Covid Relief Spending

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aafisahar said:
You don't get it do you? You pay either way, either it's in taxes for Medicaid, food stamps, and welfare since we shouldn't let these people starve to death or go without a modicum of healthcare, or we provide a living wage so that people can actually have some social mobility.

As for a good standard, tell that to the lady with fulminant myocarditis who we just sent home to hospice. Her supposedly good insurance doesn't cover LVAD or transplant and she makes too much as a pharmacy tech to qualify for Medicaid. Mother of 2 young boys. This is the America we live in.
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Not saying I’m proud that this is our system, but can’t you guys get her on disability, qualifying her for SS and Medicare? That should pay for it?
 
ambiturner said:
Not saying I’m proud that this is our system, but can’t you guys get her on disability, qualifying her for SS and Medicare? That should pay for it?
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Potentially, but it takes about a year to qualify for SSI disability nowadays. She's looking into it as an option but realistically, we wouldn't have discharged her without a transplant. She's going home on milrinone and massive doses of diuretics to try to keep her dry.
 
aafisahar said:
Potentially, but it takes about a year to qualify for SSI disability nowadays. She's looking into it as an option but realistically, we wouldn't have discharged her without a transplant. She's going home on milrinone and massive doses of diuretics to try to keep her dry.
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And this is the "first world" country that people on here who are afraid of socialized healthcare so espouse. I think Covid has shown the world what a "first world" country we are after all. A very "Me First" kind of country.
I don't understand how people can't see that we all ultimately pay somehow someway for this s hitty ass healthcare system where people die needlessly and we flog 75-90 year-olds in their last weeks of life spending insane amounts of money on them trying to keep them "alive" forever.
 
aafisahar said:
quick 2 minute google search:

khn.org

No Cash, No Heart. Transplant Centers Require Proof Of Payment. - KFF Health News

The case of a Michigan woman told to fundraise $10,000 for a heart transplant sparked viral outrage, but experts say “wallet biopsies” are common.
khn.org khn.org
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Took care of a 22 year old with ESRD and now a failing liver as well who apparently qualifies for a transplant but not after care. WTF? She's 22. If she was from a middle class or wealthy family this would be a non issue because she'd have better funding.
This is just like my home country, which is labeled "third world." where poor people die due to lack of money for healthcare and the universal healthcare is terrible.
And we are first world over here. Love it.
 
chocomorsel said:
And this is the "first world" country that people on here who are afraid of socialized healthcare so espouse. I think Covid has shown the world what a "first world" country we are after all. A very "Me First" kind of country.
I don't understand how people can't see that we all ultimately pay somehow someway for this s hitty ass healthcare system where people die needlessly and we flog 75-90 year-olds in their last weeks of life spending insane amounts of money on them trying to keep them "alive" forever.
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Yep. I see people not infrequently who present with advanced pathology due to lack of insurance even though they've known something was wrong for years.

Then I get 75+ year old with multiple end stage competing pathologies full code with progressing copd, code blue, chest tube x2, cvc, aline, bronch, ett, and 1-7 days of critical care later I've billed 20k in physician work charges alone and they die just the same with far less dignity.

I am increasingly convinced that the last person who should be making code status decisions are the people who earned their end stage pathologies and their enablers. All too often I have family insist on full code after an arrest in a near vegetative state who also has stage iv cancer then get upset when I try to approach the insanity of this multiple times over a week telling me to stop talking about limitations I'm care.

Let me take a patient's preferences in to consideration but forcing me to drag out the inevitable is ridiculous and a misuse of my training. Might as well just dispel liability all together and have families order medical treatments on google then we can just deliver whatever was ordered regardless of whether or not it is indicated. The new digital future.
 
chessknt said:
Yep. I see people not infrequently who present with advanced pathology due to lack of insurance even though they've known something was wrong for years.

Then I get 75+ year old with multiple end stage competing pathologies full code with progressing copd, code blue, chest tube x2, cvc, aline, bronch, ett, and 1-7 days of critical care later I've billed 20k in physician work charges alone and they die just the same with far less dignity.

I am increasingly convinced that the last person who should be making code status decisions are the people who earned their end stage pathologies and their enablers. All too often I have family insist on full code after an arrest in a near vegetative state who also has stage iv cancer then get upset when I try to approach the insanity of this multiple times over a week telling me to stop talking about limitations I'm care.

Let me take a patient's preferences in to consideration but forcing me to drag out the inevitable is ridiculous and a misuse of my training.
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Let's not forget the Covid elderly. Who always die but family is like "do everything, he/she's a fighter!" with all the above interventions you describe. And they take 3-5 weeks to die but the family believes they will pull thru. I mean haven't families in these smaller communities started talking to each other about their experiences a year later? Or on Facebook? That these old people do not survive especially once they get tubed better yet code. We have a 73 year old on day #53 of intubation, I kid you not. Has been hypoxic on iNO for weeks and family is like do everything. WTH? When is this madness gonna end. Where is ethics? I wish we were Italy sometimes.
 
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chocomorsel said:
Let's not forget the Covid elderly. Who always die but family is like "do everything, he/she's a fighter!" with all the above interventions you describe. And they take 3-5 weeks to die but the family believes they will pull thru. I mean haven't families in these smaller communities started talking to each other about their experiences a year later? Or on Facebook? That these old people do not survive especially once they code? We have a 73 year old on day #53 of intubation, I kid you not. Has been hypoxic on iNO for weeks and family is like do everything. WTH? When is this madness gonna end. Where is ethics? I wish we were Italy sometimes.
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no trach?!
 
cchoukal said:
At the end of the day, both parties drive up the debt horrifically, it’s just that the dems do it to improve the safety net and the GOP does it by giving rich people more money and buying bombs.
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Close, but the very small "safety net" spending is a smokescreen just to buy the peasants' votes while the real money goes to special interests, pork for the home city, or just flat out stolen.

And yes, both sides suck.
 
emergentmd said:
I like to keep everything simple and the law of economics always eventually wins out. There is just no way to game it and may socialistic and communistic societies have repeatedly tried and failed.

Bottom line is economically, you can not "create jobs" or "create wealth" by just giving it away.

The piper will be paid, inflation will happen.

No time in history have we had such a big downward market driver (Covid) of GDP but the market still goes up. We should have had a large correction with the lower GDP and higher unemployment rate.

So why is the market keep going up? Because the government has injected trillions of dollars into the economy and people continue to use this money to buy stocks. Bottom line. I know of many well to do families getting stimulus money.

Unless the government continue to inject regular trillions into the economy, it will eventually tank. - You can not "game" the laws of economics.

When the government stops injecting trillions into the economy, then you will see a market crash when people will be pulling $$$ out of to fund inflationary expenditure.
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It's refreshing to occasionally come across a math mind that grasps the economic basics of what's going on. I'm always amazed how many believe in a few lunch. Great post.

"Bottom line is economically, you can not "create jobs" or "create wealth" by just giving it away."

No you can't. Jobs are a horrible measure of wealth anyway. Communism has a 100% employment rate. Production of goods and services is what matters, and the goal is to do each job with as FEW people as possible. Unless of course you'd rather get rid of heavy machinery and give everyone a shovel so it takes thousands of more jobs to complete a project. Borrowing money to pay for bozo jobs created that produce next to nothing does absolutely nothing for the national economy and wealth.
 
emergentmd said:
We will never agree and the discussion comes to a complete halt when someone pulls either the race card, homeless card, or in your case the "you are not decent to let the less fortunate suffer".
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Yes, and it's so exhausting to listen to as if it's some kind of refutation to logical reasoning.
 
Splenda88 said:
The huge difference is that Biden appears to be competent.
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You may like what's going on, that's your opinion and fine, but i don't think I'd be giving credit to the guy locked in the basement that they won't let answer any questions.
 
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emergentmd said:
If you think a manage typically making 2x what a HS/college student/unskilled makes bagging groceries at 7/hr suddenly gets bumped to 15/hr would be happy with this the manager is dumb and deserves what he makes.

Most managers would either ask for a similar raise, do less work as a bag boy, or look for another job.

A more similar comparison is if my PA who makes $70/hr and suddenly makes $140/hr, and I make 140/hr, then I surely would be unhappy. Let me be a PA taking care of cough/colds with very little liability or I am bolting.
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Patient care minimum goes up to $140/hr like you say. PAs and Docs making the same. Take a wild guess where college students will be applying between PA school and med school?

Grocery bagger gets $15 an hr, same as EMTs and other fields that take time, schooling, and expense. The landscape shifts to having a ridiculously more talented bagging industry and less talented EMTs. "Dang it, bagging applications at Krogers was too competitive for me. Now i have to go to EMT school."

Like you say, you can't mess with the physics of how an economy operates.
 
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dr doze said:
It was fine for teenagers and college students to gain work experience and pay for extras. Not for people to raise families.
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A minimum wage job takes no more qualification than just being a teenager. Are these jobs now supposed to support families? That's a lot of subsidization for jobs producing next to nothing.
 
We'llBeDoneIn15Minutes said:
You may like what's going on, that's your opinion and fine, but i don't think I'd be giving credit to the guy locked in the basement that they won't let answer any questions.
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I am talking strictly about response to Covid19... If it's not him, at least his administration appears more competent than the previous one. Anyway, I did not vote for either these bozos because I did not think either of them would be good for the country.
 
We'llBeDoneIn15Minutes said:
A minimum wage job takes no more qualification than just being a teenager. Are these jobs now supposed to support families? That's a lot of subsidization for jobs producing next to nothing.
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I agree with you but I think $7/hr is too low. I think $10-11/hr would be a good compromise.
 
It's amazing how little awareness one has to have to not realize that someone has to clean the toilets, empty the trash, serve our meals, bag our groceries, watch our kids, take care our elderly etc, and that that someone deserves a fair, living wage---- and not just condescending out-of-touch dumbsht blathering implying that everyone can go to college and/or get a high paying job.
 
vector2 said:
It's amazing how little awareness one has to have to not realize that someone has to clean the toilets, empty the trash, serve our meals, bag our groceries, watch our kids, take care our elderly etc, and that that someone deserves a fair, living wage---- and not just condescending out-of-touch dumbsht blathering implying that everyone can go to college and/or get a high paying job.
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I don't think it's about that TBH... $15/hr is little bit high IMO. However, I agree with you that there will be a percentage of the population that the government has to take care of. I like to think that the people have an IQ close to 2 standards deviation below the mean. Unfortunately, It exists in every society. Also, the other ~7% above these people can only do menial jobs because as you said not everyone has the means or intelligence to have a college degree.
 
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chocomorsel said:
Let's not forget the Covid elderly. Who always die but family is like "do everything, he/she's a fighter!" with all the above interventions you describe. And they take 3-5 weeks to die but the family believes they will pull thru. I mean haven't families in these smaller communities started talking to each other about their experiences a year later? Or on Facebook? That these old people do not survive especially once they code? We have a 73 year old on day #53 of intubation, I kid you not. Has been hypoxic on iNO for weeks and family is like do everything. WTH? When is this madness gonna end. Where is ethics? I wish we were Italy sometimes.
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Yeah but they read a story once on a random, unverified website that someone’s loved one woke up from brain death, or woke up in the morgue after being declared dead so the doctors are wrong about their loved one too
 
We'llBeDoneIn15Minutes said:
A minimum wage job takes no more qualification than just being a teenager. Are these jobs now supposed to support families? That's a lot of subsidization for jobs producing next to nothing.
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Unfortunately the world has changed. Low skill living wage jobs are in short supply. As are good paying middle skill jobs. As are high paying high skill jobs..

Most docs, lawyers, finance and other people are working harder for less. People who push brooms and clean houses and prepare food are too. It hits them lots harder than us. Social mobility and rewards for education and hard work have been declining for some time. The decline of the American dream.

Dark side of globalization, technology, free trade, increased productivity. Which on balance are good things. We hope.
 
Splenda88 said:
I don't think it's about that TBH... $15/hr is little bit high IMO. However, I agree with you that there will be a percentage of the population that the government has to take care of. I like to think that the people have an IQ close to 2 standards deviation below the mean. Unfortunately, It exists in every society. Also, the other ~7% above these people can only do menial jobs because as you said not everyone has the means or intelligence to have a college degree.
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No, it's not too high. 15 * 8 * 5 * 48 is $28,800 per annum in the year 2021.

And to reiterate, calling these jobs "menial" is totally missing the point. Society falls apart without people doing these "menial" jobs. Just because they don't require graduate education doesn't make them any less essential or not worthy of earning a living wage.
 
chessknt said:
That is different than not covering the procedure and related to income and drug coverage. Developmental issues for kids being uncovered I have seen before but having worked in a transplant center the only scenarios where people got rejected for financial reasons were related to people with no other member of the family that could work to continue to provide insurance coverage. I never saw one where the insurance plan actually completely refused to pay as the primary problem.
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Just because you didn’t see it, doesn’t mean it doesn’t happen. Especially to minorities who tend to be there poorer people in this country.
I saw plenty of people, mostly minorities who needed transplants and didn’t qualify or weren’t referred in time. We had a professor from one of the big name programs come out and speak on the disparities there and there is actual research behind it. Did you see my story of the 22 year old ESRD? Guess what race she was? How wealthy she was. This is South Texas.
 
We'llBeDoneIn15Minutes said:
A minimum wage job takes no more qualification than just being a teenager. Are these jobs now supposed to support families? That's a lot of subsidization for jobs producing next to nothing.
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What a classist thing to say. Seriously? Producing next to nothing? What do you think many of these factory workers or food service workers are producing? Air? WTH is wrong with you? Did you fall out of a golden uterus?
 
vector2 said:
No, it's not too high. 15 * 8 * 5 * 48 is $28,800 per annum in the year 2021.

And to reiterate, calling these jobs "menial" is totally missing the point. Society falls apart without people doing these "menial" jobs. Just because they don't require graduate education doesn't make them any less essential or not worthy of earning a living wage.
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Agreed with everything except for the four week vacation part. You know many of these jobs offer little to no vacation right?
 
We'llBeDoneIn15Minutes said:
A minimum wage job takes no more qualification than just being a teenager. Are these jobs now supposed to support families? That's a lot of subsidization for jobs producing next to nothing.
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I imagine you complain about the subsidization of the medicaid/food stamp population who makes the choice to NOT work, because it isn't worth it. And yet here you say a job SHOULD NOT support livelihood (house, food, clothes, etc.). You can't have it both ways.
 
anbuitachi said:
oh ino for weeks! wow. impressive. thats going to be a massive hospital bill
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Ha in residency I had a homeless guy on ino and cvvh for days. No family, no chance of recovery but they kept not pulling the trigger on stopping everything in case they found someone related to him. Such a massive waste of resources, especially when we were short nurses. This country is ****ed.
 
chocomorsel said:
Just because you didn’t see it, doesn’t mean it doesn’t happen. Especially to minorities who tend to be there poorer people in this country.
I saw plenty of people, mostly minorities who needed transplants and didn’t qualify or weren’t referred in time. We had a professor from one of the big name programs come out and speak on the disparities there and there is actual research behind it. Did you see my story of the 22 year old ESRD? Guess what race she was? How wealthy she was. This is South Texas.
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www.hhs.gov

Lifetime & Annual Limits

The current law prohibits health plans from putting annual and lifetime dollar limits on most benefits you receive.
www.hhs.gov www.hhs.gov

An ACA compliant plan should have no limit on transplant surgery costs. Now someone young can be declined if they cant afford the deductible (which if they are on a bronze plan and it is 15k/yr or something is understandable if not married) or dont have someone to help bring them to/from appointments or live at home, or have a history a substance abuse, or housing issues etc etc that minorities are more likely to tick boxes off but to say that insurance just wont cover it as an included benefit, again, is not something I have encountered and as far as I know is not legal under the ACA.
 
chessknt said:
www.hhs.gov

Lifetime & Annual Limits

The current law prohibits health plans from putting annual and lifetime dollar limits on most benefits you receive.
www.hhs.gov www.hhs.gov

An ACA compliant plan should have no limit on transplant surgery costs. Now someone young can be declined if they cant afford the deductible (which if they are on a bronze plan and it is 15k/yr or something is understandable if not married) or dont have someone to help bring them to/from appointments or live at home, or have a history a substance abuse, or housing issues etc etc that minorities are more likely to tick boxes off but to say that insurance just wont cover it as an included benefit, again, is not something I have encountered and as far as I know is not legal under the ACA.
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I live in Texas. We did not expand Medicaid.
You are speaking like someone who’s read book chapters and papers on how to treat a disease but has not actually treated lots of said disease in order to see that not all theory applies in the the real world.
And again, just cuz you haven’t seen it, doesn’t mean it doesn’t exist.
 
chocomorsel said:
I live in Texas. We did not expand Medicaid.
You are speaking like someone who’s read book chapters and papers on how to treat a disease but has not actually treated lots of said disease in order to see that not all theory applies in the the real world.
And again, just cuz you haven’t seen it, doesn’t mean it doesn’t exist.
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Ok but I rotated through outpatient lung transplant clinic and sat in on transplant conferences so I saw more of what happens behinds the scenes than the icu population and possibly more than you including reasons for outpatient denials.

That website isn't for medicaid it is for Aca compliant private plans and isn't a book chapter but a summarization of a law. I am not saying it cannot exist just that I wanted to make sure that the original poster actually meant lack of insurance coverage since that is not something I thought was possible under aca.
 
chessknt said:
Ok but I rotated through outpatient lung transplant clinic and sat in on transplant conferences so I saw more of what happens behinds the scenes than the icu population and possibly more than you including reasons for outpatient denials.

That website isn't for medicaid it is for Aca compliant private plans and isn't a book chapter but a summarization of a law. I am not saying it cannot exist just that I wanted to make sure that the original poster actually meant lack of insurance coverage since that is not something I thought was possible under aca.
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It is possible.
Plenty of people remain uninsured even with the ACA.
 
Southpaw said:
I imagine you complain about the subsidization of the medicaid/food stamp population who makes the choice to NOT work, because it isn't worth it. And yet here you say a job SHOULD NOT support livelihood (house, food, clothes, etc.). You can't have it both ways.
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"I imagine...." and then you criticize for something you imagined. Doesn't seem fair, does it?

Check out negative income tax. Probably isn't perfect but I like that it keeps the incentive to work at all levels while also helping the poor instead of incentivizing the very poor to not work as you say.
 
The answer to all this is.... death panels. It’s the best idea we’ve had in a century of healthcare debate. And everything we pay for in healthcare needs to have calculable benefit (either in life-years or quality-of-life #s assigned).

Also universal basic income is not a terrible idea. Most of these low training jobs will eventually be automated and then what? I do worry about a largely idle, supported underclass turning to more crime though with nothing to do.
 
vector2 said:
It's amazing how little awareness one has to have to not realize that someone has to clean the toilets, empty the trash, serve our meals, bag our groceries, watch our kids, take care our elderly etc, and that that someone deserves a fair, living wage---- and not just condescending out-of-touch dumbsht blathering implying that everyone can go to college and/or get a high paying job.
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Just thinking out loud... would things be better 200 years ago? What does a living wage provide? Do we all deserve to have cell phones? Cars? Cable and TV? Cigarettes? Alcohol?

I think you may conflate equal opportunity to equal possessions, no? Do you think life will ever be totally fair and equal outcome? Why do people deserve more possessions beyond food and shelter, especially if they don't prioritize it? Do possessions=happiness? Says who?

I dislike programs that invite manipulations and freeloaders. Why? Because they disproportionately consume/contribute which leaves less for the ones truly in need. It disengages normal avenues of humane charity b/c of abuse of the charity.

I know I care about people, but I just don't arrive at the same conclusions as you (and I assume you care almost as much as I do🙂
 
vector2 said:
No, it's not too high. 15 * 8 * 5 * 48 is $28,800 per annum in the year 2021.

And to reiterate, calling these jobs "menial" is totally missing the point. Society falls apart without people doing these "menial" jobs. Just because they don't require graduate education doesn't make them any less essential or not worthy of earning a living wage.
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I think if society falls apart b/c they are not done, then demand for these jobs will go up and salary will go up.

Someone correct me if I am wrong as I did not major in economics and this concept is very hard for me.
 
We'llBeDoneIn15Minutes said:
"I imagine...." and then you criticize for something you imagined. Doesn't seem fair, does it?

Check out negative income tax. Probably isn't perfect but I like that it keeps the incentive to work at all levels while also helping the poor instead of incentivizing the very poor to not work as you say.
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I don't believe I put words in your mouth. If you're consistent then you don't 1) believe a job should provide a living wage (which you've already stated) and 2) it's okay to live on the government dole. My guess is that doesn't describe your belief system, but feel free to correct me if i'm wrong.
 
BobLoblaw78 said:
I think if society falls apart b/c they are not done, then demand for these jobs will go up and salary will go up.

Someone correct me if I am wrong as I did not major in economics and this concept is very hard for me.
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Absolutely correct. Straight forward supply and demand.

The argument reminds me of the same people that say their house "won't sell in this market." Everything, including your house, will sell in any every type of market you can possibly imagine; you just may not like the market driven (ie, supply/demand) price.
 
chocomorsel said:
What a classist thing to say. Seriously? Producing next to nothing? What do you think many of these factory workers or food service workers are producing? Air? WTH is wrong with you? Did you fall out of a golden uterus?
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Many jobs produce nothing. Many of the requirements are nothing. Stating facts does not mean you don't care. Some people don't have the self discipline to apply themselves. Or the self discipline to sweat. I know of many jobs right now that will pay $15/hr, but they remain open b/c people don't want to work hard.

Many people have it too easy and refuse to work hard. Certain things/systems reward these people. It is these people that it kills me to see them skate by and leech off the system. I care about the unfortunate immensely, but not the type that refuse to work hard when they can. In case you don't know, most people want to care for the unfortunate. It is the pretenders, fakers, lazy, manipulators, conmen, etc that people are referring to when they don't want to help. Seriously, I know of lots of manual labor jobs that people are "too good" to do.
 
BobLoblaw78 said:
Many jobs produce nothing. Many of the requirements are nothing. Stating facts does not mean you don't care. Some people don't have the self discipline to apply themselves. Or the self discipline to sweat. I know of many jobs right now that will pay $15/hr, but they remain open b/c people don't want to work hard.

Many people have it too easy and refuse to work hard. Certain things/systems reward these people. It is these people that it kills me to see them skate by and leech off the system. I care about the unfortunate immensely, but not the type that refuse to work hard when they can. In case you don't know, most people want to care for the unfortunate. It is the pretenders, fakers, lazy, manipulators, conmen, etc that people are referring to when they don't want to help. Seriously, I know of lots of manual labor jobs that people are "too good" to do.
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And when you group them all together, the fakers and non fakers who are just trying to make ends meet and survive, where does that leave the genuine “unfortunate”?
 
doctalaughs said:
The answer to all this is.... death panels. It’s the best idea we’ve had in a century of healthcare debate. And everything we pay for in healthcare needs to have calculable benefit (either in life-years or quality-of-life #s assigned).

Also universal basic income is not a terrible idea. Most of these low training jobs will eventually be automated and then what? I do worry about a largely idle, supported underclass turning to more crime though with nothing to do.
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Let's not do universal income until we have automation to the degree that society does not need to work. Just my opinion. And I think every one should have to pay taxes. Even if welfare has to go up to help cover their taxes. I would like those people to be equally outraged about the waste of our government representatives spending. It may not work but I like the idea.
 
Southpaw said:
I don't believe I put words in your mouth. If you're consistent then you don't 1) believe a job should provide a living wage (which you've already stated) and 2) it's okay to live on the government dole. My guess is that doesn't describe your belief system, but feel free to correct me if i'm wrong.
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I did. I believe in the negative income tax to cover a "livable" quality of life. We probable differ on the definition of livable (I wouldn't classify anything beyond very basic TV/internet/phone/food/dwelling/transportation/etc as livable).

Do you believe every job deserves a livable wage, particularly your definition of livable? That's a lot to ask for, say, a helper who is needed just to steady objects that require 2 people so the guy with the actual skill can work, etc.

Prioritizing "heart" over the laws the economics doesn't mean you will actually be helping; in the end that system hurts more people.
 
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