Trump: "[health] insurance for everybody," Replacing the ACA

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Skeptic Ginger said:
Really? You can't just admit to poor wording of your sentence calling a GP an HMO? :rolleyes:

See that period after HMO? See anything in the sentence that says one's GP within the HMO?

Because I don't.

Here's the full sentence falsely equating the GP with the HMO proper:

The HMO is not a GP. It is an entire medical care system that includes GPs as primary care specialists, specialists, clinics, labs, hospitals, and walk-in clinics.

HMO: Health Maintenance Organization.
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I assumed that you were following the context of the conversation. We were talking about scheduling with your regular doctor -the GP as you put it (even though there really aren't many GPs in the US). But if it helps your understanding, I will correct my statement to the following: "It's still not easy to schedule an urgent visit with an HMO GP."
 
xjx388 said:
You can't walk in to your regular doctor 24/7, now can you? That's what we were discussing -scheduling a visit with your regular doc in an HMO environment vs an independent doc. I addressed the urgent care availability, which is available to patients of most any insurance product.
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Maybe this is true now, but pre ACA there was “insurance” that essentially covered nothing at all.
 
lomiller said:
Maybe this is true now, but pre ACA there was “insurance” that essentially covered nothing at all.
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That's not true. Insurance coverage didn't magically change when ACA went into effect. What happened was that insurance was available to more people, theoretically. But people who had insurance before ACA still had access to urgent care facilities.
 
Minoosh said:
This happened last week (from LA Times):

While you watched Comey, Senate GOP moved to cripple healthcare (and California moved to expand it)

I did not know that.
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I think the problem that the republicans aren't considering is that they can't compel insurance companies to participate. We're already seeing multiple carriers exiting the individual and small group markets. If they make this plan worse, you'[ll see more dropping out.

And yes, I know, lots of people will complain about insurance company profits and all that, and insist that whatever the republicans propose is going to somehow line the pockets of insurers. But the exact same thing was said about ACA, and that didn't materialize either. So far, everything proposed by the republicans have made the market much less sustainable, and much less attractive to insurers in general.

So... yeah, it will suck in the short term and a lot of people will be without coverage. But where it used to be that some people with high cost medical conditions were excluded from coverage... now it will end up being the case that only larger employers will have access to coverage. How long do you think that will last before congress caves and moves toward some form of universal coverage? I'm betting not too long.

It's not my preferred approach. I don't care for throwing the baby out with the bathwater. I generally don't support short-term thinking without consideration for the impacts. But since our congresscritters seem pathologically (in the colloquial sense) unable to discuss things like rational human beings... this might be the best available path to that outcome.
 
xjx388 said:
I assumed that you were following the context of the conversation. We were talking about scheduling with your regular doctor -the GP as you put it (even though there really aren't many GPs in the US). But if it helps your understanding, I will correct my statement to the following: "It's still not easy to schedule an urgent visit with an HMO GP."
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:rolleyes:

I was following it. You erroneously equated GP with HMO.

Look, I can't help it if you didn't keep your terms straight. Just admit it and move on, or don't and thread readers can draw their own conclusions.
 
xjx388 said:
That's not true. Insurance coverage didn't magically change when ACA went into effect. What happened was that insurance was available to more people, theoretically. But people who had insurance before ACA still had access to urgent care facilities.
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Does not covering hospital care count as nothing do you consider that effective coverage?
 
xjx388 said:
That's not true. Insurance coverage didn't magically change when ACA went into effect.
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Wrong. Certain dishonest practices by the insurance companies became illegal with the ACA such as canceling policies when patients developed expensive illnesses.

In addition certain preventative care has been mandated to be covered by all insurers with no copays.

xjx388 said:
What happened was that insurance was available to more people, theoretically. But people who had insurance before ACA still had access to urgent care facilities.
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Not sure of your point here given no ED could then or can now turn a patient away. It's the followup care that is the problem with the uninsured.
 
Skeptic Ginger said:
:rolleyes:

I was following it. You erroneously equated GP with HMO.
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No, you clearly weren't following it. xjx had no errors. You conflated an entirely different conversation into the mix. Here is the background:
Emily's Cat said:
It makes it difficult to get a timely appointment with a generalist, which complicates the whole "building a relationship" thing. You end up having to schedule your annual physicals and such two to three months ahead, and if you have something moderately urgent crop up, you're still often looking at a wait of several weeks.
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xjx388 said:
This is the number one factor as to why adults don't go to the doctor. It takes so long to get in that by the time you actually are scheduled to see the doctor, you probably aren't sick anymore. We combat that problem by only scheduling half our slots in advance and leaving the other slots open for walk-in/urgent. Not all doctors operate that way, of course. The fear is: what if you don't get any walk-in/urgent patients? It's much safer to be fully booked every day.
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Bob001 said:
Just a question here. How do HMOs schedule patients? The docs are usually salaried, so they don't have a financial incentive to fill every slot in advance; the parent company has to balance its financial considerations with customer satisfaction and quality of care. How hard is it to get a routine appointment at an HMO?
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xjx388 said:
HMOs are a different animal. They can run things differently than an independent practice. Basically, their model depends on the idea of getting people NOT to come in for doctor visits. They employ a wide variety of methods to achieve this. They might hire more NPs and PAs to provide cheaper care while still increasing access. They might provide more telehealth. Sometimes they limit the number of visits that a patient can have per year without cost share.

Even so, in my experience, it's still not easy to schedule an urgent visit with an HMO. The number of HMO providers in a particular area is still rather small and there's too large a pool of patients for the number of providers willing to contract with an HMO. This is changing in that many HMOs are contracting with or creating their own urgent care centers
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++++
Skeptic Ginger said:
Look, I can't help it if you didn't keep your terms straight. Just admit it and move on, or don't and thread readers can draw their own conclusions.
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You might consider admitting that you mistook the context and errantly inserted your own version of reality here.

ETA: It might not go amiss for someone else to provide the genesis of this conversation to SG.
 
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Skeptic Ginger said:
Wrong. Certain dishonest practices by the insurance companies became illegal with the ACA such as canceling policies when patients developed expensive illnesses.
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You know that was illegal before ACA, right?

The only nuance is that related to pre-existing conditions. If a covered individual was dishonest on their application and didn't disclose a pre-existing condition, the insurer had the right to rescind coverage that they would not have approved had they known all the information.

On some occasions (not actually very many), an insurer has been found to have been overzealous, and abused the right to rescind for their own advantage. There are also many dishonest practices by patients mixed up in there too, though.
 
Skeptic Ginger said:
Wrong. Certain dishonest practices by the insurance companies became illegal with the ACA such as canceling policies when patients developed expensive illnesses.
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That is true,; however lomiller replied to my comment specifically about urgent care, which was covered by insurance prior to ACA, just as it is now. lomiller seemed to be implying that before ACA, insurance did not cover urgent care, which is not true.

In addition certain preventative care has been mandated to be covered by all insurers with no copays.
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OK. But this does not relate to urgent care coverage.
Not sure of your point here given no ED could then or can now turn a patient away. It's the followup care that is the problem with the uninsured.
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:confused: EDs can and do turn away patients who are not experiencing emergency conditions; EMTALA does not apply to anything except emergency conditions. Non-emergency patients are directed to urgent care facilities instead which is the whole point. Urgent Care centers have been around for awhile now and have been covered under insurance plans -ACA did not affect that one bit.
 
xjx388 said:
Insurances have always covered hospital care; ACA didn't change that.
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Sure but often only a couple of grand worth see

"
“I was aware that it wasn’t a great plan, but I wasn’t concerned because I wasn’t sick,” she says. But in July 2011 she was diagnosed with breast cancer, at which point the policy’s annual limits of $1,000 a year for outpatient treatment and $2,000 for hospitalization became a huge problem. Facing a $30,000 hospital bill, she delayed treatment. “Finally my surgeon said, ‘Judy, you can’t wait anymore.’ While I was waiting my tumor became larger. It was 3 centimeters when they found it and 9 centimeters when they took it out.” After a double mastectomy, radiation treatments, and reconstructive surgery, Goss is taking the drug tamoxifen to prevent recurrence.
"

http://www.consumerreports.org/cro/magazine/2012/03/junk-health-insurance/index.htm

That is the kind of great insurance policies that Obamacare outlawed that people want back.
 
ponderingturtle said:
Sure but often only a couple of grand worth see

"
“I was aware that it wasn’t a great plan, but I wasn’t concerned because I wasn’t sick,” she says. But in July 2011 she was diagnosed with breast cancer, at which point the policy’s annual limits of $1,000 a year for outpatient treatment and $2,000 for hospitalization became a huge problem. Facing a $30,000 hospital bill, she delayed treatment. “Finally my surgeon said, ‘Judy, you can’t wait anymore.’ While I was waiting my tumor became larger. It was 3 centimeters when they found it and 9 centimeters when they took it out.” After a double mastectomy, radiation treatments, and reconstructive surgery, Goss is taking the drug tamoxifen to prevent recurrence.
"

http://www.consumerreports.org/cro/magazine/2012/03/junk-health-insurance/index.htm

That is the kind of great insurance policies that Obamacare outlawed that people want back.
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Or one discussed in these forums where someone linked the lady complain her $350 per year insurance was discontinued and on some deeper digging it turns out that the maximum yearly payout was $500 and she had basically been giving her money away to the insurance company.
 
lomiller said:
Or one discussed in these forums where someone linked the lady complain her $350 per year insurance was discontinued and on some deeper digging it turns out that the maximum yearly payout was $500 and she had basically been giving her money away to the insurance company.
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But they were happy with them, or not in the case I cited.
 
xjx388 said:
If that were the case then it would have been easy to see exactly what I meant.
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I did see what you meant, you meant to equate the HMO with the GP because you don't understand that an HMO is an entire health care system. A person making the mistake you made sees an HMO only in terms of the doctors and doesn't get it that it is a system.
 
xjx388 said:
That is true,; however lomiller replied to my comment specifically about urgent care, which was covered by insurance prior to ACA, just as it is now. lomiller seemed to be implying that before ACA, insurance did not cover urgent care, which is not true.

OK. But this does not relate to urgent care coverage.

:confused: EDs can and do turn away patients who are not experiencing emergency conditions; EMTALA does not apply to anything except emergency conditions. Non-emergency patients are directed to urgent care facilities instead which is the whole point. Urgent Care centers have been around for awhile now and have been covered under insurance plans -ACA did not affect that one bit.
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Your answers again suggest you do not work in health care.

I've never seen an ED turn a patient away with the exception they sometimes have to kick out malingerers. It doesn't matter what the EMTLA says, EDs treat everyone that walks in the door with few exceptions. Maybe they only give a cursory exam and offer little treatment besides a referral, but they still see the patient.

Otherwise you'd have to have triage nurses turning people away, and that's not within their scope of practice. So at a minimum the patient is checked in and evaluated by an NP/PA or an MD.

Or maybe you'd have the clerk decide who to turn away.
 
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Skeptic Ginger said:
I did see what you meant, you meant to equate the HMO with the GP because you don't understand that an HMO is an entire health care system. A person making the mistake you made sees an HMO only in terms of the doctors and doesn't get it that it is a system.
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No, that's not at all what xjx meant, as appears to be clear to everyone else in the thread. Xjx did not make the mistake you insist has been made.
 
Skeptic Ginger said:
Your answers again suggest you do not work in health care.

I've never seen an ED turn a patient away with the exception they sometimes have to kick out malingerers. It doesn't matter what the EMTLA says, EDs treat everyone that walks in the door with few exceptions. Maybe they only give a cursory exam and offer little treatment besides a referral, but they still see the patient.

Otherwise you'd have to have triage nurses turning people away, and that's not within their scope of practice. So at a minimum the patient is checked in and evaluated by an NP/PA or an MD.
Or maybe you'd have the clerk decide who to turn away.
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This is not true. Not everyone is checked in, nor is everyone evaluated. *Most* are, as *most* cases are are Emergent/Urgent or cannot be determined to be non-emergent until being evaluated. But it's not universally true.

I myself spoke with a triage nurse about a cut that wouldn't clot (it had bled for 20 minutes before I decided to leave for the hospital, suspecting it needed stitches). When I got there, the triage nurse asked to see the wound. We spoke briefly about the volume of blood, and the fact that the seepage had substantially reduced. She recommended that I give it another 15 minutes or so, since I had previously had an alcoholic beverage which can slow clotting. She did not take my name, she did not check me in, and I was never billed for the encounter.

FYI - I live in the Seattle metro area, which is where you have claimed to practice. There is no possibility of being subject to different local regulations.
 
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Skeptic Ginger said:
I did see what you meant, you meant to equate the HMO with the GP because you don't understand that an HMO is an entire health care system. A person making the mistake you made sees an HMO only in terms of the doctors and doesn't get it that it is a system.
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Your response only makes sense if you read my posts in the most disingenuous way possible.

The mistake was yours in taking my posts out of context. I understand that an HMO is a "system." We were discussing a specific aspect of that system: Getting in to see your regular doctor and the wait times involved with an HMO employed doctor vs an independent doctor.
Skeptic Ginger said:
Your answers again suggest you do not work in health care.

I've never seen an ED turn a patient away
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Oh, you've never seen it so it must not happen. And therefore, I must not work in health care.
with the exception they sometimes have to kick out malingerers. It doesn't matter what the EMTLA says, EDs treat everyone that walks in the door with few exceptions.
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No, they don't.
Maybe they only give a cursory exam
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Called "triage,"
and offer little treatment besides a referral,
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Called, "Turning them away,"
but they still see the patient.
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Yes, they see the patient with their eyes...

If you walk into the average ER with a cough and congestion, do you think the ER is going to give you a bed, a full exam and treatment? No, they aren't, for the most part. The triage team is going to determine you aren't an emergency and then the intake team is going to ask you for payment.

Some hospitals do indeed operate in the manner you suggest; indeed, I stated that the hospital I am invested in has decided to provide an attached urgent care center which will not turn people away for payment issues. But most hospitals do ask for payment for non-emergent conditions, your incredulity notwithstanding.

Otherwise you'd have to have triage nurses turning people away, and that's not within their scope of practice. So at a minimum the patient is checked in and evaluated by an NP/PA or an MD.

Or maybe you'd have the clerk decide who to turn away.
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I would have a screening for emergency conditions by a triage team and then having the intake team collect payments before non-emergent conditions are admitted to the ER for treatment -exactly what happens all over the country right now.
 
xjx388 said:
...
Oh, you've never seen it so it must not happen. And therefore, I must not work in health care. No, they don't. Called "triage," Called, "Turning them away,"Yes, they see the patient with their eyes...

If you walk into the average ER with a cough and congestion, do you think the ER is going to give you a bed, a full exam and treatment? No, they aren't, for the most part. The triage team is going to determine you aren't an emergency and then the intake team is going to ask you for payment.

Some hospitals do indeed operate in the manner you suggest; indeed, I stated that the hospital I am invested in has decided to provide an attached urgent care center which will not turn people away for payment issues. But most hospitals do ask for payment for non-emergent conditions, your incredulity notwithstanding.

I would have a screening for emergency conditions by a triage team and then having the intake team collect payments before non-emergent conditions are admitted to the ER for treatment -exactly what happens all over the country right now.
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This is like the Trump has a mental illness thread where you've read something online you don't understand and try to present yourself as knowledgeable.

What you don't understand about that is it is a means of increasing collections, it doesn't mean if you can't pay you are turned away.

Read the wording:
However, patients the hospital deems nonemergent will be charged with a $150 deposit through cash, credit or debit card for rendered services.
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Or what? Do you see the or they will be sent packing? No. You don't see that anywhere in that article.

Here's the detailed statement from the "here's the Rockdale Citizen article":
The statement went on to say, "Per the Emergency Medical Treatment and Labor Act (EMTALA,) all patients will continue to receive a medical examination and offered treatment. If a patient is determined to have an emergency, they will continue to receive care, regardless of ability to pay. However, if a patient is determined not to have an emergency, and still requests further treatment, they will be required to pay a $150 initial deposit via cash, credit or debit card for services rendered. Patients that choose to seek care elsewhere will be given a community resource guide for available services."
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AKA they get initial treatment and, BTW, it is the provider who decides, not the triage nurse.

Here's the second link:
Newton Medical spokeswoman Moseley said the hospital's triage process (a medical term for an initial evaluation of a patient) will not change.
Hospitals are required to examine and offer treatment to any patient who comes to the emergency department under the Emergency Medical Treatment and Labor Act. She said there are populations that are exempt, including the very young and the very old.
According to the American College of Emergency Physicians, the law, known as the "anti-dumping" law, was designed to prevent private hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.
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Imagine that, people who read something on the Net and think they know everything might not realize, they don't know the finer points of the law Don't feel bad, I Have to advise doctors sometimes that more than one law applies to some things as well.

And the third link:
If non-emergency patients can’t afford the fee, hospital officials said they will direct them in the right direction.

“We are also providing a community resource guide, so should they not qualify as having an emergency, we do provide them with options,” Komich said.

Bradford added, “There are primary care physicians and several doctors who work along with the hospital who are agreeing to see these patients at a lower cost.”
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If you can't pay, and you've been initially evaluated (I can guarantee you the triage nurse does not decide. The hospital would accumulate lawsuits like candy if they did that), then they'll refer you to alternative resources. That is not the same as just sending you out the door. Though it would not surprise me if they did little to stop someone who chose to leave when asked to pay upfront without realizing they can be seen at least for an evaluation.


BTW, you don't get a bed in the ED like you get a bed in a hospital room. You get something akin to a very nice stretcher or maybe even just a stretcher. You are there to be evaluated, given initial care then a hospital bed if you need one.
 
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I'm going to throw my hat in the ring and say that the neverending discussion of who is right and who is wrong one whether it's easy or hard to schedule an appointment for a moderately urgent condition with a PCP (with consideration for whether it is easier within an HMO system or not), as well as exactly what the distinction is between "screening and determining not emergent and sending away" and "not required to treat non-emergent/urgent conditions"...

...Is a massive derail that needs to go away now.
 
Minoosh said:
I wish they had quoted the sentence where he used the word "mean." Unless it's in there but I didn't see it.
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I can't find it, and I've checked several different articles.

Honestly, I'm really tired of the one and two word "quotes" floating around out there, with no context. How hard is it to actually provide comprehensive information?
 
Minoosh said:
I wish they had quoted the sentence where he used the word "mean." Unless it's in there but I didn't see it.
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There isn't going to be a transcript of a private meeting. It sounds like multiple people remembered and recounted the key word:

Their descriptions of Trump's words differed slightly.

One source said Trump called the House bill "mean, mean, mean" and said, "We need to be more generous, more kind." The other source said Trump used a vulgarity to describe the House bill and told the senators, "We need to be more generous."

Two other congressional GOP officials confirmed that the general descriptions of Trump's words were accurate.
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http://abcnews.go.com/Health/wireStory/ap-sources-trump-tells-senators-house-health-bill-48015512
 
Emily's Cat said:
Lol.

OMG, Trump is now saying pretty much the same thing that we've all been saying about this bill. Bad Trump!

:confused:
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The problem is that Trump was saying how great the bill is. Probably because he had no idea what was in it. He must have watched some TV and found out what was actually in the bill.
 
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mike81 said:
The problem is that Trump was saying how great the bill is. Probably because he had no idea what was in it. He must have watched some TV and found out what was actually in the bill.
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A while back, my surface read of it didn't seem too bad. High level, it appeared not horrible, and if one had limited understanding of the market place, it could even have seemed like a decent approach. But then you get into the details. And yeah, it sucked. But if you don't get into the details it may not be obvious.

Especially if someone (Trump) is predisposed to think that Republicans are going to come up with something good. I'm not particularly surprised that he would assume positive intent and a more generous interpretation of the high level aspects of the bill. I assume that he was basing his opinions on what other people (Republicans) told him the bill would do, and a very surface level review of it (if any). Now he's seen it in more detail.

Maybe I'm jaded. I'm kind of at a "take what I can get" stage. So right now, I'm pretty content to say "Yay! He has recognized that this bill is a horrible idea!" I'm going to call this a victory. It's the only one I've got so far, and I'm not really anticipating any more in the next few years :(

ETA: There's still the game-theory part of my brain that thinks this whole thing is one enormous practical joke, and that Trump is playing the long con. Coming in with all of the Republican schtick, all of the party-line regurgitation and populism... knowing full well that he's not going to deliver that, and planning to gradually destroy the party from the inside. Because that can't really be any weirder than what's already happening, and at least that would make a really good screen-play that he could capitalize on in the future. :p
 
If congress is going to do something, then do it. We can't really move forward to sign up for much of anything in 2018 if we do not know costs. And the insurance companies can only offer "short term insurance" which somehow acts outside of Obamacare and does not have to follow its rules.
 
Emily's Cat said:
ETA: There's still the game-theory part of my brain that thinks this whole thing is one enormous practical joke, and that Trump is playing the long con. Coming in with all of the Republican schtick, all of the party-line regurgitation and populism... knowing full well that he's not going to deliver that, and planning to gradually destroy the party from the inside. Because that can't really be any weirder than what's already happening, and at least that would make a really good screen-play that he could capitalize on in the future. :p
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I hate that your fevered dreams are the most hopeful scenario. We are in bizzarro world.
 
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