Trump 2.0 vs Obama's Second Term: Implications for Pain?

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Will Trump 2.0 be better for Pain that Obama's second term?

  • YES

    Votes: 14 53.8%
  • No

    Votes: 12 46.2%

  • Total voters
    26

drusso

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Will Trump 2.0 be better for Pain than Obama's second term?

"In his second inauguration address, Obama proclaimed that "while freedom is a gift from God, it must be secured by His people here on Earth". He called for laws to combat climate change, enactment of immigration reform and gun control. Obama stated that more progress was needed on human rights and civil rights (including racial minority rights, women's rights, and LGBT rights). He vowed to promote democracy abroad and stated that the United States must "be a source of hope to the poor, the sick, the marginalized, the victims of prejudice" around the world. Additionally, the president vowed to keep existing alliances strong, emphasized the economic recovery and the end of wars, and stated that "no one has a greater stake in a peaceful world than its most powerful nation". During the speech, Obama linked the Seneca Falls Convention, Selma to Montgomery marches and Stonewall riots."
 
The worst thing for medicine is that the goals of the State do not match the goals of the patient.

So an activist government, like Obama/Biden is usually to the detriment of the patient.
 
Will Trump 2.0 be better for Pain than Obama's second term?

"In his second inauguration address, Obama proclaimed that "while freedom is a gift from God, it must be secured by His people here on Earth". He called for laws to combat climate change, enactment of immigration reform and gun control. Obama stated that more progress was needed on human rights and civil rights (including racial minority rights, women's rights, and LGBT rights). He vowed to promote democracy abroad and stated that the United States must "be a source of hope to the poor, the sick, the marginalized, the victims of prejudice" around the world. Additionally, the president vowed to keep existing alliances strong, emphasized the economic recovery and the end of wars, and stated that "no one has a greater stake in a peaceful world than its most powerful nation". During the speech, Obama linked the Seneca Falls Convention, Selma to Montgomery marches and Stonewall riots."

Will Trump 2.0 be better for Pain than Obama's second term? "In his second inauguration address, Obama proclaimed that "while freedom is a gift from God, it must be secured by His people here on Earth". He called for laws to combat climate change, enactment of immigration reform and gun control. Obama stated that more progress was needed on human rights and civil rights (including racial minority rights, women's rights, and LGBT rights). He vowed to promote democracy abroad and stated that the United States must "be a source of hope to the poor, the sick, the marginalized, the victims of prejudice" around the world. Additionally, the president vowed to keep existing alliances strong, emphasized the economic recovery and the end of wars, and stated that "no one has a greater stake in a peaceful world than its most powerful nation". During the speech, Obama linked the Seneca Falls Convention, Selma to Montgomery marches and Stonewall riot
How does your quote relate at all to medicine? Let alone pain?
 
When was the last time a US president was good for physicians in general?

Chat GPT o1-mini seems to think so, but to me these are all net negatives:

Over the past five decades, several U.S. presidents have implemented policies and initiatives that have supported the interests of physicians. These efforts have focused on various aspects, including healthcare reform, medical education funding, reimbursement rates, regulatory changes, and initiatives aimed at improving the overall healthcare system. Below is an overview of key presidential actions and policies that have positively impacted physicians:

1. Ronald Reagan (1981-1989)​

  • Medicare Fee Schedule: Reagan's administration worked to control healthcare costs by implementing the Medicare fee schedule, which set fixed reimbursement rates for physicians providing services to Medicare beneficiaries. While aimed at cost containment, this also provided a more predictable payment structure for physicians.

2. Bill Clinton (1993-2001)​

  • Health Information Technology Initiatives: Although comprehensive healthcare reform under Clinton did not pass, his administration promoted the use of health information technology, laying the groundwork for more efficient medical practices.
  • Physician Workforce Initiatives: Clinton supported programs to increase the number of healthcare providers, including physicians, to address shortages in underserved areas.

3. George W. Bush (2001-2009)​

  • Medicare Part D (2003): The Bush administration enacted Medicare Part D, providing prescription drug coverage to Medicare beneficiaries. This expanded the role of physicians in managing patients' medication therapies.
  • Physician Payments Sunshine Act: Introduced transparency in financial relationships between physicians and the pharmaceutical industry, fostering ethical practices.

4. Barack Obama (2009-2017)​

  • Affordable Care Act (ACA) (2010):The ACA had significant implications for physicians, including:
    • Expanded Insurance Coverage: Increased the number of insured patients, potentially increasing demand for medical services.
    • Medicare Payment Reforms: Introduced value-based purchasing and other payment reforms aimed at improving care quality.
    • Funding for Medical Education: Provided funding to expand residency programs, addressing physician shortages.
  • Telemedicine Expansion: Promoted the use of telehealth services, allowing physicians to reach a broader patient base.

5. Donald Trump (2017-2021)​

  • Regulatory Reforms: The Trump administration worked to reduce regulatory burdens on physicians by repealing certain provisions of the ACA and promoting policies that aimed to increase healthcare flexibility.
  • Telehealth Enhancements: Expanded telehealth services, especially during the COVID-19 pandemic, allowing physicians to continue providing care remotely.

6. Joe Biden (2021-Present)​

  • Strengthening the ACA: Biden has focused on expanding and strengthening the ACA, which continues to affect physicians by increasing patient coverage and supporting payment reforms.
  • Physician Workforce Support: Initiatives to address physician burnout and mental health, recognizing the pressures faced by medical professionals.
  • Medicare and Medicaid Enhancements: Proposals to increase reimbursement rates for physicians under Medicare and Medicaid, aiming to ensure fair compensation.
  • Investment in Medical Research: Increased funding for medical research and public health initiatives, supporting physicians involved in cutting-edge treatments and public health.

Additional Supportive Measures Across Administrations​

  • Funding for Medical Education: Multiple administrations have provided grants and loan forgiveness programs to support medical education, encouraging more individuals to enter the physician workforce.
  • Public Health Initiatives: Support for public health campaigns and infrastructure improvements indirectly benefit physicians by improving community health and reducing disease burdens.
  • Malpractice Reform Efforts: Various presidents have advocated for tort reform to address malpractice insurance costs and litigation concerns that affect physicians.

Conclusion​

While each administration has its own approach to healthcare policy, many U.S. presidents over the past 50 years have taken steps that support the interests of physicians. These efforts range from financial incentives and regulatory reforms to initiatives aimed at expanding access to care and addressing workforce challenges. The interplay between presidential policies and the medical profession is complex, often balancing the needs of physicians with broader public health objectives. Physicians and medical organizations frequently engage with the executive branch to advocate for policies that support their practice and enhance patient care.
 
there is patient care and there is $$$ (physician pay). they are not the same.

i worry the OP is more concerned regarding the latter than the former.
 
there is patient care and there is $$$ (physician pay). they are not the same.

i worry the OP is more concerned regarding the latter than the former.
while I don’t think democrats or republicans will do a damn thing to actually improve it, and if you take a look through the chatGPT list you’ll see they’ve both been working long and hard to destroy it, physician autonomy is a keystone of both physician pay and patient care. It’s the difference between standard of care and standardized care. One directed by physicians and the other by hospitals, nurses, and insurance companies.
 
It's clear that Obama had/has a different view of "freedom" than many, including myself.

To answer your original question though:
Frankly, the whole system is screwed and more government interference will likely only make it worse. That being said, I don't think anybody, at least in my memory, has done more to ruin our healthcare than Obama and the ACA.
 
Shots fired. Anybody here from AZ?

 
Shots fired. Anybody here from AZ?

Yep. Schweikert is my rep. Me worried? Nah.
 
Why doesn’t this concern you? Because it’s unlikely to pass? Or something else?
Not concerned at all. First of all it JUST got introduced. It will have to go through the wringer if it is ever to become law.

But I think it's great for the fed to get out of the way and let states do what their constituents want.

It's positively mind boggling how some people who despise Trump and think he's Hitler want his administration to impose laws on their liberal state. Like what is wrong with you people? Govern yourselves ffs.
 
Not concerned at all. First of all it JUST got introduced. It will have to go through the wringer if it is ever to become law.

But I think it's great for the fed to get out of the way and let states do what their constituents want.

It's positively mind boggling how some people who despise Trump and think he's Hitler want his administration to impose laws on their liberal state. Like what is wrong with you people? Govern yourselves ffs.

I agree I think it’s unlikely for this specific bill to pass.

It seems a near certainty that AI will be a significant part of medicine in the future. But it also seems a bit wild that a high-level official wants to seriously float this idea (which may not ever make sense in our lifetime) so early in the development and validation of this tech. It’s basically giving AI (and the corp that owns it) a medical license. Wreaks of either profound naivety or special-interest influence or both.

But maybe we should, I dunno, have some well-validated and time-tested use-case evidence showing both the efficacy and safety of AI playing doctor? Or will big tech use their considerable political clout and lobbying dollars to simply dodge all of this?

And then there’s the whole thing about if this is overall a good thing or a bad thing for your job security and financial outlook. Is it?
 
I think because AI is really hot right now, there’s a rush to be the first to cash in on anything that looks like a good idea. Some of it will stick and some of it will fail dramatically.
 
Why doesn’t this concern you? Because it’s unlikely to pass? Or something else?
AI can’t examine a patient and those capabilities aren’t anywhere on the horizon either. AI can help but not replace a physician. If someone wants to go the pure-AI route it won’t take long before an incorrect diagnosis and lack of capability to correct the error sours the masses on this.
 
AI can’t examine a patient and those capabilities aren’t anywhere on the horizon either. AI can help but not replace a physician. If someone wants to go the pure-AI route it won’t take long before an incorrect diagnosis and lack of capability to correct the error sours the masses on this.

Any idea why he’s pitching this bill?
 
They probably read that article that was all over the lay press about how ChatGPT outperformed physicians on diagnosing medical cases, and then got a lobbying pitch from some AI tech bros about how great AI is at everything.
 
Just as an American, I would love to see the proliferation of private, cash services for imaging and blood draws with AI reads for dirt cheap. People could sign a disclaimer that it's not "medical advice", etc.
 
But it is medical advice if AI is involved. We can get labs now with results without AI. I’d never want to be the company that puts the AI device out there. How easy is it for an attorney to get around a disclaimer like that with a class action suit?
 
Just as an American, I would love to see the proliferation of private, cash services for imaging and blood draws with AI reads for dirt cheap. People could sign a disclaimer that it's not "medical advice", etc.
AI is going to helpfully tell you a mild elevation in your WBC could be leukemia and the DDD on your MRI means you could need a spinal fusion surgery
 
AI is going to helpfully tell you a mild elevation in your WBC could be leukemia and the DDD on your MRI means you could need a spinal fusion surgery

Exactly. Were AI to be used in this way, it will just disproportionately result in more of the worried well flooding the healthcare system seeking care they don’t need. People trying to diagnose themselves via Google and many midlevels already do this to a significant degree.
Much of the time it just results in a needless waste of resources. If I had a penny for every time a genius overtesting midlevel sent something totally benign on imaging into my ED for an “urgent eval and possible admission” (and terrifying the patient in process)…
And in a smaller percent of cases, over testing reveals something indeterminant that sparks a wild goose chase that can lead to invasive testing/“treatment” that can legit harm patients.
 
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Exactly. Were AI to be used in this way, it will just disproportionately result in more of the worried well flooding the healthcare system seeking care they don’t need. People trying to diagnose themselves via Google and many midlevels already do this to a significant degree.
Much of the time it just results in a needless waste of resources. If I had a penny for every time a genius overtesting midlevel sent something totally benign on imaging into my ED for an “urgent eval and possible admission” (and terrifying the patient in process)…
And in a smaller percent of cases, over testing reveals something indeterminant that sparks a wild goose chase that can lead to invasive testing/“treatment” that can have legit harm patients.

Agree
 
Chatgpt, grok, Google Gemini, etc all provide AI answers and (un)helpful, often ridiculously inappropriate guidance for medical questions. Some of them, Grok for example, can already read your images and provide you a report NOW for free. No lawsuits that I'm aware of thus far.

How much worse do you think it would be if people could get images/labs to help guide the AI?
 
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Chatgpt, grok, Google Gemini, etc all provide AI answers and (un)helpful, often ridiculously inappropriate guidance for medical questions. Some of them, Grok for example, can already read your images and provide you a report NOW for free. No lawsuits that I'm aware of thus far.

How much worse do you think it would be if people could get images/labs to help guide the AI?
Because then they take that nonsense to overworked, burned out real doctors who have to spend extra time explaining why the AI advice is bad
 
I think AI has the potential to replace most or all of the cognitive specialties. Imagine a model trained on thousands of the AI scribed visits of the best doctors in specialty, the entirety of the medical literature on the subject, including textbooks, pubmed, expert analyses of the primary literature from editorials and responses, conference posters and abstracts, all of UpToDate, etc. Such a model would require a technician trained in performance of physical exam, but I bet it will be able to ultimately outperform the best human doctors. Trained off of the actual conversations between doctor and patient, it will be able to take a history and ignore irrelevant details. Providing compassionate responses and steering off-topic people back to the main point are probably already within its capability. Such a model, though, is probably at least 5 years of heavy investment and R&D away, not to mention the medicolegal questions to be answered. Handing over prescriptive authority to AI now is putting a cart that isn’t built before a horse that isn’t born.
 
I think AI has the potential to replace most or all of the cognitive specialties. Imagine a model trained on thousands of the AI scribed visits of the best doctors in specialty, the entirety of the medical literature on the subject, including textbooks, pubmed, expert analyses of the primary literature from editorials and responses, conference posters and abstracts, all of UpToDate, etc. Such a model would require a technician trained in performance of physical exam, but I bet it will be able to ultimately outperform the best human doctors. Trained off of the actual conversations between doctor and patient, it will be able to take a history and ignore irrelevant details. Providing compassionate responses and steering off-topic people back to the main point are probably already within its capability. Such a model, though, is probably at least 5 years of heavy investment and R&D away, not to mention the medicolegal questions to be answered. Handing over prescriptive authority to AI now is putting a cart that isn’t built before a horse that isn’t born.
I am skeptical AI will replace human docs for cognitive work. For prescription/orders, it would be a non starter for me.

But when we're talking about prescription/orders for completely noninvasive diagnostic studies that do not require medical knowledge for safety, like MRI, stool eval, etc, I don't think anyone should need an order.
 
They do that now. Do you think medical discussion by AI should be outlawed to protect the overworked doctors?

Eh no people using AI to ask medical questions and read about health shouldn’t be restricted. Though it will likely be more of a time-consuming PITA to re-orient patients who receive bad information from AI… since “c’mon doc there are studies saying AI are the same or better than you guys!” It would be helpful if AI companies included a disclaimer in bright flashing lights saying the best patient-specific advice will come from their doctor.

But people going out and getting all the imaging and lab tests that they want? For me I think that crosses into the territory of overall being harmful to patients and society. What if Karen wants three CT scans today and has $1000 burning a hole in her pocket. And then a few weeks later Karen hears from an influencer on TikTok that the imaging center across town has a super special CT machine that can pick up on things others don’t. Then she goes and gets more CTs. Then she decides she should get them every 6 months “for monitoring.” Is that a good thing?

Or a gym rat who checks his BMP, has a K of 3.4, see the “L” flag, then and downs a bottle of grandma’s PO potassium…because hey “it’s all natural what could go wrong.”

These may sound far fetched to you, but I have had similar cases to these this in the ED (imaging one was courtesy of an enormously shady set up between a cash only imaging center with a “walk-ins welcome” sign and a urgent care right next-door— patient goes in to the imaging center, imaging center sends patient next-door to the “urgent care” who writes a prescription for whatever images the patient desires and sends them back next door).
 
Also, all this talk about AI replacing doctors is kind of dumb. We may be replaced eventually, but not before other tons of other occupations— and hopefully by that point society will figure out a way to deal with all the displaced unemployed workers (aside from making us batteries lol). But if that isn’t figured out, it will likely lead to significant civil conflict and upheaval which at that point would make AI taking our jobs lower down on the hierarchy of daily life concerns.
 
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I do wonder how much AI might assist radiology or pathology?
One of the radiologists for an imaging center I use uses AI. It generates a report, then he puts in an addendum that has edits. Most of the time there are none or minor. Basically like attending signing off on resident's read. I bet he's churning.
 
Furthermore, it’s a bit maddening that the roll out of AI into the job market involves it going after jobs that people actually want to do and pay decently/well (I get it, the big tech corps are going where they think the most $ is). But how about AI doing jobs to help with life‘s annoyances and jobs that nobody else wants to do.

I’m watching both of my kids today as my wife has to work. Toddler A has the flu and is taking most of my attention. Toddler B is recently potty trained, but I couldn’t notice his tells in time that he had to go. When I could finally recognize this and get him moving towards the bathroom, he couldn’t hold it anymore and pooped on the floor.

Where is AI to help babysit (I tried to find one, couldn’t)? Where is AI to help clean poop off the floor lol? Where is AI to do the dishes?
 
One of the radiologists for an imaging center I use uses AI. It generates a report, then he puts in an addendum that has edits. Most of the time there are none or minor. Basically like attending signing off on resident's read. I bet he's churning.

good point. AI is helpful as an assist, not as a replacement.

I wish I could figure out a way to use AI for my notes. We used a system based on dictation, there are no dot phrases I can use.

however, I wish there was a way to use something standarized for conservative care, or for common meds and the risk warnings I gave the patient...
 
I think AI has the potential to replace most or all of the cognitive specialties. Imagine a model trained on thousands of the AI scribed visits of the best doctors in specialty, the entirety of the medical literature on the subject, including textbooks, pubmed, expert analyses of the primary literature from editorials and responses, conference posters and abstracts, all of UpToDate, etc. Such a model would require a technician trained in performance of physical exam, but I bet it will be able to ultimately outperform the best human doctors. Trained off of the actual conversations between doctor and patient, it will be able to take a history and ignore irrelevant details. Providing compassionate responses and steering off-topic people back to the main point are probably already within its capability. Such a model, though, is probably at least 5 years of heavy investment and R&D away, not to mention the medicolegal questions to be answered. Handing over prescriptive authority to AI now is putting a cart that isn’t built before a horse that isn’t born.
It's like the self driving cars experiment. Theoretically lower error rate than humans, but then you get cars that run into walls. For the time being I'd rather ride with a young Uber driver. Will be a long time, if ever, that I trust a computer over a PA even.
 
It's like the self driving cars experiment. Theoretically lower error rate than humans, but then you get cars that run into walls. For the time being I'd rather ride with a young Uber driver. Will be a long time, if ever, that I trust a computer over a PA even.

Once AI becomes sentient an acquires "a will to live," that problem will be self-correcting.
 
Eh no people using AI to ask medical questions and read about health shouldn’t be restricted. Though it will likely be more of a time-consuming PITA to re-orient patients who receive bad information from AI… since “c’mon doc there are studies saying AI are the same or better than you guys!” It would be helpful if AI companies included a disclaimer in bright flashing lights saying the best patient-specific advice will come from their doctor.

But people going out and getting all the imaging and lab tests that they want? For me I think that crosses into the territory of overall being harmful to patients and society. What if Karen wants three CT scans today and has $1000 burning a hole in her pocket. And then a few weeks later Karen hears from an influencer on TikTok that the imaging center across town has a super special CT machine that can pick up on things others don’t. Then she goes and gets more CTs. Then she decides she should get them every 6 months “for monitoring.” Is that a good thing?

Or a gym rat who checks his BMP, has a K of 3.4, see the “L” flag, then and downs a bottle of grandma’s PO potassium…because hey “it’s all natural what could go wrong.”

These may sound far fetched to you, but I have had similar cases to these this in the ED (imaging one was courtesy of an enormously shady set up between a cash only imaging center with a “walk-ins welcome” sign and a urgent care right next-door— patient goes in to the imaging center, imaging center sends patient next-door to the “urgent care” who writes a prescription for whatever images the patient desires and sends them back next door).
As long as there is a potential medical risk, like radiation, I think it's reasonable to require physician involvement.

Your second example of the gym rat is Darwin's law and is necessary to cull the herd. We don't make laws for this.

Obviously my phone is spying on me bc I suddenly started seeing ads for blood tests.

This one says 100+ lab tests per year for a subscription fee.

This is completely fine imo. People should have access to unlimited information. It's the job of despots and fascists to restrict the flow of information.

 
As long as there is a potential medical risk, like radiation, I think it's reasonable to require physician involvement.

Your second example of the gym rat is Darwin's law and is necessary to cull the herd. We don't make laws for this.

Obviously my phone is spying on me bc I suddenly started seeing ads for blood tests.

This one says 100+ lab tests per year for a subscription fee.

This is completely fine imo. People should have access to unlimited information. It's the job of despots and fascists to restrict the flow of information.


In the grand scheme of all of the healthcare “system’s” problems, I have little issue with premise of service you linked to since they do this:
“Test results with Clinician's Summary Receive a comprehensive summary written by our Clinical Team, who review each biomarker to present a detailed perspective on your health. A clinician will call you promptly if any urgent results arise so you are informed and empowered to act.”

Seems gimmicky and it’s probably a weak value proposition for the “patient,” especially since it seems like most of their “care” is delivered by midlevels. But hey, it’s a free country and patients can burn their cash as they like. And it’s probably safer than having the average midlevel as one’s “PCP.”

If you’re interested in the vein of medicine/science that this service seems to offer a watered-down version of, consider checking out this book:

 
There is a very strong anti-science, anti-medicine under current to this administration that is going to have a long-lasting effect on medicine. You’re better off getting an NP and opening a wellness clinic paying a homeless MD/DO $400/month to “supervise” you
 
My understanding is that the KOL's have convened to fix this.

Phew we're saved

Screenshot 2025-03-09 at 3.15.12 PM.png
 
There is a very strong anti-science, anti-medicine under current to this administration that is going to have a long-lasting effect on medicine. You’re better off getting an NP and opening a wellness clinic paying a homeless MD/DO $400/month to “supervise” you
If, by science, you mean blindly following the prominent narrative, and absolutely stifling any and all dissent, then yeah, this is chilling! A dark time...
 
initially I disliked your comment but you are right. The anti-science crowd of Trump, RFK, Oz and their minions and their sycophants are suppressing science and data- and it's chilling.

MTG espousing measles parties?

RFK giving more emphasis on vit A and suggesting steroids and cod liver oil are the way to go with measles? And suspending CDC flu shot advisory meeting and not rescheduling it?
 
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