Obamacare “repeal”

[ny_quant]

А где-нибудь в ЖЖ уже обсуждают какой это прекрасный план и как Трамп быстро выполнит очередное предвыборное обещание? Кстати, уважуха консерваторам которые против.

Comments

[nefedor.livejournal.com]

А, понятно.

Но вопрос тогда такой - хватит ли денег? Для ветеранов эта ВА им это дело и оплачивает. Армия у нас небедная, и денег у неё на это хватает. А чем принципиально отличается общий случай - у нас может не хватить денег на всех так, чтобы было такое же нормальное покрытие как у ВА. То есть либо будет очень дорого, либо придётся делать существенно хуже покрытие. Не может так быть?

И второй вопрос - чем это ВА принципиально отличается от той же канадской системы?

[tandem-bike.livejournal.com]

may i speak english? plz.

YES, teh coverage will neeed to shrink. at teh VAs, too, as more veterans are released from active duty, and more services are needed, these are about >50% people with serious health needs. so, there will need to be cuts.

how is VA different from Canda - mostly ACCESS... with some exceptions - recall the scandal ? a year ago - VA provides excellent access to care. also - QUALITY with a few exceptions, VA hospitals are affiliated with medical schools and all MDs there are professors. often they have dual appointments at teh UNI-VA which has a system of "eighths".

[nefedor.livejournal.com]

Sure, eng is ok.

So the bottom line is that this socialistic coverage would be covering less that known prototypes. Maybe far less, depends from the money available.

In general I kind of like the idea of such base "safety net" plus private insurances on top for those who can.

Though for poor people that would mean decrease of the amount of services they are getting so they'd be strongly against that and we are having the political dead end we are having...

[tandem-bike.livejournal.com]

i think that people with REAL NEED for services - the disabled, cancer patients, etc, etc - will continue to get maximal care. with some reductions i already accepted - say a kid had a nurse come for a hime visit 4 times a week, now one time....

the reductions for "poor people" will not apply to "really ill poor people".

[nefedor.livejournal.com]

I have something with my shoulder - need to see orthopedist. I'll survive without it, so technically I'm not in real need, but the quality of life is definitely lower if I can't lift a tea pot full of water without pain. That is kind of sad for those who unlike me can't pay for visit and most importantly, needed treatment.

So while I generally agree with the safety net concept for the extreme cases, I'd be careful about details - what exactly such net covers.

[tandem-bike.livejournal.com]

there are charity clinics, free clinics, resident clinics fro the indigent, etc etc etc.

before you summon up so much compassion for those shoulders ;-) - think of HOW these people show up in charity care. often wearing thousands of dollars in bling. my colleague wellnessusa says she saw it.. a lot. and i see it too.

no papa Karlo who sells his jacket to be seen by a doctor. nopes. more lika Papa Karlo grudgingly agreeing to buy less coke this week so he can send his wife to a GYN clinic for $200.

[nefedor.livejournal.com]

Shoulders don't attract your mercy, I get it ;-)

I believe you. But the concern is that by profiling those who show up to those clinics we aren't getting correct profile of those who need help (with their shoulders). So the case studying actual patients there could be misleading somewhat.

[tandem-bike.livejournal.com]

anecdotal profiling can be misleading. or/and racist.

the point is not the bling and the diamonds in the teeth of those using charity care.

we will never get a "correct profile" unless people show up.

an aching shoulder usually .. stops aching, unless it is like a rotator cuff tear, for example. there are lots of futile, unnecessary visits by patients of all sorts to all sorts of clinics. so levels of care need to be tiered in a way that serious clients are not discarded, and bogus customers - LOTS of them seekigng disability - are filtered.

[nefedor.livejournal.com]

Serious and unnecessary clients - is that division a priori or a posterior?

Off topic: how data profiling can be racist is a mystery to me...

[tandem-bike.livejournal.com]

it can serve racist purposes. if your visibly well-dressed clients who park their huge mercedes SUVs . in front of a clinic for indigents - that gives a skewed view of the poor.

[nefedor.livejournal.com]

Still don't see it. Than can be biased - for sure, but how is that racist?

And the honest data collecting itself - how can it be characterized by usages? It's a problem of who is using, not the objective data collectors.

[tandem-bike.livejournal.com]

racism is only one form of a bias, dear :-)

[nefedor.livejournal.com]

Warning: I just had a several days long discussion on the topic of racism so I come prepared :)
According to its definition, racism isn't a bias at all, it's a system of views with certain typical characteristics like stating superiority in something based on racial traits.
In simple words, to be racist, researcher must believe that certain race is superior and behave accordingly. Just sampling bias doesn't fit here (or I don't see how it fits).

[tandem-bike.livejournal.com]

that is ONE of definitions of racism. there is a more casual one - a racist statement is one that pins certain characteristics, values, or behaviour as typical for a particular race :-)

[tandem-bike.livejournal.com]

however, i have finally made peace with two ideas:

1. universal health care is a must
2. some people will have better care than others.



both are "anti=american" in essence...

[nefedor.livejournal.com]

Somehow I feel good about those anti-American ideas of yours ;)

[tandem-bike.livejournal.com]

well, 1. is "communist", but just.. unavoidable, in any civilized society, and 2. is.. actually hard to swallow.

we are programmed to think, and proud of, every janitor being treated the same as a congressman. the thing is - a janitor with a university insurance will continue to have the same treatment as a senator. but the person with this "universal" hypothetical one - will get care that is not the same. for most not all conditions. including end of life.

[nefedor.livejournal.com]

Well, I'd say that we're much more programmed to think like that recently in Obama times.

But regardless of origins - this is exactly the problem. As soon as we have parallel basic universal + private extra there will be socialists who'd blow the universal part to unrealistic and unsupportable proportions "just because they all deserve it".

[tandem-bike.livejournal.com]

i don't get it. how so? who will blow what where???

[nefedor.livejournal.com]

Imagine we have it. Perfect way. Nice inexpensive universal and a market for private insurances for those with money.

Imagine a left populist comes to the White House.

Guess what his proposition would be? Of course: extend the universal coverage for this and that. Always extend, never reduce (cause it's unpopular to reduce).

Outcome is obvious: after some time that perfect inexpensive universal will turn into all consuming unbearable monster.

[tandem-bike.livejournal.com]

you are saying that the wishing well is bottomless. but there is no populis, left or right, that would allow free-for-all-unlimited.

[nefedor.livejournal.com]

If people won't do something right away, they can be convinced to do that step by step since each step is smaller and doesn't look as ridiculous as the whole thing. They will add here and there in small adjustments and will inflate the originally cheap "safety net universal" to epic proportions. I believe this is unavoidable unless some hard-to-avoid roadblocks will be created.

[tandem-bike.livejournal.com]

well, that did not happen in the VA system! it really is an exemplary socialist medicine outfit, with the pros and the cons.

[nefedor.livejournal.com]

Here I can't comment because I lack the knowledge. I believe you, of course, and wonder how could they keep it this way.

[tandem-bike.livejournal.com]

well, do you want me to tell you about it? it is simple. everything is run M.A.S.H. style, with the same absurdity at times. teh resources are capped, and when an expensive drug is needed, a vet may hear sorry, sir, not on the formulary. there are some exceptions. you want to see THIS doctor but you cannot, you see whomever they gave you. you want to see the same doctor every time but no way, you will see a different resident staffed by different attendings. you want a motorized wheelchair but "VA no longer pays for those"". etc.

and - a HUGE reliance on volunteers for all kinds of tasks.