Healthcare going forward

[Kulindahr]

It's interesting that your system is being unravelled while our system in Ontario is expanding. Beginning next year, Ontario will be offering over 400 free prescriptions to younger people 25 years old and younger as long as they have an OHIP card (Ontario Health Insurance Plan). Many of the prescriptions are for mental conditions and chronic health conditions such as diabetes, asthma, etc.

No kidding. The GOP seems determined to make health care more expensive and less available, for no other reason than to avoid the cheaper universal care approach just because it's "socialism".

But that's the mark of ideology: no facts, no logic, just hate.

 

[KaraBulut]

It's not lowering the corporate rate that resulted in the $1.5tn additional debt, it's the breaks for the super-wealthy. It's typical GOP strategy: make things worse for the poor so they don't have the time or energy to be

Hmmm... well, actually the majority of the shortfall is from the corporate tax cut. It's hard to separate "corporations" from "people" because they made some significant rate reductions on "pass-through corporations" which are officially corporations but they flow into a personal tax return.

The tax cuts actually lowered the revenue into the government by $1.6 trillion but there was about another $200 million in revenue increases, so the net ended up being close to $1.46 trillion in revenue reduction (read: deficit increase) over a 10 year period.

Of that $1.6 trillion, $1 trillion of it comes from lowering the top corporate tax rate from 35% to 21%. The true sin of this legislation is not that it lowered the corporate tax rate; the sin is that it kept most of the existing loopholes and special tax exemptions. Very few corporations actually pay 35%. Because of all of the loopholes and exemptions, most are paying significantly less. So, with the retained loopholes that lower the effective rate AND the lowering of the rate to 21%, it's unclear how much corporations will actually be paying, so the numbers may be worse than $1 trillion in revenue lost in the end.

 

[Kulindahr]

Hmmm... well, actually the majority of the shortfall is from the corporate tax cut. It's hard to separate "corporations" from "people" because they made some significant rate reductions on "pass-through corporations" which are officially corporations but they flow into a personal tax return.

The tax cuts actually lowered the revenue into the government by $1.6 trillion but there was about another $200 million in revenue increases, so the net ended up being close to $1.46 trillion in revenue reduction (read: deficit increase) over a 10 year period.

Of that $1.6 trillion, $1 trillion of it comes from lowering the top corporate tax rate from 35% to 21%. The true sin of this legislation is not that it lowered the corporate tax rate; the sin is that it kept most of the existing loopholes and special tax exemptions. Very few corporations actually pay 35%. Because of all of the loopholes and exemptions, most are paying significantly less. So, with the retained loopholes that lower the effective rate AND the lowering of the rate to 21%, it's unclear how much corporations will actually be paying, so the numbers may be worse than $1 trillion in revenue lost in the end.

All that, when both Ryan and Trump said loopholes were going to be closed.

Once again, liars will be liars.

 

[KaraBulut]

All that, when both Ryan and Trump said loopholes were going to be closed.

Once again, liars will be liars.

The frustrating thing is that I've been reading legislation for years, starting with draft legislation through the final Bill. I've never seen legislation like the "bills" that the Republicans have been passed this year (and this stuff has been a completely Republican effort, not the least bit bipartisan). They're just short of being written with crayons on a cocktail napkin. Everyone has been scrambling to read the legislation after it was passed to figure out who got the goodies and who got the shaft.

The Orwellian "Tax Cuts and Jobs Act" is a 500+ page bill. It's hard to know exactly which version was the last version that was scored by the CBO because this bill started with some special interest group and was written by a bunch of Congressmen in the wee hours of the night with no hearings, no expert testimony and no economic analysis. History tells us that when Congress makes significant changes in economic legislation, it generally distorts the economy, leading to boom-bust situations.

If this is the way Congress intends to do business, it's time to clean house and get people who understand (or are not willing to feign ignorance of) the legislative process.

 

[Stardreamer]

The future of Trumpcare?

Man captures video of "patient dumping" outside Baltimore hospital

The point of trying to provide comprehensive coverage for the poor is to provide a means for hospitals and other care providers to have some compensation in these cases so crap like this doesn't happen. We need a default public option that kicks in to cover those who have no insurance.

 

[gsdx]

^ I'm stunned. I can't imagine that happening, especially in sub-freezing weather.

I'm actually speechless here.

 

[TX-Beau]

^ I'm stunned. I can't imagine that happening, especially in sub-freezing weather.

I'm actually speechless here.

Why are you stunned? Republican healthcare operates under the crawl off and just fucking die already principle. You can't jeopardize profit by paying to heal slackers, wetbacks, and lazy Negroes.

 

[gsdx]

^ How can they not be criminally charged? Is that considered 'legal'?

 

[KaraBulut]

The future of Trumpcare?

Man captures video of "patient dumping" outside Baltimore hospital

The point of trying to provide comprehensive coverage for the poor is to provide a means for hospitals and other care providers to have some compensation in these cases so crap like this doesn't happen. We need a default public option that kicks in to cover those who have no insurance.

Well, the issue isn't Trumpcare, per se. It's Medicaid (Medi-cal in California) and the lack of community resources like half-way houses and assisted living facilities.

The same thing happens a lot with public psych facilities- unless there's a family member that shows up at the hospital to pick up the patient, they're given their clothes, a small amount of money and driven to the bus station or to a homeless shelter.

It's about to get worse- the US House has proposed two disturbing bills- one would repeal the patient-dumping requirements of EMTALA and the other would attach a work requirement to Medicaid (meaning people would only be eligible for Medicaid if they worked or did public service).

 

[TX-Beau]

^ How can they not be criminally charged? Is that considered 'legal'?

American principle, everything is legal unless proven otherwise.

 

[gsdx]

The same thing happens a lot with public psych facilities- unless there's a family member that shows up at the hospital to pick up the patient, they're given their clothes, a small amount of money and driven to the bus station or to a homeless shelter.

I've read about that happening for years, but it's a little different wheeling someone out of a hospital where they went to get help to a bus stop in freezing weather in only a hospital gown. That, to me, is cruel, heartless, and inhumane. Money should not be more important than someone's life.

 

[ballcaphair]

I believe that EMTALA applies to everyone, not just Medicaid patients. The whole system is at sea, alas.

 

[KaraBulut]

I've read about that happening for years, but it's a little different wheeling someone out of a hospital where they went to get help to a bus stop in freezing weather in only a hospital gown. That, to me, is cruel, heartless, and inhumane. Money should not be more important than someone's life.

It's the same issue. A lot of the homeless in cities where State Hospitals are located were discharged from the State Hospital. It's a revolving door. They are admitted for mental illness. The State Hospital gets them on meds. They get better. They get discharged. There's no plan to re-integrate them into society. They have no money to buy their psych meds. They don't take their meds. They have another psychic break. They end up back in the State Hospital (or quite often, they end up in county jails). And the cycle starts over.

There are Federal regulations (and laws in some States) that require discharge planning. Unfortunately, when the patient has no family members, has mental illness and has no ability to pay, the options for where to discharge them to becomes a problem. There's no easy answer when there's no place that has available outpatient beds.

 

[thewiz]

The future of Trumpcare?

Man captures video of "patient dumping" outside Baltimore hospital

The point of trying to provide comprehensive coverage for the poor is to provide a means for hospitals and other care providers to have some compensation in these cases so crap like this doesn't happen. We need a default public option that kicks in to cover those who have no insurance.

This is the Republican Health Care Plan. Unless you are working and can pay for it -- better to just drop you off and let you die so that you won't be a problem to society. That "pro-life" mentality is certainly of value; about as much as their "pro-family" stances that are usually dashed when the Republican official is found sucking cock in his office or banging his office staff or the local waitress at the diner.

As a former President of a small, rural hospital (that no longer exists because it had to be sold to a larger hospital in order to remain financially viable), this problem is not limited to just Baltimore or large cities. We used to set aside nearly 1/3 of our $16 million budget for "uncompensated care:" care that we needed to provide as a small, community hospital and that we knew we'd never receive payment for. All hospitals face the same struggle and the Affordable Care Act (also known as Obamacare) provided the first opportunity to reverse that crisis because everyone would have insurance and, therefore, care would be paid for on an individual patient basis versus trying to raise rates enough and charge only those who could afford insurance. The bullshit talking points used by Ben and others that ACA was somehow "socialist" or "communist" is just that; bullshit.

Hospitals, doctors, and professionals have to make a living. If they can't collect from some patients, they have no choice but to charge others more and cover the losses. Rural hospitals, under the Republican plain, will soon be no more (one only needs to look at Louisiana and other red states to find even larger hospitals in crisis).

In my small community, we worked with community mental health, our hospital, and other non-profits to get people assistance so they would not end up warehoused in jails or the prison system. It costs about $50,000 to house an inmate per year; it costs about half of that to put them in normal housing and keep them treated. In addition, it removes the pressure on courts, the stigma of homeless and panhandling, and is likely to result in them working and paying taxes (much to Republican's delight).

However, Republicans would rather warehouse them in private prisons that reward their donors handsomely. It's a lose-lose system that European countries far distance themselves ahead of what we do in the U.S.

 

[frankfrank]

the US House has proposed two disturbing bills- one would repeal the patient-dumping requirements of EMTALA

and the other would attach a work requirement to Medicaid

If I could readily find my posts, I would put links to them. I HAVE BEEN WARNING PEOPLE ABOUT THIS FOR YEARS AND YEARS. I knew that Republicans would eventually try to repeal this EMTALA bill, which was originally signed by President Ronald Reagan in, I think, 1987.

As for the second, would that mean that ALL PATIENTS, who are now getting nursing home care under Medicaid, would be expelled and denied care? Sounds like euthenasia to me.

It's the same issue. A lot of the homeless in cities where State Hospitals are located were discharged from the State Hospital. There's no plan to re-integrate them into society.

Two friends who worked at a State Hospital that was shut down in 1982 under the Reagan-era cuts to psychiatric care, told me horrific stories that will haunt me to my grave. They had to be involved in the final interactions with patients that were being forced out of all care (while the Hospital was being closed down...and, of course, it was repurposed as a prison), and they were the ones who were told to give the discharged patients $50 and a one-way bus ticket to Chicago. A couple of these patients were scared, terrified, and screaming that it was probably tantamount to a death sentence, which it very likely was. IT WAS IN JANUARY IN THE MIDDLE OF WINTER.

 

[KaraBulut]

If I could readily find my posts, I would put links to them. I HAVE BEEN WARNING PEOPLE ABOUT THIS FOR YEARS AND YEARS. I knew that Republicans would eventually try to repeal this EMTALA bill, which was originally signed by President Ronald Reagan in, I think, 1987.

I've been on the fence about the EMTALA absoluteness- hospitals that receive Medicare are not allowed to ask about insurance until after the patient is seen by the ED physician or a nurse practitioner. Reasonably, there's no other business that is required to provide services to customers who may not be able to pay.

Rep Pete Stark of California was one of the authors of the EMTALA mandates. At a speech that I saw Rep Stark make at a conference, he was asked by a hospital administrator about these "unfunded mandates". Stark's position was that the US taxpayers give billions of dollars to hospitals from US government spending; they subside the education of most people who get a healthcare-related degrees in the US and they subsidize physician training programs in hospitals; he told the administrator that hospitals and physicians were expected to repay the taxpayers' largess by providing charity services to the taxpayers who couldn't afford to pay when they needed healthcare.

Before the ACA mandated that everyone had to have health insurance, Stark's position made sense. But once the ACA mandated that everyone had to have insurance, why was EMTALA still needed?

It's probably a moot point now. The "tax reform" bill that was passed in Dec, 2017 by the Republicans repealed the mandate that everyone had to have health insurance. So, if that's the case, why didn't they repeal the mandate that hospitals accept all patients in the ED before determining if they could pay?

As for the second, would that mean that ALL PATIENTS, who are now getting nursing home care under Medicaid, would be expelled and denied care? Sounds like euthenasia to me.

I think there's an intentional message that certain groups want to make that paints Medicaid recipients as minority people who are lazy and are leeching services off the government (aka the "welfare queen" stereotype). No matter how many times that we point out that Medicaid provides services to children, elderly people and people in nursing homes, the stereotype persists.

The mystery is... if this were to pass, how many children, elderly people and people in nursing homes will be able to meet some sort of work requirement? This is where the idea falls apart.

Two friends who worked at a State Hospital that was shut down in 1982 under the Reagan-era cuts to psychiatric care, told me horrific stories that will haunt me to my grave. They had to be involved in the final interactions with patients that were being forced out of all care (while the Hospital was being closed down...and, of course, it was repurposed as a prison), and they were the ones who were told to give the discharged patients $50 and a one-way bus ticket to Chicago. A couple of these patients were scared, terrified, and screaming that it was probably tantamount to a death sentence, which it very likely was. IT WAS IN JANUARY IN THE MIDDLE OF WINTER.

Just about every Sheriff of a major urban area will tell you that a significant part of their job and a significant portion of law enforcement officer time is spent dealing with the mentally ill- on the street, in private homes, in public places and in county jails.

The mental health reforms that date back to the 1960s (it originated with the well-intended Community Mental Health Act of 1963 signed by JFK) transferred the mentally ill out of institutions and into community-based outpatient care. Unfortunately, it hasn't really worked out that way because the outpatient care has never been fully funded which leaves the mentally ill with few options. Because of those reforms, you can be homicidal or suicidal but it is very difficult for us to hold you for more than 3 days. On the other hand, if you are mentally ill and you commit a crime, a jail can hold you more than 3 days. See the problem?

One of the reforms in the ACA was requiring that Medicaid and private insurance cover mental health care as "medical care" instead of some separate category with its own limitations on deductibles and lifetime caps. It's also one of the piece of the ACA that are endangered by the repeal efforts. Without the ACA mandates, people risk loss of coverage for mental illness and psychiatric care.

 

[bendted]

would attach a work requirement to Medicaid (meaning people would only be eligible for Medicaid if they worked or did public service).

Why's that disturbing? For the able bodied of course.

 

[TX-Beau]

Why's that disturbing? For the able bodied of course.

Not disturbing at all until they tell you you don't qualify because you have a job at Wal-Mart where of course you don't get healthcare.

What is up with people these days. No compassion, just stingy judgement. Guess what, who do you think pays for people who go to emergency rooms because the Doctor won't see them? YOU and ME - and it costs more that to just let them have Medicaid in the first place.

PLUS what kind of human wants people to not have health care because somehow they don't deserve it? What kind of person is that do ya think?

EVERYONE in the first world except us has universal healthcare and the only reason we don't - is greedy fucking ass-hats who put money and condescension over a healthier society.

 

[KaraBulut]

Why's that disturbing? For the able bodied of course.

It's not disturbing. It's misinformed.

Well, 15% of the adult population and a whopping 38% of children are on Medicaid. That's about 29 million adults and and 30 million children.

Of the approximately 70 million covered by Medicaid in 2016:

• 43% are under age 18 years old.
• 10% are over 65 years old.
• 14% are permanently disabled.

Of the remaining 33% - about 3/4 of these adults are in working families who are below the poverty limit for their state. In other words, most of the able-bodied adults on Medicaid ARE already working; either they don't make enough in their job to pay for insurance or their employer doesn't offer them medical group coverage.

Specific to the gay population: Medicaid covers the cost of anti-retrovirals which allows people who have HIV to maintain their health and work where possible.

Of the $553 billion spent on Medicaid, $118 billion (21%) of it goes to nursing homes or long-term care facilities. In most states, about 50% of newborn deliveries are paid by Medicaid.

Legislators know all of this. Yet, the stereotypes about people on Medicaid persist.

 

[Kulindahr]

The frustrating thing is that I've been reading legislation for years, starting with draft legislation through the final Bill. I've never seen legislation like the "bills" that the Republicans have been passed this year (and this stuff has been a completely Republican effort, not the least bit bipartisan). They're just short of being written with crayons on a cocktail napkin. Everyone has been scrambling to read the legislation after it was passed to figure out who got the goodies and who got the shaft.

The Orwellian "Tax Cuts and Jobs Act" is a 500+ page bill. It's hard to know exactly which version was the last version that was scored by the CBO because this bill started with some special interest group and was written by a bunch of Congressmen in the wee hours of the night with no hearings, no expert testimony and no economic analysis. History tells us that when Congress makes significant changes in economic legislation, it generally distorts the economy, leading to boom-bust situations.

If this is the way Congress intends to do business, it's time to clean house and get people who understand (or are not willing to feign ignorance of) the legislative process.

They would never use crayons on cocktail napkins -- it would mean actual work.

Sharpies on restroom paper towels, now....