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ACA Running Thread

Tobacco Road said:
Rafi, I don’t have questions. Sincerely, thank you. I’m living it. Just saying things are now covered does not lead to the system automatically working. I’m aware of what you are saying exists on paper. Again, that doesn’t mean it just works. There is much provided, staff and patient education/training that has to happen. Prior video visits were for issues that lended themselves to video and by patients that specifically sought that (tech savvy). Now, we are forcing visits into that format. Also, most of us rarely bill based on time. Rather, on elements documented. Time-based is a back up.
I am telling you that billing is dramatically down for many outpatient providers. There are many reasons going into that. It is not just as simple as bill telephone or video. Please understand that we are scrambling to meet the needs of our patients with new limitations. I am not going about this with a primary goal of figuring out how I can bill for all of those services. I am trying to help my patients get through this and setting up all encounters to be billable would get in the way of that.
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I’m living it the exact same as you. I was just trying to be helpful. I’ll send you a DM. Keep up the good work, and I hope everything goes well for you during these times.
 
Thanks, Rafi. I know you were being helpful. Sorry that my last message was hard to read. Typed it on my phone while supervising bounce house.
 
Rafi said:
I’m living it the exact same as you. I was just trying to be helpful. I’ll send you a DM. Keep up the good work, and I hope everything goes well for you during these times.
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Amen. A civil discourse on the OGBoards...Who woulda thunk it possible.
 
Highland Deac said:
Maybe the reason the government response was inept was because of the bungling and incompetent leadership at the top, and the real lesson is that professional government-run healthcare would be better at responding to the crisis than unqualified narcissistic pols dumping their responsibility onto the states, who in some (red state governors) cases then dumped their responsibilities onto overwhelmed local officials. Nah, posting a stupid meme is just a better explanation.
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This is an interesting post. I struggle at times aligning how we finance the delivery of health care (M4ALL) with the role of public health. They are very different things. Public health (communicable disease control, emergency delivery of care, environmental protections and regs, overall promotion of health, etc) is very different than the gov't financing the delivery of every day health care on our country.

Both sides are using this public health crises as a means to make their point (get gov't our of health care, offer M4All) when really we need to take a long hard look at how we manage an effective public health policy.

I suspect if we had a highly capable president who could lead and effectively communicate, the debate would be different. Wed still be in crises for sure, that was largely unavoidable, but we'd likely have less political wrangling. Or maybe not as the crazies on both side would always take a crises and reshape it to fit their narrative.
 
CHDeac said:
This is an interesting post. I struggle at times aligning how we finance the delivery of health care (M4ALL) with the role of public health. They are very different things. Public health (communicable disease control, emergency delivery of care, environmental protections and regs, overall promotion of health, etc) is very different than the gov't financing the delivery of every day health care on our country.

Both sides are using this public health crises as a means to make their point (get gov't our of health care, offer M4All) when really we need to take a long hard look at how we manage an effective public health policy.

I suspect if we had a highly capable president who could lead and effectively communicate, the debate would be different. Wed still be in crises for sure, that was largely unavoidable, but we'd likely have less political wrangling. Or maybe not as the crazies on both side would always take a crises and reshape it to fit their narrative.
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I don't think our healthcare system is perfect by any means. However, I don't think there's any doubt that a more competent, less corrupt, and more capable POTUS would be handling this situation far better than Trump. I don't see an Obama or Clinton (Bill or Hillary) refraining from taking a more active role in managing the crisis and just dumping much of their responsibilities onto the states, and literally forcing the states to compete with one another to get vital medical equipment, or in some cases actually have to negotiate with China or other countries to get the necessary equipment. Nor do I see an Obama or Clinton appointing their son-in-law or some other kin, who has no experience in this sort of thing, to try to manage it, while also appointing his VP to manage other parts. I simply don't think that we would be in this same situation if we had someone more competent (not just highly capable, but simply competent) to manage it.
 
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CHDeac said:
This is an interesting post. I struggle at times aligning how we finance the delivery of health care (M4ALL) with the role of public health. They are very different things. Public health (communicable disease control, emergency delivery of care, environmental protections and regs, overall promotion of health, etc) is very different than the gov't financing the delivery of every day health care on our country.

Both sides are using this public health crises as a means to make their point (get gov't our of health care, offer M4All) when really we need to take a long hard look at how we manage an effective public health policy.

I suspect if we had a highly capable president who could lead and effectively communicate, the debate would be different. Wed still be in crises for sure, that was largely unavoidable, but we'd likely have less political wrangling. Or maybe not as the crazies on both side would always take a crises and reshape it to fit their narrative.
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If Obama was in the WH, we’d get less cooperation from Pubs for economic relief. Pretty sure.
 
Highland Deac said:
I don't think our healthcare system is perfect by any means. However, I don't think there's any doubt that a more competent, less corrupt, and more capable POTUS would be handling this situation far better than Trump. I don't see an Obama or Clinton (Bill or Hillary) refraining from taking a more active role in managing the crisis and just dumping much of their responsibilities onto the states, and literally forcing the states to compete with one another to get vital medical equipment, or in some cases actually have to negotiate with China or other countries to get the necessary equipment. Nor do I see an Obama or Clinton appointing their son-in-law or some other kin, who has no experience in this sort of thing, to try to manage it, while also appointing his VP to manage other parts. I simply don't think that we would be in this same situation if we had someone more competent (not just highly capable, but simply competent) to manage it.
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I don't disagree with the theme and not defending how Trump has handled. That being said, Im pretty sure we'd be in a roughly similar situation than we are today if someone else was leading. It might be more orderly with less stupidity and rancor for sure but we'd still be in lockdown, with a shortage of critical supplies. We were simply unprepared and bad leadership added some fuel to the fire. This isn't an issue we've had to deal with on this scale for 100+ years. I have a graduate degree in public health and the topic of pandemic has been a major concerns for decades. Trump gets a failing grade for sure but this would have been bad regardless IMHO. Ido think this is Trump's death knell until the Dems mess it up.

My broader point is there is a big difference between public heath policy and health care financing. Im a huge advocate for public health policy expansion but highly suspect of M4All. I think those can co-exist.
 
ConnorEl said:
If Obama was in the WH, we’d get less cooperation from Pubs for economic relief. Pretty sure.
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Maybe. Maybe not. My guess is it would have been more like the bail out in 2008 with Bush and the dems. More bickering but a deal likely would have been made relatively quickly. I think the crash was so violent and so quick coupled with the scary UK report would have kicked most into gear. But who really knows.
 
CHDeac said:
Maybe. Maybe not. My guess is it would have been more like the bail out in 2008 with Bush and the dems. More bickering but a deal likely would have been made relatively quickly. I think the crash was so violent and so quick coupled with the scary UK report would have kicked most into gear. But who really knows.
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The record reflects that Republicans chose to pathologically oppose Obama, even to our national detriment. Of course it’s speculation, but I’ve little doubt.
 
CHDeac said:
This is an interesting post. I struggle at times aligning how we finance the delivery of health care (M4ALL) with the role of public health. They are very different things. Public health (communicable disease control, emergency delivery of care, environmental protections and regs, overall promotion of health, etc) is very different than the gov't financing the delivery of every day health care on our country.

Both sides are using this public health crises as a means to make their point (get gov't our of health care, offer M4All) when really we need to take a long hard look at how we manage an effective public health policy.

I suspect if we had a highly capable president who could lead and effectively communicate, the debate would be different. Wed still be in crises for sure, that was largely unavoidable, but we'd likely have less political wrangling. Or maybe not as the crazies on both side would always take a crises and reshape it to fit their narrative.
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You don't think a competent POTUS would have lowered the impact of Covid? If we had acted sooner and had a single message like other countries, you don't think the numbers would be way down?

I'm not saying we would have avoided it. Just that it wouldn't be as devastating.
 
The biggest problem with Democrat presidents is the ~40% of the country who will oppose anything the Ds say, completely on principal.

You think the idiots are pushing back against stay at home now...
 
CHDeac said:
I don't disagree with the theme and not defending how Trump has handled. That being said, Im pretty sure we'd be in a roughly similar situation than we are today if someone else was leading. It might be more orderly with less stupidity and rancor for sure but we'd still be in lockdown, with a shortage of critical supplies. We were simply unprepared and bad leadership added some fuel to the fire. This isn't an issue we've had to deal with on this scale for 100+ years. I have a graduate degree in public health and the topic of pandemic has been a major concerns for decades. Trump gets a failing grade for sure but this would have been bad regardless IMHO. Ido think this is Trump's death knell until the Dems mess it up.

My broader point is there is a big difference between public heath policy and health care financing. Im a huge advocate for public health policy expansion but highly suspect of M4All. I think those can co-exist.
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No doubt the situation would still be bad, but I do think there's a good chance that lockdowns would have started earlier, and the supply situation would be better, and there would be a national response to the crisis instead of the chaos we've seen over the past month. What a more competent POTUS and administration would have done is to provide some sense of order and confidence, the Defense Production Act would have been invoked earlier, and so on. I agree that we likely couldn't have avoided much of this, but once it hit we certainly could be handling the situation better than we currently are. I don't disagree that this was going to be bad, but I don't agree that we'd still be in essentially the same situation with a more capable POTUS at the helm.
 
RJKarl said:
You don't think a competent POTUS would have lowered the impact of Covid? If we had acted sooner and had a single message like other countries, you don't think the numbers would be way down?

I'm not saying we would have avoided it. Just that it wouldn't be as devastating.
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Lower yes. But still devasting. Just less so.
 
Highland Deac said:
No doubt the situation would still be bad, but I do think there's a good chance that lockdowns would have started earlier, and the supply situation would be better, and there would be a national response to the crisis instead of the chaos we've seen over the past month. What a more competent POTUS and administration would have done is to provide some sense of order and confidence, the Defense Production Act would have been invoked earlier, and so on. I agree that we likely couldn't have avoided much of this, but once it hit we certainly could be handling the situation better than we currently are. I don't disagree that this was going to be bad, but I don't agree that we'd still be in essentially the same situation with a more capable POTUS at the helm.
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We may be saying close-ish to the same thing. Based on what I've seen and what I was taught, this was gonna be bad. Just degrees of bad.

The broader point Im arguing is that I don't think COVID should impact our M4All debate (for or all). It should however greatly influence our public health debate.
 
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CHDeac said:
We may be saying close-ish to the same thing. Based on what I've seen and what I was taught, this was gonna be bad. Just degrees of bad.

The broader point Im arguing is that I don't think COVID should impact our M4All debate (for or all). It should however greatly influence our public health debate.
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I agree that this was going to be a mess, and I do think we're basically on the same page, so I'll let it drop. As for your broader point I'll let others more qualified discuss it.
 
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