OBAMA/TRUMPCARE MEGATHREAD

[Balta1701]

The shutdown could have bought healthcare.gov 40 times over'

I think the author of that post is crossing his or her numbers up. The $24 billion cost estimate is not the cost to the government, it's the cost to the entire economy of the shutdown according to an S&P estimate. The government definitely lost billions, maybe more than $10 billion (I haven't seen a reliable, complete accounting of that yet) but I know where the $24 billion # comes from.

[StrangeSox]

Farhad Manhoo also has a piece in the WSJ covering what went wrong with healthcare.gov and why this same sort of thing goes wrong in most large-scale public/government tech projects.

 

http://online.wsj.com/news/articles/SB1000...139461596987366

[StrangeSox]

I think the author of that post is crossing his or her numbers up. The $24 billion cost estimate is not the cost to the government, it's the cost to the entire economy of the shutdown according to an S&P estimate. The government definitely lost billions, maybe more than $10 billion (I haven't seen a reliable, complete accounting of that yet) but I know where the $24 billion # comes from.

 

It says "estimated economic losses" right in the first sentence. It wasn't an argument about the direct cost to government, but to point out that we're going to hear a lot about how this crappy website cost hundreds of millions of dollars, but not so much about the tens or hundreds of billions of dollars that the sequester, shutdown and debt ceiling brinksmanship has cost our economy as a whole.

[Jenksismyhero]

The shutdown could have bought healthcare.gov 40 times over'

 

As liberals would say, meh, that's a drop in the bucket.

[Balta1701]

This fact check of claims about the PPACA's awfulness is really quite a treat.

[Soxbadger]

If I stick my head in the sand then it has to be night out because its dark.

[ptatc]

An interesting topic came up today at our advisory board meeting with local clinician's. The popularity of the physical therapy field is always ties to insurance reimbursement. The clinician's as a group said that over the last 3 months there has been a reduction in reimbursement across the board. Earlier in the year there were 10 jobs for every PT. Now, the clinics are getting 10 applicants for every opening as they dry up. Everyone is holding their breaths to see how all of this unfolds and are really cutting back.

[NorthSideSox72]

An interesting topic came up today at our advisory board meeting with local clinician's. The popularity of the physical therapy field is always ties to insurance reimbursement. The clinician's as a group said that over the last 3 months there has been a reduction in reimbursement across the board. Earlier in the year there were 10 jobs for every PT. Now, the clinics are getting 10 applicants for every opening as they dry up. Everyone is holding their breaths to see how all of this unfolds and are really cutting back.

This seems incongruous with other trends. The lack of doctors problem, and the drive to cut medical costs by having non-Doctoral medical professionals do a larger bulk of the load, as examples. Those trends, I think, will win out in the long run over lower reimbursement levels for physical therapy. I could be wrong of course, but that is my view.

 

I read a great pilot program and study, as an example, some 15 years ago. Not PT, but on the topic of balancing which types of professionals do what work. In a rural area in the mountainous west, they decided to try an alternative to expensive clinics to serve spares and spread out communities for basic medical needs. The basic idea was, the only medical professionals in these areas are often the fire/rescue volunteers - EMT's and Paramedics. So they trained some of them on things like immunizations, some limited medication scripting, therapeutic techniques, etc. And they delivered much of the care in person, in their homes. The results were dramatically increased general health, for relatively low costs, because ovehead was so low. This sort of out-of-the-box thinking could benefit medical costs as a whole.

 

[ptatc]

This seems incongruous with other trends. The lack of doctors problem, and the drive to cut medical costs by having non-Doctoral medical professionals do a larger bulk of the load, as examples. Those trends, I think, will win out in the long run over lower reimbursement levels for physical therapy. I could be wrong of course, but that is my view.

 

I read a great pilot program and study, as an example, some 15 years ago. Not PT, but on the topic of balancing which types of professionals do what work. In a rural area in the mountainous west, they decided to try an alternative to expensive clinics to serve spares and spread out communities for basic medical needs. The basic idea was, the only medical professionals in these areas are often the fire/rescue volunteers - EMT's and Paramedics. So they trained some of them on things like immunizations, some limited medication scripting, therapeutic techniques, etc. And they delivered much of the care in person, in their homes. The results were dramatically increased general health, for relatively low costs, because ovehead was so low. This sort of out-of-the-box thinking could benefit medical costs as a whole.

This type of program generally works, i think. It most other counties if you have a minor injuries such as a sprained ankle you don't go to the expensive physician. You go directly to the "physio" (PT) who in most cases is better trained in orthopedics than most GP physicians. This saves a great deal of time and money for the system. In many states this type of direct access is legal but underutilized due to the public perceptions of physician's as "gate keepers" of all medicine.

[caulfield12]

This seems incongruous with other trends. The lack of doctors problem, and the drive to cut medical costs by having non-Doctoral medical professionals do a larger bulk of the load, as examples. Those trends, I think, will win out in the long run over lower reimbursement levels for physical therapy. I could be wrong of course, but that is my view.

 

I read a great pilot program and study, as an example, some 15 years ago. Not PT, but on the topic of balancing which types of professionals do what work. In a rural area in the mountainous west, they decided to try an alternative to expensive clinics to serve spares and spread out communities for basic medical needs. The basic idea was, the only medical professionals in these areas are often the fire/rescue volunteers - EMT's and Paramedics. So they trained some of them on things like immunizations, some limited medication scripting, therapeutic techniques, etc. And they delivered much of the care in person, in their homes. The results were dramatically increased general health, for relatively low costs, because ovehead was so low. This sort of out-of-the-box thinking could benefit medical costs as a whole.

 

 

Except gas/transportation costs have gone up a lot compared to 15 years ago. And the costs for allocation of those vehicles, in general, for different tasks. But it's better than most of the alternatives.

[Balta1701]

Except gas/transportation costs have gone up a lot compared to 15 years ago. And the costs for allocation of those vehicles, in general, for different tasks. But it's better than most of the alternatives.

Which is why places like CVS and Walgreens have been getting in to the act...they're already in these locations with facilities anyway.

[Texsox]

The other area we could look at is what drugs are available over the counter. Down here many people self medicate by visiting pharmacies in Mexico for what we could consider basic drugs.

[Jenksismyhero]

So, Obama is calling in the experts (Verizon) to sort out the website mess. I guess we can expect a 90 million dollar bid project to turn into a billion dollar project. Sounds about right for the US Government.

[Cknolls]

So, Obama is calling in the experts (Verizon) to sort out the website mess. I guess we can expect a 90 million dollar bid project to turn into a billion dollar project. Sounds about right for the US Government.

 

 

Just call the 1 800 #.

 

 

 

 

Edited October 22, 2013 by Cknolls

[Cknolls]

http://www.nationalreview.com/corner/36185...-andrew-johnson

 

 

 

Its easy. Just do what this guy did. LMAO....Big gov't at its best......f***ing disaster......cannot wait to watch this turd defend this s*** for the next however many years.....

 

 

 

How many people have signed up? We have no f***ing clue.......Oh wait yes we do but we will look like asses .....so we'll get back to you in a month when we hope more people have visited, oops have signed up(fingers crossed)..

[Balta1701]

The other area we could look at is what drugs are available over the counter. Down here many people self medicate by visiting pharmacies in Mexico for what we could consider basic drugs.

Unfortunately in fixing that problem we have the pharmaceutical lobby in the way, and they're very happy to spend money to keep people dramatically overpaying for drugs.

[EvilMonkey]

http://www.dailymail.co.uk/news/article-24...eath-lists.html

 

GPs have been paid bonuses to put elderly patients on controversial ‘death lists’ in an attempt to save the NHS money by cutting the number of people who die in hospital.

They have been given £50 a time to draw up ‘end-of-life advanced care plans’ for patients they predict will pass away within a year.

The payments are designed to encourage doctors to start talking about death with elderly and seriously ill patients and to keep a record of where, ideally, they would like to die.

NOw on one level I have no problem with this. End of life care is the most expensive out there. But the NHS already had one scandal where doctors were putting people on the 'Death Pathway' without even telling them or their families. I can see where people are sceptical of motives. Just remember, when you get 80+ and want that new treatment that will extend your life a few more months, there will be someone, somewhere, besides you, deciding if you can get it or not.

 

Also, two for one! Seems that 'free' healthcare may not be sustainable, at least in England.

http://www.independent.co.uk/life-style/he...rn-8876505.html

 

"Treasury funding for the service will be at best level in real terms," they write. "Given that demand continues to rise, drugs cost more, and NHS inflation is higher than general inflation, the NHS is facing a funding gap estimated at up to £30bn by 2020."

 

[Balta1701]

First of all, I can't find the £30bn quote in the article you linked.

 

Secondly, it's unclear whether that is a cumulative deficit or a 1 year deficit. However, in either case, it's useless because there's no context, i.e. the size of the UK economy. That's exactly what I mean when I complain about "oh that's a large number!" writing.

 

A 1-year deficit of £30bn would be about the equivalent of 2% of the nation's GDP. Even if reforms are not undertaken, filling that gap would require effectively a fairly small tax hike.

 

Similarly worth noting would be that the UK currently spends about 8% of its GDP on healthcare, so increases in that number aren't out of line with other countries. Canada spends about 10%, France about 11%. The United States of course spends about 16% of its GDP on health care.

[Texsox]

http://www.dailymail.co.uk/news/article-24...eath-lists.html

 

 

NOw on one level I have no problem with this. End of life care is the most expensive out there. But the NHS already had one scandal where doctors were putting people on the 'Death Pathway' without even telling them or their families. I can see where people are sceptical of motives. Just remember, when you get 80+ and want that new treatment that will extend your life a few more months, there will be someone, somewhere, besides you, deciding if you can get it or not.

 

Also, two for one! Seems that 'free' healthcare may not be sustainable, at least in England.

http://www.independent.co.uk/life-style/he...rn-8876505.html

 

We are very close in agreement here. The cold calous person in me says if you have the money to extend your life from 80 years 3 months to 80 years 7 months, go for it. If you don't

[Balta1701]

By the way, I should add this.

 

Kathleen Sebelius should be fired for the website errors.

 

Unfortunately I don't know what the succession sequence at HHS would be like or if the President even has the authority to appoint an interim head, and it would probably take the Senate 6+ months to confirm a replacement, but when 20+ states can pull off building a website appropriately and the HHS cannot, then HHS needs a different leader.

[NorthSideSox72]

By the way, I should add this.

 

Kathleen Sebelius should be fired for the website errors.

 

Unfortunately I don't know what the succession sequence at HHS would be like or if the President even has the authority to appoint an interim head, and it would probably take the Senate 6+ months to confirm a replacement, but when 20+ states can pull off building a website appropriately and the HHS cannot, then HHS needs a different leader.

I would agree with that. This website is the public face of ObamaCare, and if she can't find a way to manage it's implementation reasonably well, then that is her management failure.

 

[NorthSideSox72]

And, for the record, I don't agree with the concept that cabinet posts require Senate confirmation at all. I believe the chief executive should be able to choose whatever lieutenants he or she wants.

 

[cabiness42]

And, for the record, I don't agree with the concept that cabinet posts require Senate confirmation at all. I believe the chief executive should be able to choose whatever lieutenants he or she wants.

 

I'm fine with Senate confirmation, but I don't think the minority should be allowed to prevent an up or down vote because of cloture.

 

[StrangeSox]

[mandatory "abolish the filibuster" comment]

[EvilMonkey]

And, for the record, I don't agree with the concept that cabinet posts require Senate confirmation at all. I believe the chief executive should be able to choose whatever lieutenants he or she wants.

With the power that some of these positions have, like head of the EPA which essentially makes up laws on its own, they do need some oversight.