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

[WisconsinWildcard]

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

I've had chronic kidney failure (alport syndrome) my entire life with ESRF since the early nineties. I know chronic and acute...don't know what basic is.

If my ten weeks as a medicine intern on a nephrology team count for anything...I never heard that term used. Either AKI (acute kidney injury) and CKD (chronic kidney disease). AKI turns into CKD when glomerular filtration rates (GFR) do not rebound within a relatively variable amount of time. You can have AKI on CKD. CKD is divided into stages 1-5 (5 being the worst). There is no real distinction between CKD stage 5 and end stage renal disease (ESRD) except that a nephrologist has made the decision to initiate dialysis (and are obligated to continue it). That is different from dialysis initiated in the setting of severe AKI (or a few other indications remembered by the mnemonic AEIOU) which patients are expected to recover from and thus no longer need dialysis. There are rare examples of patients being deemed ESRD and being able to come off of dialysis months or years down the road although if a patient were doing well on dialysis, one would need a very compelling reason to try to wean them off.

 

[Kepler]

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

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

 

[St. Clown]

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

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

Don't give me that. He's got it all cribbed on the palm of his hand.

 

[brookyone]

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

If my ten weeks as a medicine intern on a nephrology team count for anything...I never heard that term used. Either AKI (acute kidney injury) and CKD (chronic kidney disease). AKI turns into CKD when glomerular filtration rates (GFR) do not rebound within a relatively variable amount of time. You can have AKI on CKD. CKD is divided into stages 1-5 (5 being the worst). There is no real distinction between CKD stage 5 and end stage renal disease (ESRD) except that a nephrologist has made the decision to initiate dialysis (and are obligated to continue it). That is different from dialysis initiated in the setting of severe AKI (or a few other indications remembered by the mnemonic AEIOU) which patients are expected to recover from and thus no longer need dialysis. There are rare examples of patients being deemed ESRD and being able to come off of dialysis months or years down the road although if a patient were doing well on dialysis, one would need a very compelling reason to try to wean them off.

I did a decade of dialysis combined between a first transplant and a 2nd. During that time several fellow dialysis patients suffering from acute failure came and then went for having recovered kidney function. Never heard of anyone being able to come off dialysis with chronic failure. Every Nephrologist I've ever had has told me function per chronic failure never returns to allow a patient coming off dialysis. Never witnessed that happening in those ten years. I have only known one reason a fellow patient stops coming to dialysis. Make that two...including transplant recipients.

I put off starting until I was too sick...not starting wasn't an option any longer, when my Nephrologist said it's time in no uncertain terms. I had fought him on it for quite awhile.

 

[brookyone]

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

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

There are some doctors who aren't that impressive. I've had a few. Mostly I agree on doctors...especially surgeons. A special, gifted breed who can do those things. the folks who well deserve the big bucks in my opinion.

The vast majority in the medical field are the most caring, compassionate people you'll ever meet.

 

[dxmnkd316]

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

People who impress me solely based on their jobs:

1. Mathematicians and theoretical physicists at 1st tier universities
2. Any doctor
3. ... Nah, that's basically it.

I just cannot fathom how you folks are able to store and use that much insanely complicated information, in a rigorously logical context, with f-cking death on the line.

I think you need to work with more chemical engineers based on that last paragraph

 

[Kepler]

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

I think you need to work with more chemical engineers based on that last paragraph

I'm impressed by plenty of people after working with them. That's not the trick.

 

[ScoobyDoo]

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

Based on my experiences with Insurance Companies this year and their money grubbing system I'd have to say our Health Care system sucks. I get better service and more care about my needs from my home/auto insurer.

 

[busterman62]

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

There are some doctors who aren't that impressive. I've had a few. Mostly I agree on doctors...especially surgeons. A special, gifted breed who can do those things. the folks who well deserve the big bucks in my opinion.

The vast majority in the medical field are the most caring, compassionate people you'll ever meet.

I'm reminded of the following joke (Disclaimer: you might have to be in the field to see the humor):

Three physicians are out duck hunting. A bird flies by and the Pathologist stands up, shoots once and the bird drops. The dog retrieves the bird and the Pathologist states "A duck. Anas platyrhynchos"
Another bird flies by and the Internist takes a shot. Upon retrieval by the dog, the Internist states "A duck. Rule out Goose. Rule out Swan. Rule out Loon." Another bird flies past and the Surgeon stands up and unloads all six shots into the air. Feathers and parts fly everywhere and there is nothing for the dog to retrieve. The Surgeon states "I have no idea what the Hel-l that was but I got it"

 

[Kepler]

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

I'm reminded of the following joke (Disclaimer: you might have to be in the field to see the humor):

Three physicians are out duck hunting. A bird flies by and the Pathologist stands up, shoots once and the bird drops. The dog retrieves the bird and the Pathologist states "A duck. Anas platyrhynchos"
Another bird flies by and the Internist takes a shot. Upon retrieval by the dog, the Internist states "A duck. Rule out Goose. Rule out Swan. Rule out Loon." Another bird flies past and the Surgeon stands up and unloads all six shots into the air. Feathers and parts fly everywhere and there is nothing for the dog to retrieve. The Surgeon states "I have no idea what the Hel-l that was but I got it"

That's awesome but I like the idea of the surgeon using an RPG. "Give a man a knife, he wants to cut."

 

[WisconsinWildcard]

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

I did a decade of dialysis combined between a first transplant and a 2nd. During that time several fellow dialysis patients suffering from acute failure came and then went for having recovered kidney function. Never heard of anyone being able to come off dialysis with chronic failure. Every Nephrologist I've ever had has told me function per chronic failure never returns to allow a patient coming off dialysis. Never witnessed that happening in those ten years. I have only known one reason a fellow patient stops coming to dialysis. Make that two...including transplant recipients.

I put off starting until I was too sick...not starting wasn't an option any longer, when my Nephrologist said it's time in no uncertain terms. I had fought him on it for quite awhile.

Not being a nephrologist myself, I have never had the longitudinal follow up to see a ESRD come off of dialysis (nor used my medical license to put a patient on dialysis). By definition, ESRD means you should be dialysis dependent for life (pending transplant of course). However, I trained with several excellent nephrologists (and a few who were not) including a former president of the American Association of Nephrology, and I was told that although rare, it has happened. Judge that at face value I guess.

You are not alone in putting of dialysis. Hope things are going well with the transplant!

 

[SonofSouthie]

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

Aetna (AET) is sharply cutting its participation in Obamacare exchanges for 2017. The health insurer said it will offer individual Affordable Care Act (ACA) exchange plans in just four states, down from 15 this year, in an effort to reduce its losses.

"As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision," Marc Bertolini, Aetna chairman and CEO, said in a statement.

The insurance giant says it will offer ACA exchange plans in Delaware, Iowa, Nebraska and Virginia, slashing its Obamacare footprint by 70 percent next year. It will offer ACA plans in just 242 counties, nationally, down from nearly 780 this year.

http://www.msn.com/en-us/money/heal...obamacare-plans-in-2017/ar-BBvFIOq?li=BBnb7Kz

 

[5mn_Major]

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

Aetna (AET) is sharply cutting its participation in Obamacare exchanges for 2017. The health insurer said it will offer individual Affordable Care Act (ACA) exchange plans in just four states, down from 15 this year, in an effort to reduce its losses.

"As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision," Marc Bertolini, Aetna chairman and CEO, said in a statement.

The insurance giant says it will offer ACA exchange plans in Delaware, Iowa, Nebraska and Virginia, slashing its Obamacare footprint by 70 percent next year. It will offer ACA plans in just 242 counties, nationally, down from nearly 780 this year.

http://www.msn.com/en-us/money/heal...obamacare-plans-in-2017/ar-BBvFIOq?li=BBnb7Kz

They're also trying to consolidate the top 5 players down to 3 to eliminate competition...this is primarily to enforce pricing power over providers (hospitals) and consumers. The move is being contested by the government. No wonder they're lashing out against the same party but on the exchanges - an unrelated matter.

The exchanges allow consumers to shop for insurance with more transparency. No wonder insurance companies that are charging high rates for similar services don't like it. If you can't compete in a marketplace, you shouldn't participate.

 

[Rover]

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

Payback because the regulators blocked their merger. It will be interesting to see how this plays out.

 

[SJHovey]

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

Payback because the regulators blocked their merger. It will be interesting to see how this plays out.

B.S. Notwithstanding all of your blathering about the "success" of the ACA, we know how it's going to turn out. Badly.

A year ago in Minnesota it was Medica which withdrew from the exchange. Then, a few months later, United Healthcare. Now this summer it was BlueCross BlueShield. Were all of these because some regulator somewhere "blocked a merger?"

 

[ScoobyDoo]

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

B.S. Notwithstanding all of your blathering about the "success" of the ACA, we know how it's going to turn out. Badly.

A year ago in Minnesota it was Medica which withdrew from the exchange. Then, a few months later, United Healthcare. Now this summer it was BlueCross BlueShield. Were all of these because some regulator somewhere "blocked a merger?"

Does anyone around here have some real insight into this? ACA seemed to be a giveaway to the Insurance Companies. If the public option was available or we went to Medicare for all the insurance companies would be rubble. So, what gives? And if the extra money that everyone is paying into the system now isn't covering things how were they covered before? Cause I guarantee that people who weren't covered before were still getting Health Care. And supposedly in the more expensive Emergency Room variety. So, what gives? I don't get it.

We were told costs were supposed to go down and they're going nothing but up. Everywhere. And what they call affordable coverage is utter and complete BS.

 

[Rover]

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

B.S. Notwithstanding all of your blathering about the "success" of the ACA, we know how it's going to turn out. Badly.

A year ago in Minnesota it was Medica which withdrew from the exchange. Then, a few months later, United Healthcare. Now this summer it was BlueCross BlueShield. Were all of these because some regulator somewhere "blocked a merger?"

I hate to keep humiliating you like this, but 20M extra people are covered and costs are lower than they would have been had the law not been passed. Only a total idiot or someone with an axe to grind would still be questioning this. If an insurer or insurers wants to leave a market that's their right. Any state that feels they are undercovered on the exchanges should utilize the law's existing provisions and set up their own public option.

So yes, occasionally an insurer will leave a marketplace...just like before the ACA. And sometimes rates will go up....just like before the ACA. The law isn't intended to prevent any of these things ever happening. However, its a simple judgment as to the law's success. Are we better off than before it went into effect? Answer: a clear yes. Even Fishy has given up the ghost on this for chrissakes.

 

[ScoobyDoo]

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

I hate to keep humiliating you like this, but 20M extra people are covered and costs are lower than they would have been had the law not been passed. Only a total idiot or someone with an axe to grind would still be questioning this. If an insurer or insurers wants to leave a market that's their right. Any state that feels they are undercovered on the exchanges should utilize the law's existing provisions and set up their own public option.

So yes, occasionally an insurer will leave a marketplace...just like before the ACA. And sometimes rates will go up....just like before the ACA. The law isn't intended to prevent any of these things ever happening. However, its a simple judgment as to the law's success. Are we better off than before it went into effect? Answer: a clear yes. Even Fishy has given up the ghost on this for chrissakes.

Is there documentation somewhere comparing what the costs would have been for a middle class family of (4) that always had coverage between keeping the old system and the ACA? if there is I'd like to see it.

 

[St. Clown]

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

Is there documentation somewhere comparing what the costs would have been for a middle class family of (4) that always had coverage between keeping the old system and the ACA? if there is I'd like to see it.

I know nothing of the organization or the article's authors, but there are a two graphs for you to review. One might incite some people to action while the other may placate those who really want the PPACA to work yet others will note that while the trend is positive, it's not exactly what the country was promised back in 2009.

ETA: Also, read the actual article in which the graphs were presented. There are some important things actually stated by the writers to help their readers get a clearer picture of things.

 

[Rover]

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

I know nothing of the organization or the article's authors, but there are a two graphs for you to review. One might incite some people to action while the other may placate those who really want the PPACA to work yet others will note that while the trend is positive, it's not exactly what the country was promised back in 2009.

ETA: Also, read the actual article in which the graphs were presented. There are some important things actually stated by the writers to help their readers get a clearer picture of things.

Never heard of them either but this seems well done. Also like how they pointed out medical care cost control seems to be getting better but prescription drug costs are rising too fast.