Tag Archives: health care

March 2020 in Review

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To state the obvious, March 2020 was all about the coronavirus. At the beginning of the month, we here in the U.S. watched with horror as it spread through Europe. We were hearing about a few cases in Seattle and California, and stories about people flying back from Italy and entering the greater New York area and other U.S. cities without medical screening. It was horrible, but still something happening mostly to other people far away on TV. In the middle of the month, schools and offices started to close. By the end of the month, it was a full blown crisis overwhelming hospitals in New York and New Jersey and starting to ramp up in other U.S. cities. It’s a little hard to follow my usual format this month but I’ll try. Most frightening and/or depressing story:
  • Hmm…could it be…THE CORONAVIRUS??? The way the CDC dropped the ball on testing and tracking, after preparing for this for years, might be the single most maddening thing of all. There are big mistakes, there are enormously unfathomable mistakes, and then there are mistakes that kill hundreds of thousands of people (at least) and cost tens of trillions of dollars. I got over-excited about Coronavirus dashboards and simulations towards the beginning of month, and kind of tired of looking at them by the end of the month.
Most hopeful story:
  • Some diabetics are hacking their own insulin pumps. Okay, I don’t know if this is a good thing. But if medical device companies are not meeting their patient/customers’ needs, and some of those customers are savvy enough to write software that meets their needs, maybe the medical device companies could learn something.
Most interesting story, that was not particularly frightening or hopeful, or perhaps was a mixture of both:
  • I studied up a little on the emergency powers available to local, state, and the U.S. federal government in a health crisis. Local jurisdictions are generally subordinate to the state, and that is more or less the way it has played out in Pennsylvania. For the most part, the state governor made the policy decisions and Philadelphia added a few details and implemented them. The article I read said that states could choose to put their personnel under CDC direction, but that hasn’t happened. In fact, the CDC seems somewhat absent in all this other than as a provider of public service announcements. The federal government officials we see on TV are from the “Institute of Allergies and Infectious Diseases”, which most people never heard of, and to a certain extent the surgeon general. I suppose my expectations on this were created mostly by Hollywood, and if this were a movie the CDC would be swooping in with white suits and saving us, or possibly incinerating the few to save the many. If this were a movie, the coronavirus would also be mutating into a fog that would seep into my living room and turn me inside out, so at least there’s that.
https://www.youtube.com/watch?v=4chSOb3bY6Y

hospital capacity data visualization

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I was going to stop posting coronavirus tracker apps but this one looks really useful. Now that we know most infected people aren’t tested, the number of confirmed cases isn’t all that helpful as a metric except maybe to look at trends over time. The number of people in the hospital, on the other hand, is a hard number, and comparing that number to hospital capacity is very useful. This app from the University of Washington does that. It also forecasts future hospitalizations and gives a confidence range (which is quite wide, but there it is to ponder.)

This is by state, which is a slightly big and arbitrary geographic unit. Looking at my home state of Pennsylvania, things look almost reassuring, but then looking at New Jersey, they look dire. It would take me five hours to drive to Pittsburgh, Pennsylvania but I could almost spit on Camden, New Jersey. There will clearly be pressure to move patients across state lines within and between nearby metro areas, and in fact that is already in the news this morning.

The situation in New York looks just awful. I didn’t look at all 50 states, but a quick sampling suggests that states with large cities (and by proxy, probably large hospital systems), and states that started social distancing relatively early, are likely to do a lot better. People might think they would be safer in more rural areas, and perhaps it is true that your odds of infection are much lower, but your chances of survival if you do get infected could also be much lower. This is partially speculation and based on a few anecdotes I have heard, but I do know that this trend holds for car accidents and gun shot wounds.

To this water resource engineer, the differences in capacity use between states and the differences in the timing of available capacity suggest that you could move patients around, or move equipment and medical staff around, between regions in an organized way and save lives. Maybe somebody should get on that if they haven’t already.

private equity and surprise medical billing

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This article from Center for Economic and Policy Research (I admit I don’t know much about this organization) claims that private equity firms have bought up medical practices and intentionally insert out-of-network doctors into teams treating you at your in-network hospital. Members of Congress have introduced legislation to curb this, but the financial lobby has been too powerful to beat.

Private equity-owned physician staffing firms grow by buying up many small specialty practices and “rolling them up” into umbrella organizations that serve health care systems across the United States. KKR-owned Envision Healthcare with 69,300 employees, and Blackstone-owned TeamHealth with 20,000 employees, dominate the market for outsourced doctors’ practices. A team of Yale University health economists examined what happened when private equity-owned companies EmCare (part of Envision Healthcare) and TeamHealth took over hospital emergency departments.5 They found that when EmCare took over the management of emergency departments, it nearly doubled its charges for caring for patients compared to the charges billed by previous physician groups. The researchers also found that TeamHealth took a somewhat different tack. It used the threat of sending high out-of-network surprise bills for ER doctors’ services to an insurance company’s covered patients in order to gain high fees from insurance companies as in-network doctors.6 This avoids the situation where a patient gets stuck with a large, surprise medical bill, but it raises premium costs for everyone. In both cases, healthcare costs increase when outsourced emergency rooms and other physician services are owned by private equity firms.

My take: Campaign finance reform and Medicare for All, baby!

how defense cuts could fund Medicare for all

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This New York Times op-ed goes through a series of defense cuts that could save $300 billion per year, enough to fund Medicare for All. The big ones are shutting down the big wars that are accomplishing little or nothing (or worse, creating future enemies and risks), closing foreign bases (and/or asking the foreign countries to fund them if they actually want them there), and phasing out most or all nuclear weapons.

I personally am indifferent between paying a monthly insurance premium vs. a monthly payroll tax to provide the same care at the same cost. But if we could get part of the way there with no tax increases at all, that is even better. Or, we could have a serious discussion about where else some of those current defense dollars could be spent (by the government) that would make us safer, richer, or healthier in the future.

is the U.S. becoming a developing country?

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This Bloomberg article has a list of areas where the U.S. is following behind its peer group of developing nations.

  • roads, highways, bridges
  • high construction costs for all types of infrastructure, particularly high speed rail causing planned projects to be canceled
  • health care costs and outcomes
  • life expectancy
  • maternal mortality
  • rents rising faster than inflation
  • opioid addiction
  • suicide
  • lead in drinking water
  • poverty and hunger

The article offers the cautionary tale of Italy, which has been sliding backward over a decade or so following many years of similarly flashing warning lights before that.

want to know a price? go f— yourself!

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Actually, on this site I am still allowed to say fuck, as far as I know. Why is it hard to type that in the title though? I would probably get more hits. Apologies to any parents out there whose children stumbled across this post. Then again, you should be sheltering them from mind-warping casual violence in entertainment, providing age-appropriate sex education, and teaching them the judicious, appropriate, and occasionally humorous uses of four letter words.

Anyway, this made me laugh. And while it is clearly satire, it is the least fake news I have read today.

Welcome to America General Hospital! Seems you have an oozing head injury there. Let’s check your insurance. Okay, quick “heads up” — ha! — that your plan may not cover everything today. What’s that? You want a reasonable price quote, upfront, for our services? Sorry, let me explain a hospital to you: we give you medical care, then we charge whatever the hell we want for it.

If you don’t like that, go fuck yourself and die…


Fun story: This one time we charged two parents $18,000 for some baby formula. LOL! We pull that shit all the time. Don’t like it? Don’t bring a baby, asshole.

Ha ha. It’s funny ’cause it’s true and it happens to all of us all the time, and we don’t do anything about it.

disturbing numbers on U.S. suicides

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The U.S. suicide rate is climbing alarmingly at a time when rates are falling in other modern democracies. What is going wrong with our society? Other than these three paragraphs, this long article is about some examples of practical steps psychologists can take to prevent suicide.

Over the last two decades, suicide has slowly and then very suddenly announced itself as a full-blown national emergency. Its victims accompany factory closings and the cutting of government assistance. They haunt post-9/11 military bases and hollow the promise of Silicon Valley high schools. Just about everywhere, psychiatric units and crisis hotlines are maxed out. According to the most recent figures from the Centers for Disease Control and Prevention, there are now more than twice as many suicides in the U.S. (45,000) as homicides; they are the 10th leading cause of death. You have to go all the way back to the dawn of the Great Depression to find a similar increase in the suicide rate. Meanwhile, in many other industrialized Western countries, suicides have been flat or steadily decreasing.

What makes these numbers so scary is that they can’t be explained away by any sort of demographic logic. Black women, white men, teenagers, 60-somethings, Hispanics, Native Americans, the rich, the poor—they are all struggling. Suicide rates have spiked in every state but one (Nevada) since 1999. Kate Spade’s and Anthony Bourdain’s deaths were shocking to everybody but the epidemiologists who track the data.

And these are just the reported cases. None of the numbers above account for the thousands of drug overdose deaths that are just suicides by another name. If you widen the lens a bit to include those contemplating suicide, the problem starts to take on the contours of an epidemic. In 2014, the federal government estimated that 9.4 million American adults had seriously considered the idea.

@RealObamaCareForecast

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The Congressional Budget Office has a new forecast of the fate of Obama care over the next 10 years. And the verdict is…the system is not in a death spiral. Premiums are forecast to rise faster than inflation, which is bad, and the number of people without insurance is forecast to rise slightly, which is bad unless you believe for some reason that these people are not entitled to the same human rights you are entitled to, for whatever reason, but that system is “stable”, i.e. not in a “death spiral”

The paragraph below caught my eye for a couple reasons. First, Obama care is only 10% of all government health care expenditures. Medicare is also only about 10%, which is amazing and I suspect almost everyone has the wrong idea about that. Medicaid and the Children’s Health Insurance Program are a whopping 40%.  Subsidies for corporate health insurance are the remaining 40%.

Net federal subsidies for insured people in 2018 will total $685 billion.
That amount is projected to reach $1.2 trillion in 2028. Medicaid and the
Children’s Health Insurance Program account for about 40 percent of that
total, as do subsidies in the form of tax benefits for work-related insurance.
Medicare accounts for about 10 percent, as do subsidies for coverage
obtained through the marketplaces established by the Affordable Care Act
or through the Basic Health Program.

So what surprises me is that we are covering the elderly pretty thoroughly and pretty cost-effectively, while coverage for the poor seems to be both inadequate and extremely cost inefficient. And certainly, the system of hidden tax subsidies for corporate workers is grossly inefficient. So why does the public put up with all this? First, old people love to complain but at the end of the day they are reasonably well taken care of at a reasonable price. Upper-middle-class professional workers receive high quality care and don’t realize how heavily-subsidized and cost-inefficient that care is. These two groups make up a lot of the swing voters. The majority of those swing voters have bought into the decades of neo-fascist propaganda that the poor are undeserving for one reason or another, and therefore their sense of natural human empathy is damped down. and the poor themselves are not politically mobilized. Big business in general might be just as happy for government to take the responsibility for health coverage off their shoulders, but they are not really disadvantaged financially by the present system so they don’t fight it. The big exception of course is the insurance/finance industry which benefits directly from the inefficiencies of the current system, and certainly is politically mobilized.