Raider5678

On March 23rd, 2010 the Affordable Care Act passed into law and mostly took effect on January 1st, 2014(the delay mostly due to infrastructure requirements). Since then it insured on average 11.4 million people in 2017. But it did more than just establish a government insurance program, it also established several independent hospital guidelines, health insurance regulations, and more. However, there are several problems with the ACA that I feel we could improve on. First off, the HACRP, which stands for Hospital-Acquired Condition Reduction Program. It's designed to penalize hospitals scoring in the worst quartile for rates of hospital-acquired conditions outlined by the CMS(Center for Medicare and Medicaid Services). At the moment, we don't have enough information to judge the impact of HACRP on hospital readmission rates, because prior to HACRP taking effect, there was already a 17% decrease. So we don't know if the decrease we're currently seeing, which is following the trend we saw previous, can be accredited to HACRP. What we do know, however, is that the majority of hospitals penalized by HACRP are from lower-income areas, safety net hospitals, and hospitals with the sickest patients based off of case-mix indices. Essentially, hospitals that already have the sickest and poorest patients, received the brunt of all the penalties which include reduced funding. Since having the sicker patients is directly linked with higher readmission rates and patients living in lower income areas also have higher readmission rates, hospitals with either or both of these characteristics received penalties. HACRP didn't account for these direct links to readmission rates, it's currently taking funding away from some of our poorest and neediest hospitals. While I'm nowhere near well versed on all of HACRP, I do feel this problem should be addressed in the program by either eliminating it all together or changing it so this isn't a problem anymore. The thing is, however, is that I don't know how I'd go about changing it without it resulting in rich hospitals getting more funding. If you remove penalties and simply put in incentives, this is what will happen. If you give incentives to hospitals who do worse, I'm not sure we'd get the desired effect. Thoughts? Secondly, the HRRP has created a similar problem to HACRP. HRRP required CMS to reduce payments to short-term, acute-care hospitals for readmissions within 30 days for specific conditions. However, it didn't account for a hospital's patient characteristics(income, education level, Medicaid status,etc). As a result, the hospitals in the poorest communities with the sickest patients are again taking even more penalties. How can we change HRRP to better reflect the realities that hospitals face without incentivizing hospitals which do worse? Again, I'm not extremely well versed in HRRP either, so I don't know if there is a specific clause/section we could modify, or if simply eliminating it all together would be better, or replacing. Thoughts? Third, and finally, because I'm running out of time before my next meeting, HVBP , which stands for the Hospital Value-Based Purchasing Program(it should be HVBPP to follow the other programs, but whatever), is different from the other two programs I listed. Unlike the other two, this program incentives hospitals which improve, which is better than simply rewarding hospitals which are already the best(typically the ones in richer areas, etc). However, it hasn't shown any promising change relative to pre-HVBP times for many different conditions. Additionally, it also suffers from the same problem as the other two programs, where poorer communities(or in this case communities which become poorer/have a few hardships) are penalized over communities which are doing well and improving. Additionally, HVBP doesn't properly account for the complexities of many illnesses, and as a result, penalizes physicians which are already treating extremely sick patients. For the third and final time as well, I'm not extremely well versed in HVBP, so I don't know what's the best way to improve this program either. Any thoughts on the smartest and most effecient approch to this program as well? Thoughts? TLDR; How can we improve the Affordable Care Act?

Repurposing it doesn't require doing anything to the firework other then setting it off where it shouldn't be set off.

Agreed. I'm waiting for someone to begin blaming Israel for being so violent.

We don't have Jim Crow laws anymore, we got rid of them. Additionally, the politicians aren't forcing you to break the law, regardless of what it is. What law do we have that must be broken to show how unjust it is? Having the right to get high off of drugs doesn't rank high on my list of "unjust laws", which is my main point. We don't have enough laws that are incredibly unjust for me to say that we must afford prisoners the right to vote so they can help change the law. So smoking weed is being loyal to your country? Those who do it don't strike me high on the list of freedom fighters. Typo or am I missing something? It also adds a whole lot of other problems. Where do the prisoner's vote's count? As per the constitution, they count where they reside. Which would be the prison. Which means small towns with a prison in it, will literally be outvoted by prisoners. Do the prisoners vote for judges as well? I get the feeling that judges would change how they sentence people if those same people would be voting for them, and I don't want to see that. Yes it does. If the prosecutor knows that the minimum sentence, if someone is convicted, is 15 years in federal prison, they are either more inclined or less inclined to press those charges. Massively. Because there is no longer any "inbetween". It's all or nothing. Is the current law not the current law?

I see where you're coming from, but I disagree. We live in a democracy where people can use their ability to vote to choose politicians to make laws. As a result, their responsibility is abiding by those laws, and if they want them changed to advocate for them being changed. If they break them, however, they threaten the foundation of democracy: People have the ability to govern themselves. If they're breaking the law then they're not consenting to what the majority have chosen as the law. As a result, I don't feel they should have the privilege to choose the law while they're serving out their punishment. Politicians aren't forcing people into jail so they can't vote. They're doing that to themselves.

Agreed. So let's focus on that for now. Do you think those in prison should be able to vote or not? Regarding a national scale. My initial position on this is no.

I can agree that the right to vote should be universally enforced in regards to the states. However, there is only a certain amount that you can enforce that before you're taking away state rights. If the entire country made it so that if you're in jail, you don't vote, and then once you're out you can vote again, I'd support that. However, I wouldn't support the federal government than using that position to change laws in all states to decide what does and doesn't constitute who goes to jail. And I say that fully knowing should the government take that position, then the states that have legalized marijuana would have people being put in jail, not states being forced to legalize marijuana. It is a state's right to decide if it wants to legalize marijuana or not. I agree that people should have the right to vote once they get out of jail. However, I don't support saying that just because it's legal in some states, other states shouldn't be able to jail people for it.

So you support mandatory minimum sentencing? I've never been able to get behind that cause because it removes the ability for cases to be decided on a case by case basis. Let's us Marijuana as an example. If it's your first time ever getting caught, you don't have any other misdemeanors, etc, why should you get the same sentence as someone who has repeatedly been caught, has committed other crimes, etc?

And if I broke the law and get punished for it, I.E. getting a speeding ticket, I don't gripe that on the highway it's 65 so I should be able to do 65 where I got the speeding ticket.

It's marijuana man. Not the end of humanity. And again. It's the law. This is a democracy. You can vote politicians in to change the law. Just because you don't like a law doesn't mean you can defy it and complain when you go to jail because of it. Marijuana is illegal in some states, it's legal in others. That is the way it is.

Saying that the law is the law isn't enjoying how imperfect laws are. It's saying it's the law. Period. Additionally, we have state laws for a reason. Just because the majority of the people in the country want something, doesn't mean all the states have to do it. Wyoming gave women the right to vote 51 years before the rest of the country when it was still massively unpopular with the rest of the nation. Perhaps you feel all women should have all waited until 1920 to get the right to vote?(This is a rhetorical question) We can bring up examples of history until the cows come home, but the law is the law. Period. Unless you're advocating states shouldn't have the right to have laws individually.

Regardless of the crime. The law is the law. Just because something is legal in another state doesn't mean you can simply ignore your state's laws and expect to get away with it. Democracy is democracy. If the people around you routinely vote politicians in who don't make Marijuana legal, then that is their choice. If their choice is that they don't want Marijuana legal there, they don't want Marijuana legal there. You live there. You follow their laws. If you don't like it, move somewhere else. Which is my main problem with Florida's system. The people who aren't in jail should be allowed to vote. And I say that fully knowing they'd probably vote differently than I.

I choose to draw the line in jail. If you're in jail you don't vote. Florida requires you to go through an entire process to get the right to vote back after you've gotten out, and even then it's not guaranteed and it's expensive. Those are two entirely different situations.

It has less to do with the idea of their influence in the election, then the idea of a rapist taking part in the vote to elect someone to office. Regardless of who they choose.

I agree with this sentiment in regards to those currently in jail. Additionally, how you'd count the votes of those in jail would have to be different as well. Would you agree though that after they get out they should get the ability to vote back again?

Agreed. My view on it is that if you're in jail you shouldn't vote, otherwise as soon as you're free and off of probation, you may vote again. That should be the standard federal law in my opinion.

I've discussed this issue several times at national conferences, and the general consensus eventually came to the conclusion of no for numerous reasons. It's off topic, so if you want to discuss I'm more then willing to provide the opinions of hundreds of people around the country, but I lean towards it being a questionable idea as well. Not a terrible one, and probably one I'd support given caveats, but I'd need your specific opinion on this to decide if I supported your idea.

I have no idea what the climate was much longer than prior to Obama, but I know that after Obama took office those factories started closing down and hundreds of people were laid off. I suspect that was part of the 2008 recession, however again the cognitive bias is a lot strong when you're looking at the exact same variable. To them, jobs went away when Obama got in office. The factories closed down, the gas price went up, businesses and stores closed down, and the refinery closed down. Trump gets into office, and less then a year later all of them are open again. They don't know the same thing would have happened under Hillary and Trump. They just know that it happened under Trump. What can we do to prevent this cognitive bias from entering into politics?

Since I've been gone I've gotten into personal contact with several Senators, Representatives, State Senators, and State Representatives. I've discussed with the head of the YMCA about independents and I've gathered opinions from so many political leaders throughout our country that I can't even keep them straight. Additionally, I'm currently active in several different candidates political campaigns, and I'm planning on running myself in a few years using what I've learned helping to run campaigns for local politicians in my area. I've traveled across the country to conferences to debate matters of international and national importance and I've sat in on meetings with politicians in my state government and I'm also currently working in conjunction with my local state senator to discuss the possibility of proposing a major education reform for my state which will literally set Pennslyvania apart from the world. I can personally tell you that one of the biggest fears of every candidate who is running is that someone will show up who will convince all those who don't usually vote to vote for them instead. Me, not voting will add to that fear, even if just by a little. I'm actively engaged in politics from the local level to the national level and trust me, I'm not voting out of lack of engaging, but because I've personally seen their fears and know this will add to it. Even if it's minuscule. And, as iNow stated, this is off topic and this is my last reply to this topic as well.

I see it a different way. One of my main goals is to push for independent candidates in the U.S. Me voting for one of the party candidates, ever so slightly, increases their opinion that people still support their party. The fewer people that vote for party candidates, the more and more tempting it is for candidates to run as independents to try to collect the votes of those who aren't voting currently. Should an independent candidate show up who I support, I'd absolutely vote. If otherwise, there are no candidates that I support, I'd rather vote for neither.

This is true. I conceded.

Yet the majority still lies in party hands. We have a single independent governor in all of the United States of America. We have no independent members of the house. We have 2 independent senators. To seem viable to the general population, you have to have at least 33%(1/3) of the seats going to independents. If you disagree then I guess we disagree. However, in my opinion, to seem viable a significant portion of the seats must be independent. Perhaps the president, however, Congress would be much closer to being aligned by the population. The winner takes all system is only in case of the president. For the legislative branch, it's tons of smaller elections which are winner take all, but overall it's not. This is one of the necessary evils of democracy sadly. Candidates not only have to be smart and qualified(Trump and a few other presidents being the exception), they have to be likable. The only way to overcome this likability requirement would be regulating who could vote to those who are considered "educated" however I think those can be used for other agendas and I wouldn't support it. I honestly probably wouldn't vote in the Presidential election even if I could. I can't speak for everywhere, however, one of the things I noticed is that people generally gauge how well they're currently doing with the people in the office. My area supports Trump now more then they did when election time came around. However, several stores have open, several factories have reopened, and unemployment has plummeted. They cannot find enough workers here. The factory right down the road from my house is offering $18 an hour for the first 90 days, with a $2000 bonus if you stay all 90 days and a $21 an hour wage after the 90 days as well. There's another factory that is hiring people for slightly lower wages, however, they're trying to fill over 100 positions at any given time. Both of these factories are going to high school graduations and handing out job applications right there for students, and a lot of these students are taking them up on these offers. Two years ago the best job you could find with a high school diploma was $12, may $15 if you got a higher position at those factories. And jobs were far and few between. Almost every high school student moved away as soon as they graduated because there were no jobs here. Houses are being rebuilt, the county has enough money to repave and fix almost every road, and schools are offering more and more extracurricular activities as well as hiring more teachers for the core subjects, as well as extra subjects like engineering, computer programming, and other things. People around my area are directly attributing these things to Trump. Whether Trump caused this or not is not the discussion, but this is how my area is gauging the current administration's success. They're also looking at the state house and the state senate, both of which are absolutely dominated by Republicans now. They're not going to look into the policies, and read studies on how much of this success is caused by Obama, they're saying things look good now as compared to when Obama was in, and they like it and won't be voting to change it.

Quote the line right prior to that as well. I mentioned starting with state legislatures, then Congress, then some governors, and eventually the president.

After Trump, I believe anything is possible.

Not the right time. The first major area to go to independents will not be president. Bernie Sanders stood no chance because in the court of public opinion he wasn't a viable candidate for president. Only party politicians are so far. It won't be long before state legislatures begin going to independent candidates. It only takes 1 or 2 candidates from those to make it seem a lot more viable, and those elections are much easier to win. There are thousands of them every year. Once the state legislatures begin to go to the Independents people will see independents as a viable "party" if you will. Then comes Congress. Then some governors. Then the President. Bernie Sanders couldn't win not because he wasn't the right person, but because it was the wrong time.