positive, and the issue of "people not being paid enough" is something that needs to be deal with regardless.
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May 18, 2018 23:02
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Ytlaya posted:There's no reason to trust that it would actually transition to single payer "We worked too hard on Medicare Extra to throw it all away now for quote-end-quote better ideas that will never ever happen"
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May 19, 2018 02:44
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Peven Stan posted:CAPs medicare XXXtra plan institutionalizes 80AV plans as the new normal, a standard of benefit that's much lower than most employer paid plans. For example, a 80AV plan in my state usually has a $1500 deductible and $5000 OOP max. Hardly "affordable" Defenestration posted:I mean yeah, there's wonk things to do to figure out how UHC works, but you can't not support it because of opinion polls. It is a moral imperative. Defenestration posted:If I recall most people didn't support desegregation in the US but we did it anyway. And it was hard. But it was the right thing to do. Ytlaya posted:There's no reason to trust that it would actually transition to single payer, particularly given that it's being offered in response to an actual-single-payer bill and can very easily be sabotaged through limiting how competitive the public option is. Almost everyone would love to get the same quality-and especially same network/doctors-for a lower price! The problem is that you have to actually convince them that they'll be getting the same (or similar) care and coverage that they're happy with now. Given that trust in the presidency, the GOP, the Dems, and Congress are all underwater (the latter 3 by 20+), that's going to be an uphill battle. Especially when what you're promising will be better..... doesn't exist yet. And that's why I couldn't give less of a gently caress about the allegedly Machiavellian motives of Spiro/CAP/etc as they present UHC plans. Even if this is a complex plot by Neera to kick the legs out of superior alternatives, it would still ease the transition to Single Payer by providing real, tangible, comprehensive, universal government healthcare. I do apologize though- "Designed with a potential transition to Single Payer in mind" ascribes an intent to the authors that may not be present. I should have gone with "Designed in a manner that lays the groundwork for a potential transition to Single Payer". Ytlaya posted:- As a result of the former, you just shouldn't care and pass the policy regardless (unless running on it is having a noticeable negative impact on people supporting the politician, and you can't use support for the policy as a proxy for whether people will vote for the politician who supports it). If a politician who supports MfA manages to get elected, they should just try to pass it because it's the right thing to do. It's not like the people making arguments like yours apply this same level of "IT MUST BE ABSOLUTELY APPROVED BY A MAJORITY AS DEMONSTRATED BY POLLS" to literally every bill the government passes. I never saw these arguments coming from the same liberals regarding the ACA, for example. And I think we'd all agree that the people who hem-hawed about polls when it came to stuff like gay marriage were also shitheads, right?  it. If you can show me in the post you've quoted, or any in this thread, where I make the bolded argument (that Dems should abandon UHC (or specifically SP/MFA) based on weak polling numbers), I'll eat a ban. Or, more productively, donate  each to two candidates of your choice. The most I think I've done is use polling to support my suggestion that the unique hurdles of SP mean a multipayer solution may be the superior path to UHC in the modern US, and I'm not certain that was even on SA. For gently caress's sake, I post positive polling numbers for MFA and a note that the poll indicates a fundamental misunderstanding among some of its supporters, and you inkblot it into a caricature of weak-kneed, focus grouped centrism. As you look through my contributions to the thread, you may even notice me lambasting politicians who ran on SP and proceeded to claim victory after passing utterly Potemkin legislation. Ytlaya posted:The only legitimate concern, and something that I think should be addressed alongside something like MfA, is that many employers would likely just cut employees' pay for the amount of money they no longer had to pay as health insurance. In this situation, someone could end up paying more, since the increase in taxes (assuming it was drawn from almost everyone to some degree) wouldn't be offset by an increase in earnings due to their employer no longer covering health care. Even then, it would still be a net positive, and the issue of "people not being paid enough" is something that needs to be deal with regardless.
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May 19, 2018 06:00
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