Healthcare going forward

[ballcaphair]

^ All of this. First Res-ponders are an ER on wheels staffed with Paramedics who are educated and brilliant angels of mercy. Much of our heavy lifting is done before reception.

 

[Kulindahr]

I never know what to say on the topic of healthcare because it endlessly confuses me why it's a paid-for privelege. Government never runs out of money for wars or expansion projects, tax cuts for big corporations or private jets and luxury vacations but as soon as somebody gets a cold (or cancer) suddenly we're the poorest country in the world.

"Poorest"? No -- just the most barbaric, letting our own suffer and thus demonstrating that "We, the people" has been made hollow by those who would rather use government to enrich themselves than to help anyone.

What Trump has spent on golf weekends in one year could build three new medical schools to increase the supply of doctors. If he keeps up this rate, by the end of his term he will have thrown away enough money to have built a dozen new medical schools.

 

[Kulindahr]

EMTALA said that hospitals had to assess patients and determine their condition before evaluating their insurance status. It also said that if the patient is pregnant, the hospital must evaluate both the patient and the fetus.

It just struck me that this explains something not quite two years ago with my mom: I took her to the ER and they started in on insurance questions and forms. I said, "No, treatment first", and pushed my way past the desk. The guy with the forms muttered something about bedside lawyers.

The ACA mandates insurance, expands Medicaid and it also removes the "preferred provider" requirement for emergency conditions. That pretty much removes the problem that EMTALA was designed to fix.

Sadly it didn't change the bureaucratic mindset that first you have to give up your home and impoverish your heirs before they let a doctor get involved.
And they left some idiocy in Medicare, as well: my mom ended up dying sooner than she should have because they Medicaid rules said she had to go home after being treated for what she entered a skilled nursing facility for, even though she had developed a new condition -- she had to go home and then stat the process of getting skilled care all over again, guaranteeing her substandard care because we are not professionals.

It would be acceptable at this point for there to be a requirement that all patients are triaged by a nurse in the ED. If the patient does not have an emergency condition, they should be referred to a clinic or their family physician. But because not all states expanded Medicaid and because of the efforts to undermine the ACA, we're probably stuck with EMTALA in its present form.

I'm glad Adventist hospitals do that anyway -- several times my mom or I have been switched from the clinic to the ER or the other way around. They even cut a separate door in the hospital so there's a straight line between the ER and the clinic.

EDs have completely restructured the way they do business. Instead of sitting in a waiting room, you can expect that a triage nurse will see you within 15 minutes of arrival. The nurse will assess you and assign you an acuity score that determines who will see you and how fast you will be seen.

Some very smart EDs have setup a Fast Track area that is staffed with physician assistants or nurse practitioners. If you have a minor condition- a fever, an infection, having stitches removed, etc- you are sent into Fast Track which runs more like an outpatient clinic. Moving low-acuity patients out of the emergency room opens up beds in the emergency room for patients who actually need to be seen by an emergency room physician.

Yeah. When my buddy had a seizure last year and I got him to the emergency room, a nurse started in with questions and I interrupted and said "Seizure"; the questions ended and he was moved right to the "fast lane".

 

[KaraBulut]

It just struck me that this explains something not quite two years ago with my mom: I took her to the ER and they started in on insurance questions and forms. I said, "No, treatment first", and pushed my way past the desk. The guy with the forms muttered something about bedside lawyers.

The language is found in EMTALA Section 1867 which says that a patient must receive "appropriate medical screening examination" to "determine whether or not an emergency medical condition exists".

Each ED has a slightly different interpretation.

Some hospitals will have you see the triage nurse who does the screening and initiates testing and treatment. Then the patient representative will collect your registration and insurance, whether you've seen the ED physician or not.

Other hospitals will have you see the triage nurse who does a "mini-reg" that doesn't collect any ability-to-pay information. After you have seen a physician and given a diagnosis, the patient representative will then collect your insurance information and copayments, etc.

Because Congress chose the word "medical" in the "screening" and "condition" language, some hospitals err on the side of caution and delay ability-to-pay screening until after the ED physician has seen the patient. There's no requirement of treatment prior to financial screening per se; the focus is more upon determining that the patient is stable and doesn't have an emergent condition.

 

[gsdx]

There was a new commercial for Xarelto (treatment for blood clots) on television last night with a new disclaimer at the bottom of the screen. In similar wording, it claimed that the 'test subjects were studied for 208 days'.

208 days!!
7 months!!

I was stunned. I thought this type of research went on for years. No wonder there are lawsuits popping up every day if this is the norm.

 

[Stardreamer]

Good News, A story in Forbes says that the insurers that stuck it out and remained in the ACA are finding the markets are stabilizing and they are showing a profit. This includes the carriers that stepped up to fill the gaps being left by others fleeing the market.

It was a high inevitability after all if you are the only carrier servicing a small area you have all the business in that area and are better able to manage the costs. Competition would be more desirable but a monopoly is better than nothing.

Now to me, this means that with the repeal of the mandate, the Republicans now unquestionably own healthcare and any and all blame for high costs and premiums under the ACA going forward is in their laps since all the actions they are taking to kill the ACA is currently what is driving up costs.

 

[KaraBulut]

Good News, A story in Forbes says that the insurers that stuck it out and remained in the ACA are finding the markets are stabilizing and they are showing a profit. This includes the carriers that stepped up to fill the gaps being left by others fleeing the market.

This was what had been predicted- that people who had been uninsured and had been going without primary care would get their chronic health issues addressed and the costs would begin to decrease.

Some of the insurers who got out earlier were already starting to see signs of turnaround. A couple of the companies who got out were also involved in potential mergers that the Obama administration was balking at... not that they would act out of revenge or to create additional leverage favoring the merger.

Fun Fact: one of the companies that has actually expanded their ACA market is Oscar. The Kushner family (yeah, that Kushner family) has heavy investments in Oscar and Jared's brother is an executive with Oscar.

Now to me, this means that with the repeal of the mandate, the Republicans now unquestionably own healthcare and any and all blame for high costs and premiums under the ACA going forward is in their laps since all the actions they are taking to kill the ACA is currently what is driving up costs.

The ACA is a case study in how not to pass major legislation and the political costs of not selling legislation to the voters.

The Democrats cobbled together an idea that combined a Republican plan (the individual marketplace) with expansion of Medicaid. They spent months having hearings and accepting amendments but the Democrats' efforts were stymied by the Republicans who, in the end, did not vote for it. The bill was passed with a 51 vote majority which was a short-term advantage but this setup a long-term problem in that Republicans have the same 51 vote threshold in their attempts to unravel the ACA.

The Republicans (with funding from special interest groups funded by the Koch brothers) also took a short term strategy of portraying the ACA as government takeover of healthcare, "death panels" and increasing taxes.

Trump's lack of knowledge about healthcare has done a lot of short-term damage to the ACA. Premiums have gone up significantly and they will continue to go up (although much of this cost is picked up by the government not the policyholders). Uncertainty exists in the market because of the attempts to sabotage the ACA.

All of this was fixable. So much time has been wasted on attempts to "repeal" and sabotage the ACA when most of the issues are fixable (and the wasted time could have been spent fixing it if the Congress were a functional legislative body).

You're correct. It's now Trumpcare. The party in power now owns the problems.

 

[Kulindahr]

The states ought to go into the insurance business under the ACA with their own publicly-owned insurance companies.

 

[gsdx]

How do drug advertisements get away with making claims without FDA approval? I've noticed it in a number of commercial disclaimers with something similar to this: "These statements have not been approved by the FDA."

How can the FDA approve a drug without really knowing what it does?

 

[Benvolio]

How do drug advertisements get away with making claims without FDA approval? I've noticed it in a number of commercial disclaimers with something similar to this: "These statements have not been approved by the FDA."

How can the FDA approve a drug without really knowing what it does?

Those are usually drugs and supplements which the FDA does not have authority to regulate.

 

[ballcaphair]

Those are usually drugs and supplements which the FDA does not have authority to regulate.

Those would include reverse engineered "replicas" from China and beyond, suspect for lead, cadmium, and selenium. You know, sort of like a fake Rolex. One that poisons you.

 

[gsdx]

Those are usually drugs and supplements which the FDA does not have authority to regulate.

But they have the authority to regulate Breakfast Cereal??

 

[Benvolio]

But they have the authority to regulate Breakfast Cereal??

New drugs require very expensive clinical tests to prove that they are both safe and effective. The manufacturer has a period of patent monopoly during which it can charge high prices to recover its investments and a profit. The vitamins, minerals and supplements are already in the public domain; no patent is available. If testing was required, it could not happen because there is no way to recover the expense. The stuff would be brought in from other countries.

 

[gsdx]

New drugs require very expensive clinical tests to prove that they are both safe and effective. The manufacturer has a period of patent monopoly during which it can charge high prices to recover its investments and a profit. The vitamins, minerals and supplements are already in the public domain; no patent is available. If testing was required, it could not happen because there is no way to recover the expense. The stuff would be brought in from other countries.

1 - This does not address my post at all. What gives the FDA the right to regulate breakfast cereals?
2 - If there was so much testing (did you read post #2065?), then why in hell are there so many bloody class action lawsuits for side effect they either didn't know about or didn't tell anybody about?

 

[Benvolio]

1 - This does not address my post at all. What gives the FDA the right to regulate breakfast cereals?
2 - If there was so much testing (did you read post #2065?), then why in hell are there so many bloody class action lawsuits for side effect they either didn't know about or didn't tell anybody about?

Congress has given FDA power to regulate food.
All drugs have possible side effects, including aspirin and Tylenol. Clinical trials involve balancing the public’s need for the new drug against the possibility of side effects which only show up long after. Some effects only show up after approval. A high percentage of those class actions claim that the patients were not adequately advised of possible side effects. Class actions are always for the primary benefit of the lawyers, and are almost always settled soon with big lawyer fees and a few dollars to thousands of members. Even anphoney lawsuit involves risk and expense to the company, justifying a settlement making the lawyer rich.

 

[gsdx]

Congress has given FDA power to regulate food.

You still haven't answered a question I have about why drugs can make claims about their products without FDA approval when breakfast cereal cannot.

I'm referring to the Cheerios fiasco of a few years ago. It has long been known that oats are very high in fibre and are a naturally control cholesterol. It's not something people didn't know before. Yet, when General Mills put that information on their Cheerios boxes, the FDA was all over them.

Drug companies are allowed to make unsubstantiated claims for products with a list of side effects and the FDA doesn't even know if the drug does what the company claims it can do.

In my eyes, that is a complete failure in the system, and both the drug companies and the FDA should be held responsible for deaths or injuries caused by the drugs that they didn't know about.

 

[cityboy-stl]

You still haven't answered a question I have about why drugs can make claims about their products without FDA approval when breakfast cereal cannot.

Because there is no officially sanctioned and reviewed study that says Cherrios can lower cholesterol which is medical health claim they cannot make. There needs to be study that verifies the truth of a specific medical claim.

Drug companies cannot (or aren't supposed to) do that either. It isn't true that drug companies can make "unsubstantiated claims". They can only make claims for which the FDA has approved usage of the drug as long as they also list side effects. They cannot say the drug also treats some other unapproved medical condition. That's not to say they don't push the limits or there may be unknown side effects however.

 

[gsdx]

Because there is no officially sanctioned and reviewed study that says Cherrios can lower cholesterol which is medical health claim they cannot make. There needs to be study that verifies the truth of a specific medical claim.

The health benefits of oats have been known for centuries and the ability of oats to control and reduce bad cholesterol have been known since the 80s. To say that the FDA needs studies to show this simply shows how stupid they are because the studies are out there and have been known for decades. Why should General Mills have to do their own studies when the data has been around for over 30 years? Why do drug companies get a pass when a box of cereal can't?

 

[cityboy-stl]

I don't disagree with you but that's the reason anyway. There is a study to show that Lipitor (or pick some drug) specifically lowers cholesterol. There is no such study to show that Cheerios specifically does anything better or differently than any other brand even if there are all kinds of studies saying oats in general do that. Therefore the FDA does not allow a specific medical claim that it does.

WebMD: https://www.webmd.com/food-recipes/news/20090513/fda-warns-on-cheerios-health-claims

Besides...Cherrios does still say it's product is healthy in a way that is consistent with the regulations.

Cherrios: http://www.cheerios.com/en/hearts-matter.aspx?gclid=CjwKCAiAj53SBRBcEiwAT-3A2PFOLZlfM3HDX_cVsX_sU4DHnAUfRRhtSvroxY_BaOO82nNqLgxXbhoCp5kQAvD_BwE&gclsrc=aw.ds&dclid=COHN4pzIstgCFeynUQodHIIMyA

http://www.cheerios.com/Articles/Does-Cheerios-help-lower-cholesterol


However...the FDA under Trump would probably allow them to say Cherrios cures athletes foot... lol

 

[gsdx]

Therefore the FDA does not allow a specific medical claim that it does.

I understand the reasoning but that reasoning doesn't explain drug companies getting away with making similar unsubstantiated claims without any studies to back them up.

It's obvious who owns the FDA.