Later On

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Archive for the ‘Healthcare’ Category

Those without healthcare insurance: The US vs. other nations

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That’s from a brief post by Kevin Drum.  I suppose conservatives will brag that here, as in so many cases, the US is No. !.

Written by Leisureguy

8 September 2020 at 12:46 pm

Posted in Daily life, Healthcare

American healthcare: A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984.

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Actual cost: around $8. Marshall Allen reports in ProPublica:

When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.

The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.

The case is the latest to show how providers have sometimes charged exorbitant prices for visits for simple and inexpensive COVID-19 tests. ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a different free-standing ER in Texas. In that situation, the health plan said the payment for the visit would be reduced and the facility said the family would not receive a bill. In Sussman’s case, the insurer paid it all. But those dollars come from people who pay insurance premiums, and health experts say high prices are a major reason why Americans pay so much for health care.

Sussman, a 44-year-old pathologist, was working under contract as a part-time medical director at four of Physicians Premier’s other locations. He said he made $4,000 a month to oversee the antibody tests, which can detect signs of a previous COVID-19 infection. It was a temporary position holding him over between hospital gigs in Austin and New Mexico, where he now lives and works.

In May, before visiting his family in Scottsdale, Arizona, Sussman wanted the test because he had recently had a headache, which can be a symptom of COVID-19. He decided to go to one of his own company’s locations because he was curious to see how the process played out from a patient’s point of view. He knew the materials for each antibody test only amounted to about $8, and it gets read on the spot — similar to an at-home pregnancy test.

He could even do the reading himself. So he assumed Physicians Premier would comp him and administer it on the house. But the staff went ahead and took down his insurance details, while promising him he would not be responsible for any portion of the bill. He had a short-term plan through Golden Rule Insurance Company, which is owned by UnitedHealthcare, the largest insurer in the country. (The insurance was not provided through his work.)

During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.

About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost.

“It may as well say Gucci on the outside,” he said of the facility. Physicians Premier says on its website that it bills private insurance plans, but that it is out-of-network with them, meaning it does not have agreed-upon prices. That often leads to higher charges, which then get negotiated down by the insurers, or result in medical bills getting passed on to patients.

Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.

He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”

USA Emergency Centers  . . .

Continue reading. There’s more.

Written by Leisureguy

5 September 2020 at 10:20 am

What Ails America: More on the American “system” of “healthcare”

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Timothy Snyder writes in the NY Review of Books:

I was in Germany when I got sick. Late at night in Munich on December 3, 2019, I was admitted to a hospital with abdominal pain and then released the next morning. In Connecticut, on December 15, I was admitted to the hospital for an appendectomy and released after less than twenty-four hours. In Florida on vacation, on December 23, I was admitted to the hospital for tingling and numbness in my hands and feet but released the following day. Then I began to feel worse, with a headache and growing fatigue.

On December 27, we decided to return to New Haven. I had not been satisfied with treatment in Florida, and I wanted to be home. But it was my wife, Marci, who had to make the decisions and do the work. On the morning of the twenty-eighth, she packed everything up and got our two kids ready to go. I was a burden. I had to lie down to rest after brushing my teeth and after putting on each article of clothing. Marci arranged for wheelchairs at the airports and got us where we needed to be.

At the Fort Myers airport I sat in a wheelchair with the children on a curb while she returned the rental car. As she remembers the journey, “You were fading from life on the flight.” At the Hartford airport she wheeled me from the plane straight to a friend’s car and then stayed with the kids to wait for the luggage. Our friend had not known what was happening; she looked at me in the wheelchair, said “What have they done?” in Polish, shook her head, and got me into the front seat. I lay down flat as she sped to New Haven, because my head hurt less that way.

I struggled to get admitted to the emergency room in New Haven. I had to use a wheelchair to get from the parking lot to the lobby of the emergency department. Another friend, a doctor, was waiting for me there. When I was admitted to the emergency room at midnight, I used the word malaise to describe my condition to the doctor. My head ached, my hands and feet tingled, I was coughing, and I could barely move. Every so often I was seized by tremors.

Although I did not understand this then, I had a severe infection in my liver, which was leaking into my bloodstream. I had an abscess the size of a baseball in my liver, and the infection had spilled into my blood. I was in a condition known as sepsis; death was close.

The nurses guarding the entrance to the emergency room did not seem to take me seriously, perhaps because I did not complain, perhaps because the friend who advocated for me, though a physician, was a black woman. She had called ahead to say that I needed immediate treatment. That had no effect.

After the better part of an hour sprawled between a wheelchair and a table in the lobby, I finally got into the emergency department. Nothing much happened then, so I reflected on what I had seen as I stumbled from the lobby to an emergency room bed. I have been in emergency rooms in six countries, and have a feel for them. Like most American emergency departments, this one was overflowing, with beds lining the hallways. In Florida six days before, the overcrowding had been even more severe. I felt lucky in New Haven that night to get a small area to myself: not a room, but a sort of alcove separated by a yellow curtain from the dozens of other beds outside.

After a while, the curtain started to bother me. Getting attention in emergency rooms is a matter of figuring out who staff are and catching someone’s eye. I couldn’t see people passing when the curtain was closed, and so it was hard to decipher the uniform colors and the name badges and ask for help. The first doctor who opened the curtain decided that I was tired, or perhaps had the flu, and gave me fluids. My disconcerted doctor friend tried to suggest that my condition was something more serious.

“This is someone who was running races,” she said. “And now he cannot stand up.”

My friend told the resident that this was my second emergency room visit within a few days, so extra attention was warranted. The resident left unconvinced, and with the curtain partway open behind her, I caught a glimpse then of the two nurses who had admitted me and heard what they said as they passed: “Who was she?” “She said she was a doctor.” They were talking about my friend. They laughed. I couldn’t write this down then but did later in the diary I kept while I was in the hospital: racism hurt my life chances that night; it hurts others’ every moment of their lives.

I was tested, slowly, for  . . .

Continue reading.

Written by Leisureguy

4 September 2020 at 2:49 pm

Cost per capita of US healthcare, compared to other nations

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That’s from a post by Kevin Drum (worth reading) in which he notes:

Much of this cost is hidden in the form of Medicare taxes and payments by corporations for private health insurance. In the end, though, it all comes out of the paychecks of working Americans. It’s a hell of a tax to pay just for the privilege of being able to say that we allow health care providers to charge anything they want without government interference.

Written by Leisureguy

4 September 2020 at 9:47 am

COVID-19 Hall of Shame: Failed States Where COVID-19 Has Run Amok

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That’s from an interesting if depressing article by Karla Zabludovsky, Nishita Jha, and Christopher Miller in Buzzfeed News, which begins:

The pandemic has put the United States in unusual and humbling global company.

Once viewed as a beacon of government competence and a model for public health, the US has fumbled the response to the coronavirus pandemic even more than countries known for widespread corruption, poor healthcare, and ubiquitous poverty — to the shock of many around the world. By many measures, the US is now faring worse than Mexico, Brazil, India, and Russia.

This is not lost on people in those countries, many of whom are watching the situation unfold in the US with shock and bewilderment.

Roxana Sánchez, an economist in Mexico City, has always resented her country’s corrupt presidents and looked longingly at the seemingly upright politics of the US. But these days, as she watches President Donald Trump musing on television about drinking disinfectant, she sees in the US an even more dangerous kind of leader: an ignorant one.

Alexey Raksha, an independent demographer in Moscow, grew distressed this summer as he watched Russians emerge from months of lockdown and promptly begin partying, going to restaurants, and generally ignoring recommendations from public health experts. Coronavirus cases in the country surged. When he turned on the TV, he was shocked to see similar scenes playing out in the US. It looked to him like Russia’s impoverished, remote regions “had a lot in common with states like Florida, Texas, and Georgia, where cases are currently spiking.”

Nondita D’Souza, principal of a school in western India, watched with dismay as parents in her area threw temper tantrums when schools closed because of the pandemic; she then experienced a jolt of disappointment and recognition as the same kinds of debates playing out in the US.

While these countries seem so different, the response to the pandemic in each place has underscored all the other things they have in common: populist or authoritarian-leaning leaders, officials who have flouted the advice of their top scientists while pushing absurd remedies to fight the virus, and enormous swaths of the population with no safety net to help them stay at home.

“The US is no longer an example for other countries to follow,” said Sánchez, the Mexico City economist. Instead, she said, it has become an example of something else: “In the countries where the death toll is the highest, there is no real leadership.” . . .

Continue reading.

Written by Leisureguy

23 August 2020 at 1:21 pm

“We Are Living in a Failed State”

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George Packer writes in the Atlantic:

When the virus came here, it found a country with serious underlying conditions, and it exploited them ruthlessly. Chronic ills—a corrupt political class, a sclerotic bureaucracy, a heartless economy, a divided and distracted public—had gone untreated for years. We had learned to live, uncomfortably, with the symptoms. It took the scale and intimacy of a pandemic to expose their severity—to shock Americans with the recognition that we are in the high-risk category.

The crisis demanded a response that was swift, rational, and collective. The United States reacted instead like Pakistan or Belarus—like a country with shoddy infrastructure and a dysfunctional government whose leaders were too corrupt or stupid to head off mass suffering. The administration squandered two irretrievable months to prepare. From the president came willful blindness, scapegoating, boasts, and lies. From his mouthpieces, conspiracy theories and miracle cures. A few senators and corporate executives acted quickly—not to prevent the coming disaster, but to profit from it. When a government doctor tried to warn the public of the danger, the White House took the mic and politicized the message.

Every morning in the endless month of March, Americans woke up to find themselves citizens of a failed state. With no national plan—no coherent instructions at all—families, schools, and offices were left to decide on their own whether to shut down and take shelter. When test kits, masks, gowns, and ventilators were found to be in desperately short supply, governors pleaded for them from the White House, which stalled, then called on private enterprise, which couldn’t deliver. States and cities were forced into bidding wars that left them prey to price gouging and corporate profiteering. Civilians took out their sewing machines to try to keep ill-equipped hospital workers healthy and their patients alive. Russia, Taiwan, and the United Nations sent humanitarian aid to the world’s richest power—a beggar nation in utter chaos.

Donald Trump saw the crisis almost entirely in personal and political terms. Fearing for his reelection, he declared the coronavirus pandemic a war, and himself a wartime president. But the leader he brings to mind is Marshal Philippe Pétain, the French general who, in 1940, signed an armistice with Germany after its rout of French defenses, then formed the pro-Nazi Vichy regime. Like Pétain, Trump collaborated with the invader and abandoned his country to a prolonged disaster. And, like France in 1940, America in 2020 has stunned itself with a collapse that’s larger and deeper than one miserable leader. Some future autopsy of the pandemic might be called Strange Defeat, after the historian and Resistance fighter Marc Bloch’s contemporaneous study of the fall of France. Despite countless examples around the U.S. of individual courage and sacrifice, the failure is national. And it should force a question that most Americans have never had to ask: Do we trust our leaders and one another enough to summon a collective response to a mortal threat? Are we still capable of self-government?

This is the third major crisis of the short 21st century. The first, on September 11, 2001, came when Americans were still living mentally in the previous century, and the memory of depression, world war, and cold war remained strong. On that day, people in the rural heartland did not see New York as an alien stew of immigrants and liberals that deserved its fate, but as a great American city that had taken a hit for the whole country. Firefighters from Indiana drove 800 miles to help the rescue effort at Ground Zero. Our civic reflex was to mourn and mobilize together.

Partisan politics and terrible policies, especially the Iraq War [a war that George Packer strongly supported, it should be noted — LG], erased the sense of national unity and fed a bitterness toward the political class that never really faded. The second crisis, in 2008, intensified it. At the top, the financial crash could almost be considered a success. Congress passed a bipartisan bailout bill that saved the financial system. Outgoing Bush-administration officials cooperated with incoming Obama administration officials. The experts at the Federal Reserve and the Treasury Department used monetary and fiscal policy to prevent a second Great Depression. Leading bankers were shamed but not prosecuted; most of them kept their fortunes and some their jobs. Before long they were back in business. A Wall Street trader told me that the financial crisis had been a “speed bump.”

All of the lasting pain was felt in the middle and at the bottom, by Americans who had taken on debt and lost their jobs, homes, and retirement savings. Many of them never recovered, and young people who came of age in the Great Recession are doomed to be poorer than their parents. Inequality—the fundamental, relentless force in American life since the late 1970s—grew worse.

This second crisis drove a profound wedge between Americans: between the upper and lower classes, Republicans and Democrats, metropolitan and rural people, the native-born and immigrants, ordinary Americans and their leaders. Social bonds had been under growing strain for several decades, and now they began to tear. The reforms of the Obama years, important as they were—in health care, financial regulation, green energy—had only palliative effects. The long recovery over the past decade enriched corporations and investors, lulled professionals, and left the working class further behind. The lasting effect of the slump was to increase polarization and to discredit authority, especially government’s.

Both parties were slow to grasp how much credibility they’d lost. The coming politics was populist. Its harbinger wasn’t Barack Obama but Sarah Palin, the absurdly unready vice-presidential candidate who scorned expertise and reveled in celebrity. She was Donald Trump’s John the Baptist.

Trump came to power as the repudiation of the Republican establishment. But the conservative political class and the new leader soon reached an understanding. Whatever their differences on issues like trade and immigration, they shared a basic goal: to strip-mine public assets for the benefit of private interests. Republican politicians and donors who wanted government to do as little as possible for the common good could live happily with a regime that barely knew how to govern at all, and they made themselves Trump’s footmen.

Like a wanton boy throwing matches in a parched field, Trump began to immolate what was left of national civic life. He never even pretended to be president of the whole country, but pitted us against one another along lines of race, sex, religion, citizenship, education, region, and—every day of his presidency—political party. His main tool of governance was to lie. A third of the country locked itself in a hall of mirrors that it believed to be reality; a third drove itself mad with the effort to hold on to the idea of knowable truth; and a third gave up even trying.

Trump acquired a federal government crippled by years of right-wing ideological assault, politicization by both parties, and steady defunding. He set about finishing off the job and destroying the professional civil service. He drove out some of the most talented and experienced career officials, left essential positions unfilled, and installed loyalists as commissars over the cowed survivors, with one purpose: to serve his own interests. His major legislative accomplishment, one of the largest tax cuts in history, sent hundreds of billions of dollars to corporations and the rich. The beneficiaries flocked to patronize his resorts and line his reelection pockets. If lying was his means for using power, corruption was his end.

This was the American landscape that lay open to the virus: in prosperous cities, a class of globally connected desk workers dependent on a class of precarious and invisible service workers; in the countryside, decaying communities in revolt against the modern world; on social media, mutual hatred and endless vituperation among different camps; in the economy, even with full employment, a large and growing gap between triumphant capital and beleaguered labor; in Washington, an empty government led by a con man and his intellectually bankrupt party; around the country, a mood of cynical exhaustion, with no vision of a shared identity or future.

If the pandemic really is a kind of war, it’s the first to be fought on this soil in a century and a half. Invasion and occupation expose a society’s fault lines, exaggerating what goes unnoticed or accepted in peacetime, clarifying essential truths, raising the smell of buried rot.

The virus should have united Americans against a common threat. With different leadership, it might have. Instead, even as it spread from blue to red areas, attitudes broke down along familiar partisan lines. The virus also should have been a great leveler. You don’t have to be in the military or in debt to be a target—you just have to be human. But from the start, its effects have been skewed by the inequality that we’ve tolerated for so long. When tests for the virus were almost impossible to find, the wealthy and connected—the model and reality-TV host Heidi Klum, the entire roster of the Brooklyn Nets, the president’s conservative allies—were somehow able to get tested, despite many showing no symptoms. The smattering of individual results did nothing to protect public health. Meanwhile, ordinary people with fevers and chills had to wait in long and possibly infectious lines, only to be turned away because they weren’t actually suffocating. An internet joke proposed that the only way to find out whether you had the virus was to sneeze in a rich person’s face.

When Trump was asked about this blatant unfairness, he expressed disapproval but added, “Perhaps that’s been the story of life.” Most Americans hardly register this kind of special privilege in normal times. But in the first weeks of the pandemic it sparked outrage, as if, during a general mobilization, the rich had been allowed to buy their way out of military service and hoard gas masks. As the contagion has spread, its victims have been likely to be poor, black, and brown people. The gross inequality of our health-care system is evident in the sight of refrigerated trucks lined up outside public hospitals. . .

Continue reading.

Written by Leisureguy

23 August 2020 at 1:02 pm

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

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