The PPACA Thread Part III - Let's have a healthy debate!

[unofan]

But isnt that argument that health care should be more local and less on the Fed? If a federal plan (especially a pretty weak wristed one like ObamaCare) only works in the big cities then it really isnt as useful as you think it is. Not everyone is going to live in the Big City...

Scooby and St. Clown nailed it.

The population in this country is roughly 80% urban these days (counting suburbs and exurbs as part of a greater metropolitan area). You can only subsidize the remaining 20% so much. And it doesn't help that those 20% often vote against the things that would help them more than others.

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

But isnt that argument that health care should be more local and less on the Fed? If a federal plan (especially a pretty weak wristed one like ObamaCare) only works in the big cities then it really isnt as useful as you think it is. Not everyone is going to live in the Big City...

Scooby and St. Clown nailed it.

No, no they really didn't. You are saying, "domes on stadiums do nothing about traffic jams, so maybe they're not as useful as you think they are."

One clause has literally NOTHING to do with the other.

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The population in this country is roughly 80% urban these days (counting suburbs and exurbs as part of a greater metropolitan area). You can only subsidize the remaining 20% so much. And it doesn't help that those 20% often vote against the things that would help them more than others.

We heavily subsidize rural voters, because both parties find that to be extremely useful symbolically. The list of districts which receive far more (i.e., from 10x to 1000x) in tax dollars than they contribute is dominated by rural districts. Famously, 97 of the poorest 100 districts in the country are Republican. They are overwhelmingly rural, and they receive federal benefits up the wazoo.

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I lived in Hanover for 5.5 years, and have some vague memories of growing up in Steamboat Springs until I was four.

Nope. Give me a metro area of at least a half million any day. There's a reason people continue to flock to cities around the globe.

I would never move back to NYC after having been there for 6 months , but all else being equal, I'd move to the Chicago area or twin cities in a heart beat.

My ideal is to live 30 miles from a city of 300,000; west of 105° W.

People flock to cities for jobs, because the 20th century reduced the number of farmers we need from 95% to 5% of the population, and thank god since other than mining farming has to be the worst job on the planet for an even semi-sentient being.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

My ideal is to live 30 miles from a city of 300,000; west of 105° W.

People flock to cities for jobs, because the 20th century reduced the number of farmers we need from 95% to 5% of the population, and thank god since other than mining farming has to be the worst job on the planet for an even semi-sentient being.

Kep, people are flocking to cities not just for jobs, but for entertainment. City living is trendy now. Not saying that will always be the case, but right now people want to be where the action is, not looking out over the prairie where the deer and the antelopes play. The country is a good place to visit on the weekend. Live there? Nah.

Regarding health care in rural areas, look life's full of tradeoffs. Yes its generally cheaper to live in a rural area, but there's some conveniences you'll have to give up. Easy access to multiple health care providers is most likely one of them, along with indoor plumbing and a good hockey team.

[Handyman]

Re: The PPACA Thread Part III - Let's have a healthy debate!

No, no they really didn't. You are saying, "domes on stadiums do nothing about traffic jams, so maybe they're not as useful as you think they are."

One clause has literally NOTHING to do with the other.

That isnt what I am saying at all. What you and a few others (and what I often say as well) is that City > Rural and that people who live in rural areas should either move to the city for better health care or well...too bad for them. That is a ridiculous attitude.

The problem with ObamaCare it did zero to address what was an easy problem to see...it would only work in certain places.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

That isnt what I am saying at all. What you and a few others (and what I often say as well) is that City > Rural and that people who live in rural areas should either move to the city for better health care or well...too bad for them. That is a ridiculous attitude.

The problem with ObamaCare it did zero to address what was an easy problem to see...it would only work in certain places.

But how do you make doctors practice in rural areas? If they don't want to live in East Buttf*k, Nebraska - what exactly can the gubmint do to make them?

And yes, most hayseeds would be better off relocating to a dynamic city environment than running around tipping cows over for fun all day and night.

[brookyone]

Re: The PPACA Thread Part III - Let's have a healthy debate!

The problem with ObamaCare it did zero to address what was an easy problem to see...it would only work in certain places.

A problem with healthcare in the US. A significant distinction from the popular blaming it on the ACA. I imagine that's why people come from all over the world for critical / specialty care to places like Mayo...U of M, UPMC and many others. You don't have to move but you may have to travel for accelerated specialty care. I have. Many patients do. It's not uncommon at all. Folks with serious or chronic health issues are familiar with the circumstances. Others, probably not.

It is without question, fortunate to live near a major medical center with many quality specialists on staff, when you require specialized care.

[Kepler]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Kep, people are flocking to cities not just for jobs, but for entertainment. City living is trendy now. Not saying that will always be the case, but right now people want to be where the action is, not looking out over the prairie where the deer and the antelopes play. The country is a good place to visit on the weekend. Live there? Nah.

Young people like cities because cities are full of start up companies, places to drink, and other young people to f-ck. But by the time you hit 30 cities are just as boring as small towns: the type of kid who drops off the conveyor belt in Boston or San Francisco is different from the one in Little Rock or Mankato, but he's every bit as boring -- he's just boring in a different way. In addition cities are a hassle, a nightmare to raise kids in, and, you know, diversity's great til it's going through your trash.

F-ck cities.

[Handyman]

Re: The PPACA Thread Part III - Let's have a healthy debate!

A problem with healthcare in the US. A significant distinction from the popular blaming it on the ACA. I imagine that's why people come from all over the world for critical / specialty care to places like Mayo...U of M, UPMC and many others. You don't have to move but you may have to travel for accelerated specialty care. I have. Many patients do. It's not uncommon at all. Folks with serious or chronic health issues are familiar with the circumstances. Others, probably not.

It is without question, fortunate to live near a major medical center with many quality specialists on staff, when you require specialized care.

It should be noted I am not blaming it on the ACA it is a problem that existed before and will for quite some time. I am saying the ACA did nothing to fix an obvious problem and just because a few of my fellow Lefties refuse to see it doesnt make it any less true

We incentivize people to do things all the time. You are telling me the Government cant find a way to convince a nice hospital and some doctors and staff to move to Bumphuck, IA? We have programs that convince teachers to work in schools in pretty bad parts of major cities and yet none of us can think of ways to convince doctors with massive amounts of debt to go to places with less competition for service? We cant find a way to convince say, Fairview or Mayo to open up a satellite hospital closer to these towns...where land is often unused and probably cheap?

Here...in case I was too vague offer doctors loan forgiveness for moving to the sticks and working for X amount of years and find some tax break or federal subsidy you can offer the big hospitals (along with cheap land rates) to open up in more rural areas. That took all of 3 minutes for me to cook up.

[5mn_Major]

Re: The PPACA Thread Part III - Let's have a healthy debate!

A problem with healthcare in the US. A significant distinction from the popular blaming it on the ACA. I imagine that's why people come from all over the world for critical / specialty care to places like Mayo...U of M, UPMC and many others. You don't have to move but you may have to travel for accelerated specialty care. I have. Many patients do. It's not uncommon at all. Folks with serious or chronic health issues are familiar with the circumstances. Others, probably not.

It is without question, fortunate to live near a major medical center with many quality specialists on staff, when you require specialized care.

Travel for serious health issues like life-threatening chronic kidney disease? Never. That's for vacations only. You snob.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

It should be noted I am not blaming it on the ACA it is a problem that existed before and will for quite some time. I am saying the ACA did nothing to fix an obvious problem and just because a few of my fellow Lefties refuse to see it doesnt make it any less true

We incentivize people to do things all the time. You are telling me the Government cant find a way to convince a nice hospital and some doctors and staff to move to Bumphuck, IA? We have programs that convince teachers to work in schools in pretty bad parts of major cities and yet none of us can think of ways to convince doctors with massive amounts of debt to go to places with less competition for service? We cant find a way to convince say, Fairview or Mayo to open up a satellite hospital closer to these towns...where land is often unused and probably cheap?

Here...in case I was too vague offer doctors loan forgiveness for moving to the sticks and working for X amount of years and find some tax break or federal subsidy you can offer the big hospitals (along with cheap land rates) to open up in more rural areas. That took all of 3 minutes for me to cook up.

This would be fine and dandy if there were actually enough inner city teachers. The incentives (loan forgiveness) might not be meeting up with the need.

Second, you can work in an inner city but still live in a nicer part of town or a nearby suburb. Boring rural America is what it is. There's no moving to an interesting part of it and then commuting to your job in Snoreville.

Lastly, if its not financially feasible Mayo etc aren't going to open up a satellite facility to serve 50 people.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

A few thoughts...

First off, specialty care is very common. It is your cardiologist, neurologist, dermatologist, etc. Even a small town (20-30,000) can support a few days of clinic a week. Specialist treat common diseases, like heart failure, atrial fibrillation, diabetes, rheumatoid arthritis, cancer of all sorts, stroke, seizures...you get the point. These are things that frequently require close follow-up and frequent visits. Most people cannot take off several days a month to see a doctor. Many people have trouble getting to the office. A good portion are disabled in some way and it is a very big ordeal to get transport within town, let alone a 6 hour drive some are proposing as reasonable.

Outpatient care is cheap(er) and is often effective. Many hospitalizations are secondary to missed appointments or insufficient specialty care. There are large incentives to keep heart failure patients out of the hospital (in a good way) and a bounceback can cost the hospital a lot of money. Feeling short of breath? Well you can't see a cardiologist for a month, or your cardiologist is 2 hours away...pretty easy to call 911 and you can bet that patient will be admitted.

I have avoided mentioning ACA because 1, I do not have good solutions to the complex problems and 2, there is a lot of baggage that comes with it that I just do not have the time or energy to parse through. But that being said, there are a lot of misconceptions about heathcare and a lot of privilege within this community (I do not use that word lightly) that is far from representative of the vast majority of Americans.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

But if I get what I feel is the best health care for me six hours away vs. one an hour away...I'm a snob?

What you said is that if you cannot be "bothered" to drive 6 hours, it is not serious. That statement is privileged bull**** and there is no way around it.

Medical error is the third leading cause of death. http://www.bmj.com/content/353/bmj.i2139.

If you want to talk about medical errors I am more than willing but throwing that in there like it is not nuanced or controversial point is reckless. Very briefly, you can demonize medical errors and what will result from that is physicians not doing things for patients. The risk benefit ratio of interventions of all kinds is very poorly distilled in your quoted study. From prior medical conversations (like that time you tried to invalidate EEG monitoring with spurious claims), I do not have high hopes that you can be divorced from your preconceived conclusions.

Yes, you're a snob. Good for you that you can have the ability to go anywhere you deem fit for treatment or can get the $70K car and take off a day of work when needed, but you're completely ignore people's resources available to them - not limited to money as the only resource - and say that if they don't make the same choices as you, then you're not taking it seriously. Some people can't take a six-hour ride to visit a doctor, either they don't have access to a vehicle, their condition may prevent them from driving altogether, or they can't miss time away from work - farmers in NoDak have their very sense of being tied very closely to those farms and the abandon them in the middle of September might as well be like demanding you to give up your religion. A six-hour ride to the doctor is at least thirteen hours of commitment in one day, more likely sixteen to seventeen hours once you factor in meal times, waiting for the physicians, prep time in getting ready for a long-distance visit to a doctor, pure exhaustion from the stress of it all, and other factors. Chances are for a visit to a place like Mayo, people are not making that trip alone.

Adding the money factor into it, chances are better than not that a clinic six hours away from where you live is not covered as part of your insurance plan. That makes things very expensive for the Average Joe on the street, including a great many of those who live in places like North Minneapolis.

But of course, none of that matters. If it were serious, they'd make the trip to Mayo.

Also, all those inferior doctors my mother visited (three of them independently) who were not working at Mayo in Rochester diagnosed her with Alzheimer's back in 2004. We decided to make the trip down to Mayo, which required of her multiple follow up visits to see a panel of doctors, which in turn required time from her family that we happily gave, though not everyone has such resources available to them. Mayo diagnosed her as simply being too stressed out and that was leading to her memory issues. Odd thing is that when she was in the process of passing away over the next nine years, absolutely everything she experienced met every exact and gruesome detail as provided by the resources I read for Alzheimer's patients. The vaunted panel of Mayo doctors got it wrong. There's my anecdote compared to yours. Mayo is not infallible.

Well said. Must spread rep.

[5mn_Major]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Not sure I get your point. I can get the best car for me - a Japanese or German rather than American. I'm not a snob. I can get the best travel destination for me - in Florida not the upper Midwest. I'm not a snob. But if I get what I feel is the best health care for me six hours away vs. one an hour away...I'm a snob?

Medical error is the third leading cause of death. http://www.bmj.com/content/353/bmj.i2139.

If you want to talk about medical errors I am more than willing but throwing that in there like it is not nuanced or controversial point is reckless.

So literally, who is being reckless towards health of others?

You poo poo some of the best methods we have of choosing quality health care for ourselves. When I say one may need to travel to get the best health care for themselves...you disagree. When in response I raise the fact that there are significant ramifications to making bad choices in serious health care...you say informing people about this is reckless. Enough threats...tell us why all facts are wrong. You're missing the point. Yet again, all health care is not the same for all individuals.

So I'm travelling for a few days...but I say be honest about the choices people should make about the quality of health care and what's best for themselves.