Healthcare by Executive Order

yeeezuz

Somebody forgot to tell AJ that if he dresses up as Scarface for Halloween, he's supposed to wait until the 31st of October to snort the mountain of coke.

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:D
 
They forced hospitals to give away their ER services.

Which caused problems...big time that led to legislative bandaids though attaboy deals and cronyism to keep the junk system running.

Fast forward 30 years and this is the automotive cluster fuck equivalent of our corrupted, mutant, non-functional HC "system".


If Nixon did it up, which is entirely possible then ok. I'm just ignorant of the details surrounding his stance and actions involving HC.

This is when the rule went into place that ERs could not turn away people who were uninsured or unable to pay - EMTALA of 1986, correct?

If I recall this law was passed in reaction to people dying etc because they could not afford insurance or medical care.

Two questions:

What caused the situation in which people could not afford insurance or medical care?

What, in your opinion, would have been a better solution?
 
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This is when the rule went into place that ERs could not turn away people who were uninsured or unable to pay - EMTALA of 1986, correct?

If I recall this law was passes in reaction to people dying etc because they could not afford insurance or medical care.

Yep. 100%.

And they provided NO WAY of paying for it.

Two questions:

What caused the situation in which people could not afford insurance or medical care?

Life and more often than not shitty decision making capabilities.

I don't see how the shit is relevant.

What, in your opinion, would have been a better solution?

To either fund the socialization of the HC industry and turn it into the HC public service.

Or stay the fuck out of it and let the businesses run their own businesses.

The half way there but not really bullshit we seem intent on going for all the time is nothing but fail. From Reagan-care to Obama-care....nothing but half ass garbage.

They need to own it or get the fuck outta the way....at this point I don't even care, I just want them to shit or get off the pot.
 
Yep. 100%.

And they provided NO WAY of paying for it.



Life and more often than not shitty decision making capabilities.

I don't see how the shit is relevant.



To either fund the socialization of the HC industry and turn it into the HC public service.

Or stay the fuck out of it and let the businesses run their own businesses.

The half way there but not really bullshit we seem intent on going for all the time is nothing but fail. From Reagan-care to Obama-care....nothing but half ass garbage.

They need to own it or get the fuck outta the way....at this point I don't even care, I just want them to shit or get off the pot.

Yes and no. ER's are apparently called ED's now - which is its own little irony, but there you have it.

ED's are generating a profit. Yes the insured are entirely subsidizing the uninsured, but the vast majority of those that use the ED's are insured, mainly private insurance and then secondarily through medicare/medicaid.

Interesting reading:

source

  • profit margin of 7.8% on average
  • privately insured patients subsidized all other ED patients
  • privately insured patients visit the ED most
  • admitted patients drive the bottom line - if admitted as high as 20.7% profit, if not then about 3.2%
  • things like infectious diseases, traumas and other surgical conditions were most profitable, while psychiatric were the least.
  • EDs are likely to become more profitable with the ACA, increasing to 11.7% by 2023

source

To better understand the financial viability of hospital emergency departments (EDs), we created national estimates of the cost to hospitals of providing ED care and the associated hospital revenue using hospital financial reports and patient claims data from 2009. We then estimated the effect the Affordable Care Act (ACA) will have on the future profitability of providing ED care. We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms

Now onto some brass tacks:

source

It was called a "wallet biopsy." Or "dumping." Very simply, prior to the implementation of the Emergency Medical Treatment and Active Labor Act of 1986, a patient coming into a hospital emergency department often had no right to treatment or even evaluation, no matter how dire his or her condition. If patients could not prove that they had the resources to pay for care, they could be turned away or sent elsewhere—sometimes in a taxi, sometimes on foot. They often suffered adverse health consequences as a result of delayed care. And sometimes they died.

EMTALA has had both good and bad effects. It was and is an unfunded mandate, to be sure; but most hospitals were not in the habit of turning away people with emergency conditions before it was passed. Besides, data on what was going on before EMTALA, compared with what has happened since, are virtually nonexistent, and are usually incompatible when they can be found. The factors that led to its birth were anecdotes and policy concerns, not data.

So yes it was completely left to the hospitals to absorb the costs, but most hospitals already did anyway. It was put in place to stop the bad apples - which were the minority.

Now as to the situation that caused all these uninsured people to seek treatment. I think it is important because specifics to the why of a problem help point to solutions. Yes the person is drowning - but it is it because they can't swim (teach them) or because they are a paraplegic (keep them away from water without a life preserver please and thanks). If we don't know the whys than any long term solutions are going to be flailing guess work at best.

"One of the challenges we face," says Pollack, "is that the ED ends up being the place where all the things at which society fails come because of the lack of any alternative. The hospital becomes the last resort for care—the family doctor for the uninsured. And in certain cities, when police are frustrated with mentally ill or homeless people, they just drop them off at the ED. Hospitals are at the receiving end of society's problems."

And it is an expensive, fragmented, uncoordinated way to take care of people. Anderson says, "Failure to get uninsured poor people into systems of care poses the same moral dilemma [as dumping]—with a different pinstripe." Gage adds, "By the time someone is in emergency care, the system has failed because it has not found them earlier."

We have of course the easily identifiable homeless folks and then the poor. Well before EMTALA, the poor people couldn't afford insurance either. So in the time before EMTALA the insurance rates were still too steep for them to have it.

One thing of interest about EMTALA is that the culture of "dumping" has been pretty much eliminated. Hospitals and doctors now can't imagine doing such a thing.

Also, I am more inclined to think that profiteering and crony capitalism are more closely related than we'd like to think.

I had one term wrong - it's chargemaster, not pricemaster. And their lack of basing prices in reality is a huge problem.

source

“A viral upward pressure on chargemasters has led to higher healthcare costs across the board,” said George Nation, professor of law and business at Lehigh University. “These list prices do have an impact-hospitals have every incentive to keep raising them and no incentive not to.”

Chargemaster prices have been steadily climbing, with some more than doubling in the past decade. While hospitals don't typically receive the full list price in the chargemaster, the uninsured and out-of-network patients are generally charged the full amount. Those prices have little bearing on the actual cost or quality of the procedure, according to a recent Health Affairs study.

Now I do agree with you that EMTALA has had some effect on costs - but considering that most hospitals absorbed the cost for uninsured care anyway, it cannot explain it all.

When health insurance became even more common due to the enactment of Medicare and Medicaid in 1965, insurers generally reimbursed hospitals based on the cost plus a 10% supplement for administrative work, Nation said.

By the early 1990s, government insurers tightened their reimbursements through their own case-based system using DRGs (diagnosis-related groups). Meanwhile, private insurers were paying hospitals lower negotiated discounted rates. Hospitals tried to make up the difference by raising chargemaster rates, resulting in an increasing gap between charges and prices paid by most insurers.

So back to profiteering and crony capitalism?

I do agree with you that this halfway bullshit is harmful and needs to be resolved. I'm inclined to go with models across the globe that have worked well for countries like The Netherlands, Switzerland and Britain. The reality is we spend well over double what they do per patient per year. With no real significantly greater outcomes. And certainly not more than double.
 
Yes and no.

Just yes.

There is nothing about what you said that contradicts or even challenges anything I said.

There is no "no" about it.

Also, I am more inclined to think that profiteering and crony capitalism are more closely related than we'd like to think.

Only if you ignore what those terms mean.

If I'm illegally making excessive profits on the black market I'm profiteering.

If I'm legally making excessive profits because I'm schmoozing with the government I'm a "crony capitalist" even though there is nothing capitalist about government ownership, control and administration over the means and the markets.

Now I do agree with you that EMTALA has had some effect on costs - but considering that most hospitals absorbed the cost for uninsured care anyway, it cannot explain it all.

Not all but a large part and played a huge role in winding up where we are today.

No they didn't absorb the cost for uninsured either, they sent them to a country/church hole or let them die in the streets.

So back to profiteering and crony capitalism?

Only if the government is allowed to continuously fuck about the market with zero commitment to anything that might be possibly functional.

I do agree with you that this halfway bullshit is harmful and needs to be resolved. I'm inclined to go with models across the globe that have worked well for countries like The Netherlands, Switzerland and Britain. The reality is we spend well over double what they do per patient per year. With no real significantly greater outcomes. And certainly not more than double.

Of course, you're a socialist....and after HC it will be one industry/market after another that you crusade for government ownership over.

Being America and all about freedumb I'd rather shit get back to grass cash or ass.
 
It was nice for a moment to think that we might be able to converse intellectually or in a civil manner until you just went straight to asshole again.

Can't say I didn't try. Go about your business, I'm done. I have no interest in conversing with you or interacting with you.
 
It was nice for a moment to think that we might be able to converse intellectually or in a civil manner until you just went straight to asshole again.

Can't say I didn't try. Go about your business, I'm done. I have no interest in conversing with you or interacting with you.

I went asshole?

LOL

I don't think you ever did....you do this shit to anyone who isn't your "Yes" puppet.
 
Yes you most certainly did.

If you want the last word you can have it. Like I said, I'm done interacting with you. You don't know how to be civil with me and I'm tired of your abuse.
 
Yes you most certainly did.

If you want the last word you can have it. Like I said, I'm done interacting with you. You don't know how to be civil with me and I'm tired of your abuse.

But I'm not guilty of anything.

Abuse? LMFAO!!!
 
Adrina wasn't even here when Obama was our President.


So.....

You can't prove it. I knew it.


Hypocrite.

That's my point too.

She cannot point to my posting history unless she provides proof or is lying about just joining.

I'm leaning towards an older alt who wants to at the same time, keep her image pure and clean while being outraged by Trump on a daily basis and engaging in all the oldest forms of hypocrisy possible.

Because if she were truly outraged about the President using EOs to run health care, then she would be cheering as the Donald rolls back the original EOs issued to run health care in a truly royal fashion...

But, this, as we all know, has nothing to do about health care and everything to do with how much the Left hates Trump.
 
Does 'Rumpy's plan allow for bimbos to get bigger boobies for free?
 
That's my point too.

She cannot point to my posting history unless she provides proof or is lying about just joining.

I'm leaning towards an older alt who wants to at the same time, keep her image pure and clean while being outraged by Trump on a daily basis and engaging in all the oldest forms of hypocrisy possible.

Because if she were truly outraged about the President using EOs to run health care, then she would be cheering as the Donald rolls back the original EOs issued to run health care in a truly royal fashion...

But, this, as we all know, has nothing to do about health care and everything to do with how much the Left hates Trump.



I thought I was Laurel? :rolleyes:

Your posting history is easily found and your attitude is on full display.

I don't trust Trump. He's got the attention span of a gnat, rode daddies coattails and is an egomaniac with a heavy dose of narcissism. Any and every liberal woman would be foolish to trust Donald. Especially given his history and his VP.

This isn't rocket science. But in your usual manner you overcomplicate things until they are so twisted that bear no resemblance to reality.
 
Indeed.


You keep saying that, but you cannot post any proof of your contentions...



Fucking hypocrite.
 
Aglo already did. I did a search before she did. There's no need.

Go investigate reality. :rolleyes:

So, then, are you at all going to admit to any outrage over the Obama EOs that "ran" health care from the White House?


And please, enlighten me, show me the "results" of your search.


I am becoming more and more convinced that you are lying about being some sort of "new" member...
 
So, then, are you at all going to admit to any outrage over the Obama EOs that "ran" health care from the White House?


And please, enlighten me, show me the "results" of your search.


I am becoming more and more convinced that you are lying about being some sort of "new" member...

I'm Laurel, remember? Before that I was Fermina. And there was my stint as Disgustipated. I had a moment as KingOrfeo, but that was short because I was banned. I can't remember who I was before that. The list is quite long.

Paranoia.
 
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