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About jm192

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  1. yeah, I think there’s going to have to be Concessions on both sides. I don’t think that $500 should be considered a catastrophic expense. It certainly makes life harder, and people should be willing to work with them to finance it.
  2. I disagree. It's not my experience at all. Most cancer, as tragic as it is, is not an emergency. Furthermore, you can't diagnose it without a biopsy. You can't treat it without a biopsy. If you show up in an ER with a lung mass or an abdominal mass, etc: a large percentage of the time, you'll be hospitalized. You'll meet the person who can biopsy/remove it. You'll meet an oncologist. Those that aren't hospitalized will be given a follow up with the appropriate physicians to keep the ball rolling. ER doctors don't do chemo plans, you are correct. But they will make the appropriate referral or hospitalize you. People who don't have primary care doctors that show up with poorly controlled problems tend to be admitted whereas they would be sent home if they weren't. Drives up the cost. But they get the care. I think most are saying we want some sort of plan that pays for major cost problems--catastrophe sort of plan.
  3. The in-network/out of network shouldn't apply to Emergency rooms at the very least and it should probably extend to hospitalized services. You can't show up in a true emergency and worry about whether or not the 1 or 2 doctors there are "in network."
  4. Again, I'm a physician, so I deal with it on a daily basis. EMTALA is an anti-dumping policy. If you have the capacity to treat a patient and do not do so--that in itself is an EMTALA violation. Because you have "dumped" the patient. Specialists take "EMTALA" call. And if a patient needs a specialist in the ER and that specialist fails to show up--that's a violation. Furthermore, if you send a patient to a facility for a specialist that you have at your hospital--that is a violation. A hospital in the state I live in got an EMTALA violation for not taking a surgical patient. The patient goes to hospital A which has an ER but no surgeon. Surgeon at Hospital B says no I'm not taking the patient. Surgeon at hospital C takes the patient and reports surgeon at Hospital B because he should have under EMTALA taken the patient. Surgeon and Hospital at Hospital B both get penalties. A medical screening exam leads to medical liability as well. And no physician is prepared to take on that lawsuit. "Well, I found out from my screening exam that you are bleeding to death. But because you have no insurance, I will just now allow it to happen." It simply doesn't work that way. The screen and stablize applies to cases in which the ER is connected to a hospital without a certain speciality. If you're having a heart attack and your local ER doesn't have a cardiologist--they have to screen and stablize you--then they are able to send you to the hospital with the cardiologist. And the Hospital with the cardiologist is obliged via EMTALA to accept that patient.
  5. I disagree. And this again highlights a keypoint. Your belief seems to be that Trump supporters support Trump regardless of anything. We just care that he's Trump. I was anti-Trump in the 2016 Primary season. I thought this guy was just a rich joker thinking he could come in and do something he had no idea about. I was more anti-Hillary, and so I voted for Trump. I was very anxious about how he would do, and how the country would fair under him. But the Economy is in fact booming. Unemployeement is down across most demographics. I was very much in favor of repealing the mandate--and his tax changes more or less ended it. And that was a victory in my eyes. Trade deals with Mexico, China and Canada will support American workers. We've seen progress on the Opioid front. And at the end of the day, I just care more about these things than I do "But what about Trump university?!" He's delivered. He's won me over. He's done a great job. And I can only wonder how much more he could have accomplished if he wasn't under constant sham investigations.
  6. LOL. People have more jobs and are getting paid more. People have better retirement accoutnts. But honestly nothing's better.
  7. I don't know your friends or their situations--so I'm not arguing their case. But a lot of people say ACA saved their lives. You will actually get medical care for Emergency services regardless of ability to pay. If you show up with a surigcal problem in any ER, they will operate and figure out the billing stuff later. The bill will exist. And while there's a whole debate about "Well people don't want to go if they can't afford it," the ACA didn't change their access to life-saving care. There are some some exceptions.
  8. 100% this. Obama and Pelosi held hands saying "We did!" "Yes we can, and Yes we did." And we gave people insurance that wasn't accepted. We gave people insurance with high deductibles and bills that they still had to pay. More people sought care and were unpleasantly suprised when the bills fell back to them.
  9. I get annoyed at the constant "Party over Country" when the Liberals disagree with me. But I realize their right to say it 100 times over and over. I was spamming Orangemanbad at a point. And it was in response to a constant "And Trump did this. And he did this. And what about this. I actually won't talk about policy or issues ever, just bad things Trump did." And what in the world is the point if that's all we're doing. I made a conscious effort to cut back on the phrase--because I realize it doesn't help discussion anymore than what the other posters were doing. So I don't appreciate you auto correcting the phrase. But I do appreciate and respect you owning it and apologizing.
  10. I said in either of the Pete or the Bernie thread that more Primary care is a huge part of the key--if not the key. I think we'd see a lot fewer catastrophic bills if everyone went to primary care. But I think in order to get it to the right place, we need more primary care doctors. Currently primary care docs make the lowest of their respective totem poles. Family Medicine, General Internal medicine and Peds are the lowest paying specialties. And in each of those--working in the hospital or urgent care pays better. The hospital is absolutely already full of poor people who got into problems because they didn't want to go to primary care. Diabetes don't get foot exams--they get infections and amputations. People don't get their blood pressure controlled--they develop heart failure or have strokes.
  11. I'm honestly not even sure of the AMA's role in the situation. But I'll readily concede that they're the worst medical organization. I don't belong to it. I don't feel that they represent my interests or the interests of physicians. I don't feel that they do a great job of representing patients. I think they collect a lot of money to do their own politics. As to your point about financial...maybe? I do think there has to be some demonstrated competency before someone that's not trained here practices. I think failure to require something opens up a ginormous pandora's box.
  12. Sure. But if the "goal" is that everyone should have access to care regardless to pay, then there's the answer. It exists. The problem is solved. We can all stop worrying about it. If the goal is more primary care, then that's different. And I'm just trying to pin down to the nitty gritty exactly what is being viewed as the goal.
  13. Care to elaborate? Between med school, residency and my real job I've worked across 3. Most profits are given back in terms of "write offs" for patients that can't pay.