The Democratic Primary is Upon Us! - Biden is the Presumptive Nominee
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Just checking. Criticism is not taken well on the internet...Avnger said:Genuinely serious. It's a good write-upTireseas said:
Trump can do something to save himself: treat the pandemic as a war. Historically, Americans don't tend to change horses in the executive in the middle of a war (the closest was Lincoln's second election, which was saved once the Union actually started getting victories to shift public opinion). If Trump just activated some powers and shifted the perspective, he could ride out this pandemic, mishandled or not, into a second term.Pseudonym said:
He has only made very tepid steps in this direction so far, though, so the thought probably hasn't occurred to him. Wonder what will happen if it does.
Oh have you missed Trump bailing out hospitals and doctors, and possibly making COVID healthcare costs free for everyone? What happens in November after a few months of your doctor saying "Trump saved our clinic"?SupahEwok said:
Granted. Though he has actually bailed out hospitals.SupahEwok said:
https://www.fiercehealthcare.com/hospitals-health-systems/cms-has-doled-out-nearly-34b-advance-accelerated-payments-to-providers-to
The way he is going about this is part of the problem and does not guarantee actual treatment for patients, and will cause people to not be able to receive the medications and treatment they actually require. Most Patient care is actually outside of the Hospital, and the patients WILL still receive bills regardless of Trumps " cash" payments and due to how many of the physicians and specialists are paid, Physician payments are not billed through the hospital, they are billed through the individual physicians, and are separate from hospital expenses, and even medicare patients receive bills for expenses not covered by medicare rates as actual expenses incurred greatly vary by hospital and region due to different structures and systems in place. Physicians will not be paid for their services through these funds being provided, rather the money will instead go to hospital administration. Once a patient is stabilized, but still in need of additional treatment, they are released from the ER, how will they afford the treatment they receive outside of the hospital? How will they afford the prescriptions that were prescribed by the Physicians in the ER? How this usually works in the ER is the patient comes in, and is stabilized, once stabilized they are released and given a prescription and a physician referral and is often receiving the majority of their treatment outside of the hospital as is common with respiratory illnesses, they may require long term treatment at home and that is where patients struggle to receive what they need due to the long term financial impact.crimson5pheonix said:
Who is actually providing the oversight to ensure that this funding is actually used to treat low income patients? When you provide funding through actual medicaid, medicare and insurance, they provide the oversight as we already have systems in place to be able to do that. From what we have seen from Trump thus far, he already removed the people who were supposed to be providing oversight on the how the funding is spent. If he had used the funding to expand medicaid or Obamacare to actually cover patients care, they would be able to receive the medications they need to be able to receive their treatment rather than having many who are not able to afford them. Expanding Obamacare to cover everything they need right now would have better solved the problem to ensure both the patients are cared for AND all providers are paid. The breathing medications (not including my other medications) I am forced to use every single day after surviving a similar respiratory illness cost over $2000 a month if I was uninsured and I am not elderly so this has to be paid for a very very long time-for the rest of my life. With insurance my copays add up to about $100 a month. How are these patients going to survive once they go home? Next Month? Next Year? I literally will stop breathing if I am unable to receive my medication, so will many of these people leaving the Hospitals with similar damage to their lungs after surviving this. In states that refused the medicaid expansion, like Texas, and that have many people who are uninsured, Obamacare is the only lifeline they have if they lose their insurance through their job. In addition, when they receive these unpaid physician bills that are not going to be covered by Trump's funding, and are unable to pay them, their Credit will be destroyed, and will have difficultly even being able to rent an apartment when their credit is ruined from this. The funding That is being sent to people directly isn't even enough to pay a month's bills in many places, and even if bill payment is allowed to be postponed temporarily, they will still have to pay all of these back payments at some point in addition to needing funding to survive each current month.
https://www.politico.com/news/2020/03/31/trump-obamacare-coronavirus-157788
https://www.npr.org/sections/coronavirus-live-updates/2020/04/02/826423917/fact-check-money-to-hospitals-plan-to-treat-coronavirus-patients-could-face-prob
https://www.nbcnews.com/politics/white-house/trump-admin-will-not-reopen-obamacare-exchanges-during-coronavirus-pandemic-n1173871
This is of course in addition to his bumbling of providing first responders with adequate SINGLE USE PPE when we needed it most, waiting too long to implement the Defense production act, claiming this was a hoax, claiming he is not a shipping service as first responders plead for the Federal government to do their job, accusing healthcare providers of stealing masks and claiming they do not need what they desperately require as he suggests methods that have been proven inadequate protection for those risking their own lives to save others. We still do not have what we need to test. Most people who need tests are still unable to get tested. We still do not have enough PPE for our first responders let alone the PPE that the federal government should be providing to the general public.
https://www.nytimes.com/2020/03/19/health/coronavirus-masks-shortage.html
Trump's response has been incompetent at best. These are things that we are supposed to have ready to go in advance, but oh yea he didn't even have a Pandemic team in advance and does not appear to be capable of thinking proactively so many more Americans are going to lose their lives that would have lived if he had responded adequately in the first place. We really cannot afford to have our people die because we have a leader that only knows how to slowly react rather than plan ahead. We have lost and are going to lose many more of those who are saving others due to Trump's bad choices. Trump failing to accept responsibility for his ignorant decisions and trying to lie and blame others as usual is beyond disgusting at this point tbh.
Lil devils x said:
Well of course, the whole point here is to expand medicare, but not quite enough so he can say later "I helped in every way the government could and it didn't help, this is why we should scrap all government healthcare initiatives to save money." And there will be plenty of people who would buy it.
Personally I think the basis of the idea, expand medicare to cover it and don't bill the people, is the best solution that could be implemented. If it were implemented fully that is, with no spending cap and no questions asked about why something is being billed to the government (apart from bureaucratic purposes).
What I don't believe is going to Obamacare to be the correct solution here. It's still private health insurance and people are still jobless, they aren't in a position to sign up for insurance now, that's something that needed to be done before a crisis like this.
I agree that repairing and expanding medicare is the best long term option, we don't have time to wait for that. Currently, low income people in States like Texas only have Obamacare options that can be implemented and used today to meet the immediate need. The way it worked (prior to Trump) for people with no or very low income in States like Texas, they signed up for Blue Cross Blue Shield In Texas on the healthcare exchange and they did not make any monthly payments, but instead it would be taken out of their tax return if their taxes were even high enough for them to deduct at the end of the year so they could receive immediate treatment now and worry about payment later. I want us to move to single payer, just I do not think we have time to fix and switch everyone over to medicare when we are in an emergency situation like we are now. We need to use what we have ready in the short term while we work to make a better long term solution.crimson5pheonix said:
Sadly though since Trump took office, many of those using Obamacare that way who needed it most, at least in Texas, have had difficulties due to Trump delaying or refusing to pay the subsidies and insurance companies claiming they did not receive their subsidy for patients so they drop them out of nowhere interrupting their treatment and adding more obstacles for them to obtain treatment or coverage. Due to Trump's BS like this:
https://money.cnn.com/2017/10/13/news/economy/trump-obamacare-subsidies/index.html
It has been hurting lower income patients, often who are those with the most dire medical issues. If Trump would stop making things so much worse for those who are most at risk, this would go much smoother, and many more lives would be saved.
EDIT: In addition, due to the GOP making applying for medicaid and assistance in general intentionally cumbersome , it usually takes much longer for someone to qualify for government services vs insurance right now. They really need to overhaul the entire process to remove all the intentional obstacles in order for it to even be able to handle the applicant load that we are experiencing from an emergency like this. I have seen them cancel an 8 year old cancer patient's medicaid out of nowhere and not reapprove them for 90 days when nothing at all changed in their status and not bother covering the bills during that time and interrupting the child's treatment. They have dysfunction designed in to make people give up so they have fewer people able to use the system. I honestly do not think we can afford to risk people's lives right now waiting for them to fix the existing system. They have to have something to use right now WHILE they fix the system in order to save the most lives.
I think you have it a bit backwards, you can sign up for Blue Cross Blue shield and make no payments as long as the government is paying the subsides they are supposed to have been paying in the first place. This would allow people to receive their medications, tests and treatment outside of the hospital rather than leaving them with without treatment due to Trumpcare not covering those expenses.
Lil devils x said:
I mean the whole point of this is "send the bill to the government", it could be payed out over time just like blue cross/shield would have been, except there wouldn't be questions about who qualifies for it. And that's the problem, if you don't qualify for the real low income options (which is a frequent enough position, especially in this suddenly jobless timeframe), you'd be asking people to pay on average more than 400 a month in premiums by reopening the exchanges, and then the deductibles. Just being jobless now doesn't qualify you for low income benefits without new legislation, oversight, and funding that would easily rival the complexity of just expanding Medicare/Medicaid (even if only temporarily). And with the added downside of making people go through the rigmarole of signing up for insurance that they'll presumably have to pay for at the end of crisis, and some of these people are already sick and laying on what might be their deathbeds, and the solution is to have them navigate health insurance right now.
It would take a lot more legislation to change medicaid and medicare to make it actually work here than it would to use Obamacare and would take much longer. We have states that refused the medicaid expansion and the Supreme Court already ruled the Federal government couldn't force them to. You can't fix that without a lot of work. That would leave the people in states like Texas with large uninsured populations completely screwed.crimson5pheonix said:
EDIT: Also you do realize it is more difficult, not less to sign up for medicaid right? The GOP made it difficult on purpose because they do not believe " in a Welfare State". Their system cannot even remotely handle it, and it currently will not cover their medications outside of what is given to them in the hospital. If you are low income enough, you don't have to pay for the insurance, those are the subsides Trump keeps complaining about that he doesn't want to pay and the Insurance provided DOES cover their prescriptions.
EDIT2: Prior to the current crisis, we already had many on their deathbeds in Hospitals without the ability to pay and the Hospitals were already being given grants and tax write offs to cover those expenses. We just needed an expansion of those existing funds to cover those patients. Where the real crisis is having patients die at home because they could not afford their prescriptions that are not being covered at all right now. We have many more patients in that position than actually in the hospital receiving care. The patients in the hospital are going to receive care regardless of payment, and payment is sorted out after the fact for that. It is the patients going home that will receive no care due to having no money right now that will be more at risk. There are many areas in the US where there is no physical place to even receive government provided medication at all, so those who cannot afford it out of pocket simply do without and yes, just go home to die due to this.
The funding issue isn't the primary immediate problem with the Hospitals right now, it is lack of ability to obtain physical equipment and staff to be able to treat the sheer numbers coming in. Not providing ample single use PPE means staff will become ill and we will not have enough staff to treat the patients, so more people will die. Not providing enough equipment means longer waits and less people granted entry to receive treatment and that means we will lose many people who could have been saved otherwise. The funding issue for Hospitals comes later, right now they have more difficulty obtaining equipment due to failure to adequately implement the defense production act quickly enough due to global shortages regardless of funding. Waiting until doctors are having to work unprotected to implement the act is inexcusable and unacceptable.
Trump failed to get the supply lines going fast enough with enough equipment and that directly results in more deaths. Not only should our government have had first responders equipped, they should have been able to provide equipment for the general public to slow the spread, but due to mismanagement, they are not able to do either. States should not be competing with one another for equipment and the Federal government should not have had their heads up their arse saying stupid things. "Our ventilators are not for the states they are for the federal government" " Chinese Virus is a hoax" " The Federal Government is not a shipping service" "masks are going out the back door" are not appropriate things leadership should say/ do in a time of crisis while Americans are dying.
That's why Trump's power play is brilliant, even if it's a poison apple. Technically it's not an expansion of Medicare, he told healthcare providers to send the bill to the government and they'd be paid back at Medicare rates. That could serve as the basis of universal healthcare because there is no signing up, as there shouldn't be in a single-payer environment. The Democrats should be pressing this into wider coverage at large because it's a good solid and quick acting basis. And that would be the model if it became standard, there's no reason to sign up for anything, all those barriers put into place would be meaningless, there's no questions about who qualifies or what they qualify for.Lil devils x said:
How do they bill at medicare rate without determining whether or not they qualify, or is the plan to screw the hospitals over when they bill and then just lie to the general public instead? You have to have oversight and have this approved on a case by case basis otherwise they could just invent charges at will and the fund would run out of money before all hospitals who actually did provide services would be appropriately paid. There is no way to bill the government at medicare rates without having each application for payment approved.Yes, that still means they have to approve each person on an individual basis. You know what sort of clusterf*Ck that would cause?crimson5pheonix said:
Also, how do you cover prescriptions this way?
I'm sure that's actually the plan as this is Trump and I already said why I think he's doing this.Lil devils x said:
As for actually making it work, the same way this works for Medicare or private insurance currently, the hospital sends the bill and relevant information and the payer determines whether they pay or not, and then sends back the payment. Yes a healthcare provider can attempt to defraud the government, but they can already do that, there would be investigations. There's nothing novel about this except you'd skip over the step of determining if the government covers these particular procedures. Because the answer is "they do".
Exact same way (theoretically). That is the point of this, reducing things to a single-payer system eliminates a ton of questions of "what's covered and under what situations". Unless you plan on needlessly complicating it by stratifying how much coverage you get by last year's income or other such silliness.
Yes, but it'll be a bad look if it looks like Trump did more to help than the Democrats. And that's how the current trajectory looks.Silvanus said:
https://www.politico.com/news/2020/04/08/obama-trump-biden-coronavirus-leadership-poll-173346crimson5pheonix said:
According to Politico polling, that's what people currently believe. Despite the fact that apparently 50% of people think Trump isn't doing enough about the crisis, 44% of people believe Trump is handling it better than Biden would with 36% of people believing the opposite (with 20% undecided/no opinion) . The poll also has stats for Trump vs Obama, where Obama wins with 52% vs 38% (10% undecided).
Right. But that's because the wind was blowing differently by that point. The second wave got to Sweden by being blown west cross Europe to France, then meeting winds coming from the Atlantic which blew it northeast over the UK and Scandinavia. A much, much longer, circuitous distance.Eacaraxe said:
Okay, so you want to talk about "falling" and terminal velocity - i.e. gravity. So you seem to argue the forces at play here are simply explosion kinetics, gravity, and let's leave aside air resistance for the moment.
Sweden is about 1000 km away from Chernobyl. We know the blast threw up radioactive material up about 2km. Now, bear in mind that assuming equal air pressure, the blast will radiate in all directions it can (i.e. assuming it's not constrained by solid matter) with equal force. An explosion therefore has a "dome" shape, because the more the direction of force is horizontal to the surface of the earth, the less force can make it go higher.
So, let's think about what this looks like.
With no air resistance, we take an object, and shoot it at 1000m/s directly upwards with Earth gravity so a = 10m/s. Crunch the numbers (v'^2) = (v^2)+2as and it reaches ~50km. Shot at a 45 degree angle, vertical / horizontal v is ~700m/s. It's in the air 2t seconds where it reaches maximum height at time calculated from v'-v+at, so 2t = ~140s, so it goes 140*700 = ~100,000m (100km) horizontally. Just so we have some sort of idea of what this all looks like: a maximum horizontal distance roughly twice the maximum vertical
With no air resistance, we take an object, and shoot it at 1000m/s directly upwards with Earth gravity so a = 10m/s. Crunch the numbers (v'^2) = (v^2)+2as and it reaches ~50km. Shot at a 45 degree angle, vertical / horizontal v is ~700m/s. It's in the air 2t seconds where it reaches maximum height at time calculated from v'-v+at, so 2t = ~140s, so it goes 140*700 = ~100,000m (100km) horizontally. Just so we have some sort of idea of what this all looks like: a maximum horizontal distance roughly twice the maximum vertical
Now, at the point you're arguing you have a horizontal movement of 1000km with only 2km vertical, you're already into a pretty weird place. The initial explosion in Chernobyl wasn't even that big. 300t TNT? That's two orders of magnitude less than the atomic bombs in WW2. Even with optimal angle, if a blast goes up a few km, there is no way it is going to go horizontally 1000km. Gravity will have its say long, long before that distance.
Now let's bring air resistance back in. You want to suggest that a particle is susceptible enough to drag so that its descent by gravity will be slowed enough to gently float down (apparently taking ~2 days having stopped). But that sort of particle is therefore also going to meet a lot of air resistance as it's being propelled out of an explosion. Drag equations are getting way out of my familarity. But in still conditions, pick up a 100g pebble and throw it far as you can, then pick up 100g dry sand and throw that as far as you can. Which goes further? Then try it in a firm breeze. What difference would you notice the breeze makes to the flight of sand compared to the pebble? These fine particulates are not going to propelled 1000km horizontally purely by the explosion with any air resistance consistent with them taking 2 days to float down.
Why? that's overwhelmingly horizontal movement, not vertical.
They deplete the ozone layer much, much less because they tend to break down elsewhere than where the ozone is, and they release less stuff like chlorine when they do. So a marked improvement. To quote your source:
"According to the model, their impact is such that HFCs will cause a 0.035 percent decrease in ozone by 2050.
"HFCs? contribution to ozone depletion is small compared to its predecessors. For example, trichlorofluoromethane, or CFC-11, a once common coolant that is no longer used, causes about 400 times more ozone depletion per unit mass than HFCs.".
Just 0.035%, and 400 times less damaging than their predecessors. Seems like a big win to me.
Yep, indeed it is. But that's not the same thing as saying they fucked up because the solution didn't turn out perfect.
I'm being realistically critical. You are not.
I'm defending it in terms of the parameters it was operating under: specifically, to cut production of gases that were wrecking the stratospheric ozone layer in the late 80s. It wasn't there to solve global warming.
What you are implicitly suggesting is that around the late 80s, companies should have gone away and researched alternatives - a process of years, and then all those replacements would have had to have been exhaustively tested for multiple factors (ozone depletion, AGW effects, etc.) - a process requiring lots more years. Perhaps here in about 2020 anyway we'd have finally picked one that didn't have problems. Except we'd have spent another 30 years belting out objectively worse stuff whilst we looked into it all.
Never mind that companies aren't going to research alternatives unless forced to: why are they going to spend R&D money to no benefit? You haven't even provided any compelling evidence they would have done so entirely on their own due to the oil price. I can see you saying that, but just because you say it doesn't means it's right.
Patiently remind your doctor that the clinic would have needed a lot less and much cheaper effort to save if orange blobby had managed to tear himself away from Fox and Friends to take the pandemic seriously six weeks earlier, and hadn't defunded the CDC and canned pandemic resource teams in the previous few years. And that the administration organised a response properly, instead of chaos such as pissing away taxpayer money needlessly by driving up equipment costs through the states and the federal government all trying to outbid each other.crimson5pheonix said:
You can congratulate someone for their efforts in capturing an escaped horse, whilst still ideally remembering that they should be fired for leaving the stable door open.