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The Unraveling of America

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Wade Davis, an anthropologist who holds the Leadership Chair in Cultures and Ecosystems at Risk at the University of British Columbia and author of award-winning books including Into the Silence and The Wayfinders and his new book, Magdalena: River of Dreams, writes in Rolling Stone:

Never in our lives have we experienced such a global phenomenon. For the first time in the history of the world, all of humanity, informed by the unprecedented reach of digital technology, has come together, focused on the same existential threat, consumed by the same fears and uncertainties, eagerly anticipating the same, as yet unrealized, promises of medical science.

In a single season, civilization has been brought low by a microscopic parasite 10,000 times smaller than a grain of salt. COVID-19 attacks our physical bodies, but also the cultural foundations of our lives, the toolbox of community and connectivity that is for the human what claws and teeth represent to the tiger.

Our interventions to date have largely focused on mitigating the rate of spread, flattening the curve of morbidity. There is no treatment at hand, and no certainty of a vaccine on the near horizon. The fastest vaccine ever developed was for mumps. It took four years. COVID-19 killed 100,000 Americans in four months. There is some evidence that natural infection may not imply immunity, leaving some to question how effective a vaccine will be, even assuming one can be found. And it must be safe. If the global population is to be immunized, lethal complications in just one person in a thousand would imply the death of millions.

Pandemics and plagues have a way of shifting the course of history, and not always in a manner immediately evident to the survivors. In the 14th Century, the Black Death killed close to half of Europe’s population. A scarcity of labor led to increased wages. Rising expectations culminated in the Peasants Revolt of 1381, an inflection point that marked the beginning of the end of the feudal order that had dominated medieval Europe for a thousand years.

The COVID pandemic will be remembered as such a moment in history, a seminal event whose significance will unfold only in the wake of the crisis. It will mark this era much as the 1914 assassination of Archduke Ferdinand, the stock market crash of 1929, and the 1933 ascent of Adolf Hitler became fundamental benchmarks of the last century, all harbingers of greater and more consequential outcomes.

COVID’s historic significance lies not in what it implies for our daily lives. Change, after all, is the one constant when it comes to culture. All peoples in all places at all times are always dancing with new possibilities for life. As companies eliminate or downsize central offices, employees work from home, restaurants close, shopping malls shutter, streaming brings entertainment and sporting events into the home, and airline travel becomes ever more problematic and miserable, people will adapt, as we’ve always done. Fluidity of memory and a capacity to forget is perhaps the most haunting trait of our species. As history confirms, it allows us to come to terms with any degree of social, moral, or environmental degradation.

To be sure, financial uncertainty will cast a long shadow. Hovering over the global economy for some time will be the sober realization that all the money in the hands of all the nations on Earth will never be enough to offset the losses sustained when an entire world ceases to function, with workers and businesses everywhere facing a choice between economic and biological survival.

Unsettling as these transitions and circumstances will be, short of a complete economic collapse, none stands out as a turning point in history. But what surely does is the absolutely devastating impact that the pandemic has had on the reputation and international standing of the United States of America.

In a dark season of pestilence, COVID has reduced to tatters the illusion of American exceptionalism. At the height of the crisis, with more than 2,000 dying each day, Americans found themselves members of a failed state, ruled by a dysfunctional and incompetent government largely responsible for death rates that added a tragic coda to America’s claim to supremacy in the world.

For the first time, the international community felt compelled to send disaster relief to Washington. For more than two centuries, reported the Irish Times, “the United States has stirred a very wide range of feelings in the rest of the world: love and hatred, fear and hope, envy and contempt, awe and anger. But there is one emotion that has never been directed towards the U.S. until now: pity.” As American doctors and nurses eagerly awaited emergency airlifts of basic supplies from China, the hinge of history opened to the Asian century.

No empire long endures, even if few anticipate their demise. Every kingdom is born to die. The 15th century belonged to the Portuguese, the 16th to Spain, 17th to the Dutch. France dominated the 18th and Britain the 19th. Bled white and left bankrupt by the Great War, the British maintained a pretense of domination as late as 1935, when the empire reached its greatest geographical extent. By then, of course, the torch had long passed into the hands of America.

In 1940, with Europe already ablaze, the United States had a smaller army than either Portugal or Bulgaria. Within four years, 18 million men and women would serve in uniform, with millions more working double shifts in mines and factories that made America, as President Roosevelt promised, the arsenal of democracy.

When the Japanese within six weeks of Pearl Harbor took control of 90 percent of the world’s rubber supply, the U.S. dropped the speed limit to 35 mph to protect tires, and then, in three years, invented from scratch a synthetic-rubber industry that allowed Allied armies to roll over the Nazis. At its peak, Henry Ford’s Willow Run Plant produced a B-24 Liberator every two hours, around the clock. Shipyards in Long Beach and Sausalito spat out Liberty ships at a rate of two a day for four years; the record was a ship built in four days, 15 hours and 29 minutes. A single American factory, Chrysler’s Detroit Arsenal, built more tanks than the whole of the Third Reich.

In the wake of the war, with Europe and Japan in ashes, the United States with but 6 percent of the world’s population accounted for half of the global economy, including the production of 93 percent of all automobiles. Such economic dominance birthed a vibrant middle class, a trade union movement that allowed a single breadwinner with limited education to own a home and a car, support a family, and send his kids to good schools. It was not by any means a perfect world but affluence allowed for a truce between capital and labor, a reciprocity of opportunity in a time of rapid growth and declining income inequality, marked by high tax rates for the wealthy, who were by no means the only beneficiaries of a golden age of American capitalism.

But freedom and affluence came with a price. The United States, virtually a demilitarized nation on the eve of the Second World War, never stood down in the wake of victory. To this day, American troops are deployed in 150 countries. Since the 1970s, China has not once gone to war; the U.S. has not spent a day at peace. President Jimmy Carter recently noted that in its 242-year history, America has enjoyed only 16 years of peace, making it, as he wrote, “the most warlike nation in the history of the world.” Since 2001, the U.S. has spent over $6 trillion on military operations and war, money that might have been invested in the infrastructure of home. China, meanwhile, built its nation, pouring more cement every three years than America did in the entire 20th century.

As America policed the world, the violence came home. On D-Day, June 6th, 1944, the Allied death toll was 4,414; in 2019, domestic gun violence had killed that many American men and women by the end of April. By June of that year, guns in the hands of ordinary Americans had caused more casualties than the Allies suffered in Normandy in the first month of a campaign that consumed the military strength of five nations.

More than any other country, the United States in the post-war era lionized the individual at the expense of community and family. It was the sociological equivalent of splitting the atom. What was gained in terms of mobility and personal freedom came at the expense of common purpose. In wide swaths of America, the family as an institution lost its grounding. By the 1960s, 40 percent of marriages were ending in divorce. Only six percent of American homes had grandparents living beneath the same roof as grandchildren; elders were abandoned to retirement homes.

With slogans like “24/7” celebrating complete dedication to the workplace, men and women exhausted themselves in jobs that only reinforced their isolation from their families. The average American father spends less than 20 minutes a day in direct communication with his child. By the time a youth reaches 18, he or she will have spent fully two years watching television or staring at a laptop screen, contributing to an obesity epidemic that the Joint Chiefs have called a national security crisis.

Only half of Americans report having meaningful, face-to-face social interactions on a daily basis. The nation consumes two-thirds of the world’s production of antidepressant drugs. The collapse of the working-class family has been responsible in part for an opioid crisis that has displaced car accidents as the leading cause of death for Americans under 50.

At the root of this transformation and decline lies an ever-widening chasm between Americans who have and those who have little or nothing. Economic disparities exist in all nations, creating a tension that can be as disruptive as the inequities are unjust. In any number of settings, however, the negative forces tearing apart a society are mitigated or even muted if there are other elements that reinforce social solidarity — religious faith, the strength and comfort of family, the pride of tradition, fidelity to the land, a spirit of place.

But when all the old certainties are shown to be lies, when the promise of a good life for a working family is shattered as factories close and corporate leaders, growing wealthier by the day, ship jobs abroad, the social contract is irrevocably broken. For two generations, America has celebrated globalization with iconic intensity, when, as any working man or woman can see, it’s nothing more than capital on the prowl in search of ever cheaper sources of labor.

For many years, those on the conservative right in the United States have invoked a nostalgia for the 1950s, and an America that never was, but has to be presumed to have existed to rationalize their sense of loss and abandonment, their fear of change, their bitter resentments and lingering contempt for the social movements of the 1960s, a time of new aspirations for women, gays, and people of color. In truth, at least in economic terms, the country of the 1950s resembled Denmark as much as the America of today. Marginal tax rates for the wealthy were 90 percent. The salaries of CEOs were, on average, just 20 times that of their mid-management employees.

Today, the base pay of those at the top is commonly 400 times that of their salaried staff, with many earning orders of magnitude more in stock options and perks. The elite one percent of Americans control $30 trillion of assets, while the bottom half have more debt than assets.  . .

Continue reading. There’s much more.

Later in the article:

Finns live longer and are less likely to die in childhood or in giving birth than Americans. Danes earn roughly the same after-tax income as Americans, while working 20 percent less. They pay in taxes an extra 19 cents for every dollar earned. But in return they get free health care, free education from pre-school through university, and the opportunity to prosper in a thriving free-market economy with dramatically lower levels of poverty, homelessness, crime, and inequality. The average worker is paid better, treated more respectfully, and rewarded with life insurance, pension plans, maternity leave, and six weeks of paid vacation a year. All of these benefits only inspire Danes to work harder, with fully 80 percent of men and women aged 16 to 64 engaged in the labor force, a figure far higher than that of the United States.

Written by LeisureGuy

9 August 2020 at 11:36 am

The health care scare

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Confession relieves one of a moral burden, but this confession strikes me as rather late.

Wendell Potter @wendellpotter is a former vice president of Cigna who became a whistleblower against the health insurance industry. He serves as president of the Center for Health and Democracy.

He writes in the Washington Post:

In my prior life as an insurance executive, it was my job to deceive Americans about their health care. I misled people to protect profits. In fact, one of my major objectives, as a corporate propagandist, was to do my part to “enhance shareholder value.” That work contributed directly to a climate in which fewer people are insured, which has shaped our nation’s struggle against the coronavirus, a condition that we can fight only if everyone is willing and able to get medical treatment. Had spokesmen like me not been paid to obscure important truths about the differences between the U.S. and Canadian health-care systems, tens of thousands of Americans who have died during the pandemic might still be alive.

In 2007, I was working as vice president of corporate communications for Cigna. That summer, Michael Moore was preparing to release his latest documentary, “Sicko,” contrasting American health care with that in other rich countries. (Naturally, we looked terrible.) I spent months meeting secretly with my counterparts at other big insurers to plot our assault on the film, which contained many anecdotes about patients who had been denied coverage for important treatments. One example was 3-year-old Annette Noe. When her parents asked Cigna to pay for two cochlear implants that would allow her to hear, we agreed to cover only one.

Clearly my colleagues and I would need a robust defense. On a task force for the industry’s biggest trade association, America’s Health Insurance Plans (AHIP), we talked about how we might make health-care systems in Canada, France, Britain and even Cuba look just as bad as ours. We enlisted APCO Worldwide, a giant PR firm. Agents there worked with AHIP to put together a binder of laminated talking points for company flacks like me to use in news releases and statements to reporters.

Here’s an example from one AHIP brief in the binder: “A May 2004 poll found that 87% of Canada’s business leaders would support seeking health care outside the government system if they had a pressing medical concern.” The source was a 2004 book by Sally Pipes, president of the industry-supported Pacific Research Institute, titled “Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer.” Another bullet point, from the same book, quoted the CEO of the Canadian Association of Radiologists as saying that “the radiology equipment in Canada is so bad that ‘without immediate action radiologists will no longer be able to guarantee the reliability and quality of examinations.’ ”

Much of this runs against the experience of many Americans, especially the millions who take advantage of low pharmaceutical prices in Canada to meet their prescription needs. But there were more specific reasons to be skeptical of those claims. We didn’t know, for example, who conducted that 2004 survey or anything about the sample size or methodology — or even what criteria were used to determine who qualified as a “business leader.” We didn’t know if the assertion about imaging equipment was based on reliable data or was an opinion. You could easily turn up comparable complaints about outdated equipment at U.S. hospitals.

(Contacted by The Washington Post, an AHIP spokesman said this perspective was “from the pre-ACA past. We are future focused by building on what works and fixing what doesn’t.” He added that the organization “believes everyone deserves affordable, high-quality coverage and care — regardless of health status, income, or pre-existing conditions.” An APCO Worldwide spokesperson told The Post that the company “has been involved in supporting our clients with the evolution of the health care system. We are proud of our work.” Cigna did not respond to requests for comment.)

Nevertheless, I spent much of that year as an industry spokesman, my last after 20 years in the business, spreading AHIP’s “information” to journalists and lawmakers to create the impression that our health-care system was far superior to Canada’s, which we wanted people to believe was on the verge of collapse. The campaign worked. Stories began to appear in the press that cast the Canadian system in a negative light. And when Democrats began writing what would become the Affordable Care Act in early 2009, they gave no serious consideration to a publicly financed system like Canada’s. We succeeded so wildly at defining that idea as radical that Sen. Max Baucus (D-Mont.), then chair of the Senate Finance Committee, had single-payer supporters ejected from a hearing.

Today, the respective responses of Canada and the United States to the coronavirus pandemic prove just how false the ideas I helped spread were. There are more than three times as many coronavirus infections per capita in the United States, and the mortality rate is twice the rate in Canada. And although we now test more people per capita, our northern neighbor had much earlier successes with testing, which helped make a difference throughout the pandemic.

The most effective myth we perpetuated — the industry trots it out whenever major reform is proposed — is that Canadians and people in other single-payer countries have to endure long waits for needed care. Just last year, in a statement submitted to a congressional committee for a hearing on the Medicare for All Act of 2019, AHIP maintained that “patients would pay more to wait longer for worse care” under a single-payer system.

While it’s true that Canadians sometimes have to wait weeks or months for elective procedures (knee replacements are often cited), the truth is that they do not have to wait at all for the vast majority of medical services. And, contrary to another myth I used to peddle — that Canadian doctors are flocking to the United States — there are more doctors per 1,000 people in Canada than here. Canadians see their doctors an average of 6.8 times a year, compared with just four times a year in this country.

Most important, no one in Canada is turned away from doctors because of a lack of funds, and Canadians can get tested and treated for the coronavirus without fear of receiving a budget-busting medical bill. That undoubtedly is one of the reasons Canada’s covid-19 death rate is so much lower than ours. In America, exorbitant bills are a defining feature of our health-care system. Despite the assurances from President Trump and members of Congress that covid-19 patients will not be charged for testing or treatment, they are on the hook for big bills, according to numerous reports.

That is not the case in Canada, where there are no co-pays, deductibles or coinsurance for covered benefits. Care is free at the point of service. And those laid off in Canada don’t face the worry of losing their health insurance. In the United States, by contrast, . . .

Continue reading.

Written by LeisureGuy

8 August 2020 at 5:47 pm

“It’s the healthcare system, stupid”

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Charles Frank writes in Le Monde Diplomatique:

The great underlying political crisis of this plague year, it is often said, is the stubborn refusal of Americans to respect expert authority. There’s an epidemic raging… and just look at those people frolicking in a swimming pool at the Lake of the Ozarks, repeating stupid conspiracy theories, spreading non-peer-reviewed medical advice on social media, running errands without a mask on, setting off roman candles in the street. And just look at their idiot of a president, dismissing the advice of his own medical experts, blaming everyone but himself for the disaster, suggesting we inject ourselves with Clorox because it’s effective on countertops and toilet bowls.

In truth, this grand conflict between the ignorant and the enlightened has been a motif of our politics for years (1). Liberals, we believe, are uniquely attuned to objective reality; they dutifully heed the words of Nobel laureates and Genius Grant winners. But Republicans are different: they live in a world of myth and fable where the truth does not apply.

Ordinarily our punditburo plays this conflict for simple partisan point-scoring. Us: smart! Them: stupid!

But the pandemic has given the conflict an urgency we have not seen before. These days, right-thinking Americans are tearfully declaring their eternal and unswerving faith in science. Democratic leaders are urging our disease-stricken country to heed the findings of medical experts as though they were the word of God.

Our ‘thought leaders’, meanwhile, have developed a theory for understanding the crazy behaviour we see around us: these misguided people are not merely stupid, they are in the grip of a full-blown philosophy of anti-expertise called ‘populism’. These populists are the unlettered who resent the educated and sneer at the learned (2). They believe in hunches instead of scholarship; they flout the advice of the medical profession; they extol the wisdom of the mob. Populism is science’s enemy; it is at war with sound thinking. It is an enabler of disease, if not a disease itself.

So sweetly flattering, so gorgeously attractive is this tidy little syllogism that members of our country’s thinking class return to it again and again. Medical science is so obviously right and populism so obviously wrong that celebrating the one and deploring the other has become for them one of the great literary set pieces of the era, the raw material for endless columns and articles.

Crushing national failure

Unfortunately, it’s all a mistake. Donald Trump’s prodigious stupidity is not the sole cause of our crushing national failure to beat the coronavirus. Plenty of blame must also go to our screwed-up healthcare system, which scorns the very idea of public health and treats access to medical care as a private luxury that is rightfully available only to some. It is the healthcare system, not Trump, that routinely denies people treatment if they lack insurance; that bankrupts people for ordinary therapies; that strips people of their coverage when they lose their jobs — and millions of people are losing their jobs in this pandemic. It is the healthcare system that, when a Covid treatment finally arrives, will almost certainly charge Americans a hefty price to receive it (3).

And that system is the way it is because organised medicine has for almost a century used the prestige of expertise to keep it that way.

Populism, meanwhile, was the reform impulse that tried (and failed) to change the system so that it served ordinary people.

Which is to say that the pundits and the scholars and the thinktankers in their grave solemnity have got it entirely backward. Bowing down before expertise is precisely what has made public health an impossible dream. And the populism that our pundits so hate and fear is, in fact, the cure for what ails us.

Who was a populist?

Begin with the word. The term ‘Populist’ was coined in Kansas in 1891 to describe members of a brand-new American farmer-labour party who demanded a modern currency, a war on monopoly, and the nationalisation of the railroads. The movement caught fire, and the people who called themselves Populists seemed poised to succeed at first. Instead, their party fizzled out by the end of that decade. Still, Populism’s influence lived on for decades; its ideas can be traced through the American Socialist Party, the New Deal of the 1930s and 40s, and the Bernie Sanders campaigns of 2016 and 2020.

The rise and fall of the American Populists — again, the people who invented the word — has long been a favourite subject of romantically inclined historians. The Populist party’s principles and its leading figures are well known to scholars and are the subject of many books.

A curious fact that is repeated often in those books: the Populists were not opponents of science or learning. On the contrary: Populists produced homages to technology and scholarship and education that were so earnest and ornate that they are embarrassing to read today. They thought their own ideas about regulation and the welfare state were in full alignment with the scientific advances of the late 19th century.

At the same time, the Pops fought endlessly with the business and academic elites of their day — experts who regarded the established order as the work of God. Populists regarded all special privilege with suspicion, including the prestige that props up the professional class. A clear illustration of this theme can be seen in the famous Garden of Eden sculpture garden in Lucas, Kansas, which was built as a primer on Populist/socialist principles. One of its focal points is a rendering of ‘Labour crucified’ and the people who can be seen torturing the working man to death are society’s honoured professionals: banker, lawyer, doctor, preacher.

The Populist way of looking at things was radically democratic: the people came first. The correct role of experts, the original Populists thought, was to serve and inform the people as they went about their lives as citizens of a democracy.

The original Populist movement didn’t have much to say about healthcare policy. In the 1890s, American medicine had not yet hardened into the supremely costly bureaucratic labyrinth we know today. But as the price of medicine grew out of reach in the decades that followed, farmers and unions and charities proposed all kinds of alternative, more democratic arrangements, and always with the same aim: to make healthcare an affordable part of life for ordinary, working-class people. . .

Continue reading.

Written by LeisureGuy

7 August 2020 at 4:29 pm

How the Pandemic Defeated America

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Ed Yong  writes in the Atlantic:

How did it come to this? A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS‑CoV‑2—the new coronavirus behind the disease COVID‑19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID‑19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.

Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable. A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread. A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID‑19. The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood. The same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories during the 2020 pandemic.

The U.S. has little excuse for its inattention. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. In 2018, I wrote an article for The Atlantic arguing that the U.S. was not ready for a pandemic, and sounded warnings about the fragility of the nation’s health-care system and the slow process of creating a vaccine. But the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is something of an anti-Goldilocks virus: just bad enough in every way. Its symptoms can be severe enough to kill millions but are often mild enough to allow infections to move undetected through a population. It spreads quickly enough to overload hospitals, but slowly enough that statistics don’t spike until too late. These traits made the virus harder to control, but they also softened the pandemic’s punch. SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,” Zeynep Tufekci, a sociologist at the University of North Carolina and an Atlantic contributing writer, asked me.

Despite its epochal effects, COVID‑19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us. It needs a full accounting of every recent misstep and foundational sin, every unattended weakness and unheeded warning, every festering wound and reopened scar.

Apandemic can be prevented in two ways: Stop an infection from ever arising, or stop an infection from becoming thousands more. The first way is likely impossible. There are simply too many viruses and too many animals that harbor them. Bats alone could host thousands of unknown coronaviruses; in some Chinese caves, one out of every 20 bats is infected. Many people live near these caves, shelter in them, or collect guano from them for fertilizer. Thousands of bats also fly over these people’s villages and roost in their homes, creating opportunities for the bats’ viral stowaways to spill over into human hosts. Based on antibody testing in rural parts of China, Peter Daszak of EcoHealth Alliance, a nonprofit that studies emerging diseases, estimates that such viruses infect a substantial number of people every year. “Most infected people don’t know about it, and most of the viruses aren’t transmissible,” Daszak says. But it takes just one transmissible virus to start a pandemic.

Sometime in late 2019, the wrong virus left a bat and ended up, perhaps via an intermediate host, in a human—and another, and another. Eventually it found its way to the Huanan seafood market, and jumped into dozens of new hosts in an explosive super-spreading event. The COVID‑19 pandemic had begun.

“There is no way to get spillover of everything to zero,” Colin Carlson, an ecologist at Georgetown University, told me. Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

Curtailing those viruses after they spill over is more feasible, but requires knowledge, transparency, and decisiveness that were lacking in 2020. Much about coronaviruses is still unknown. There are no surveillance networks for detecting them as there are for influenza. There are no approved treatments or vaccines. Coronaviruses were formerly a niche family, of mainly veterinary importance. Four decades ago, just 60 or so scientists attended the first international meeting on coronaviruses. Their ranks swelled after SARS swept the world in 2003, but quickly dwindled as a spike in funding vanished. The same thing happened after MERS emerged in 2012. This year, the world’s coronavirus experts—and there still aren’t many—had to postpone their triennial conference in the Netherlands because SARS‑CoV‑2 made flying too risky.

In the age of cheap air travel, an outbreak that begins on one continent can easily reach the others. SARS already demonstrated that in 2003, and more than twice as many people now travel by plane every year. To avert a pandemic, affected nations must alert their neighbors quickly. In 2003, China covered up the early spread of SARS, allowing the new disease to gain a foothold, and in 2020, history repeated itself. The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans, and only confirmed as much on January 20, after millions had traveled around the country for the lunar new year. Doctors who tried to raise the alarm were censured and threatened. One, Li Wenliang, later died of COVID‑19. The World Health Organization initially parroted China’s line and did not declare a public-health emergency of international concern until January 30. By then, an estimated 10,000 people in 20 countries had been infected, and the virus was spreading fast.

The United States has correctly castigated China for its duplicity and the WHO for its laxity—but the U.S. has also failed the international community. Under President Donald Trump, the U.S. has withdrawn from several international partnerships and antagonized its allies. It has a seat on the WHO’s executive board, but left that position empty for more than two years, only filling it this May, when the pandemic was in full swing. Since 2017, Trump has pulled more than 30 staffers out of the Centers for Disease Control and Prevention’s office in China, who could have warned about the spreading coronavirus. Last July, he defunded an American epidemiologist embedded within China’s CDC. America First was America oblivious.

Even after warnings reached the U.S., they fell on the wrong ears. Since before his election, Trump has cavalierly dismissed expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was twice ignored.

Being prepared means being ready to . . .

Continue reading. There’s more — and no paywall.

Written by LeisureGuy

5 August 2020 at 4:09 pm

President Trump promised a rollout of an overhaul to the US healthcare system within two weeks

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The promise was made two weeks ago. I can find no signs of the overhaul of the US healthcare system, but I did find this report by Anne Gearan, Amy Goldstein, and Seung Min Kima in the Washington Post:

It was a bold claim when President Trump said that he was about to produce an overhaul of the nation’s health-care system, at last doing away with the Affordable Care Act, which he has long promised to abolish.

“We’re signing a health-care plan within two weeks, a full and complete health-care plan,” Trump pledged in a July 19 interview with “Fox News Sunday” anchor Chris Wallace.

Now, with the two weeks expiring Sunday, there is no evidence that the administration has designed a replacement for the 2010 health-care law. Instead, there is a sense of familiarity.

Repeatedly and starting before he took office, Trump has vowed that he is on the cusp of delivering a full-fledged plan to reshape the health-care system along conservative lines and replace the central domestic achievement of Barack Obama’s presidency.

No total revamp has ever emerged.

Trump’s latest promise comes amid the outbreak of the novel coronavirus, which has infected millions, caused more than 150,000 deaths and cost Americans their work and the health benefits that often come with jobs. His vow comes three months before the presidential election and at a time when Trump’s Republican allies in Congress may least want to revisit an issue that was a political loser for the party in the 2018 midterm elections.

Yet Trump has returned to the theme in recent days.

“We’re going to be doing a health-care plan. We’re going to be doing a very inclusive health-care plan. I’ll be signing it sometime very soon,” Trump said during an exchange with reporters at an event in Belleair, Fla., on Friday. When a reporter noted that he told Fox’s Wallace that he would sign it in two weeks, Trump added: “Might be Sunday. But it’s going to be very soon.”

Trump’s decision to revive a health-care promise that he has failed to deliver on — this time with less than 100 days before Election Day — carries political risks. Although it may appeal to voters who don’t like the ACA, it also highlights his party’s inability to come up with an alternative, despite spending almost a decade promising one.

It also raises questions about what exactly his plan would look like and whether it would cover fewer Americans than the current system as the pandemic ravages the country. . .

Continue reading.

Today was the day President Trump said he would reveal the plan.

Why do some people continue to support this lying buffoon?

Written by LeisureGuy

2 August 2020 at 1:42 pm

How a $175 COVID-19 Test Led to $2,479 in Charges in The Best Healthcare System in the World™

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Marshall Allan reports in ProPublica:

As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.

Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.

De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.

The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000.

De Cordova didn’t think her fees for the test could rise into the six figures. But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook. She knew she couldn’t sign the document. But that created a problem: She still needed to get her test results.

Even in a public health emergency, what could be considered the first rule of American health care is still in effect: There is no set price. Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them. Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact.

The CARES Act, passed by Congress in March, includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests. Insurance representatives told ProPublica that the charge for a COVID-19 test in Texas can range from less than $100 to thousands of dollars. Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment, insurance representatives said. Some costs may be passed on to the patient, depending on their coverage and the circumstances.

As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”

Dr. Hashibul Hannan, an emergency room physician, lab director and manager at SignatureCare, told ProPublica his facility is an emergency room that offers testing, not a typical testing site. He said de Cordova should have been allowed to pay the $175 cash price. The staff members were concerned about being accused of fraud because they had already entered her insurance information into the record, he said. So they didn’t want it to appear she was being double-billed. Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law.

Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test.

“I Would Have Signed Anything”

Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.

Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.

So just to be safe, on June 12, Charara took their son to the same SignatureCare, the Heights location, for a COVID-19 test. The line was so long they had to wait for hours, go home, come back and wait for hours again in their car in the 100-degree heat. Charara, a poet who teaches at the University of Houston, said he didn’t take a close look at the financial disclosure paperwork. De Cordova wasn’t with them. It had been 10 hours of waiting by the time the boy was tested, so “I would have signed anything,” he said. (The child tested negative.)

Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.

The facility fee was $1,784 and the physician fee $486.

The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said. . .

Continue reading. There’s more including photos of the paperwork.

Written by LeisureGuy

1 August 2020 at 1:51 pm

Trump administration “war on coronavirus” has some flaws

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Remember when Trump claimed he was a “wartime President” because of his role in directing the fight against Covid-19? (And also remember when he said he would accept no responsibility for what happened?)

It doesn’t seem to be going well. From Kevin Drum’s daily tracking post this moring:

Written by LeisureGuy

30 July 2020 at 10:08 am

Hospitals Are Suddenly Short of Young Doctors — Because of Trump’s Visa Ban

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Donald Trump actively works against American strength and security. Dara Lind reports in ProPublica on one example:

As hospitals across the United States brace for a difficult six months — with the first wave of the coronavirus pandemic still raging and concerns about a second wave in the fall — some are acutely short-staffed because of an ill-timed change to immigration policy and its inconsistent implementation.

proclamation issued by President Donald Trump on June 22, barring the entry of most immigrants on work visas, came right as hospitals were expecting a new class of medical residents. Hundreds of young doctors were unable to start their residencies on time.

Trump’s order included the H1-B visa for highly skilled workers, which is used by some practicing doctors abroad who get U.S. residency slots. The proclamation stated that doctors “involved with the provision of medical care to individuals who have contracted COVID-19 and are currently hospitalized” should be exempt from the ban, but it delegated the issuing of guidance to the departments of State and Homeland Security. That guidance has been slow and inconsistent.

Many consulates started approving doctors’ visas on Thursday, after ProPublica asked the State Department about the delay. Others say they’re still awaiting guidance.

At hospitals where many incoming residents are visa holders, even a delay of a few weeks in arriving in the U.S. creates a staffing crisis. Doctors and administrators are afraid that the repercussions will last for the rest of the year — leaving them overworked and ill-prepared even before a second wave of the virus hits.

ProPublica has heard from 10 would-be medical residents stuck abroad because of H1-B visa issues. Six of them had gotten emergency consulate appointments for visa approval, but when they arrived for meetings they were told their visas could not be approved. Three were still waiting on DHS approval for their visas, a necessary step before a visa gets a consulate stamp. One resident had application approval but was denied an emergency consulate interview appointment because of the ban. All were destined for hospital positions treating COVID-19 patients.

The State Department told ProPublica on Tuesday that it, “in conjunction with the Department of Homeland Security and interagency partners, is establishing and implementing procedures” for the visa ban, and that it “has communicated and will continue to communicate implementation procedures” to consulates abroad.

On Thursday, the State Department’s website posted guidance, spelling out that doctors treating COVID-19 patients were exempt from the ban. On that day, many of the residents ProPublica spoke to said they had suddenly received visa approvals. “A quite remarkable turnaround, given that I received a rejection email three days ago,” one said. In at least five countries, however, consulates were still not processing doctors’ visas.

The Committee of Interns and Residents, an affiliate of the Service Employees International Union, has heard from over 250 interns stuck abroad. Over 150 of them are on H-1B visas.. (The others are on visas that weren’t covered in Trump’s ban, but can’t get approval because their consulates are still closed due to the pandemic.) Union president Jessica Edwards pointed out to ProPublica that while that number may sound small, each intern is responsible for the care of thousands of patients.

As of 2017, there were 2,532 medical residents on H1-B visas, according to the Journal of the American Medical Association — though the Trump administration’s continued restrictions to legal immigration may have made it less appealing for hospitals to sponsor visas in the last few years. But the impact on hospitals is highly concentrated in the less-prestigious hospitals that tend to rely on residents from overseas.

At one New York City hospital serving low-income residents, nearly half the incoming class is still stuck abroad, multiple sources confirmed to ProPublica. One hospital in a large Midwestern city told ProPublica that “roughly half” of its first-year doctors started on time. In the Deep South, a region now overwhelmed by COVID-19 cases, a doctor who was set to start told ProPublica he was among 10 residents still awaiting visa approval as of early July. All hospitals and doctors spoke to ProPublica on the condition of anonymity because they worried about jeopardizing their visa applications.

ProPublica has also spoken to more-experienced doctors facing the same issue — including an infectious-disease specialist blocked from starting a job in an area of the Western U.S. where COVID-19 cases are rising.

When there aren’t enough incoming residents to replace departing third-year residents, staffing crunches result.

At the New York City hospital, a doctor told ProPublica that after only 10 days of short-staffing, one resident had called in sick from exhaustion. The doctor recounted a recent shift in which there had only been two junior residents on call, compared with the typical six. Even by having residents work individually instead of in teams of two, they couldn’t keep up with new patient admissions.

“The patients had to just stay there waiting in the (emergency department) for the residents to finish their first admission, in order to see them,” the doctor said. “When the shift was over, I logged into the computer and I would see notes written at 10 p.m., 11 p.m. And these residents are expected to go home and then come back again at 6:30 a.m.” . . .

Continue reading.

Written by LeisureGuy

17 July 2020 at 9:02 am

Who would kick millions off health insurance in the middle of a pandemic?

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Catherine Rampell writes in the Washington Post:

In the midst of a pandemic — when Americans most need health insurance, and millions can’t find work — the Trump administration wants to kick Americans off their health insurance if they aren’t working.

Heartless, but it’s true.

This week, the Trump administration and the state of Arkansas asked the Supreme Court to allow reinstatement of Medicaid work requirements. This disastrous policy was struck down by lower courts last year after causing 18,000 low-income Arkansans to lose their insurance. Subsequent research found that 95 percent of residents targeted by the policy were working, or had qualified for an exemption. They were kicked off Medicaid all the same.

That’s because the program’s reporting requirements were so onerous and confusing that it was nearly impossible to prove compliance.

These efforts to erect artificial barriers to safety-net services that Americans are legally entitled to, and desperately need, are of apiece with other Trump regulatory actions.

President Trump claims to favor slashing red tape and bureaucracy. He boasts about his “historic deregulation.” Yet his administration has repeatedly raised regulatory costs for disfavored groups or perceived enemies (poor people, immigrants, media companies). It has been especially active in heightening administrative burdens as a backdoor way to limit access to safety-net programs, even when Congress rejected proposals to cut these programs directly.

For example, the administration has tried, also during the pandemic, to raise work requirements for the Supplemental Nutrition Assistance Program (SNAP, a.k.a. food stamps). Another proposed rule would restrict states’ ability to make families “categorically eligible” for nutritional services based on their receipt of another government benefit; this would cause nearly 1 million schoolchildren to lose automatic eligibility for free lunches.

It has required states to get more frequent and onerous documentation from families re-enrolling in Medicaid — even when those states have the necessary information on file from administrative records. This has caused sick children to abruptly lose access to care.

The strategy is not unique to the Trump administration. Florida, for instance, made its application process for unemployment insurance more difficult to reduce spending.

Many such policies have been added under the pretext of reducing waste, fraud and abuse. If genuine, this would perhaps be a worthy goal. But the (over) emphasis on compliance — when there are relatively few errors in benefit use, and takeup rates for eligible families remain pitifully low — appears at best misguided. At worst, it may be racially motivated, the latest iteration in the ugly myth of (black) “welfare queens.”

Better 10 poor families go hungry, the thinking goes, than one possibly “undeserving” moocher get food stamps. But in an economy suffering double-digit unemployment, shouldn’t critical safety-net programs be accessible to all the families they’re supposed to serve?

It’s tempting to think of this as a partisan divide: Democrats prefer big government, and tend to err on the side of slashing administrative burdens to serve as many people as possible; Republicans prefer small government, so tilt toward more paperwork that will catch the cheats. But that’s not entirely right.

As Pamela Herd and Donald P. Moynihan argue in their excellent book, “Administrative Burden: Policymaking by Other Means,” conservatives want government to operate efficiently, too. Requiring reams of unnecessary or duplicative paperwork creates costs for both beneficiaries and the government agencies that process applications.

And there are good examples of Republican efforts to reduce administrative burden in order to improve program access and efficiency.

The George W. Bush administration, for example, reduced compliance costs for SNAP enrollment when officials noticed participation had plummeted. Republican-controlled Idaho had also been a leader in making Medicaid re-enrollment relatively painless — until the Trump administration intervened.

There are also ways to streamline benefit enrollment and root out fraud without making applicants’ lives a living hell.

In Michigan, for example, the state’s previous (Republican) administration was so hyperfocused on benefit fraud it falsely accused 40,000 residents of it. This obsession — and the additional administrative burdens it inspired — appears somewhat motivated by a widely circulated anecdote about a person arriving at a benefits office in a Hummer.

When a Democratic administration took office last year, it redesigned policies and reduced paperwork requirements to make safety-net programs more accessible. But it also requested more inspector-general funding to help develop “targeted, analytically informed enforcement,” according to Robert Gordon, director of Michigan’s Department of Health and Human Services. . .

Continue reading.

Written by LeisureGuy

16 July 2020 at 8:41 pm

It’s here: The completely expected and widely predicted and easily foreseen upturn in covid-19 deaths in the US

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That’s from this morning’s post in Kevin Drum’s daily update of per-capital covid-19 deaths in various countries. Trump’s repeated decisions to take no action (and accept no responsibility) regarding the pandemic is having the totally expected consequences. Apparently, contrary to Republican belief, the virus doesn’t just “go away.”

Still, I don’t think Trump will admit any error or allow the Federal government to take any effective action of show any leadership whatsoever.

The biggest surges tend to be in Republican states whose political leadership denied the crisis and refused to take steps such as mandatory face masks.

Example: headline in the Washington PostCoronavirus update: Florida shatters single-day infection record with 15,300 new cases.

Written by LeisureGuy

12 July 2020 at 9:19 am

Elite Hospitals Have an Epidemic of Greed

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Philip Longman and Udit Thakur write in the Washington Monthly:

In early March, public health officials issued warnings about what the spreading coronavirus could mean for the Pittsburgh region. Debra Bogen, director of the health department for surrounding Allegheny County, forecast that between 40 to 60 percent of the adults in western Pennsylvania could come down with COVID-19 unless strong mitigation measures were taken. The Harvard Global Health Institute predicted that Pittsburgh-area hospitals could need between 480 to 720 percent more beds than were currently available. Meanwhile, federal officials, ranging from the surgeon general of the United States to scientists at the Centers for Disease Control and Prevention, warned that hospitals would spread the contagion further if they continued performing non-urgent care. 

Heeding this expert advice, Pennsylvania Governor Tom Wolf issued an executive order on March 19 requiring all the state’s hospitals and doctors to stop performing elective procedures. Such surgeries are highly lucrative. But hospitals understood the gravity of the situation, or at least recognized Wolf’s authority. Systems throughout the state quickly complied. 

Except one. 

In their headquarters atop the 64-story former U.S. Steel Tower in downtown Pittsburgh, executives of the University of Pittsburgh Medical Center (UPMC), a $21 billion hospital chain and health insurer, took a different course. Ignoring not only the governor’s order but also an open protest letter signed by 291 of their own doctors, UPMC decided on March 20 that the 40 hospitals they control would continue conducting elective surgeries. 

At a press conference, UPMC tried to justify its decision by asserting that there were only five known COVID-19 cases in the Pittsburgh area at the time, and that, despite insufficient numbers of tests, they were monitoring the situation closely. They also argued that they weren’t technically violating the governor’s order because the elective procedures weren’t really elective, at least as they used the term. “ ‘Elective’ commonly means scheduled cases, but scheduled does not mean unnecessary,” Donald Yealy, UPMC’s chair of emergency medicine, said. Bogen disputed those semantics. “We ask that UPMC, like all the other health care providers in our community, begin to address this request from the governor and from us,” she said. The Pittsburgh PostGazette, the city’s leading newspaper, lambasted UPMC for its decision. The hospital system, they wrote, was “endangering lives by continuing to perform elective surgeries despite pleas by state and local health officials to postpone them.” 

It wasn’t as if UPMC’s managers could not afford to do the right thing. Though chartered by the state of Pennsylvania as a nonprofit, charitable institution affiliated with the University of Pittsburgh’s medical school, UPMC has morphed over the past three decades into a money-making machine. According to its latest financial statement, the corporation commands reserves amounting to $5.5 billion in unrestricted cash and investments. Nor are UPMC’s executives hurting for money. In 2018, UPMC President and CEO Jeffrey Romoff, who has said he seeks to make UPMC “the Amazon of health care,” took home $8.54 million, while 33 other executives each earned more than $1 million. As the editors of the PostGazette wrote, “This cannot be a medical decision. It’s a greed decision.”

The tense relationship between UPMC and its surrounding communities has been building for years. A wide range of voices—from civil rights and labor leaders to local politicians and Pennsylvania’s attorney general—have long accused the corporation of shirking its civic responsibilities, jeopardizing access to health care for millions of local residents, stripping doctors of their independence, and leaving rank-and-file health care workers struggling to make a living wage. 

Pittsburgh, however, is not the only city with growing acrimony surrounding a nonprofit hospital. Most major metropolitan areas of the United States now feature large medical systems, typically affiliated with a local university, that wield extraordinary economic and political power. These institutions typically enjoy high margins because they face little competition, having spent the last several decades buying up, and often shutting down, rival hospitals. They are then able to charge monopoly prices for highly lucrative specialty treatments while downplaying medical services, like mental health and primary care, that don’t pay well. They advertise these high-end treatments to rich medical tourists from across the world, offering them deluxe accommodations, while ignoring the poor and working-class residents who live, quite literally, next door. 

Legally, however, these institutions are still considered charities. That’s despite not just negligent attitudes toward their communities, but also their bottom lines. Many major academic medical centers make big profits. According to a study published in Health Affairs, seven of the 10 most profitable hospitals in United States are officially “nonprofits.” An analysis by Axios of 31 prominent nonprofit hospital systems found that . . .

Continue reading. There’s much more, though it is somewhat depressing.

Single-payer healthcare under a good government, accompanied by good investigative (and independent) journalism seems the best solution.

Written by LeisureGuy

11 July 2020 at 10:11 am

As predicted: ‘All the Hospitals Are Full’: In Houston, Overwhelmed ICUs Leave COVID-19 Patients Waiting in ERs

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Unforeseen tragedies are bad, but perhaps foreseen (and widely predicted and publicized) tragedies are worse.  Charles Ornstein, ProPublica, and Mike Hixenbaugh, NBC News, report in ProPublica:

Houston hospitals have been forced to treat hundreds of COVID-19 patients in their emergency rooms — sometimes for several hours or multiple days — as they scramble to open additional intensive care beds for the wave of seriously ill people streaming through their doors, according to internal numbers shared with NBC News and ProPublica.

At the same time, the region’s 12 busiest hospitals are increasingly telling emergency responders that they cannot safely accept new patients, at a rate nearly three times that of a year ago, according to data reviewed by reporters.

The increase in ambulance diversions, coupled with the spike in patients being held indefinitely in emergency rooms, are the latest indicators that Houston hospitals are straining to keep up with a surge of new coronavirus patients. ProPublica and NBC News have previously reported that a public hospital in Houston ran out of a medication to treat COVID-19 patients and that a spike in at-home deaths from cardiac arrest suggests that the death toll from the coronavirus may be higher than official statistics show.

On Thursday, 3,812 people were hospitalized with COVID-19 in the region, including more than 1,000 in intensive care units, a record since the pandemic began. At the same time, since Texas officials have not issued another stay-at-home order to slow the virus’s spread, hospitals are also still seeing a steady flow of patients in need of care as a result of car accidents, violent crime and heat-related medical emergencies.

Officials in Houston are warning that the situation could become a replay of what happened in New York City in March and April, when thousands of people died as hospitals struggled to keep up with the surge of patients, but without the same level of government intervention to stem the tide.

Typically when people arrive at a hospital emergency department, they’re evaluated and treated by the medical staff. Those sick or injured enough to require hospitalization are then moved to other areas of the hospital for specialized care. But increasingly in Houston, particularly for patients suffering from COVID-19, there’s nowhere for them to go.

“Normally that patient would just go to an ICU bed, but because there are no beds available, they continue to board in the emergency room,” said Harris Health System president and CEO Esmaeil Porsa, who oversees the city’s two public safety-net hospitals. “It is not an optimal level of care. This is not something we would choose to do. The only reason this is happening is because we are being forced to do it.”

Although hospital leaders say they are working to provide high-quality care for patients being held in emergency rooms — in part by bringing specialized medical staff and equipment to patients being treated there — studies done before the coronavirus pandemic show that the longer patients stay in ERs, the worse their outcomes.

ICUs and other hospital units are staffed with doctors, nurses and other support personnel who have specialized training and experience caring for critically ill patients in need of specific medical interventions, whereas the mission of emergency department medical workers is to quickly assess patients, stabilize them and get them to where they need to be.

“The problem is you can’t get them to where they need to be, and now it puts the ER doc in the position of having to function like the hospitalist or the intensive care doctor, and that’s not a role that we’re really supposed to be in,” said Dr. Cedric Dark, an emergency physician at Baylor College of Medicine in Houston. “The bad thing about having any patient boarded in the emergency department, regardless of the situation, is that it slows down the beginning of care for somebody who needs hospitalization, and the beginning of care for any medical condition is the most crucial period of time.”

The same scenario is playing out at hospitals across the Houston region.

A daily status report prepared Wednesday by the SouthEast Texas Regional Advisory Council, which coordinates the Houston region’s emergency medical response, showed multiple hospitals running out of immediately available nonsurgical ICU beds, including both of the city’s top-tier trauma centers, Ben Taub Hospital and Memorial Hermann’s flagship hospital in the Texas Medical Center.

As of Wednesday afternoon, about 145 patients were being held in emergency departments throughout the Memorial Hermann Health System, according to internal numbers provided separately by a Memorial Hermann physician and confirmed by a hospital executive. Several other Houston area hospitals have reported holding multiple patients in their ERs, including four with more than a dozen. . .

Continue reading.

The strange thing is that it was well-known that this would happen. But: Texas.

Written by LeisureGuy

10 July 2020 at 2:11 pm

She Needed Lifesaving Medication, but the Only Hospital in Town Did Not Have It

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Another report from The Best Healthcare System in the World™ (which the GOP is determined to make worse), this one by Brianna Bailey, The Frontier, and Maya Miller, ProPublica:

Mabel Garcia had just said good morning to her grandson, who slept overnight in a chair near her hospital bed. Then suddenly, she stopped talking.

The right side of her face sank and her eyes fluttered as nurses at Memorial Hospital of Texas County in Guymon, Oklahoma, surrounded her bed. Her mouth gaped open.

“Mabel. Mabel. Can you look at me?” a nurse asked.

Her grandson, Fabian Daniels, used his cellphone to record while hospital employees attempted to get the 67-year-old to respond. He quickly texted his mom, who was at work waiting to hear how Garcia was feeling a day after she checked in with dizziness and chest pains.

“Mima is not talking to them right now,” the 17-year-old wrote early that Thursday morning in April 2019.

“Why?” asked his mother, Jennifer Daniels.

“They don’t know. She was talking a little bit ago,” he replied.

Health care professionals at the hospital, which sits in a remote part of Oklahoma known as No Man’s Land, determined that they couldn’t provide the “higher level of care” Garcia required, according to medical records reviewed by The Frontier and ProPublica. They called an ambulance to drive her to an airstrip where a medical helicopter took her about 130 miles south to a hospital in Amarillo, Texas.

More than 3½ hours after her initial symptoms, doctors at BSA Hospital in Amarillo found that Garcia had a stroke. They gave her Activase, a time-sensitive medication that helps break down clots, but told her daughter that too much time had elapsed since her initial symptoms.

Garcia had suffered brain damage.

“They said the result would not have been as bad if she had been treated sooner,” Jennifer Daniels said, recalling her conversation with doctors. (BSA hospital did not return requests for comment.)

Surrounded by 2,000 square miles of prairie and dotted with small farming communities, Memorial Hospital is among at least 13 facilities in the state that hired private management companies based on promises of financial turnarounds but were instead left scrambling after sinking deeper into debt, an investigation by The Frontier and ProPublica found.

The hospital cycled through four management companies in five years, including Synergic Resource Partners, which managed the facility until days after Garcia arrived. Memorial Hospital laid off about half of its staff, shuttered its obstetrics department and stopped stocking lifesaving drugs to treat strokes, heart attacks and rattlesnake bites in the 1½ years Synergic Resource Partners was in charge, according to interviews and records.

Records do not show whether hospital staff members diagnosed Garcia with a stroke or if they determined that she needed Activase. But even if they had, the hospital didn’t have the medication, according to Maria Puebla, the drug supply room manager, and Dr. Emmanuel Barias, who served as the hospital’s interim CEO from late April 2019 to March 2020. They said the hospital ran out of its supply in March 2019.

The hospital’s board has since cut ties with the company and taken control itself. Even with new leadership, efforts to repair years of financial strain under multiple management companies have grown increasingly difficult as the hospital faces a new challenge: The county has the highest rate of COVID-19 cases in Oklahoma. Patients have been sent to other hospitals because the facility in Guymon does not have the staff to handle the increased numbers.

Rochelle Leyva, chairwoman of the hospital board, blames a parade of management companies for the facility’s financial troubles. “I don’t think they’ve been here for the right reasons,” Leyva said.

Doug Swim, the owner of Synergic Resource Partners, declined interview requests.

Barias said he approached the supplier to try to purchase more Activase after taking the helm of the hospital but was told he would first have to pay off outstanding debts. The hospital could not afford to purchase the medication until July, Barias said.

Months earlier, in January 2019, state health inspectors released the findings of an investigation that revealed the hospital failed to provide basic emergency care, turning away one stroke patient because it did not have Activase. In response to the investigation, hospital officials said the facility kept Activase in stock but only used it for heart attack patients.

Officials pointed out that as a low-level stroke center, the hospital is only required to assess, resuscitate and provide emergency intervention for stroke patients before transferring them to hospitals with more resources. But Memorial Hospital used Activase for stroke patients before falling behind on payments and is again using the medication now that the facility is controlled by the county government.

Hospital officials declined to talk specifically about Garcia’s case, but Dr. Martin Bautista, a physician and the current chief of staff, said keeping the medication on hand to treat stroke patients is vital to achieving the hospital’s mission, which is providing access to critical care. Transferring patients to a larger facility can take more than an hour. The wait, he said, could cause permanent damage to the brain.

“That’s the difference between a for-profit and a not-for-profit community hospital,” Bautista said. “If we can’t serve our elderly people who’ve paid taxes all their lives, then we shouldn’t be open.”

Mounting Bills and Cuts to Services

Synergic Resource Partners was hired to run Memorial Hospital in October 2017 after Swim, an attorney from Oklahoma City, promised leaders in the meatpacking town of nearly 11,000 people that he could inject up to $2 million into the hospital’s coffers, according to former board members and Mike Boring, Texas County’s district attorney.

The offer from Swim, who had never run a hospital, arrived just as county officials were considering closing the facility. Across the country, rural hospitals face dwindling numbers of patients, shortages of doctors and nurses and low reimbursement rates from the federal government that place them at high risk of closure. Nearly 130 rural hospitals, including nine in Oklahoma, have closed in the past decade. . .

Continue reading.

Wealthiest nation in the world, but that’s for the wealthy.

Related:  Deep-Red Oklahoma Narrowly Passes Medicaid Expansion

Written by LeisureGuy

1 July 2020 at 1:47 pm

The US and its new “Can’t Do” spirit, expressed in a graph

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From this article:

Written by LeisureGuy

30 June 2020 at 12:53 pm

The 3 Weeks That Changed Everything; or, Botched Opportunities

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James Fallows writes in the Atlantic:

Coping with a pandemic is one of the most complex challenges a society can face. To minimize death and damage, leaders and citizens must orchestrate a huge array of different resources and tools. Scientists must explore the most advanced frontiers of research while citizens attend to the least glamorous tasks of personal hygiene. Physical supplies matter—test kits, protective gear—but so do intangibles, such as “flattening the curve” and public trust in official statements. The response must be global, because the virus can spread anywhere, but an effective response also depends heavily on national policies, plus implementation at the state and community level. Businesses must work with governments, and epidemiologists with economists and educators. Saving lives demands minute-by-minute attention from health-care workers and emergency crews, but it also depends on advance preparation for threats that might not reveal themselves for many years. I have heard military and intelligence officials describe some threats as requiring a “whole of nation” response, rather than being manageable with any one element of “hard” or “soft” power or even a “whole of government” approach. Saving lives during a pandemic is a challenge of this nature and magnitude.

It is a challenge that the United States did not meet. During the past two months, I have had lengthy conversations with some 30 scientists, health experts, and past and current government officials—all of them people with firsthand knowledge of what our response to the coronavirus pandemic should have been, could have been, and actually was. The government officials had served or are still serving in the uniformed military, on the White House staff, or in other executive departments, and in various intelligence agencies. Some spoke on condition of anonymity, given their official roles. As I continued these conversations, the people I talked with had noticeably different moods. First, in March and April, they were astonished and puzzled about what had happened. Eventually, in May and June, they were enraged. “The president kept a cruise ship from landing in California, because he didn’t want ‘his numbers’ to go up,” a former senior government official told me. He was referring to Donald Trump’s comment, in early March, that he didn’t want infected passengers on the cruise ship Grand Princess to come ashore, because “I like the numbers being where they are.” Trump didn’t try to write this comment off as a “joke,” his go-to defense when his remarks cause outrage, including his June 20 comment in Tulsa that he’d told medical officials to “slow the testing down, please” in order to keep the reported-case level low. But the evidence shows that he has been deadly earnest about denying the threat of COVID-19, and delaying action against it.

“Look at what the numbers are now,” this same official said, in late April, at a moment when the U.S. death toll had just climbed above 60,000, exceeding the number of Americans killed in the Vietnam War. By late June, the total would surpass 120,000—more than all American military deaths during World War I. “If he had just been paying attention, he would have asked, ‘What do I do first?’ We wouldn’t have passed the threshold of casualties in previous wars. It is a catastrophic failure.”

As an amateur pilot, I can’t help associating the words catastrophic failure with an accident report. The fact is, confronting a pandemic has surprising parallels with the careful coordination and organization that has saved large numbers of lives in air travel. Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong. In deciding whether to fly if I’m tired or if the weather is marginal, I rely on a tie-breaking question: How would this look in an NTSB report?

Controlling the risks of flight may not be as complex as fighting a pandemic, but it’s in the ballpark. Aviation is fundamentally a very dangerous activity. People are moving at high altitudes, at high speed, and in high volume, with a guarantee of mass casualties if things go wrong. Managing the aviation system involves hardware—airframes, engines, flight control systems—and “software,” in the form of training, routing, and coordinated protocols. It requires recognition of hazards that are certain—bad weather, inevitable mechanical breakdowns—and those that cannot be specifically foreseen, from terrorist episodes to obscure but consequential computer bugs. It involves businesses and also governments; it is nation-specific and also worldwide; it demands second-by-second attention and also awareness of trends that will take years to develop.

The modern aviation system works. From the dawn of commercial aviation through the 1990s, 1,000 to 2,000 people would typically die each year in airline crashes. Today, the worldwide total is usually about one-10th that level. Last year, before the pandemic began, more than 25,000 commercial-airline flights took off each day from airports in the United States. Every one of them landed safely.

In these two fundamentally similar undertakings—managing the skies, containing disease outbreaks—the United States has set a global example of success in one and of failure in the other. It has among the fewest aviation-related fatalities in the world, despite having the largest number of flights. But with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

Consider a thought experiment: What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude? I’ll jump to the answer before laying out the background: This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

The organization below differs from that of a standard NTSB report, but it covers the key points. Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf. As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

But what happened in the two months before Trump’s statement, when the United States still had a chance of containing the disease where it started or at least buffering its effects, is if anything worse.

1. The Flight Plan

The first thing an airplane crew needs to know is what it will be flying through. Thunderstorms? Turbulence? Dangerous or restricted airspace? The path of another airplane? And because takeoffs are optional but landings are mandatory, what can it expect at the end of the flight? Wind shear? An icy runway? The biggest single reason flying is so much safer now than it was even a quarter century ago is that flight crews, air traffic controllers, and the airline “dispatchers” who coordinate with pilots have so many precise tools with which to anticipate conditions and hazards, hours or days in advance.

And for the pandemic? . . .

Continue reading.

Written by LeisureGuy

29 June 2020 at 6:13 pm

The US healthcare system and its inequities

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People seem to be willing to put up with it, and the GOP is determined to destroy the reforms that came with the Affordable Care Act, with Trump’s Department of Justice even now arguing that the ACA is unconstitutional and should be struck down in its entirety. And, oddly, many Americans like the current state of healthcare in the US and indeed many support abolishing the Affordable Care Act.

Sarah Kliff reports in the NY Times:

Before a camping and kayaking trip along the Texas Coast, Pam LeBlanc and Jimmy Harvey decided to get coronavirus tests. They wanted a bit more peace of mind before spending 13 days in close quarters along with three friends.

The two got drive-through tests at Austin Emergency Center in Austin. The center advertises a “minimally invasive” testing experience in a state now battling one of the country’s worst coronavirus outbreaks. Texas recorded 5,799 new cases Sunday, and recently reversed some if its reopening policies.

They both recalled how uncomfortable it was to have the long nasal swab pushed up their noses. Ms. LeBlanc’s eyes started to tear up; Mr. Harvey felt as if the swab “was in my brain.”

Their tests came back with the same result — negative, allowing the trip to go ahead — but the accompanying bills were quite different.

The emergency room charged Mr. Harvey $199 in cash. Ms. LeBlanc, who paid with insurance, was charged $6,408.

“I assumed, like an idiot, it would be cheaper to use my insurance than pay cash right there,” Ms. LeBlanc said. “This is 32 times the cost of what my friend paid for the exact same thing.”

Ms. LeBlanc’s health insurer negotiated the total bill down to $1,128. The plan said she was responsible for $928 of that.

During the pandemic, there has been wide variation between what providers bill for the same basic diagnostic test, with some charging $27, others $2,315. It turns out there is also significant variation in how much a test can cost two patients at the same location.

Mr. Harvey and Ms. LeBlanc were among four New York Times readers who shared bills they received from the same chain of emergency rooms in Austin. Their experiences offer a rare window into the unpredictable way health prices vary for patients who receive seemingly identical care.

Three paid with insurance, and one with cash. Even after negotiations between insurers and the emergency room, the total that patients and their insurers ended up paying varied by 2,700 percent.

Such discrepancies arise from a fundamental fact about the American health care system: The government does not regulate health care prices.

Some academic research confirms that prices can vary within the same hospital. One 2015 paper found substantial within-hospital price differences for basic procedures, such as M.R.I. scans, depending on the health insurer.

The researchers say these differences aren’t about quality. In all likelihood, the expensive M.R.I.s and the cheap M.R.I.s are done on the same machine. Instead, they reflect different insurers’ market clout. A large insurer with many members can demand lower prices, while small insurers have less negotiating leverage.

Because health prices in the United States are so opaque, some researchers have turned to their own medical bills to understand this type of price variation. Two health researchers who gave birth at the same hospital with the same insurance compared notes afterward. They found that one received a surprise $1,600 bill while the other one didn’t.

The difference? One woman happened to give birth while an out-of-network anesthesiologist was staffing the maternity ward; the other received her epidural from an in-network provider.

“The additional out-of-pocket charge on top of the other labor and delivery expenses was left entirely up to chance,” the co-authors Erin Taylor and Layla Parast wrote in a blog post summarizing the experience. Ms. Parast, who received the surprise bill, ultimately got it reversed but not until her baby was nearly a year old. . .

Continue reading.

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29 June 2020 at 12:41 pm

Capitalism and death: Private equity and nursing homes — and death (and money)

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Lucy Schiller writes at TheBaffler.com:

RECENTLY, MY GRANDMOTHER LOUISE and I have discovered new uses for the slender stainless steel device known as a turkey lacer. Usually, it stitches up an avian cavity; under our set of circumstances, it gently scrapes out my grandmother’s hearing aids and loosens Velcro rollers from her hair. Our discovery of the implement’s many uses has come out of a particular necessity. About three weeks ago, my extended family extracted Louise from her assisted living facility in Denver, which is owned by a company called Brookdale Senior Living, the largest operator of senior living facilities in the United States. In the frantic move, which was spurred by a sudden burst of Covid-19 deaths in her facility, as well as similar facilities around the country, several things were lost: whatever item is actually meant to clean her hearing aids, the shoehorn she needs, a few slightly-less-essential medications.

I’m giving Louise a pseudonym in case she ever returns to her Brookdale facility. Her boyfriend still lives there, as do many of her friends. She didn’t necessarily want to leave, but she also doesn’t know if she wants to go back: at the time of this writing, her facility has twenty-six Covid-positive patients inside, most of whom Brookdale moved there from their other facilities, with seemingly no warning to residents or most staff. If residents return to the facility, they must undergo a strict two-week quarantine—but everyone inside is already on lockdown, and the two-week clock resets with every new case. Effectively, residents in Louise’s facility have been quarantined for two months in their rooms, while on the fourth floor, Covid-positive residents from Brookdale facilities across Denver struggle.

News on the building’s death statistics comes to residents and their families via mass Zoom calls. We have tried to keep good cheer around Louise, removed so far from her home. After dinner one night, we trotted out a bag of crackerjacks that had come with her from Brookdale—staff had left them at each resident’s door, to cheer them up during their enforced self-isolation. We thought she’d be pleased, but as she began to snack, Louise looked slightly rueful. “I’ll have to check the bill at the end of the month,” she said, “to see if they charged me for these.”

The comment piqued my interest. The move was tiring, and Louise was sleeping a lot of the day. Filled with that restlessly angry quarantine feeling, I began to read two large tomes about private long-term care, released into the world nearly a century apart from one another—Thomas Mann’s The Magic Mountain for joy and humor, and Brookdale’s 10-K filings with the U.S Securities and Exchange Commission for everything else. More than half of Colorado’s Covid deaths have been tied to senior care facilities; I felt, reading, like I was working to fill in the background, the backstory of an unfurling plot. I didn’t yet understand the differences between assisted living, skilled nursing, memory care, independent living, and all of the other deadening terms that the senior living industry very carefully defines—for each has its own profit to make, and each unit can be fitted to another one, like a Lego landscape in which you stand “aging in place,” as the industry calls the very lucrative act of being alive.

In the first few pages of Brookdale’s most recent 10-K, the document that most comprehensively sums up a company’s financial performance to investors, I read that although Brookdale only operates two senior living facilities in the state of Delaware (for comparison, they operate eighty-seven facilities in Florida), the company is what is known as a Delaware Corporation, incorporated there presumably for the state’s amorous relationship to its many big businesses. “The First State,” reported the New York Times in 2012, “land of DuPont, broiler chickens and, as it happens, Vice President Joseph R. Biden Jr., increasingly resembles a freewheeling offshore haven, right on America’s shores.” Reading further, I began feeling increasingly like that endlessly replicated gif so many have used to express the political web in which we’re stickily wrapped—Charlie from It’s Always Sunny in Philadelphia gesturing frantically at his complex diagram of an office mail system. It would be funny if it weren’t so numbing, the largeness of the Brookdale web, and the many directions into which one could look.

You could write a whole book, for instance, on simply the part of the story set in Nashville, where Brookdale is actually headquartered, in a little bronchiole of Brentwood, not far from where Taylor Swift keeps a house. There, too, sits one of the corporate offices of DaVita—whose logo you might recognize from their strip mall dialysis centers across the country—and HCA, the Healthcare Corporation of America. One of the first hospital management companies in the United States, it sprung up uncannily around the same time as Medicare and was structured explicitly after KFC. HCA, of course, remains slightly fragrant with Florida ex-Governor Rick Scott’s tenure as its CEO, during which, one might say, he oversaw the largest Medicare fraud in American history.

Today, for-profit health care companies in Nashville number more than five hundred. They rake in nearly $47 billion in annual revenue. Many of them have been backed by the same tangle of hedge funds, in different permutations over time, those vaguely pastoral names redolent of New England subdivisions: BlackRock, Glenview, Deerfield. Several of these for-profit health care companies donate, too, to the same Tennessee Trumper politicians (Brookdale via its own PAC): Bill Hagerty, Nashville native and free market health care proponent, and Marsha Blackburn, who has voted numerous times to repeal the ACA.

Propelled by the winds of private equity firms like BlackRock, Deerfield, and Glenview Capital Management, Brookdale has, in the past few years, set forth on a strategy of consolidation. They have . . .

Continue reading.

Written by LeisureGuy

28 May 2020 at 8:47 pm

The raccoon is the official animal of the coronavirus pandemic

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And “raccoon” is almost an anagram of “corona” (one extra “c”).

And let me urge to read Ed Yong’s article mentioned in the previous post. It is absolutely first-rate: informative and clarifying.

Written by LeisureGuy

6 May 2020 at 10:48 pm

What’s Behind South Korea’s COVID-19 Exceptionalism?

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Derek Thompson writes in the Atlantic:

In february 16, a sunday, a 61-year-old woman with a fever entered the Shincheonji Church of Jesus in Daegu, South Korea. She touched her finger to a digital scanner. She passed through a pair of glass doors and proceeded downstairs, to the prayer hall, where she sat with approximately 1,000 other worshippers in a large windowless room. Hours later, she exited the building and left behind a trail of pathogens that would lead to thousands of infections, triggering one of the largest coronavirus outbreaks in the world.

By the end of February, South Korea had the most COVID-19 patients of any country outside China. New confirmed cases were doubling every few days, and pharmacies were running out of face masks. More than a dozen countries imposed travel restrictions to protect their citizens from the Korean outbreak, including the U.S., which had, at the time, recorded an official COVID-19 death toll low enough to count on one hand.

But just as South Korea appeared to be descending into catastrophe, the country stopped the virus in its tracks. The government demanded that the Shincheonji Church turn over its full membership list, through which the Ministry of Health identified thousands of worshippers. All were ordered to self-isolate. Within days, thousands of people in Daegu were tested for the virus. Individuals with the most serious cases were sent to hospitals, while those with milder cases checked into isolation units at converted corporate training facilities. The government used a combination of interviews and cellphone surveillance to track down the recent contacts of new patients and ordered those contacts to self-isolate as well.

Within a month, the Korean outbreak was effectively contained. In the first two weeks of March, new daily cases fell from 800 to fewer than 100. (This morning, the nation of 51 million reported zero new domestic infections for the third straight day.) On April 15, the country successfully held a national parliamentary election with the highest turnout in three decades, without triggering another wave. South Korea is not unique in its ability to bend the curve of daily cases; New Zealand, Australia, and Norway have done so, as well. But it is perhaps the largest democracy to reduce new daily cases by more than 90 percent from peak, and its density and proximity to China make the achievement particularly noteworthy.

In the time that South Korea righted its course, the United States veered into disaster. In mid-March, the U.S. and South Korea had the same number of coronavirus-caused fatalities—approximately 90. In April, South Korea lost a total of 85 souls to COVID-19, while the U.S. lost 62,000—an average of 85 deaths every hour. That the U.S. population is approximately six times larger than South Korea’s does little to soften the horror of the comparison.

Juxtaposing the South Korean response with the American tragedy, some commentators have chalked up the difference to an ancient culture of docile collectivism and Confucianism across the Pacific. This observation isn’t just racist. It also exoticizes South Korea’s success and makes it seem like the inevitable result of millennia of cultural accretion, rather than something the U.S., or any other country, can learn from right now. The truth is that the Korean government and its citizens did something simple, admirable, and all too rare: They suffered from history, and they learned from it.

South korea’s covid-19 policy was forged in the crucible of previous public-health crises. In 2002, the SARS outbreak killed several hundred people in East Asia. In 2009, the H1N1 influenza, which likely originated in Mexico, spread to more than 1 million people globally and killed several hundred South Koreans. From these epidemics, South Korean public-health officials recognized the necessity of early testing and the importance of isolating new patients to prevent secondary infections.

But 2015’s Middle East Respiratory Syndrome, or MERS, created the playbook that the country has used to break the back of COVID-19.

In May 2015, a 68-year-old man returning to South Korea from a business trip to the Middle East had a fever. After visiting several clinics, he was admitted to a hospital in Seoul with a mysterious case of pneumonia. By the time doctors had diagnosed him with the viral respiratory infection MERS, the disease had spread, through the clinics and hospitals he’d visited, to several dozen patients. One of them, a 35-year-old man, left the hospital where he was infected and went to another medical center. There, he caused another outbreak. Within weeks, the disease was running rampant through the South Korean hospital system.“MERS was transfixing and frightening to Koreans, because the disease was spreading through crowded hospitals and their waiting rooms,” Scott Snyder, a senior fellow for Korea studies at the Council on Foreign Relations, told me. “People were getting sick, but they were also afraid of going to the hospital for fear that it would make them even more sick.”

The government made several damaging mistakes before arresting the spread of MERS. . .

Continue reading.

Interesting idea: that a government can learn from its mistakes. That doesn’t seem to happen in the US.

Written by LeisureGuy

6 May 2020 at 8:48 pm

One Thing the Pandemic Hasn’t Stopped: Aggressive Medical-Debt Collection

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Alec MacGillis reports in ProPublica:

Darcel Richardson knows she’s fortunate in one sense: She still has her job as a vocational counselor in Baltimore. But despite that, she won’t be able to make her rent payment this month because she’s not getting her full salary for a while. More than $400 per biweekly paycheck — about a quarter of her after-tax income — has been siphoned off by Johns Hopkins University for unpaid medical bills at one of its hospitals.

Richardson, 60, got word of the garnishment from her employer just as the coronavirus pandemic was arriving in full force last month. “My job was going to take the money out. They don’t want to get in trouble,” she said. “I spoke with our payroll accountant, and the bottom line was, even though the crisis had begun, they still had to pay my money to them.”

In a moment when hospitals nationwide are being heralded for their role at the front lines of fighting the pandemic, some Americans continue to experience a less favorable side of hospital operations: aggressive collection for unpaid medical bills, even at a time when many of the debtors are seeing their income plunge. Debt collection is occurring on other fronts as well, over unpaid college and bank loans among others, prompting debates over protecting people’s economic stimulus checks from collection agencies or suspending garnishments outright. But collection by the very hospitals that are treating coronavirus patients brings the health and economic exigencies of the moment into especially stark relief.

In a few cases, hospitals have brought new cases against former patients in recent weeks, such as in Wisconsin, where Froedtert Hospital in Milwaukee filed 46 small-claims lawsuits even after the governor declared a state of emergency on March 12, and other hospital systems in the state filed dozens more, according to a report by Wisconsin Public Radio and Wisconsin Watch. Steve Schoof, Froedtert’s director of external communications, told ProPublica in a statement that the hospital stopped filing small claims suits on March 18. “Moving forward,” the statement continued, “Froedtert Health will no longer be filing small claims suits for medical debt collection. Unfortunately, there was a miscommunication that resulted in small claims filings after March 18. We immediately rectified this miscommunication and dismissed these small claims cases that were filed after March 18.”

More often, though, the collection stems from cases filed months before the pandemic arrived, as the legal process grinds its way forward. “Where debt collection is underway for pre-COVID medical debt, they will continue to do that,” said Jenifer Bosco, a staff attorney for the National Consumer Law Center.

In Richardson’s case, the debt stemmed from a two-day 2018 visit to Johns Hopkins Bayview Medical Center in southeast Baltimore, one of a string of medical visits she has had to make over the years to deal with a knee injury from a fall, a hip injury from a car accident, hernia repairs and back trouble. She had insurance coverage through her job, which at the time was with the state Division of Correction, but it left a balance of almost $1,000 for her to pay. Richardson, who lives by herself in a modest apartment complex just east of the city, started hearing from a collections lawyer for Hopkins last fall and tried to work out a payment schedule with him, but she couldn’t make it work.

“I just didn’t have the money,” she said. “I said to the lawyer, I might be able to pay an amount monthly, but when it came time, I just didn’t have it. What can you do when you’re caught between a rock and a hard place? I prioritize. I’m going to try to pay my rent first, pay for gas and electric, cellphone costs. And I’ve got to eat.”

The court judgment was finally entered against Richardson in Baltimore City District Court in January: $923.21, plus $34 in court costs and $138.49 in attorney’s fees. The notice of wage garnishment went out on March 6 — the day after Maryland Gov. Larry Hogan announced the state’s first three coronavirus cases. The garnishment was confirmed by Richardson’s new employer, the nonprofit drug treatment organization Gaudenzia, on March 16, the day that Hogan decreed the closure of all bars, restaurants, gyms and movie theaters, and three days after Richardson and her colleagues were barred by safety precautions from providing counseling inside prisons. She now works at a small treatment center that houses seven women, where social distancing is easier.

Johns Hopkins, by far the largest private-sector employer in the state and the largest beneficiary of billionaire Michael Bloomberg’s charitable giving, has long faced scrutiny for its aggressive collection of medical debt, including from the many low-income Baltimore residents it serves, who in theory should be able to qualify for the hospital’s charity care programs. In 2008, The Baltimore Sun reported that Hopkins and other Maryland nonprofit hospitals had filed more than 32,000 debt-collection suits over the past five years, winning at least $100 million in judgments. Last May, a coalition that includes the AFL-CIO and National Nurses United, which has been trying to organize Hopkins nurses, released a report finding that Hopkins had launched 2,400 lawsuits in Maryland courts since 2009 against patients with unpaid bills, increasing from 20 in 2009 to a peak of 535 in 2016.

In response to the 2019 report, Hopkins officials said they offered considerable free and discounted services, and that “for patients who choose not to pursue those options or who have a demonstrated ability to pay, we will make every effort to reach out to them and to accommodate their schedule and needs. In those rare occasions when a patient who has the ability to pay chooses not to, we follow our state required policies to pursue reimbursement from these patients.”

The cases have slowed in pace but not stopped altogether since the report. Bayview, one of several hospitals under the Hopkins umbrella, has filed about 60 cases over the past year, according to Maryland court records. Dozens of them, including Richardson’s, remain open. . .

Continue reading. There’s much more.

Written by LeisureGuy

28 April 2020 at 3:10 pm

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