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Hello!Great question!First things first. This is what Trump tweeted:....and, if Republicans win in court and take back the House of Represenatives, your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not!— Donald J. Trump (@realDonaldTrump) January 13, 2020Needless to say that this is demonstrably false! Trump really takes a bald-faced, Orwellian lie to another level.The facts: People with pre-existing medical problems have health insurance protections because of President Barack Obama's health care law, which Trump is trying to dismantle. Who said again that irony was dead??With “Obamacare” still in place, pre-existing conditions continue to be covered by regular individual health insurance plans.Insurers must take all applicants, regardless of medical history, and charge the same standard premiums to healthy people and those who are in poor health, or have a history of medical problems.Before the Affordable Care Act, any insurer could deny coverage — or charge more — to anyone with a preexisting condition who was seeking to buy an individual policy. Those are irrefutable FACTS! Here’s a link that explains the ACA thoroughly; Affordable Care Act (ACA)However, Texas and 17 other conservative states - backed by Donald Trump’s administration - filed a 2018 lawsuit challenging the law. Why? Because for Republicans it’s all about cruelty, as in taking up to 21 million people’s health care away, and money, as in defending big health insurance companies profits. A district court judge in Texas in 2018 found the entire law unconstitutional. Trump and his administration have been pressing in court for full repeal of the Obama-era law, including provisions that protect people with preexisting conditions from health insurance discrimination.As a matter of fact, while Trump is touting his lawsuit to kill the ACA as the thing that will save health care, his Department of Justice is pleading with the Supreme Court to put off making that decision as long as possible but for goddsakes do it after the election. That doesn't sound like an administration confident in the boss's ability to do intricate policy. Here’s a nice explanatory link for you; Trump, red states ask Supreme Court to refuse Obamacare case before electionThis all happened this morning because Trump’s bigly mad about Michael Bloomberg’s coast to coast TV ads, which attack Trump’s health care record, triggered that. After all, when reading the newspaper while sitting on the toilet and there’s a guy who inherited four hundred million dollars from his Klansman father and turned it into a one point two billion dollar loss lecturing you… Oh no wait, that wasn't Mike Bloomberg, that was you. Mike Bloomberg actually earned his fortune. You jealous impeached dude.Call me crazy but for some odd reason I don't trust the guy who bankrupted casinos, airlines, football leagues, a scam university, etc to provide us with amazing and affordable healthcare…Rest assured that If Trump and Republicans "win in court," all of the guaranteed issue protections are gone. Trump’s asking the court to declare the ACA's protections for pre-existing conditions unconstitutional. Here’s the link to a pdf from the GOP lawsuit. https://affordablecareactlitigat...The truth is that Trump campaigned on repeal and replace Obamacare and came up with nothing to replace with. He has had 3 years to put forth a plan and we've gotten nothing. Trump and the GOP never had a healthcare policy.Furthermore, in early May 2019 The House of Representatives passed a bill that would’ve blocked the Trump administration from granting states the leeway to skirt Obamacare rules —- a measure designed to ensure that patients with pre-existing conditions continue to receive affordable robust coverage — in a 236 to 183 vote. The bill didn’t pass the GOP-controlled Senate, but even if it had done so, Trump threatened to veto the measure.Every House Democrat and four Republicans voted in favor of the bill, H.R. 986, known as the Protecting Americans with Preexisting Conditions Act of 2019. Meanwhile, 183 Republicans voted against it — including members who vowed in 2018 that they would protect people with pre-existing conditions. Here’s the link for you: 183 Republicans vote against bill to protect people with pre-existing conditionsThis is what happened when Obamacare became law:That’s right, the uninsured rate went down from almost 15% uninsured Americans to 9%. And it is rising again under Trump. So don’t fall for Trump’s nonsense my fellow Americans. Trump’s lying and will do everything’s in his power to kill Obamacare…

Interesting question, and I think it requires a 2 part answer to do it justice. Just for fun, let's do it in the style of a case, to make it more interesting.A 44-year-old woman named Julie suddenly loses consciousness and drops in the middle of the office while carrying a stack of papers. Documents fly everywhere as her coworkers frantically call 911. EMS arrives on the scene within 4 minutes...=== PART 1: EMS ===Of course: ABCs. Airway, Breathing, Circulation. If those aren't working, Julie might not even make it to the hospital. 2 EMS personnel immediately secure her airway, get vitals, etc, and a third is assigned to scout for any possible information. No one in the office seems to have any idea of the patient's potential medical issues; she's a new hire, and apparently she just moved to the city after her husband recently passed away from a heart attack. As far as anyone knows, she has no next-of-kin. Not good--there's no one nearby to call, and EMS doesn't have the time to go through every contact in Julie's cell phone praying clairvoyance will lead them to her best friend. EMS checks Julie's wallet--no luck, there's no a medical info card. Crap. Just load and go, load and go, now now now!You have to remember that (1) most people don't carry medical IDs, (2) securing a medical ID isn't always possible before the patient reaches the hospital depending on the gravity of the situation, and (3) EMTs are trained (quite well, I might add) to handle situations where medical IDs aren't available (which is most of the time). But let's suppose, for the sake of argument, that we always look for a medical ID and are guaranteed to find one.Exercise 1 (2 friends required):Take of piece of paper, scribble "MEDICAL ID" and a random word on it, put it in your wallet, put the wallet where you normally do when you go out (pocket, purse, etc), and then lie down on the floor pretending to be unconscious. One friend will be the timer, and the other's task is to find your wallet, secure the piece of paper, and call out the random word to herald the end of the simulation.Debrief:You'll find that with some practice, it takes 5-20 seconds to secure the wallet from an unconscious person if it's on them (depending on clothing/purse), 10-15 seconds to get their medical ID if they have one (assuming they were smart about it and placed it prominently), and then 5 seconds to quickly shout out the information to the rest of the team.That's somewhere in the ballpark of 20-40 seconds that an EMT has to spend looking for relevant info. Pretty good, that's not a whole lot of time required before they can immediately rejoin the rest of the team in treating the patient.Exercise 2:Take a 3- or 4-year-old, wiped Windows laptop running a clean copy of XP, and a fresh USB drive with a protected PDF on it. Plug the USB drive in. Wait for the drivers to install. Keep waiting. 200 years later when it finishes, open the drive. Click open that PDF. Wait for it. Watch as it tells you to install Adobe. Cry foul at the ignominy of your IT person not having the forethought to include a PDF reader when making the image for the comp. Download Adobe. Randomly disconnect your internet, because hey, USB dongles aren't uber-reliable in all parts of the world, even if they're "4G". And outside of Silicon Valley, Free WiFi isn't exactly easy to come by. Finally, Adobe downloaded. Install. Open the PDF. It has a password. Your patient is unconscious. How you would probably feel at this point:Debrief:A bit melodramatic? Yeah, I'll admit it. But not unrealistic. Point is, for delivery of life-saving care, an old-school laminated paper card can handily outclass a USB drive in terms of time.Conclusion: Making EMS personnel deal with a USB drive is an utterly horrible idea. In an emergency, always remember KISS: Keep It Simple, Stupid. Back to the case:EMS have made sure Julie is stable; she can maintain her own airway, she seems to be breathing ok, her pulse is strong, and a preliminary EKG didn't show any life-threatening arrhythmias. Blood glucose stick was normal. Blood pressure was a bit on the low side so an IV is started and 500ml of normal saline is started. They are now rushing her to the nearest ER for further evaluation/treatment...=== PART 2: HOSPITAL COURSE ===Julie arrives at the hospital in stable condition. Her vitals look great, a second EKG done upon arrival still looks completely normal, and other than her lack of consciousness, she seems to be doing fine. Things don't need to be rushed as much here. She's in the hospital, in a shock room, hooked up to monitors, with staff designated to her care.When she arrives and is stripped of her clothing, a more thorough search for belongings turns up a USB drive labeled "Medical info". The physician hands it off to his nearest computer-savvy med student to investigate. "Here, can you look into this?"The med student sticks it into his comp, opens up a PDF titled "Past medical history", correctly guesses the password to be the woman's birthdate on her drivers' license, and gets a complete list of former medical issues: chronic iron-deficiency anemia (likely dietary), and no less than 8 previous episodes of syncope. Huh. Looks like the lady has a history of fainting. The med student pulls up a PDF of her current meds: nothing. Hmm. The student relays the findings to the physician.In a hospital situation, once the emergent stuff is taken care of, that's when a medical USB would be most useful--when there are enough staff there to take care of things in case Julie starts going downhill and also investigate what exactly her known issues are. This is how the med student in the scenario probably feels:Let's finish the scenario:Physician: "Whew, something simple, eh? So she's probably just a bit anemic. We've already sent off for a complete blood count, let's see what the results say."At this point, Julie begins to regain consciousness, and she is quite startled to find herself with an IV and surrounded by medical personnel.Physician: "Ma'am? How are you feeling? You fainted while at work and were brought to the ER."Julie: "Oh geez, it's my anemia again, isn't it? I know I'm supposed to take iron, but I lost my health insurance when my husband died and I just started this new job, so I haven't had the chance to get the prescription filled when my new insurance kicked in..."*beep*Physician: "Well I'm glad we know why you probably fainted. I just got the results back from our machine here, and yeah, your hemoglobin's kind of low. You say you've got a script for that?"Julie: "Yes, I've got the prescription at my pharmacy--just haven't had a chance to fill it. Oof...my head."Physician: "Whoa there, don't push yourself; we'll need to get a CT of your head to make sure you didn't suffer any brain injury when you fainted--that bruise looks like you did hit your head pretty good--but if that's clean, we can arrange for close follow-up and you can go about your way."Julie: "OK, doc, sounds good to me."Med student: "Here's your USB drive back; I'm glad you had this on you, otherwise we would've had to do the shotgun approach and testedeverything."Julie: "Huh, so that dinky little thing my family practitioner gave me before I lost my insurance was actually useful for something, eh?" *grin*Conclusion: While a medical USB would be an utterly genius way to carry around past medical history, it's not very useful in the emergent phase of a scenario--it's far more useful once the patient has been stabilized, and there is some time to evaluate further. Julie was not admitted to the hospital for further work-up, but if she had been, this drive would've been invaluable to the team that received her.Addendum (just for fun):The physician is asked to evaluate his student's performance on the rotation. His response:The med student, upon seeing this evaluation:

Edward Jenner was not the “hero” who first discovered VACCINATIONS in the 1790s for smallpox as most people are taught. The word “vaccination” was coined by one of Jenner’s friends to distinguish his inoculation with cowpox from inoculations with smallpox developed by Chinese physicians 800 years earlier. But both meet that same biomedical definition of vaccine — a biological preparation that provides acquired immunity to a disease, typically made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.In the medieval period (900–1000 AD) Chinese physicians observed that smallpox transmitted by applying pus to a small scratch in the skin was less severe than transmission by someone coughing aerosolized sputum onto another person who breathed that in. They also noticed that dried scabs applied to scratches or nasal membranes did the same thing. That developed into a ritualized practice in which boys would receive the innoculation in the right nostril and girls in the left. Back then smallpox was not just severely disfiguring but deadly; 20–30% of cases were fatal.Because these practices did not control the “dose” of virus being given sometimes the result was a desirable mild rash followed by immunity against smallpox for life — but other times it induced full-blown smallpox that resulted in death. Thus it was not widely known and practiced until the mid 1500s, according to the author Yu T'ien-Chih and recorded in the book Miscellaneous Ideas in Medicine by Yu Chang in 1643. Meanwhile this information had spread to India where the preferred inoculation was scratching or injecting small amounts of smallpox pus under the skin. (BTW, these differences in reduced infectiousness of inoculations compared to natural smallpox transmisstion was confirmed in animal studies in 1906 by Americans Brinckerhoff & Tyzzer who inoculated monkeys in different ways and sites and produced data that matched the Chinese and Indian observations.) Smallpox innoculations spread west in the Ottoman Empire reaching Turkey by the 1700s and also being practiced in North Africa (Sudan).In 1700 English physicians Lister and Havers each published reports in the Transactions of the Royal Society on Chinese inoculations. In 1714 Greek physicians Timonis and Pylarinos who practiced this procedure in Constantinople published a report on their work in Transactions also. Reaction was skeptical until some famous people took note. One was American Cotton Mather who was prominent Massachussets Colony minister, amateur scientist, and notoriously involved in Salem Witch trials. More importantly was English Lady Mary Wortely Montegu who was a poet, writer, and wife of England’s ambassador to Turkey who had gone through her own bout of smallpox and had been disfigured. To protect her children, she had her six-year-old son inoculated while in Turkey, and in 1721, in the presence of Royal Society Members, she had her daughter inoculated in England. This led to adoption of smallpox inoculation, mainly by the aristocracy in England and Central Europe and partly in the American colonies.During America's War of Independence, George Washington had his army inoculated. British troops had the advantage of being exposed to smallpox or being inoculated, but the isolated American colonists were vulnerable. Boston, under military occupation, suffered a smallpox epidemic in 1775, and Philadelphia was hit in 1776. Concern that this would spread to the army was realized when American forces sent to Quebec were decimated by smallpox, not the British, causing Benjamin Franklin to say the army’s downfall would come from smallpox not warfare. There were fears of inoculation in America, stoked partly by a backlash to Cotton Mather’s attempts to promote it, such that the Continental Congress issued a proclamation in 1776 PROHIBITING smallpox inoculation. But Washington wrote Congress in 1777 informing them of his plan to proceed — active soldiers would not be inoculated as to incapacitate them for month of recovery making the army vulnerable to British attack, rather, inoculation would be applied only to new recruits so that they would have gotten over the mild sickness by the time they were trained, outfitted, and ready to fight. Disaster was averted.So inoculation was not a secret in Jenner’s time. In fact, Edward Jenner himself, when he was young boy, was inoculated for smallpox in 1757 .The first *recorded* smallpox vaccination was by Jenner in 1796, but the first *documented* smallpox vaccination was by Benjamin Jesty in 1774, a quarter century earlier. What’s the difference? In one case it was a matter of being published in a scientific or medical forum, and thus properly reported and “recorded” in the scientific literature. In the other case, it was a matter of having been done and written about somewhere like a newspaper or a correspondence. This is not a minor distinction, as the following will show.Jenner did the famous experiment in 1796. He then sent a communication to the Royal Society in 1797 which was rejected with the statement that Jenner “ought not to risk his reputation by presenting to the learned body anything which appeared so much at variance with established knowledge, and withal so incredible.” So he published a booklet himself about his successful cases in 1798 -- that's the date which tends to be cited as the first recorded vaccination.Anyway, the more interesting thing to this discussion is Jesty the Dorset farmer, depicted above. He did vaccinations on his own family decades earlier. It was written about in the local press of his region. Here is Jesty’s story… “Faced with a local outbreak of smallpox in 1774, Jesty devised the idea of inoculating his family with cowpox as a safer alternative to the conventional variolation method. To achieve this goal, he took his family to the hamlet of Chetnole, where he had heard there were cows with symptoms of cowpox. Jesty transferred material from lesions on the cows’ teats to the skin of the arms of his 3 subjects by insertion with a stocking needle. This act occurred 22 years before Jenner’s vaccination of James Phipps. The news soon spread... Correspondence indicates that knowledge of Jesty spread over a significant area of the south of England. This extraordinary event was validated and chronicled by sources in Dorset, including letters from William Dolling, the Reverend Hermann Drew, and the noted physician Dr Richard Pulteney. Direct evidence was recorded by the Reverend Andrew Bell, who interviewed Jesty at Swanage, and again later by the officers of the Original Vaccine Pock Institution in London.... Jesty received some recognition from the Original Vaccine Pock Institution but never from the Jennerian Society or the Royal Society.” (From: Pead, Vaccination’s Forgotten Origins, 2017)Despite lack of official recognition, there was some knowledge of Jesty’s role that circulated British medical circles. Jesty’s wife had a strong reaction which necessitated medical treatment, prompting some public criticism that labeled him a “brute.” A century later, a physician happening upon Jesty's gravestone reported on the inscription in an 1895 issue of British Medical Journal and attested to the validity of Jesty’s experiment prior to Jenner (Vaccination before Jenner). The modern, restored headstone can be seen in this photo: Jesty’s Grave, History of Vaccines.The idea that cowpox prevented smallpox was fairly well known, and this was discussed in various medical and scientific correspondences prior to Jenner’s 1796 experiment. Several physicians wrote about the belief. Among several examples that can be found, a clear statement came from a Shaftsbury surgeon by the name of Nash who died in 1795. Upon his death it was discovered that he left behind a manuscript written in 1781 which stated that cowpox in humans was not contagious, does not cause lesions, and provided reliable protection against smallpox. While that wasn’t published it’s clear that many medical men knew that cowpox blocked smallpox. A Mr. Daniel Sutton, an uncredentialed practitioner who developed a successful technique for smallpox inoculation (variolation) became well known: “In 1766 after thirteen years of activity [he] apparently inoculated twenty thousand persons without long a single one by the Inoculations.” He also became rich — he charged 10 pounds per patient. Sutton had started out testing his technique on poor peasants, and later remarked that many of them had no reaction to the variolation procedure because their resistance to smallpox was due to the fact “that they previously suffered a disease contracted by milking cows with cowpox. [Fewster & Sutton] conducted further research to test this assertion, which appeared to be true; Mr. Fewseter conveyed the information to a medical Society of which we has a member but no one thought to put this valuable observation to good use.” (From H Bazin, Vaccination: A History from Lady Montagu to Genetic Engineering).As for Jetsy’s and Jenner’s actual tests, the issue was well document when it was taken up a in court testimony from Dorset, and in an inquiry by the House of Commons in 1805 that requested evidence.Why court proceedings? Money.The story about Jenner observing the dairy maids getting cow pox and being protected from small pox is known to be apocryphal. Jenner as a lone discoverer was a myth that was purposefully cultivated and concocted later by his biographer. But in the 1800–1805 period, Jenner would be awarded £30,000 in grants by the Crown only after "Originality" had been established. That was a TON OF MONEY in those days. Jenner had a lot to be gained by having the official record show him with sole credit. There's reason to believe Jenner purposely inflated his contribution at the expense of long-known information before him.Here is another excerpt from the Pead article regarding Jenner not mentioning Jesty… "Although Jenner made no mention of Jesty in his writing, it should be noted that he rarely gave credit to the work of predecessors. These included his friend John Fewster, who had discussed cowpox with Jenner at length. Fewster must have influenced Jenner, rather than the dairymaid fable created by Jenner’s biographer John Baron, which has now been discounted. After Jenner’s death, much of his correspondence was burned without permission by Sir Everard Home, but recent scrutiny of associated communications with practitioners in Dorset indicates ways that he could have had knowledge of Jesty…. In 1807, Jenner had published a sevenfold classification of the human intellect, and it is clear from his “fair summary of the common eighteenth century wisdom on mental attitudes” that, believing himself descended from gentry (Baron Kenelem Jenour), he would never have acknowledged a tenant farmer from the “middling sort” class as having the intelligence to conceive and perform a vaccination procedure."But Jesty wasn’t the only one who felt stiffed. There was also a French hospital founder who was cut out. Jacques Antoine Rabaut-Pommier (depicted below) worked out cowpox vaccinations in 1780–84, fifteen years before Jenner.“ His plans to test his observations were interrupted by the French Revolution. However, “through a mutual friend, a Bristol merchant named James Ireland, Rabaut-Pommier passed his observations to an English physician, Dr. Pugh, who promised to pass them on to his colleague Edward Jenner, who was interested in the same problem. After the publication of Jenner's book on vaccination (1798), Rabaut was surprised not to find in it any reference to the suggestions he had made.” In the 19th century the French claimed to have discovered vaccinations before Jenner based on the story of Rabaut-Pommier, but the claim was ignored by the English and everyone else.Throughout this narrative, the word “innocuation” was carefully used as a generic term. Other terms in this story include “vaccination” and “variolation.” Sorting them out is part of the story. During Jenner’s time, the experiments caused the situation to change, so it could be confusing and he felt the need to distinguish what he did. Innoculation is a general term that can be applied to technique pioneered by the earlier Chinese physicians. What they did and everything prior to Jesty/ Rabaut-Pommier/ Jenner involved the use of live smallpox virus itself. Innoculation could also be applied to what Jesty did, but that involved the use of live cowpox virus. Understandably, a distinction became important. Jenner credited his friend and fellow physician, Richard Dunning, with combining “vacca” the the Latin root for “cow” with innocuation and came up with the term “vaccination,” which we continue to use today. But Jenner didn’t stop there. He also wanted a more specific term for the older kind of innoculation, so he combined “variola,” the name of the smallpox virus, with innoculation and came up with the term “variolation.” That distinction was important back in the turn of the 1800–1805 period. But in reading more modern sources one encounters the term “variolation” applied to the old Chinese-based method — that’s fine for being clear about things, but again, that term was invented AFTER Jenner’s experiment by Jenner. It’s a useful distinction for everyone because variolation isn’t completely safe but vaccination is — and it was personally useful for Jenner back then because he needed that ruling on Originality.Jenner tried to take the credit, he succeeded, and went down in history as the guy who conquered smallpox. But he “discovered” something essentially the same as was being done for the previous 800 years outside of Europe, and he “discovered” something that was openly discussed before and during his time, and actually performed right in his own back yard 25 years earlier by Jesty the Dorset farmer.Sources:Gross CP, Sepkowitz KA. The myth of the medical breakthrough: Smallpox, vaccination, and Jenner reconsidered Int J Infect Dis 3(1):54-60, 1998. PubMed PMID: 9831677. (PDF download is free, open source)Pead PJ, Vaccination's Forgotten Origins. Pediatrics 139(4):e20162833, 2017. doi: 10.1542/peds.2016-2833. PMID: 28270548 (PDF download is free, open source)Pauli GC. Vaccination before Jenner. British Medical Journal 2:871, 1895. doi: https://doi.org/10.1136/bmj.2.1814.871-bMilton DK. What was the primary mode of smallpox transmission? Implications for biodefense. Front Cell Infect Microbiol. 2:150, 2012. doi: 10.3389/fcimb.2012.00150. PMID: 23226686 (PDF download is free, open source)David Perlin, D and Cohen A. “Smallpox 12,000 Years of Terrror” and “Variolation: the earliest smallpox vaccines.” The Complete Idiot's Guide to Dangerous Diseases and Epidemics, 2002Filsinger AL, Dwek R. “George Washington and the First Mass Military Innoculation”. Science Reference Services, US Library of Congress, 2009Wikipedia, VariolationLing, G. Origin of smallpox vaccinationTheodorides, J. Rabaut-Pommier, A neglected Precursor Of Jenner. 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