NIH Funding

[Arcan57]

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Nobody has been able to meaningfully cut spending in the government ever so I’m ok with these seemingly drastic measures. As mentioned, it sounds like every section of spending is going to be examined so the people who give the “but it’s <1% of the budget” excuse can finally put that to rest because everything needs to be looked at. I fully acknowledge that there will be some bad cuts but that’s going to happen when you’re using an axe and not a scalpel but I’m ok with that. Cut hard and then add stuff back gradually when it becomes more apparent that particular spending is worth it. The gravy train for a lot of things is hopefully coming to an end.

What gravy train? Is there a large class of NIH researchers that live like feudal lords controlling vast estates off of the government’s dime? Most researchers are making a firmly middle class living after spending 4+ years on post graduate education.

People here have this really inaccurate idea that you can optimize research for commercial applicability while retaining the ability to make significant novel breakthroughs on a regular basis. Of course nobody wants to spend funding on things that have no real world applicability. And the current system is already heavily biased towards eventual commercially exploitable research. But identifying what’s going to hit (mRNA vaccines being a nice example) is almost impossible unless you only funding research that’s designed to incrementally improve existing tech (which is how you get a dozen me-too drugs instead of entirely new classes of pharmaceuticals).

 

[gruemd]

Nobody has been able to meaningfully cut spending in the government ever so I’m ok with these seemingly drastic measures. As mentioned, it sounds like every section of spending is going to be examined so the people who give the “but it’s <1% of the budget” excuse can finally put that to rest because everything needs to be looked at. I fully acknowledge that there will be some bad cuts but that’s going to happen when you’re using an axe and not a scalpel but I’m ok with that. Cut hard and then add stuff back gradually when it becomes more apparent that particular spending is worth it. The gravy train for a lot of things is hopefully coming to an end.

Bruh, what about the Clinton years and the first balanced budget (with a surplus!) since the 70s? This is akin to giving a flamethrower to a monkey in a cotton factory and saying "Boy, he's really getting things done, consequences be damned!" There are other much less idiotic ways to make cuts happen. To my very first point, this, and many other cuts, are extremely shortsighted.

 

[JacobMcCandles]

What gravy train? Is there a large class of NIH researchers that live like feudal lords controlling vast estates off of the government’s dime? Most researchers are making a firmly middle class living after spending 4+ years on post graduate education.

People here have this really inaccurate idea that you can optimize research for commercial applicability while retaining the ability to make significant novel breakthroughs on a regular basis. Of course nobody wants to spend funding on things that have no real world applicability. And the current system is already heavily biased towards eventual commercially exploitable research. But identifying what’s going to hit (mRNA vaccines being a nice example) is almost impossible unless you only funding research that’s designed to incrementally improve existing tech (which is how you get a dozen me-too drugs instead of entirely new classes of pharmaceuticals).

That comment was more toward the broader aspect of spending and not just NIH but it's not always just individual people but institutions.

Bruh, what about the Clinton years and the first balanced budget (with a surplus!) since the 70s? This is akin to giving a flamethrower to a monkey in a cotton factory and saying "Boy, he's really getting things done, consequences be damned!" There are other much less idiotic ways to make cuts happen. To my very first point, this, and many other cuts, are extremely shortsighted.

Clinton didn't decrease spending, bruh:

US Federal Budgetary Spending by Year – Polidiotic

I don't know anything about that website at it was one of the first to show easily digestible data but appears to get its information from government websites.

COVID spending certainly threw a wrench in the spending pattern but the trend is certainly up. It looks like 2012-2013 had a decrease but then went right back up. Like I said, nobody has been able to meaningfully cut government spending.

 

[gruemd]

You are right.. that being said so much research is frankly stupid and meaningless. Now I get that much of that is hindsight bias. The idea that the researchers will have to spend time doing work that is beneath them probably falls on deaf ears when you are speaking to docs. unless you work with residents to do your scut I bet there are plenty of docs on here who transport patients to CT, answer the phone, maybe even have to make their own calls to transfer. I spend a ton of my time at work doing stupid stuff someone else should do. Throw in the stupidity of documentation for billing purposes or filling out stupid forms.. Again, sorry if my empathy for these almighty researchers is at 0 on the topic.

I completely agree that it is craptastic to announce on Friday for a Monday implementation. I do expect that DOGE will come after the DoD/Pentagon soon. I mean they have trillions that are unaccounted for. There is a stupid amount of waste there. They know it.. I suspect it will come but since it is holy to the right they wont make quite as a big of a stink about it.

Trump and DOGE to look at military spending

I think the same for Medicare/Medicaid.. tons of waste, docs will whine and the cuts will be imperfect but 90% of it will be good and meaningful.

Regarding the brain drain you are right but people are not going to go to China. Work is work but any sane human would rather live in the US than China. I think people may stay in their home countries and start businesses there rather than coming here but as you said, I think it would be a slow process. In the end America is fairly unique in the ability to start a company and profit the way we allow here including relatively low taxes compared to many other countries.

Re USAID you are right.. that being said it doesn't work well. The ROI sucks. We have sent a ton of money to the Palestinians.. yet the soft power led to them celebrating on 9/11. That image should be burned into the brain of everyone.

You selected a few of the USAID spending points.. I think most people would agree some degree of this makes sense. That being said help me understand why we should be spending money to promote atheism in Nepal, Drag shows in south America, transgender operas,

Here are others... USAID Waste

A lot of the USAID stuff is DEI stupidity. Its like they took all the DEI buzz terms and combined it and threw money at it in other countries. Its honestly kind of wild. Again, I'm not saying it is all stupid but a certain sliver certainly is/was.

So we can argue about sesame street in Iraq but it is hard to fathom that there isn't waste (we all know there is) and some of the programs are stupid and a waste of our money.

I do agree that the trade war makes no sense. He seems to have gotten what he wants but this diplomacy would be better served behind closed doors than in the public forum. I think his mention of slowing the flow of fentanyl is frankly stupid. I don't understand what the upside is here.

The spin is really, really important here.

First, note that I absolutely agreed already there is waste to be found and cut. But cherry picking things here and there that the right wouldn't agree with anyway is a bad faith argument for why USAID apparently shouldn't exist. I brought up the programs I did because they were previously brought up in this thread. I don't have to particularly agree with every single one of them, but there's also a lot more nuance to basically all of them is the point I'm trying to make. Same with the ones you brought up. A program promoting freedom of religion in Nepal, including the ability to be nonreligious or atheist, is a far cry from "promoting atheism in Nepal." Even some very cursory fact checking online shows that many of these claims are either false, or overblown, or most frequently, spending from the State department and not USAID at all.

Sorting Out the Facts on 'Waste and Abuse' at USAID - FactCheck.org

As President Donald Trump's administration targets the U.S. Agency for International Development for closure or major downsizing, the White House and social media posts have highlighted four projects as examples of the agency's "waste and abuse." But only one was funded by USAID.

www.factcheck.org

Again, DEI boogeyman. God forbid the US uses its influence to help other nations be more tolerant of anything besides Christian heterosexuality, I guess. I get that others don't agree with that, but that's a different conversation.

What's even more concerning, which I meant to bring up before I realized I was well on my way to writing a novel, is that cutting USAID (and arguably a lot of the other recent cuts) was blatantly unconstitutional. I know this is going to be tied up in the courts for a while, but it was a department created and funded by an act of congress, and the executive has no right to step in and cut it - this should require another act of congress. This is flagrant violation of separation of powers, and yet the pearl-clutching constitution-worshipping right is suddenly mum on the issue, or worse, endorsing the actions as somehow legal, including the VP himself. If that isn't terrifying to everyone, I don't know what else to say.

 

[gruemd]

That comment was more toward the broader aspect of spending and not just NIH but it's not always just individual people but institutions.


Clinton didn't decrease spending, bruh:

US Federal Budgetary Spending by Year – Polidiotic

I don't know anything about that website at it was one of the first to show easily digestible data but appears to get its information from government websites.

COVID spending certainly threw a wrench in the spending pattern but the trend is certainly up. It looks like 2012-2013 had a decrease but then went right back up. Like I said, nobody has been able to meaningfully cut government spending.

Fair point bruh, I conflated spending and budget balances. Though tbf he did actually reduce spending as a percentage of GDP, and absolutely did accomplish a surplus - spending itself isn't inherently bad, and can stimulate the economy, but it has to be balanced with income/taxes. Tax and spend, while initially a political slur, doesn't have to be a bad thing IMO.

 

[JacobMcCandles]

The spin is really, really important here.

What's even more concerning, which I meant to bring up before I realized I was well on my way to writing a novel, is that cutting USAID (and arguably a lot of the other recent cuts) was blatantly unconstitutional. I know this is going to be tied up in the courts for a while, but it was a department created and funded by an act of congress, and the executive has no right to step in and cut it - this should require another act of congress. This is flagrant violation of separation of powers, and yet the pearl-clutching constitution-worshipping right is suddenly mum on the issue, or worse, endorsing the actions as somehow legal, including the VP himself. If that isn't terrifying to everyone, I don't know what else to say.

I know we all like to think things are cut and dry and everything is simple but I’d guess that this has already been thought out and they feel they have legal standing. Now, if (when, actually) this goes to the courts, will you respect the ruling or will you still be saying it’s unconstitutional and that the judicial branch is politicized? For me, I’ll respect the ruling and say the checks and balances were appropriately applied.

 

[gruemd]

One example about how heavy handed and ham-fisted most of these cuts have been are videos like this one. A note, I fully believe this man knows more about TB than most non-ID physicians, and probably even some of those:



Again: downstream consequences will likely be significant and long-lasting. Multiply this one issue by the hundreds of projects affected just under USAID, to not even mention the research cuts. This administration's actions so far are so, so shortsighted.

I know we all like to think things are cut and dry and everything is simple but I’d guess that this has already been thought out and they feel they have legal standing. Now, if (when, actually) this goes to the courts, will you respect the ruling or will you still be saying it’s unconstitutional and that the judicial branch is politicized? For me, I’ll respect the ruling and say the checks and balances were appropriately applied.

I think they've thought it out and believe they have reasonable chance of the supreme court agreeing with them because this SC is a joke and will probably bend the knee, but I don't think it truly gives legal standing. Who knows, maybe I'm wrong John Roberts will remember that he has a spine this time around. Let's not pretend that the SC isn't politicized already.

I'd absolutely say that it would be unconstitutional because of, you know, the Appropriations and Taxing and Spending Clauses of the constitution. Congress appropriated the funds for use through appropriate legal means, Trump [read: Musk] can't just unilaterally say "nope!" Otherwise, what is the point of Congress making laws? It wouldn't be a check or balance, it would be a blatant disregard of the rule of law. Neither of us are constitutional scholars, but there's a reason why many people smarter than I are worried about a legitimate constitutional crisis.

 

[JacobMcCandles]

I think they've thought it out and believe they have reasonable chance of the supreme court agreeing with them because this SC is a joke and will probably bend the knee, but I don't think it truly gives legal standing.

This basically tells me everything I need to know. It doesn’t matter what happens because your mind is made up. You mock the “pearl-clutching constitution-worshipping right” but when it comes down to it, you’ve got the same stance you accuse the other side of having.

 

[gruemd]

This basically tells me everything I need to know. It doesn’t matter what happens because your mind is made up. You mock the “pearl-clutching constitution-worshipping right” but when it comes down to it, you’ve got the same stance you accuse the other side of having.

Nah, big differences, and ones that you can't rightfully dismiss out of hand. First, the current SC has absolutely already given the president king-like power by basically saying "everything you do in office is legal!" which is fraught with abuse potential. This and other decisions have eroded public confidence in the highest court of the land - not just my confidence in them. I'm really, really that they prove me wrong when this is inevitably heard by them.

Secondly, yeah, I don't believe it would give legal standing, but I'm willing to hear arguments otherwise - I don't have much confidence that the arguments would change my mind, but I'd hear them, and have formulated my current opinion by seeking out arguments from both sides. Arguments from Trump, Vance, and Russel Vought (all of which I've read/listened to) do not hold water on their face - lots of precedent and current law (Impoundment Control Act), passed by the law-making bodies in our country (Congress, in case there's ambiguity there, too), support that the executive can't impound funds unilaterally like this, and when they try, that's what the GAO is there for. Now obviously there's nuance there and different kinds of impoundment, delays vs outright obstruction, etc. But make no mistake, we are headed for a very real "who watches the watchers" moment in US history. If the SC sided with this administration, they'd be throwing out a lot of precedent and current law, and it would fundamentally shift the power of the purse, which has always been with Congress, way more towards the executive, more than anyone, conservative or liberal, right or left should be comfortable with.

This isn't pearl-clutching in the same way I accused many on the right - I'm talking about rhetoric like you hear in this hilariously ironic video and the accompanying silence and even weird worship of a different immigrant billionaire mucking about in the highest levels of our government with access to all of our SSNs and other private info. My fears certainly feel legitimate, and certainly seem well-founded, and are based in not just hand-wringing but sincere research and study and constitutional law review, and many opinions of those who are more expert than I. If you'd like to try allaying those rather than writing me off, or saying "just trust the supreme court, if they say so, then it must be right and legal!" I'm all ears, but I guess you already know everything about me 🤷‍♂️

 

[EctopicFetus]

The spin is really, really important here.

First, note that I absolutely agreed already there is waste to be found and cut. But cherry picking things here and there that the right wouldn't agree with anyway is a bad faith argument for why USAID apparently shouldn't exist. I brought up the programs I did because they were previously brought up in this thread. I don't have to particularly agree with every single one of them, but there's also a lot more nuance to basically all of them is the point I'm trying to make. Same with the ones you brought up. A program promoting freedom of religion in Nepal, including the ability to be nonreligious or atheist, is a far cry from "promoting atheism in Nepal." Even some very cursory fact checking online shows that many of these claims are either false, or overblown, or most frequently, spending from the State department and not USAID at all.

Sorting Out the Facts on 'Waste and Abuse' at USAID - FactCheck.org

As President Donald Trump's administration targets the U.S. Agency for International Development for closure or major downsizing, the White House and social media posts have highlighted four projects as examples of the agency's "waste and abuse." But only one was funded by USAID.

www.factcheck.org

Again, DEI boogeyman. God forbid the US uses its influence to help other nations be more tolerant of anything besides Christian heterosexuality, I guess. I get that others don't agree with that, but that's a different conversation.

What's even more concerning, which I meant to bring up before I realized I was well on my way to writing a novel, is that cutting USAID (and arguably a lot of the other recent cuts) was blatantly unconstitutional. I know this is going to be tied up in the courts for a while, but it was a department created and funded by an act of congress, and the executive has no right to step in and cut it - this should require another act of congress. This is flagrant violation of separation of powers, and yet the pearl-clutching constitution-worshipping right is suddenly mum on the issue, or worse, endorsing the actions as somehow legal, including the VP himself. If that isn't terrifying to everyone, I don't know what else to say.

I think it is important to use our influence wisely. I would highly question how doing this in nepal benefits the US, same for the trans shows and a ton else. Condoms in countries, yep.. Meds, sure.. Again, I'm not opposed to being smart with foreign aid.. I do question why we are pushing an agenda that is not necessarily going to be helpful to the US. Sesame street in Iraq. I can see how (I'm not saying I agree but its in the realm of what makes sense), but drag shows in South America it is hard for me to comprehend how this helps soft influence for the US. I don't think we need to use US taxpayer money to fund pet projects outside of the US.

I cant comment on the constitutionality of things. Ill admit I haven't studied the details but correct me if I am wrong. The department might be created and funded by congress but they get to choose how they spend their money. I doubt that's in the law. Similarly, I am sure they can choose not to spend the money. I might be wrong so don't bite my head off.

I do agree that all the EOs by trump and all the other recent presidents is a mess and goes against what we are looking to do with our government. That being said I'm not sad about them finding waste. They just announced looking at cutting 880B from CMS. this seems easy but I haven't seen the details. I am confident I wont agree with some of what they want to clean up.. that being said anyone who works in healthcare knows finding 88B in waste a year is super low hanging fruit.

 

[EctopicFetus]

Nah, big differences, and ones that you can't rightfully dismiss out of hand. First, the current SC has absolutely already given the president king-like power by basically saying "everything you do in office is legal!" which is fraught with abuse potential. This and other decisions have eroded public confidence in the highest court of the land - not just my confidence in them. I'm really, really that they prove me wrong when this is inevitably heard by them.

Secondly, yeah, I don't believe it would give legal standing, but I'm willing to hear arguments otherwise - I don't have much confidence that the arguments would change my mind, but I'd hear them, and have formulated my current opinion by seeking out arguments from both sides. Arguments from Trump, Vance, and Russel Vought (all of which I've read/listened to) do not hold water on their face - lots of precedent and current law (Impoundment Control Act), passed by the law-making bodies in our country (Congress, in case there's ambiguity there, too), support that the executive can't impound funds unilaterally like this, and when they try, that's what the GAO is there for. Now obviously there's nuance there and different kinds of impoundment, delays vs outright obstruction, etc. But make no mistake, we are headed for a very real "who watches the watchers" moment in US history. If the SC sided with this administration, they'd be throwing out a lot of precedent and current law, and it would fundamentally shift the power of the purse, which has always been with Congress, way more towards the executive, more than anyone, conservative or liberal, right or left should be comfortable with.

This isn't pearl-clutching in the same way I accused many on the right - I'm talking about rhetoric like you hear in this hilariously ironic video and the accompanying silence and even weird worship of a different immigrant billionaire mucking about in the highest levels of our government with access to all of our SSNs and other private info. My fears certainly feel legitimate, and certainly seem well-founded, and are based in not just hand-wringing but sincere research and study and constitutional law review, and many opinions of those who are more expert than I. If you'd like to try allaying those rather than writing me off, or saying "just trust the supreme court, if they say so, then it must be right and legal!" I'm all ears, but I guess you already know everything about me 🤷‍♂️

I dont disagree with much of what you said but you have to admit the irony in your pearly clutching statement and what you wrote above. Its pearl clutching when you don't agree and when you do its cause things are politicized and the deck is stacked.

Look we all know the SCOTUS is political but that's cause things arent cut and dry. Any legit constitutional scholar will tell you the initial Roe V Wade was judicial activism. It spread the power of the courts and state in a manner not seen before. I say this as a pro choice doc.

 

[gruemd]

I dont disagree with much of what you said but you have to admit the irony in your pearly clutching statement and what you wrote above. Its pearl clutching when you don't agree and when you do its cause things are politicized and the deck is stacked.

Look we all know the SCOTUS is political but that's cause things arent cut and dry. Any legit constitutional scholar will tell you the initial Roe V Wade was judicial activism. It spread the power of the courts and state in a manner not seen before. I say this as a pro choice doc.

Eh, when I used pearl clutching I meant it how I commonly understand it to be used, which is theatrical levels of dismay about things that aren't worthy of that response. Think Obama tan suit and dijon mustard levels of outrage. I don't equate what certainly seems like a paradigm shift in government spending and enforcement of spending via direct challenging of long-held checks and balances that affects us all to be pearl-clutching but hey, I'd truly be happy to be wrong if it doesn't end up how I fear.

 

[JacobMcCandles]

I think it is important to use our influence wisely. I would highly question how doing this in nepal benefits the US, same for the trans shows and a ton else. Condoms in countries, yep.. Meds, sure.. Again, I'm not opposed to being smart with foreign aid.. I do question why we are pushing an agenda that is not necessarily going to be helpful to the US. Sesame street in Iraq. I can see how (I'm not saying I agree but its in the realm of what makes sense), but drag shows in South America it is hard for me to comprehend how this helps soft influence for the US. I don't think we need to use US taxpayer money to fund pet projects outside of the US.

I cant comment on the constitutionality of things. Ill admit I haven't studied the details but correct me if I am wrong. The department might be created and funded by congress but they get to choose how they spend their money. I doubt that's in the law. Similarly, I am sure they can choose not to spend the money. I might be wrong so don't bite my head off.

I do agree that all the EOs by trump and all the other recent presidents is a mess and goes against what we are looking to do with our government. That being said I'm not sad about them finding waste. They just announced looking at cutting 880B from CMS. this seems easy but I haven't seen the details. I am confident I wont agree with some of what they want to clean up.. that being said anyone who works in healthcare knows finding 88B in waste a year is super low hanging fruit.

What if the Supreme Court rules against Trump? Would you still feel the same way about them? If your belief in the checks and balances hinge on if you agree with the result then I’m not sure you can say you believe in the checks and balances in the first place. This is all going to go through the courts. If it’s ultimately deemed ok then I’ll accept that. If it’s ultimately deemed not ok then I’ll accept that.

 

[gruemd]

What if the Supreme Court rules against Trump? Would you still feel the same way about them? If your belief in the checks and balances hinge on if you agree with the result then I’m not sure you can say you believe in the checks and balances in the first place. This is all going to go through the courts. If it’s ultimately deemed ok then I’ll accept that. If it’s ultimately deemed not ok then I’ll accept that.

Another swing and a miss on trying to discredit me instead of any of the points I've made. Yes, I'd be happy with the decision because I view it to be in line with the rule of law and precedent as I previously said, but it wouldn't suddenly give this SC more legitimacy in my eyes. They stripped that away from themselves with toothless promises without any enforcement or punishments for "no really, we'll disclose ALL of our trips and gifts from billionaires (who just happen to have multiple cases before the court) now!" How are we supposed to trust their impartiality?

It's clear there isn't engagement on the meat of these issues so I'll disengage.

 

[EctopicFetus]

What if the Supreme Court rules against Trump? Would you still feel the same way about them? If your belief in the checks and balances hinge on if you agree with the result then I’m not sure you can say you believe in the checks and balances in the first place. This is all going to go through the courts. If it’s ultimately deemed ok then I’ll accept that. If it’s ultimately deemed not ok then I’ll accept that.

I mean is that not the check and balance, separation of powers and all. If the courts dont rule the way I want then the system is broken? Is that the logic? I agree. I accept the rule of law. Presidents and governors and others often do things that are in the gray area of the law. Biden did this with student loans. The courts said no so he tried a different approach.. He didnt just acquiesce. I also think it is fine to poke and prod to get your way.So yeah if the courts rule even in a partisan fashion that it is ok.. im fine with it.. if they say it isnt ok.. im fine with that too. Top pretend I know more about the law than a bunch of constitutional scholars and lawyers is stupid. I would never say that. It’s like the school janitor saying he knows more about medicine than I do.. It’s stupid.

I accept the outcome of the system. Be is legistlation I dont like (Obamacare), court rulings I dont like (Dobbs), or presidential EOs I dont like. My response isnt to whine about it.. It is to change the system or at least change the people who represent me in the system. I refuse to donate money to politicians and have only done this a few times in my life because people i personally knew were running for some office. That being said I always vote.

 

[southerndoc]

WARNING: This thread is turning into a political thread. Please keep the politics out of everything. I don't want to send this thread to the off-topic discussion forum.

 

[Apollyon]

Kennedy! Johnson! Lincoln! Washington!!

Is that enough politics?

/sarcasm

 

[Arcan57]

$880b dollar proposed cut to Medicaid. Wonder what the downstream consequences of that will be for EM. Critical access hospitals closing, boarding unresourced patients, spike in preventable emergencies due to not being able to afford maintenance medications. Even if you ignore the actual suffering behind those things, it's going to make your job suck more.
The four horsemen of the apocalypse are agents of change too...

 

[AlmostAnMD]

$880b dollar proposed cut to Medicaid. Wonder what the downstream consequences of that will be for EM. Critical access hospitals closing, boarding unresourced patients, spike in preventable emergencies due to not being able to afford maintenance medications. Even if you ignore the actual suffering behind those things, it's going to make your job suck more.
The four horsemen of the apocalypse are agents of change too...

The important thing to remember is that you'll be left holding the bag. Lawsuits don't demonstrably factor in ed boarding times, lobby holds or other hospital things you don't directly control. Shuttering resources will negativity impact your job and patient safety for sure, but your liability remains unchanged.

Whatever happens, it's your fault. Or at least that's what plaintiff attorney will say and swayable jurors will believe

 

[EctopicFetus]

$880b dollar proposed cut to Medicaid. Wonder what the downstream consequences of that will be for EM. Critical access hospitals closing, boarding unresourced patients, spike in preventable emergencies due to not being able to afford maintenance medications. Even if you ignore the actual suffering behind those things, it's going to make your job suck more.
The four horsemen of the apocalypse are agents of change too...

This is the main question. We know waste is there. Hard to imagine you can cut the waste without removing some meaningful items. Personally, and im an outlier here im sure.. im ok with CAH closing. Like a lot of them.. honestly it’s cheaper to use HEMS to fly people around than staff these places. I would make it where if they dont see 20 pts/day they should make the economics such that it should close. Smarter and cheaper ways than paying some doc who likely sucks $150/hr to fund what is an urgent care with incompetent nurses and docs. Again, i know im in the minority here and im ok with that.

More EDs isnt better.

 

[Franzd'Epinay]

We know waste is there. Hard to imagine you can cut the waste without removing some meaningful items.

I think people are losing sight of the actual goal here. "Cutting waste" isn't the goal. "Cutting waste to improve the country" is.

If your only goal is "cutting waste", then sure, "removing some meaningful items" is acceptable.

If your goal is to improve the country or even make the country more efficient, I fail to see how removing meaningful items is defensible.

 

[JacobMcCandles]

This is the main question. We know waste is there. Hard to imagine you can cut the waste without removing some meaningful items. Personally, and im an outlier here im sure.. im ok with CAH closing. Like a lot of them.. honestly it’s cheaper to use HEMS to fly people around than staff these places. I would make it where if they dont see 20 pts/day they should make the economics such that it should close. Smarter and cheaper ways than paying some doc who likely sucks $150/hr to fund what is an urgent care with incompetent nurses and docs. Again, i know im in the minority here and im ok with that.

More EDs isnt better.

I strongly agree with this. Every little town doesn’t need/can’t support a hospital. That’s part of the package you get when you live in more rural places. You get less amenities, including healthcare.

 

[JacobMcCandles]

I think people are losing sight of the actual goal here. "Cutting waste" isn't the goal. "Cutting waste to improve the country" is.

If your only goal is "cutting waste", then sure, "removing some meaningful items" is acceptable.

If your goal is to improve the country or even make the country more efficient, I fail to see how removing meaningful items is defensible.

Who determines what’s waste and what isn’t? Do you think anyone receiving federal funding is going to voluntarily say “we don’t need this money?”?

 

[Franzd'Epinay]

Who determines what’s waste and what isn’t? Do you think anyone receiving federal funding is going to voluntarily say “we don’t need this money?”?

I was responding to the statement "Hard to imagine you can cut the waste without removing some meaningful items" after someone mentioned potential downstream consequences of a $880 billion cut that would affect Medicaid.

As you've pointed out, you can always find someone who will define anything as wasteful. Are you suggesting any "waste cutting" is justified on these grounds?

 

[JacobMcCandles]

I was responding to the statement "Hard to imagine you can cut the waste without removing some meaningful items" after someone mentioned potential downstream consequences of a $880 billion cut that would affect Medicaid.

As you've pointed out, you can always find someone who will define anything as wasteful. Are you suggesting any "waste cutting" is justified on these grounds?

I won’t pretend to know what’s truly good spending and what isn’t but I’m in favor of being aggressive from the jump.

 

[TooMuchResearch]

This is the main question. We know waste is there. Hard to imagine you can cut the waste without removing some meaningful items. Personally, and im an outlier here im sure.. im ok with CAH closing. Like a lot of them.. honestly it’s cheaper to use HEMS to fly people around than staff these places. I would make it where if they dont see 20 pts/day they should make the economics such that it should close. Smarter and cheaper ways than paying some doc who likely sucks $150/hr to fund what is an urgent care with incompetent nurses and docs. Again, i know im in the minority here and im ok with that.

More EDs isnt better.

I cover two places that are considered critical access but combined we see around 13k patients per year that our metro hospital could absolutely not manage to absorb.

Yes we see some urgent care level stuff but we also see a lot of sick people that would have long transport times or are too old to drive into the city.

The hospitals pay us a great rate for the work because we can keep a lot of things that FP used to transfer and can begrudgingly manage patients roughly 12 steps beyond a typical EPs job before we can get a transfer.

Keep in mind we have MRI, slit lamps (haha), and at least phone access to every consultant needed to make for reasonably smooth plans and transfers.

 

[EctopicFetus]

I cover two places that are considered critical access but combined we see around 13k patients per year that our metro hospital could absolutely not manage to absorb.

Yes we see some urgent care level stuff but we also see a lot of sick people that would have long transport times or are too old to drive into the city.

The hospitals pay us a great rate for the work because we can keep a lot of things that FP used to transfer and can begrudgingly manage patients roughly 12 steps beyond a typical EPs job before we can get a transfer.

Keep in mind we have MRI, slit lamps (haha), and at least phone access to every consultant needed to make for reasonably smooth plans and transfers.

At what cost? My main point isnt that every single one doesnt need to exist but much like government waste.. if we shut down 25% of these CAHs no one would care. Again, the place you cover may be the exception.

The counter to your point is while your main hospital cant a smarter use of resources is another hospital near your main site.. It would decompress your site which seemingly needs it and could absorb these patients.

A few questions, how far are these sites from the mother ship and whats the daily volume?

 

[ScepticSkeksis]

With RFK confirmed (love him or hate him) I hope he sheds a spotlight on corrupt pharma and big food. Let's start by banning advertising of sugar to children. Goodbye Count Chocula.

 

[Apollyon]

With RFK confirmed (love him or hate him) I hope he sheds a spotlight on corrupt pharma and big food. Let's start by banning advertising of sugar to children. Goodbye Count Chocula.

Back in 2005 (before I was dx diabetic), I bought a box of Chocolate Lucky Charms, and had it with full fat chocolate milk.

I ate the whole box.

https://forums.studentdoctor.net/threads/i-may-have-found-the-cereal.189290/

 

[EctopicFetus]

With RFK confirmed (love him or hate him) I hope he sheds a spotlight on corrupt pharma and big food. Let's start by banning advertising of sugar to children. Goodbye Count Chocula.

And PBMs and all the other additives and preservatives we have in our food. Also stop the direct to consumer advertising of medications. And that includes the Hims/Hers viagra, GLP-1 nonsense.

 

[throway134]

With RFK confirmed (love him or hate him) I hope he sheds a spotlight on corrupt pharma and big food. Let's start by banning advertising of sugar to children. Goodbye Count Chocula.

I’m sure that the guy who didn’t realize it was his agency’s role to enforce emtala, couldn’t clearly delineate the responsibilities of Medicare/Medicaid, has spent his life’s work decrying the effectiveness and endorsing (often fictitious) side effects of our most effective public health interventions will do a great job.

I’m also sure he’ll remain completely impartial while running the agency, and I am filled with confidence by him giving the money to his son rather than directly profiting off of suing the maker of a vaccine who he will now be regulating. That’s a great divestment

 

[TooMuchResearch]

At what cost? My main point isnt that every single one doesnt need to exist but much like government waste.. if we shut down 25% of these CAHs no one would care. Again, the place you cover may be the exception.

The counter to your point is while your main hospital cant a smarter use of resources is another hospital near your main site.. It would decompress your site which seemingly needs it and could absorb these patients.

A few questions, how far are these sites from the mother ship and whats the daily volume?

Nobody is opening a new hospital. In fact, the opposite happened.

 

[RustedFox]

Nobody is opening a new hospital. In fact, the opposite happened.

New ones opening in this county and the next down here, bro.

Come on down; I'll let the boys at the border know to look out for you.

 

[EctopicFetus]

Nobody is opening a new hospital. In fact, the opposite happened.

All depends on the detals right.. in some places they are opening especially the FSEDs or expanding existing hospitals. I don't know where you are but that might be true there. In many markets they have expanded like crazy.

 

[gruemd]

I’m sure that the guy who didn’t realize it was his agency’s role to enforce emtala, couldn’t clearly delineate the responsibilities of Medicare/Medicaid, has spent his life’s work decrying the effectiveness and endorsing (often fictitious) side effects of our most effective public health interventions will do a great job.

I’m also sure he’ll remain completely impartial while running the agency, and I am filled with confidence by him giving the money to his son rather than directly profiting off of suing the maker of a vaccine who he will now be regulating. That’s a great divestment

Careful now, your accounting of someone's very well documented stances counter to the interest of public health might be perceived as political.

 

[Pinner Doc]

RFK isn’t shedding a spotlight on big pharmaceutical or big food. He’s working for a Republican and administration. They’re in bed with big corporations, and they’re gutting regulations.

 

[southerndoc]

Thread closed due to political nature.