bcl05

That speech was.... fine. Actually. Didn't make anything worse. Better than I expected.

https://twitter.com/GranbyCTPolice/status/895665329715544065

I lived in Houston 2004-07. Many dear friends there. I've heard some harrowing stories in the last few days. I was in medical training there when Katrina hit New Orleans, and did a few shifts in the Astrodome to help with the medical crises there. I've never been prouder - Houston was remarkably welcoming, generous and accommodating to tens of thousands of evacuees with desperate needs. Housiton is going to need that kind of generosity for years to come. Karma comes around, I guess...

How is that not sexual assault? Even if, hypothetically, a cavity search is indicated (and it absolutely does NOT seem to be in this case), 11 minutes? That's absurd. I simply don't understand how that kind of behavior is tolerated.

The Anne Frank Center just released a statement against the president. If David Duke is on your side, and the Anne Frank center isn't, you are a terrible, irredeemable person. I can't imagine any legitimate defense of this travesty.

It is hard to believe that a US president is now actually actively and aggressively defending Nazis. Actual Nazis. People with swastikas and signs celebrating the ovens. I am ashamed of our country.

The reason a box of tissues or a day's worth of tylenol is $$$ at a hospital is that there are so many charges that go un-reimbursed. This is mainly because of the uninsured (or underinsured - where people have "insurance" that doesn't pay for actual health care). A hospital needs to collect enough revenue to cover all the care provided, but can only collect from a fraction of its patients. Therefore, it needs to charge the paying patients far more than what the actual care costs. This can be improved by lowering the number of uninsured and by improving the coverage people do have. It can also be improved by decreasing unnecessary care and by improving preventative care. The republican plans will be significant steps backwards in this area, and will make the problem worse, not better.

Any legislation that improves our health care system. Improving healthcare means both increasing access to care (shrinking the uninsured and improving coverage for those who have it) and decreasing costs. Obamacare did a good job (but not as good as hoped for) at increasing access but did not do much at decreasing costs. The GOP has an excellent opportunity to improve the lives of Americans by taking the beneficial parts of Obamacare and bolstering them while addressing Obamacare's deficiencies. They control the white house and both houses of congress. They could pass a good health care bill, if they had any desire to. Instead, they seem to have chosen to dismantle health care 20+ million americans because they don't want Obama to have any measurable legacy. Or some reason. They have not articulated any vision for what their ideal (or even goal) version of a health care system is, and don't seem to have any qualms about making it far worse for many people.

I don't think that's true. At all. I hope I'm wrong. I think a MTP does exactly the opposite - it prevents hearings and experts by putting a "debate" limit of 20 hours and then a final vote. Typically those hearings and experts happen at the committee level, and McConnell has completely bypassed that process with this MTP. I may have the parliamentary process wrong here - I hope so.

The problem with today's vote is that it essentially caps the "debate" at 20 hours before a final yes/no vote. It also more or less gives McConnell final say on a bill and doesn't provide any time for analysis/CBO scoring/etc prior to the final vote. In other words, no committee hearings, no CBO, no real public debate. With today's vote, it is not really a choice to "proceed with debate." It is a choice to limit debate and fast-forward to final vote. It is a BS, anti-democraic, destructive way to tackle such a major legislative effort. A good summary of the next 48 hours is: https://www.vox.com/policy-and-politics/2017/7/24/16019984/obamacare-repeal-republican-flow-chart

Can anyone articulate why taking health care coverage away from 20 million+ people is good? I honestly don't get it. I understand, deeply, that Obamacare is imperfect. I also know that it has done a lot of good for many of the most desperate people in the country. I don't know how these GOP (or their voters) justify it. I've heard a lot of rhetoric about how awful Obamacare is (without any evidence of why, or how to fix it), but not about how this is going in the right direction. Seems awfully heartless to me. Seems to capture the main gist of the GOP policy priorities: that rich people aren't rich enough and poor people aren't poor enough. We are heading back to the days where medical costs price people out of health care at all and are the leading cause of personal bankruptcies. I don't see how that's progress.

I don't think the answer is simply to do less. I think it is to do smarter health care. I think there is a lot of health care happening that doesn't need to, and a lot that should be happening that isn't. If we spent more on prevention, population health, early detection screening, etc, we could be a lot healthier as a country. That should be the goal, I think. I think we need a system that incentivizes health and best practices, which would be very different than the system we have today. The goal shouldn't be to simply spend less. It should be to make our people healthier. I think if we do that, our health care costs would drop.

I want to be clear about what I'm saying. I am not saying that docs are doing clearly unnecessary tests or are intentionally misdiagnosing patients for purely financial reasons. Our administrators don't come out and say "do more of X." They do, however, have monthly meetings where they show us highly detailed metrics regarding patient volumes, charges, reimbursements, etc. They don't come and show us metrics of how healthy our patients are, how scientifically sound our decisions were, etc. Decision making in medicine is rarely black-and-white. How sick does someone have to be to get a chest x-ray? How many blood tests do you need to reassure yourself that this fever is just the flu and not leukemia? Are you sure you don't need an MRI for this patient with a headache? It could be a tumor... etc.etc.etc. There are many things that weigh into these decisions. The financial piece is a constant background pressure. I don't think any docs that I know actively and consciously choose things for purely financial reasons (I'm sure there are some out there). However, I think it definitely seeps into our background/unconscious decision making and keeps pushing us to do more and more. One of the problems is that this is all so opaque. There isn't anyone in the health care industry who is incentivized to reign in spending. Right now, we incentivize health care activity, not health care outcomes. If we can somehow incentivize the industry to keep people healthier, rather than keep people more engaged in the health care industry, we can actually make progress. I don't really know how that would work. I think Obamacare was a tiny step in the right direction, though was really inadequate to make the big changes that need to happen. I know the republican plan currently out there would be a huge step in the wrong direction.

It's not an either/or. We consume more health care because it is profitable. We incentivize every layer of the health care industry to do more. More testing, more intensive care, more surgery, more medications, more imaging, etc. Much of those decisions are driven by profit/insurance reimbursement. I am a doc, and my administrative overseers are constantly trying to nudge us to into spending more time and effort on patients and problems for which reimbursement/profit is highest. We try to resist, to make sure our decisions are based on science and need, not profit, but the pressure is constant. For all that consumption and spending, we have some of the poorest health metrics amongst all modern westernized societies. This system is clearly grossly inefficient and ineffective at making our population healthier.

Can someone succinctly say what the argument FOR this bill is? Other than "its not obamacare"? I really don't get it. I'm a physician, and there are plenty of problems with our current health care system. I can imagine a number of different general strategies that might improve things, but I don't see how this bill makes anything better. What is the conservative version of an ideal health care system?

The new WaPo article (https://www.washingtonpost.com/world/national-security/trump-revealed-highly-classified-information-to-russian-foreign-minister-and-ambassador/2017/05/15/530c172a-3960-11e7-9e48-c4f199710b69_story.html?hpid=hp_hp-top-table-high_trumpintel-0504pm%3Ahomepage%2Fstory&utm_term=.ab77929bf6ec) I can't imagine how anyone will defend this. I can't respect anyone who will.

I'd be very curious to hear your thoughts about the RecTec. Hope those ribs turn out well.

Worst case plausible scenario? Russia has significant leverage on Trump (financial, embarassing footage, something) and uses that to influence Trump to relax sanctions. This then emboldens Putin to become more aggressive and more destabilizing to Europe and other important areas. It emboldens Russia to continue to be uninterested in human rights violations. Because of their leverage on our leaders, US no longer can intervene and establish peace/civility. Russia then becomes strengthened as an international power. More violence ensues, millions are displaced, etc. Very very bad.

I'm a physician. I get job offers nearly every week to at least double my salary to move to a small town and be a generalist. Not tempting (I like my current job and location) but medical talent is definitely not distributed evenly across this country. There are federal programs that will repay med school debts to new grads who will go to underserved areas. Those tend to be tough jobs - lots of sick patients, minimal back up, minimal access to specialists, etc. Even with those programs, there are many gaps. Foreign-born docs fill a lot of those gaps - usually very well. There are a huge number of excellent foreign-born doctors here. I work at the Mayo Clinic, and I have colleagues from all over the planet (including quite a few from the 7 countries in the EO). Many of them are amongst the finest physicians in their field. We are lucky to have them.

Certainly not. But with government intervention and action (imperfect as it was), we are closer to 100% than we've ever been. Progress doesn't have to be complete to be celebrated.

If health care is free market, some will go without. That is how free markets work. If republicans are OK with that, they should have the courage to say so. I doubt we'll ever see them be honest about it.

Hmmm. I've never thought about it, really. My first reaction is that DUI checkpoints are theoretically more non-biased - anyone driving on this road at this hour gets stopped. The problem with stop-and-frisk isn't really the stopping and frisking (though there may be issues there too), but the way it was implemented in a biased and targeted way. But that's just a gut reaction.

I've been thinking about the drunk driving analogy some more tonight. Someone mentioned that it wasn't about the cars, and I don't think that's entirely right. It seems to me that the dramatic reduction in drunk driving deaths have occurred by both changing the culture AND changing the cars. We are far more condemning (thank goodness) of drunk driving than we were in the past. We seek it out (check points) and prosecute it far more severely. We arrest and prosecute people for drunk driving, before tragedies occur. We don't wait for an accident to arrest people for drunk driving. This is a big difference from a few decades ago. Over the same period, we've made cars far more safe than they were before. Motor vehicle accident deaths have decreased more than motor vehicle accidents have. We now have three-point belts, air bags, crumple zones, etc etc etc. Cars today are far safer than they were decades ago. All of this has lead to significant decreases in drunk driving (and motor vehicle accident in general) deaths than there were a decade or three ago. We still have a significant problem with drunk driving (we still lose far too many people on the highways) but real, important progress has been made. It seems to me that to solve the gun death problem a similar, multifaceted approach is needed. We need to change the culture by reducing criminality - perhaps by addressing poverty/drug addiction, make violence more culturally unacceptable (address the celebration of violence in TV/movies/games), make gun carelessness a stigmatized, punished practice (seek it out, prosecute it at the occurrence of carelessness, not at the occurrence of tragedy - similar to drunk driving checkpoints). Suicide is a big part of gun deaths, and it represents a failure of the mental health programs. Depression is a treatable disease - we need to do a better job detecting and treating it. At the same time, there must be a way to make guns safer. Maybe its smart technology? I don't know. The point is not to have the goal of reducing the number of guns. Speaking as a far-left (not really, but in some areas, at least) liberal, I really don't care about guns. I do care about gun violence and deaths. I think we can all agree that 30,000+ deaths is far too many. I don't expect that any single (or combination of) legislation will eliminate gun violence and death. The idea that anything we must address any and all problems to be worth doing is a debate killer and a dumb argument. But if we can get the number down to 15,000 dead Americans/year, we will have made a major and important difference. If we can get down to 15k/year, we can open up debate at that point on how to get it down to 10k...