OT: Health care struck down

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Seems to me that all NYC hospitals take Federal money. They will still try to foist difficult patients onto other hospitals ...
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Best regards
Han
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This only applies to emergency patients and those in active labor. They still can turf the rest of their patients no matter how difficult.
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"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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wrote:

A lot of hospitals simply closed their emergency rooms and only take patients through a doctor's referral or admittance. If a doctor dumps too many deadbeats into the hospital, they lose their privileges.
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snipped-for-privacy@aol.com wrote:

Where is your proof?
Care to cite that?
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wrote:

Google economic credentialing. From the AMA website: Economic Credentialing is the use of economic criteria unrelated to quality of care or professional competence in determining a physician's qualifications for initial or continuing hospital medical staff membership or privileges. (AMA Policy H-230.975)
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"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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Or a simple "hospitals closing emergency rooms" on google will bring up a long list in case you don't have any personal local knowledge. Documentation on this is rather easy to find.
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BobR wrote:

That search brings up over seven million hits.
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wrote:

And meaningless. Hospitals have closed emergency rooms since I was a lad. Others open up or expand e-room services. And I lived very near a hospital that *never* had an emergency room.
Municipalities work to keep sufficient e-rooms available for the citizenry. It's one of the things we pay them taxes to do. Also part of "national security" and "disaster recovery" It's also called "civilization. Taxpaying citizens with medical insurance need emergency rooms as much as the indigent.
This talk reminds me of "death panels."
--Vic
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Not hardly. Some areas may have special hospital taxing districts to support the hospitals, but that is not remotely all of them. Even then there is no requirement that open/maintain ER, even in their own hospitals.
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koala bears: food, water, shelter and something to crap on."
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Yes, ask Parkland Hospital in Dallas or JPS Hospital in Ft.Worth about how many communities have stopped or never have provided emergency services to their residents and are more that happy to see them forced to their facilities....without any compensation. Both Parkland ahd JPS have tried to bill those communities but with very limited success. The burden falls on the taxpayers in Dallas and Tarrant counties. Oh yes, the Obamacare bills would not have reduced the taxes required for either of those facilities by even one dime but would have required more taxes to be paid to the state to cover the additional Medicaid costs. It is also going to require those hospitals and others to spend billions to meet new reporting requirements built into the bill.

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wrote:

Not hardly what? Are you saying that municipal health agencies don't work to keep sufficient e-room services available for citizens? Or that we don't pay taxes for public health agencies? Be more clear. As I said, trauma care is a "national security" concern, and expected on the local level too. That's been the case for years and years. Hasn't changed, and it won't.

Health departments are paid for by the taxpayers. They determine e-room needs. Never said an individual hospital had to have an e-room. Said specifically otherwise.. Don't know where you live, but adequate trauma care is available where ever I've lived. Rural and backward low-tax areas might mean a long ride to the e-room. Nothing new about that either. I'm going to repeat this. Taxpaying citizens with good health insurance need e-rooms too. And scaring people that e-rooms are closing all over the place is akin to the "death panel" bullshit.
--Vic
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Yeah I am. There is no requirement for them to have any open. Some individual agencies may view that as part of their portfolio, but that is always up to the interests of whoever is in the Big Chair and waxes and wanes.

Paying for health agencies is very different from even keeping hospitals open, let along ERs open.

I haven't seen it 25 years in the biz, much in county hospitals. I also am looking forward to seeing your cites for the national security concern. taxpayers.

No, they don't directly. Some places may have a Certificate of Need system, but that is just whether or not the hospital that wants to open one can. There is no way for a hospital to be forced to open an ER.

True. Never said otherwise. You seemed to intimate that there was some authority requiring it, or even just a plain vanilla ER. Where they exist (especially trauma centers), they exist because the hospital administration want them, not because someone is mandating.

You might want to tell the LA times and the government of California about this BS. Scores of California hospitals have shut down their emergency rooms or closed entirely in the last decade. Emergency room physicians say the closures have led to long waits, diverted ambulances and, in the most extreme cases, patient deaths. The closures also mean that patients in need of emergency care may need to travel farther, delaying access to treatment. http://projects.latimes.com/hospitals/emergency-rooms /
or even the Institutes of Health. Over the decade ending in 2005, ER visits increased 26%. Meanwhile, the number of ERs declined 9% and hospitals closed 198,000 beds. TO REPEAT, Number of ERs declined 9% and hospitals closed 198,000 beds
http://www.medscape.com/viewarticle/542028
Or that bastion of Conservative Thought (sarcasm alert), the Washington Post
Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner.
http://www.washingtonpost.com/wp-dyn/content/article/2006/06/14/AR2006061 402166.html
So, unless all these people are in on the Great Conspiracy, it would seem to indicate that ERs are closing and it isn't remotely in a league with the death panels.
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koala bears: food, water, shelter and something to crap on."
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wrote:

Seems a sudden drop in e-room availability would get the locals upset the first time a fire department EMT said to a reporter, "Yup. Deacon Tate bled to death. Thirty miles to the e-room is a loooong way." Didn't look hard for cites about local health agency impact on e-rooms. First one I ran across was state health officials denying applications for hospitals wanting to build more e-rooms. http://blog.timesunion.com/business/need-for-a-clifton-park-emergency-room-not-there-doh-says/18263 /
This is all pretty much common sense. Since you're somewhere in the heath care business, I'll concede every point to you about the bureaucracies. No e-room shortage around me that has been reported. Might be different for you. My assumption is that the medical profession - as part of the larger society - naturally wants to meet the medical needs of the society, and that the public agencies have a hand in it.

I had wide scale medical emergency response capability in my head, confusing that with e-rooms, so I take that back.

Didn't mean to give that impression. I see adequate e-rooms as primarily the hospitals' doing. But if they were to become inadequate, I would put the blame on the public officials. In the end there should be collaboration between the hospitals and public agencies.

http://projects.latimes.com/hospitals/emergency-rooms /
And there are free-standing ED's opening all over. Adaptation. Last time I went to an ER - jaw exploding with pain - it was an FED. Got an antibiotic and painkiller. That was in Florida, on vacation. Worked until I got home and had my dentist yank the tooth. Much faster than my hospital e-room visits when twice I took kids of mine that broke their arm, or when I needed stitches after a street fight. I don't know if the FED could have handled those.
Don't know now which of my hot buttons was pushed to get me in this, but maybe it was a "sky is falling" suggestion that e-room availability is going away because of the health care bill. And that may have been a misread on my part. I ran across this, probably the most sane and fact filled piece on e-rooms I saw. http://www.rwjf.org/files/research/072109policysynthesis17.emergencyutilization.pdf
Make of it what you will. Where I was surprised, and learned something:
"Yet the bulk of ED volume and growth is driven by non-elderly insured middle-class patients. The growing use of the ED for ambulatory care sensitive conditions signals deterioration in access to primary care regardless of patients’ insurance status."
Don't know if I buy the "access to primary care" part. Seems if you have insurance you have a primary care doc. But maybe other areas don't have enough of them. I suspect too many folks just don't care of their health, insurance or not.
And
"Expansion of health insurance coverage on its own is likely to increase rather than decrease stress on overcrowded EDs."
hehe. That turns everything upside down.
--Vic
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Doesn't seem to, at least past the news cycle. You have what e-room are not available on diversion for large periods of time. The newspaper does a story like you suggest, people get upset for a day or two, and then it fades until the next time a reporter needs an easy story on deadline. Interesting phenomenon that is played out quite often.

Some areas are better than others, again largely dependent on what the local (most often the specific hospital management, but sometimes the government if they happen to have a hospital taxing district) honchos are interested in. Indy, for example has two level 1 Trauma Units, not bad for a town that size. But that is almost solely because both hospitals had trauma residencies and ER administrators that wanted to put out the money and effort needed. IT was entirely internal to the hospitals.

The American College of Emergency Physicians, definitely. The AMA, or the American College of Rheumatology, not so much. Like pretty much every other profession, they look out for their people.

But the public agencies, absent the hospital taxing district, don't have a dog in the hunt. Even the hospital districts are not required by law to do anything, other than provide general care.

It has the possibility of making it worse, or better. Nobody REALLY knows what the bill will end up doing.

This isn't really new, there has been a long-standing shortage of primary care docs for years. Most of it is the way the payment system is set-up (espeically in the Fed programs) where they pay a lot more for technical stuff (opening someone up, taking somethign out or putting something in) than they do for thinking, which is more what the primary care people. Thus, the early adoption of "physician extenders" such as Nurse Practitioners or Physician Assistants in Primary Care. Also access is not just having insurance. It is also being able to get to a doctor (people with insurance often use the ER because they did not want to take time off work for instance, they may use it because it is easier to travel to, etc.)
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"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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And your response brings on the image of one with their head in the sand.
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So? Hey Bub brings up quite a few too including this:
http://heybubinc.com /
Is that you?
-- Bobby G.
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Republican appointee.
Not that ALL Republican appointees are bad! Far from it. Consider, for just one, - the Rep. judge in the Dover case who ruled against the anti-Evolution crazies in one of the most important cases of the century. Of course they shot themselves in the foot with the notorious incompletely erased link between Creationism and "creation science".
concluded that the "individual mandate" part

So what idiot on the Dem. side failed to put in a severability clause!!! That is incomprehensible! Somebody was fast asleep? Or, wait a minute, WAS it possible to put in such a clause? I know it can be done in a contract, but in a Congressional bill?? Anybody know?

After Citizens United, you expect JUSTICE from that majority. I wonder how Calif. Sen. Feinstein can sleep at night after passing both Alito and Roberts out of the Judiciary Committee on which she sits, to the floor of the Senate for a vote. She could have put a Hold on both of them, using the same despicable tactic that the Radical Right Republican-Taliban have so often used.
HB
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Higgs Boson wrote:

A "severability clause" is routinely part of almost all legislation. It seems as if such a clause WAS part of the original legislation but was REMOVED during the machinations in the House!
In its decision, the court said (citations omitted), page 63:
"First, the Act does not contain a "severability clause," which is commonly included in legislation to provide that if any part or provision is held invalid, then the rest of the statute will not be affected. Although it is true that the absence of such a clause, in and of itself, "does not raise a presumption against severability," that is not the same thing as saying that its absence is irrelevant to the analysis. For example, the Supreme Court concluded that it did not have to embark on the "elusive inquiry" of whether Congress intended the unconstitutional provision in that case to be severable from the rest of the statute because Congress included a severability clause with language that was plain and unambiguous. And, the Court similarly held that the severability analysis is "eased" when there is a severability clause in the statute, such that only "strong evidence" can overcome it. By necessary implication, the evidence against severability need not be as strong to overcome the general presumption when there is no such clause.
"The lack of a severability clause in this case is significant because one had been included in an earlier version of the Act, but it was removed in the bill that subsequently became law. "Where Congress includes [particular] language in an earlier version of a bill but deletes it prior to enactment, it may be presumed that the [omitted provision] was not intended." In other words, the severability clause was intentionally left out of the Act. The absence of a severability clause is further significant because the individual mandate was controversial all during the progress of the legislation and Congress was undoubtedly well aware that legal challenges were coming. Indeed, as noted earlier, even before the Act became law, several states had passed statutes declaring the individual mandate unconstitutional and purporting to exempt their residents from it; and Congress' own attorneys in the CRS had basically advised that the challenges might well have legal merit as it was "unclear" if the individual mandate had "solid constitutional foundation." In light of the foregoing, Congress' failure to include a severability clause in the Act (or, more accurately, its decision to not include one that had been included earlier) can be viewed as strong evidence that Congress recognized the Act could not operate as intended without the individual mandate. "
Full decisioin (PDF) http://online.wsj.com/public/resources/documents/013111healthcareruling.pdf
The judge goes on to say that, severability aside, the legislation is like a clock with 450 or more pieces. For him to decide which pieces can stand alone after one main gear has been removed is tantamount to the judiciary intruding on the province of the legislative branch.
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It looks more like they just didn't, not that it was removed. You have to remember that the bill that finally was passed was not supposed to do anything other than get passed in the Senate so it could be sent to Conference Committee. It was not even remotely supposed to be the final bill. Thus, some of the "bookkeeping" stuff wasn't put in because it was thought it would be taken care of in conference.
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koala bears: food, water, shelter and something to crap on."
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If they didn't know it was removed then they clearly were not doing their job and failed to read and understand what they were voting for. Doesn't surprise me one bit when it comes to the Democrats but this one is just too damn comical to believe. Did anybody who voted for that piece of crap bill read any of it? I tried to read through it but there were so many external references to other legislation and so much double speak that it was nearly impossible.
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