visionary Posted August 1, 2019 Share Posted August 1, 2019 Have they asked the candidates about North Korea or Hong Kong yet? I can't remember. I don't think they've asked much about foreign policy. Link to comment Share on other sites More sharing options...
Springfield Posted August 1, 2019 Share Posted August 1, 2019 1 hour ago, Llevron said: So who yall feeling right now? Any change from last time? edit: (Also the post above is amusing haha) Pete Buttigueg and Joe Biden for me. Warren over Sanders who’s slightly over Harris. Thats how I rank the top 5. Also, I really like Andy Yang (but not enough to google whether or not that is his actual name) Link to comment Share on other sites More sharing options...
PeterMP Posted August 1, 2019 Share Posted August 1, 2019 37 minutes ago, tshile said: Sorry poor wording. I didn’t mean to imply there were no standards. All i I was trying to say is that if you’re going to try to control costs by giving them less money to spend, then you should account for the option of just buying inferior equipment and ask yourself if that’s how you want them to respond to cost cuts or not. Because that’s how they responded (in part) as for the rest of your post theres no new information there for me. I don’t see how it conflicts with what I said. Inferior in what context? When you say inferior, some could interpret that as the FDA isn't doing its job and is allowing things that shouldn't be used be approved (which does happen sometimes, but I don't think happen at a large level you seem to be implying at the time of the ACA). If they are buying equipment that is above and beyond what they need for the vast majority of work they are doing, then buying equipment that actually fits their needs for most of the work being done then they are saving money. (When me and my wife first bought our house and had to buy appliances, we bought high end and expensive appliances that came with all sorts of bells and whistles. For our 2nd round of appliances, we bought cheaper models that lack those bells and whistles. Now, you could say we bought inferior appliances the 2nd time. But we realized, we had paid more for features that we essentially never used. We could buy cheaper appliances that fit 95% of our needs, and we could adjust to deal with the other 5% other ways.) One way to get hospitals to actually lower costs is to have them carefully consider what they actually need and not to buy equipment that comes with features that aren't actually need. (and some of those features might sometimes be useful and staff might appreciate them, but that doesn't mean they are actually needed). Your post heavily implied the response of hospitals to the ACA was only to cut corners (cut staff, buy cheaper equipment, etc) and try to save money and game the system so that re-admissions didn't appear to be their fault (even if they were), and stopped initiatives. I'm not saying that didn't happen at all, but other things happened too, including initiatives that were actually started because of the ACA (initiatives on how to lower re-admissions), adding staff (having doctors be around more), etc. (If we're going to save money in health care, in some cases, health care technology is going to have to go down. I believe we have more MRI per a person or land area than in other country. https://www.statista.com/statistics/282401/density-of-magnetic-resonance-imaging-units-by-country/ So if you're a hospital and you want to buy an MRI machine, do you actually need it or can you have MRIs done somewhere else that's close by? If you decide that you can have them done somewhere else close by, then that hospital has saved money. Much less buy a less MRI machine that maybe doesn't have some abilities of some of the better machines.) Link to comment Share on other sites More sharing options...
CousinsCowgirl84 Posted August 1, 2019 Share Posted August 1, 2019 9 minutes ago, PeterMP said: If they are buying equipment that is above and beyond what they need for the vast majority of work they are doing, then buying equipment that actually fits their needs for most of the work being done then they are saving money. Above and beyond for the vast majority? Out of curiosity how many lives does it take before something is worth while having? (I’ll concede is probably isn’t one)... but there is medicine that’s is only useful and life saving to one percent of the population, if that.. is that “above and beyond for the fast majority”? Why should the government decide that? Quote One way to get hospitals to actually lower costs is to have them carefully consider what they actually need and not to buy equipment that comes with features that aren't actually need. (and some of those features might sometimes be useful and staff might appreciate them, but that doesn't mean they are actually needed). A staff that has has a higher moral and isn’t over encumbered by menial tasks (eg having access to those “features that aren’t actually needed” perform better. also, “take it easy on me, kid” is insulting now? Wow... Link to comment Share on other sites More sharing options...
PleaseBlitz Posted August 1, 2019 Share Posted August 1, 2019 1 hour ago, Llevron said: So who yall feeling right now? Any change from last time? edit: (Also the post above is amusing haha) Warren Harris / Buttigieg tied for second. I'm fine with Biden if his popularity remains durable and he really does have the best chance to beat Trump. Only real change from last time is I've lost hope in Beto and Harris went from 2nd alone to tied for 2nd. Link to comment Share on other sites More sharing options...
PeterMP Posted August 1, 2019 Share Posted August 1, 2019 5 minutes ago, CousinsCowgirl84 said: Above and beyond for the vast majority? Out of curiosity how many lives does it take before something is worth while having? (I’ll concede is probably isn’t one)... but there is medicine that’s is only useful and life saving to one percent of the population, if that.. is that “above and beyond for the fast majority”? Why should the government decide that? A staff that has has a higher moral and isn’t over encumbered by menial tasks (eg having access to those “features that aren’t actually needed” perform better. Somebody has to decide that. That's just reality. So why not government? In reality, in the case of the ACA, the government isn't actually deciding. The hospital is. All the ACA said is we aren't going to pay you if you can't actually make people healthy so that they don't have to come back to the hospital right away. So your argument isn't even valid. With everything, there is a line somewhere. If staff performance is down because of morale and it is affecting care (so that re-admissions go up), then that's an issue. But that's on the hospital to figure out. The ACA didn't tell the hospitals how to be hospitals. Link to comment Share on other sites More sharing options...
visionary Posted August 1, 2019 Share Posted August 1, 2019 4 minutes ago, CousinsCowgirl84 said: also, “take it easy on me, kid” is insulting now? Wow... You don't think calling an adult a kid can be viewed as insulting? Ok, child. 😉 Link to comment Share on other sites More sharing options...
CousinsCowgirl84 Posted August 1, 2019 Share Posted August 1, 2019 Just now, PeterMP said: Somebody has to decide that. That's just reality. So why not government? Because they aren’t a doctor? Just now, visionary said: You don't think calling an adult a kid can be viewed as insulting? Ok, child. 😉 Are you talking to someone half your age? Link to comment Share on other sites More sharing options...
PeterMP Posted August 1, 2019 Share Posted August 1, 2019 4 minutes ago, CousinsCowgirl84 said: Because they aren’t a doctor? Doctors don't make those decisions now. (And again, the government isn't really making them with the ACA.) Link to comment Share on other sites More sharing options...
CousinsCowgirl84 Posted August 1, 2019 Share Posted August 1, 2019 Just now, PeterMP said: Doctors don't make those decisions now. Lawyers are. Tort reform will solve it all! /s Link to comment Share on other sites More sharing options...
PleaseBlitz Posted August 1, 2019 Share Posted August 1, 2019 9 minutes ago, CousinsCowgirl84 said: Lawyers are. Tort reform will solve it all! /s Nah, whether a drug gets made or not is ultimately decided by board members acting on behalf of investors (who are usually larger funds). For example: Link to comment Share on other sites More sharing options...
Larry Posted August 1, 2019 Share Posted August 1, 2019 5 hours ago, visionary said: What do you like about it that would change or go away? 4 hours ago, tshile said: My ability to change providers if I don’t like how they’ve treated me. Could you point me at the plan that would make it impossible for you to change doctors? (Or are you using the word "provider" to refer to "insurance company"?) Link to comment Share on other sites More sharing options...
tshile Posted August 1, 2019 Share Posted August 1, 2019 33 minutes ago, PeterMP said: Your post heavily implied the response of hospitals to the ACA was only to cut corners (cut staff, buy cheaper equipment, etc) and try to save money and game the system so that re-admissions didn't appear to be their fault (even if they were), and stopped initiatives. I'm not saying that didn't happen at all, but other things happened too, including initiatives that were actually started because of the ACA (initiatives on how to lower re-admissions), adding staff (having doctors be around more), etc. And I’m not saying no good came out of it. Im just saying a lot of bad did. If your goal is to provide the highest quality care and accessibility for everyone, and your actions result in higher patient-to-nurse ratios and higher patient-to-tech ratios, and if they’re buying lower quality stuff (are we really going to argue about how acceptable the bare minimum is? Have at it if you want, I desire better), then are you meeting your goal? Is the result aligning with what you’ve promised? And we’re only barely scratching the surface here. And this isn’t a “well competition will weed the bad hospitals out” because hospitals don’t operate like a general goods store. There are 3 or 4 systems I’m aware of that chose to respond to ACA differently and my understanding is that they’ve become the standard for people in the industry that are driven primarily by patient outcomes. But there a lot of other decision makers that are driven by other motives. And there are a lot of hospitals that chose to cut corners. And there are lots of people that have to use those hospitals don’t really get much choice in using another, even if they’re knew what was going on. There’s a lot to fix with ACA. And sitting here today saying hospitals have escaped scrutiny means you don’t know what you’re talking about. Which was the context of my posts. The hospitals were hit the hardest. And other elements of the industry escaped with nothing. Some in between. So yeah asking for more scrutiny in regards to cost controls seems silly. That that to the others. And work on efficiency and patient outcomes with the hospitals. Cause that’s what they should be focused on. 33 minutes ago, PeterMP said: So if you're a hospital and you want to buy an MRI machine, do you actually need it or can you have MRIs done somewhere else that's close by? Sweet so what if you’re a community hospital that bought an MRI machine in 2006? What awesome option did ACA do for them? They’ve got a real issue with cost and ROI on that one. Im less looking for an answer, more pointing out the issue is a little more complicated than what you said. Link to comment Share on other sites More sharing options...
CousinsCowgirl84 Posted August 1, 2019 Share Posted August 1, 2019 24 minutes ago, PleaseBlitz said: Nah, whether a drug gets made or not is ultimately decided by board members acting on behalf of investors (who are usually larger funds). Well, if it is the stock market deciding we definitely don’t have to worry about over-spending on “unneeded” medical equipment... Link to comment Share on other sites More sharing options...
Larry Posted August 1, 2019 Share Posted August 1, 2019 1 hour ago, tshile said: ACA didn’t do anything to anyone regarding pricing of services. Aca put the majority (if not all) of the responsibility of cost controls on the hospitals and health care providers. It did this by significantly cutting reimbursements and implementing HCHAPS to further reduce reimbursements if he quality of care provided wasn’t high enough. The idea was to take the largest chunk of money these people receive (Medicare and medicaid reimbursements) and cut them. They will have less money to work with. Device manufacturers and suppliers and everyone else will have to lower prices because there won’t be any money to support the high prices. Except that’s not what happened. Hospitals bought lesser quality supplies; they raised patient-to-nurse ratios and tech ratios (which if you care about quality of care, that’s the worst thing you can do as these are the people doing all the care giving....) they shut down research departments. They shut down initiatives. They directed a lot of resources at absolving themselves from the penalties of re-admission and hospital born infections (because these reduce reimbursements to 0) Just saying, as someone who's working at the very basement level of the health care industry, I've seen some huge impacts from at least some of those things. At least from what I've been told (I've only been in health care for two years, and at a really crummy nursing home, at that), used to be nobody paid attention to things like bed sores. Now days, a patient gets a bed sore, the administrators start looking for who they need to punish for letting it happen. Teams get called in, to treat the problem with the best care they can deliver, to get it fixed as quickly as possible. People get investigated to see how it happened. It's been explained to me that before, when a patient got a bed sore, the facility got paid for treating the bed sore. Now? That one bed sore is going to wipe out the facility's profit from dozens of patients. (And if it happens too often, then the facility takes a 10% cut in their total Medicare reimbursement, for all patients.) Bed sores went from a shrug and business as usual to a major serious issue for the whole place. Note that I am NOT saying that the things you're saying aren't true, too. Just saying that a lot of people who are working the floor have noticed that there's a lot of things that get paid attention to, that didn't, before. Link to comment Share on other sites More sharing options...
tshile Posted August 1, 2019 Share Posted August 1, 2019 I think we’re way over simplifying what it means to change supplies in a hospital situation. There’s a lot of trial and error and training that goes on and it’s really easy to sit on a forum and say that should be easily done and is the hospitals job to make it happen its another to have a loved one be harmed in a hospital because the staff made a simple but terrible mistake because lower quality/different equipment was purchased as a knee jerk reaction to cost controls that are forced on you 3 minutes ago, Larry said: Note that I am NOT saying that the things you're saying aren't true, too. Just saying that a lot of people who are working the floor have noticed that there's a lot of things that get paid attention to, that didn't, before. Yup. The context of the conversation was that hospitals are not being scrutinized. I chose to refute that with a lot a lot of negative impacts I’m aware of happening. There are also a lot of positive impacts and generally speaking I support ACA and I wish our republicans would grow up and help fix it instead of being petulant children. But i I think the positives you and peter have posted actually support my underlying point - hospitals have faced the majority of the scrutiny. Saying otherwise.... Link to comment Share on other sites More sharing options...
Larry Posted August 1, 2019 Share Posted August 1, 2019 1 hour ago, Renegade7 said: Will a candidate that wants to get rid of private insurance lose the election because of it? It's a safe bet that the R's will try to hang a "will get rid of private insurance" label on whoever wins. It will win bigger than "socialized medicine" does. Getting rid of private insurance will terrify a lot more people than it inspires. Link to comment Share on other sites More sharing options...
tshile Posted August 1, 2019 Share Posted August 1, 2019 I would add the biggest improvement on focus I’ve seen is hospital born infections. Same me as your story with bed sores. Exactly the same. Except much more serious (in my opinion) Link to comment Share on other sites More sharing options...
PleaseBlitz Posted August 1, 2019 Share Posted August 1, 2019 23 minutes ago, CousinsCowgirl84 said: Well, if it is the stock market deciding we definitely don’t have to worry about over-spending on “unneeded” medical equipment... Right, because there are no incentives for them to create and sell useless and/or overpriced crap or to manipulate prices or to make things that have to be replaced/repaired/upgraded every few years, etc etc etc. Nope, nothing to worry about, Wall Street will take care of us. LOL. Link to comment Share on other sites More sharing options...
tshile Posted August 2, 2019 Share Posted August 2, 2019 Ok I’ve been corrected. Some of the things we’ve been discussing come from CMS and we’re developed in and rolled out in the 2003-2005 range and have had staggered milestones for providers to meet; many of the hardest hit in the years after ACA was introduced. So if you can’t find information on some of it in ACA then go look at CMS because it probably came from there. I stand by the original point that hospitals have been and still are heavily scrutinized Link to comment Share on other sites More sharing options...
88Comrade2000 Posted August 2, 2019 Author Share Posted August 2, 2019 The Democratic Party Is Culling the Field Too Soon Link to comment Share on other sites More sharing options...
Larry Posted August 2, 2019 Share Posted August 2, 2019 22 minutes ago, tshile said: I would add the biggest improvement on focus I’ve seen is hospital born infections. Same me as your story with bed sores. Exactly the same. Except much more serious (in my opinion) Oh, agreed. It's amazing how important an issue gets to these facilities, when they mention "10% reduction in your Medicare reimbursement". I picked bed sores as an example of a problem that a lot of people would think of as minor, almost trivial. But now days, a patient gets a bed sore, you'd think it was cardiac arrest. Link to comment Share on other sites More sharing options...
tshile Posted August 2, 2019 Share Posted August 2, 2019 9 minutes ago, Larry said: It's amazing how important an issue gets to these facilities, when they mention "10% reduction in your Medicare reimbursement". Especially if you cut it 33% to start with Link to comment Share on other sites More sharing options...
CousinsCowgirl84 Posted August 2, 2019 Share Posted August 2, 2019 55 minutes ago, PleaseBlitz said: Right, because there are no incentives for them to create and sell useless and/or overpriced crap or to manipulate prices or to make things that have to be replaced/repaired/upgraded every few years, etc etc etc. Nope, nothing to worry about, Wall Street will take care of us. LOL. Certainly no incentives for the cost conscience executive to buy it... you can sell what ever you like. Link to comment Share on other sites More sharing options...
PeterMP Posted August 2, 2019 Share Posted August 2, 2019 5 minutes ago, CousinsCowgirl84 said: Certainly no incentives for the cost conscience executive to buy it... you can sell what ever you like. This sort of assume that executives are cost conscience and aren't susceptible to industry incitements to spend money unnecessarily and out right corruption. https://dbknews.com/2019/03/26/umd-umms-medical-system-mayor-catherine-pugh-baltimore-schools-profit-scandal/ (In general, are you really claiming that private industry never waste money?) Link to comment Share on other sites More sharing options...
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