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  • semiticgoddesssemiticgoddess Member Posts: 14,903
    Apparently Medicare will no longer pay for long-term opioids as of April 2. The idea is to reduce the potential for abuse, since many people who are on painkillers for long durations get addicted and continue dosing even after the original pain should have subsided. The downside is that some people who have chronic conditions and suffer constant pain will have to pay more for painkillers that they do need to use constantly, and some will not be able to afford it.

    I have trouble evaluating this measure. How do you quantify the damage done by opioid addictions that result from overprescription? How do you quantify the damage done by pain that's truly chronic? What's the best way to balance these two competing objectives?
  • deltagodeltago Member Posts: 7,811
    The internet is not America.

    If the free speech argument doesn't work on this very forum, it shouldn’t have to stick with using Microsoft services.

    The key word above is also “publicly.” Privately you can still do what you want, but if you share it on a public forum that is when they will step in.
  • ThacoBellThacoBell Member Posts: 12,235
    Both my mother-in-law and a close friend's mother have fibromaialgia. Without the corect doses of proper pain medicatin (the kind of stuff that is being reduced) they literally bed-ridden. They basically spend the entire rest f their lives in pain.
  • smeagolheartsmeagolheart Member Posts: 7,963
    I'd say perhaps medical Marijuana could fill the void in pain treatment but it's still in a legal gray area of being illegal federaly which can be a huge problem and also some states allow it some of the time.
  • booinyoureyesbooinyoureyes Member Posts: 6,164

    Apparently Medicare will no longer pay for long-term opioids as of April 2. The idea is to reduce the potential for abuse, since many people who are on painkillers for long durations get addicted and continue dosing even after the original pain should have subsided. The downside is that some people who have chronic conditions and suffer constant pain will have to pay more for painkillers that they do need to use constantly, and some will not be able to afford it.

    I have trouble evaluating this measure. How do you quantify the damage done by opioid addictions that result from overprescription? How do you quantify the damage done by pain that's truly chronic? What's the best way to balance these two competing objectives?

    For your consideration on this measure:

    The rule only bans payment for long-term prescriptions of opioids, meaning that patients who need long term use have to seek new prescriptions after the initial prescription expires. The ability to seek a new prescription, while a hassle, will hopefully help mitigate the harm of chronic pain that you are worried about. Also, keep in mind that this rule only effects high dosages. I don't know the specifics, but I imagine that is designed around the chronic pain that you are concerned with; most who use opioids for chronic pain require smaller doses.

    The reason for the rule is not only that people who are on painkillers for long durations get addicted, but also that doctors will have a chance to re-evaluate patients after short periods, to see if they still need opioids for pain treatment.

    The other fear is that those already addicted can front-load use of their prescribed medications, and then seek illicit (and more dangerous) opioids to hold them over until they can get a new prescription. Shortening the

    Arizona has enacted a similar policy, allowing 14-day prescriptions for patients following surgery and 5-day prescriptions in other instances (with various exceptions for oncology treatment, traumatic injuries, etc). Arizona under Doug Ducey is considered to be one of the biggest innovators in combating the opioid crisis, so hopefully the Federal Government following suit will be a good thing. Here is a brief description of Arizona's policy: https://pharmacypmp.az.gov/sites/default/files/Opioid Epidemic Act FAQ (008).pdf
  • semiticgoddesssemiticgoddess Member Posts: 14,903
    Yes. The new change isn't a radical new development. Most folks taking painkillers will not be affected. It's not like the administration is forcing a whole bunch of people to give up their meds; it's just removing a subsidy for people who are taking large doses over long periods of time.
  • booinyoureyesbooinyoureyes Member Posts: 6,164
    ThacoBell said:

    Both my mother-in-law and a close friend's mother have fibromaialgia. Without the corect doses of proper pain medicatin (the kind of stuff that is being reduced) they literally bed-ridden. They basically spend the entire rest f their lives in pain.

    @ThacoBell I'm sorry to hear that. Has your mother in law tried Lyrica? It is supposedly better than opioids at reducing chronic pain for fibromyalgia patients.

    Keep in mind its also quite possible that the doses your mother in law takes are unaffected by the new rule.
  • booinyoureyesbooinyoureyes Member Posts: 6,164

    it's just removing a subsidy for people who are taking large doses over long periods of time.

    But they are still subsidizing shorter duration prescriptions, so their shouldn't be economic effects other than the time and costs of having to return to the doctor more often.
  • booinyoureyesbooinyoureyes Member Posts: 6,164
    edited March 2018

    I'd say perhaps medical Marijuana could fill the void in pain treatment but it's still in a legal gray area of being illegal federaly which can be a huge problem and also some states allow it some of the time.

    It is a possibility, but unfortunately the federal government's categorization of marijuana as a Schedule 1 Drug makes it difficult for pharmaceutical companies to conduct an FDA-regulated study. Even then it would typically require a decade-long study.

    An Israeli company has actually developed a THC-based painkiller, and are in the early stages of testing it. If it proves effective it might shorten the waiting period.

    edit: here is a link to the Israeli company's announcement of their initial results http://intecpharma.com/press-release/intec-pharma-reports-clinical-results-from-phase-i-trial-of-accordion-pill-for-cannabinoid-therapies/
  • MathsorcererMathsorcerer Member Posts: 3,037
    I live in Texas. Once the worst of Harvey had blown past all that was left was flooding and we can deal with flooding. Much of Puerto Rico is *still* a post-apocalyptic wasteland--not only should FEMA have been sent down there sooner and in greater numbers, that Maritime Act (the Jones Act, I think it is) should have been suspended indefinitely.
  • jjstraka34jjstraka34 Member Posts: 9,850
    edited March 2018

    I live in Texas. Once the worst of Harvey had blown past all that was left was flooding and we can deal with flooding. Much of Puerto Rico is *still* a post-apocalyptic wasteland--not only should FEMA have been sent down there sooner and in greater numbers, that Maritime Act (the Jones Act, I think it is) should have been suspended indefinitely.

    It follows a distinct pattern with Trump. Say whatever you have to say to get through the moment, or make some temporary declaration that amounts to nothing. When immigration is the issue, say you want comprehensive reform when sitting next to Diane Feinstein for the cameras, then walk back your entire position 48 hours later and add "shithole countries" to the lexicon. When the gun debate is not able to be ignored, order your Attorney General to ban a certain product without an act of Congress (which is never going to work) to make it SEEM like you are doing something. In regards to Puerto Rico, I think they suspended the Jones Act, for what, ten days?? Was it even that long?? I know it was less than two weeks.....

    It's one thing for a White House Communications Staff to constantly be having to respond to the whims of a 24-hour news cycle. It's quite another to govern based on how you are perceived in the press on a day to day basis.
  • Mantis37Mantis37 Member Posts: 1,177
    A whistleblower from Cambridge Analytica has been testifying before the UK Parliament recently. That company offered its services to one part of the Leave Campaign at a knockdown price, and those campaigns may have circumvented the restrictions on campaign spending. Of particular interest is its relative success in using data obtained from Facebook to target voters. The company is funded by Robert Mercer, who is also a supporter of Donald Trump.

    https://www.theguardian.com/uk-news/2018/mar/27/brexit-groups-had-common-plan-to-avoid-election-spending-laws-says-wylie
  • joluvjoluv Member Posts: 2,137
    Trump now wants the military to pay for his wall [Washington Post]. I don't even know what to say.
  • MathsorcererMathsorcerer Member Posts: 3,037
    joluv said:

    Trump now wants the military to pay for his wall [Washington Post]. I don't even know what to say.

    About 3 or 4 days ago I had made an off-hand comment--it might have been here...it might have been elsewhere--that if Trump wanted to start fulfilling his campaign promises right away he could just use the Army Corps of Engineers to build The Wall.

    I didn't think anyone was watching or would take me seriously.
  • FinneousPJFinneousPJ Member Posts: 6,455
    You're right there, they probably weren't or didn't...
  • MathsorcererMathsorcerer Member Posts: 3,037
    I should have mentioned these earlier: 678,000 views...14,000 likes...nearly 10,000 shares...and 19,600 comments. Gypsy got more coverage than news that there will be no charges against Baton Rouge police in connection with Alton Sterling's death or a video my wife saw of another teen being bullied at school. You know, the sort of bullying which leads directly to uncontrollable anger and outbursts of violence which usually occur with a gun because the victim cannot stand it any more.

    Anyway...a slow news day about a cat on a pole in Phoenix was bigger news and garnered more attention than tragic people-related news.
  • jjstraka34jjstraka34 Member Posts: 9,850
    joluv said:

    Trump now wants the military to pay for his wall [Washington Post]. I don't even know what to say.

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it". And yes, every person at those rallies took it quite literally, despite what they will tell you now. I defy anyone to watch any tape of those dozens of rallies and tell me those people were cheering for a metaphorical wall that Mexico was going to pay for later, somehow. To them, it was a completely realistic proposition. The reason for the retroactive change to what that meant is those people can't admit they were hoodwinked. They thought Trump the deal-maker would somehow extort billions of dollars from the Mexican government. Then, we needed Congressional funding to be paid back later. Now apparently we are going to dip into the defense budget. And 3 simple facts remain: It is March 28th, 2018, Mexico hasn't paid for shit, and Trump has what amounts to a couple wallpaper samples on the Southern border.
  • MathsorcererMathsorcerer Member Posts: 3,037

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
  • jjstraka34jjstraka34 Member Posts: 9,850

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
    True, but Bush the First could have survived that without a recession. I think the Wall/Mexico thing was way more pervasive just given the media landscape. And how outlandish it was.
  • Balrog99Balrog99 Member Posts: 7,367
    edited March 2018

    I should have mentioned these earlier: 678,000 views...14,000 likes...nearly 10,000 shares...and 19,600 comments. Gypsy got more coverage than news that there will be no charges against Baton Rouge police in connection with Alton Sterling's death or a video my wife saw of another teen being bullied at school. You know, the sort of bullying which leads directly to uncontrollable anger and outbursts of violence which usually occur with a gun because the victim cannot stand it any more.

    Anyway...a slow news day about a cat on a pole in Phoenix was bigger news and garnered more attention than tragic people-related news.
    Unfortunately it seems there are a lot of people in this country that value animals more than people. I know a few of them myself. Personally, I think that it's largely an urbanite thing. Those of us who grew up out in the country think a lot differently about animals in general.

    Edit: for instance, I wouldn't dream of calling 911 for an animal. I would call the fire department or animal control directly.
    Post edited by Balrog99 on
  • MathsorcererMathsorcerer Member Posts: 3,037
    Wasn't Bush 41's "no new taxes" a sound byte from only one speech or did he start saying every time a camera was rolling? It has been too many years so I forget. The Wall, though, was a major talking point at every stop on the campaign for Trump.

    Valuing animals is a good thing, in and of itself. I don't think Gypsy needed to be a live news feed, though,
  • booinyoureyesbooinyoureyes Member Posts: 6,164

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
    I'd like to cite "If you like your doctor, you can keep your doctor. If you like your plan, you can keep your plan" but that was more of a bald-faced lie than an unrealistic campaign promise.
  • Grond0Grond0 Member Posts: 7,395

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
    I vaguely remember an article speculating on how he could get out of that one - I think my favorite was to claim he'd said no new taxis.
  • smeagolheartsmeagolheart Member Posts: 7,963

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
    I'd like to cite "If you like your doctor, you can keep your doctor. If you like your plan, you can keep your plan" but that was more of a bald-faced lie than an unrealistic campaign promise.
    If Obama could have written the bill himself he probably would have done that. Unfortunately it was Congress and Republican obstruction was and is still trying to scuttle Obamacare.

    Democrats had drafting errors in the Affordable Care Act, and asked Republicans for years to enable fixes. Republicans refused, instead taking dozens of repeal votes and doing everything they could to undermine Obamacare. They even took some of these glitches to the Supreme Court, in an attempt to throw out large parts of the law because of a typo.

    http://time.com/3935707/supreme-court-obamacare-affordable-care/

    Now when Republicans recklessly passed their lobbyist written tax scam bill with all kinds of drafting mistakes, and they want Democrats to agree to help them solve the problems. Democrats who were shut out of the entire process of the tax law.

    http://thehill.com/policy/healthcare/241524-dems-to-gop-were-ready-to-fix-obamacare-why-arent-you

    https://www.politico.com/story/2017/12/06/tax-plan-glitches-mistakes-republicans-208049
  • UnderstandMouseMagicUnderstandMouseMagic Member Posts: 2,147
    Grond0 said:

    A survey of results of over 0.5m pupils has concluded that grammar schools (selective) don't get better exam results than other schools.

    That study is consistent with previous research I've seen over many years, so why is it that the Department for Education (DfE) response is "Research shows that pupils from disadvantaged backgrounds make better progress across core subjects in selective schools, and attain better results"?

    The answer is it depends on how you look at the results:
    - the above study looks at how pupils would be expected to perform based on a range of factors, e.g. prior attainment, poverty, language ability and age within their peer group. Taking those factors into account selective schools don't improve expected results.
    - the DfE response is based on looking at the performance of pupils against their cohort. A pupil who has high prior attainment will be likely to do better in future than one with low prior attainment. Selective schools take pupils with high prior attainment and those pupils will (on average) perform better than other pupils in their cohort.

    Many years ago I produced the first set of what are now called "value-added" exam results in my local authority - looking at the improvement in individual pupil performances compared to their prior results. At that stage doing that was difficult because pupils' results did not use unique identifiers, so matching results from different years was very time-consuming. Not long after that though the government introduced unique pupil numbers and there has been a steady move over time towards making more use of value added information. Assessing the performance of grammar schools is one of the few areas where this is not done at the government level - as to do so would undercut the political views of the current government.

    Exam performance is strongly linked to social status, so grammar schools are not just academically selective, but socially selective as well - taking a much lower proportion of pupils who receive free school meals than non-selective schools in their area. Whether that's good or bad depends on your point of view, but I would like it if people that support the idea of grammar schools would come clean about the fact that they're really interested in social engineering rather than academic achievement.

    There are only a few areas in the UK that still use grammar schools, but the same basic patterns can be seen in other types of schools as well. Some years ago the government allowed Free Schools to be set up, which are not bound by many of the normal school regulations. Those schools are very varied in nature, but some of them are at least partially selective. In such schools there is a clear trend to take better performing pupils over time, which makes their unadjusted exam results look better in the same way as at grammar schools.

    I'm much less familiar with US schooling, but the information I have seen on that over the years suggests that exactly the same situation applies, i.e. that once you control for other factors the improved exam performance in selective schools disappears. The argument for selection thus becomes essentially a social one, e.g. does attending a more socially homogeneous school better equip you for future life?


    Does anybody care, i.e employers, about "value added" exam results? I would have thought nobody outside the education system gives a damn whether a pupil obtains a "C" rather than an "A" but is then told that the "C" is just as good because of the "added value".

    It's not social enginnering to try and do the best you can as a parent for your child.

    It's social engineering when the state turns round and says parental influence has to be cancelled out by the state to make things "fair".

    And it's so short term. Every country needs the brightest, the most intelligent to do the best they can. And part of that is allowing those parents that can provide the best enviroment for their children to be part of the process. Long term that will earn the money for the state to spend.

    The UK has a very dishonest attitude towards what the "elite" with all their privelidge, all their advantages (private/selective schools ect.) has provided historically and up to now, to the country.

    We have the top ranking Universities not because it's fair, but because we have enough of a very well educated "elite" of our own to make them world beaters.
    Nothing whatsoever to do with equality or fairness.

    We have a ridiculously high ratio of Nobel Prize winners to population because we have an "elite" and all of us benefit from that.
    Nothing to do with fairness or equality.

    The mantra for equality in education never, ever looks at what happens when what actually does so well for the country gets replaced, long term.
    It never tackles the very thorny problem that children grow up in large part outside of education and that has the biggest impact.
    Short of removing children at birth from goddam awful parents, equality in education will always mean holding the brightest back when you look at outcomes.
    And the current equality mantra is to look at "outcomes", from the effing gender pay gap to the effing "diversity" quotas.

    Other countries would give their eye teeth to have so many obtaining the top strata of achievers world wide. And perhaps might be a little bit more honest about how that's achieved.
    And which ultimately keeps the country functioning on all levels.

  • booinyoureyesbooinyoureyes Member Posts: 6,164
    edited March 2018

    There has never been a more blatant campaign promise in the history of Presidential politics than "We're gonna build the wall and make Mexico pay for it".

    I don't know. "Read my lips--No. New. Taxes." is a serious contender for that title.
    I'd like to cite "If you like your doctor, you can keep your doctor. If you like your plan, you can keep your plan" but that was more of a bald-faced lie than an unrealistic campaign promise.
    If Obama could have written the bill himself he probably would have done that. Unfortunately it was Congress and Republican obstruction was and is still trying to scuttle Obamacare.

    Democrats had drafting errors in the Affordable Care Act, and asked Republicans for years to enable fixes. Republicans refused, instead taking dozens of repeal votes and doing everything they could to undermine Obamacare. They even took some of these glitches to the Supreme Court, in an attempt to throw out large parts of the law because of a typo.

    http://time.com/3935707/supreme-court-obamacare-affordable-care/

    Now when Republicans recklessly passed their lobbyist written tax scam bill with all kinds of drafting mistakes, and they want Democrats to agree to help them solve the problems. Democrats who were shut out of the entire process of the tax law.

    http://thehill.com/policy/healthcare/241524-dems-to-gop-were-ready-to-fix-obamacare-why-arent-you

    https://www.politico.com/story/2017/12/06/tax-plan-glitches-mistakes-republicans-208049
    He said this long after the bill was already passed. Hence, it was an intentional lie.


    Also, your claim of "Republican obstruction" on the ACA is wrong. It was passed without a single Republican vote.
  • semiticgoddesssemiticgoddess Member Posts: 14,903
    edited March 2018
    In this case, "Republican obstruction" refers to the GOP's attempts to repeal the ACA and to prevent enforcement of its provisions, not just the GOP's numerous demands during the process of writing the bill (some of which were granted but still resulted in no Republican votes for the bill). It's possible for the GOP to oppose the ACA during the drafting process and also oppose it after it was already passed.
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