Coronavirus

[MXLRplus]

Please link all the countries where this applies.

This took <60 seconds. England:

"You also can't choose when and what services to use in cases where speed of access to diagnosis and treatment is particularly important, such as:

• emergency services
• Rapid Access Chest Pain Clinics, where you must be seen within the 2-week maximum waiting time
• cancer services, where you must be seen within the 2-week maximum waiting time
• maternity services
• mental health services"

 

[bkp_duke]

This took <60 seconds. England:

"You also can't choose when and what services to use in cases where speed of access to diagnosis and treatment is particularly important, such as:

• emergency services
• Rapid Access Chest Pain Clinics, where you must be seen within the 2-week maximum waiting time
• cancer services, where you must be seen within the 2-week maximum waiting time
• maternity services
• mental health services"

Wait wait wait. A mom cannot pick her OB/GYN?

My wife would have gone on a shooting spree if she was assigned a random OB.

 

[JRP3]

This took <60 seconds. England

So one country, and not your regular doctor. Ever heard "out of network" in the U.S.? It's a thing.

 

[madodel]

Comparison of the healthcare systems in Canada and the United States - Wikipedia
"As reported by the Health Council of Canada, a 2010 Commonwealth survey found that 39% of Canadians waited 2 hours or more in the emergency room, versus 31% in the U.S.; 43% waited 4 weeks or more to see a specialist, versus 10% in the U.S."

"In the U.S., patients on Medicaid, the low-income government programs, can wait up to a maximum of 12 weeks to see specialists (12 weeks less than the average wait time in Canada)."

Citations are there in Wiki.

This discussion is way off topic, but here in PA it was impossible for Medicaid patients to see even primary providers let alone specialists. If you have private insurance there is usually a wait but you will eventually be seen. The scumbag moneygrubbers and misogynist primary care and other local cardiologists would send all their Medicaid or self-pay patients to my wife because she isn't an asshole and would take anyone. Though she stopped accepting those from practices that refused to send any insured patients to her. And some of those doctors weren't rightwingers, just money obsessed so it isn't political ideology. It is all about money. Almost all non-insured/Medicaid patients used the ER for most care or went out of county to get care. Most doctors only cared about getting paid here. Things changed when most practices were bought out by the hospital systems that came to the county when our then only hospital here was on the brink of folding.

Also every Canadian I know (all two of them) loves their health care plan and wouldn't change it. They accept waits as the cost of covering everyone. That is the case in Germany as well. In Canada the payer is all government (actually the Provinces in Canada), in Germany it is a hybrid of government and emloyer but the providers are mostly private. No one goes bankrupt from not being able to pay medical bills. Maybe in large cities there may be a "healthcare Market", but in most of America it is a monopoly. Anyway it is irrelevant as the healthcare system in the US is nearing collapse. Without huge government direct payments or a direct takeover many hospitals will just close. It is already happening in rural areas with hospitals closing. COVID almost closed our local hospitals in May when they had gone 7 weeks with no elective procedures. Talk about a wait list. And COVID isn't the end of pandemics.

I was on a Healthcare panel for my then Congressman a couple years ago along with insurers, union reps, area medical providers, all the hospital chains and even a Libertarian physician. The Congressman a Democrat was against Universal Healthcare and we were told upfront that wasn't an option. We were charged with coming up with suggested changes to the ACA to make it work better and be more affordable. Everyone but the Libertarian acknowledged that the only solution to bringing costs and quality of care under control was Universal healthcare. Even the health system that also was a major health insurer was ok with it as long as they could be capitized based on volume of patient care. Even the Libertarian was supportive of most of our other recommendations which included many ways to rein in pharmaceutical costs, especially patents and even a public option for the ACA exchange. I was shocked that the union reps were willing to give up their Union negotiated insurance plans which they said were becoming unsustainable. You need to get out of your bubble.

 

[TEG]

We've been down that route. They really are NOT providing good care. I have a cousin that is a physician in Canada. He has repeatedly confirmed that as a patient, you simply CANNOT walk in to a clinic and be seen for most common conditions. Wait lists are the norm, care is RATIONED out.

Coincidentally, I also have a cousin that is a doctor in Canada.
I haven't probed him much on how things go up north, but I do recall him saying something like this to me long ago:
"For basic needs, healthcare is easier and way more affordable in Canada... But if you have some exotic illness and need some specialized equipment you better get a load of cash and head down to USA..."
He also said some of the more skilled specialist doctors move to the states because they can make a lot more money...

OK, let's bring this (sort of) back on topic to COVID:

Amid Pandemic, FDA Seizes Cheaper Drugs From Canada
Trump Approves Final Plan to Import Drugs From Canada ‘for a Fraction of the Price’
Canada Blocks Export Of Medications In Short Supply In Response To Trump Plan

 

[MXLRplus]

So one country, and not your regular doctor. Ever heard "out of network" in the U.S.? It's a thing.

If you submit a PO for the minimum 2hr billing, I'll provide you with a report. You received nearly 60 seconds for free.

You are welcome.

 

[bkp_duke]

This discussion is way off topic, but here in PA it was impossible for Medicaid patients to see even primary providers let alone specialists. If you have private insurance there is usually a wait but you will eventually be seen. The scumbag moneygrubbers and misogynist primary care and other local cardiologists would send all their Medicaid or self-pay patients to my wife because she isn't an asshole and would take anyone. Though she stopped accepting those from practices that refused to send any insured patients to her. And some of those doctors weren't rightwingers, just money obsessed so it isn't political ideology. It is all about money. Almost all non-insured/Medicaid patients used the ER for most care or went out of county to get care. Most doctors only cared about getting paid here. Things changed when most practices were bought out by the hospital systems that came to the county when our then only hospital here was on the brink of folding.

Also every Canadian I know (all two of them) loves their health care plan and wouldn't change it. They accept waits as the cost of covering everyone. That is the case in Germany as well. In Canada the payer is all government (actually the Provinces in Canada), in Germany it is a hybrid of government and emloyer but the providers are mostly private. No one goes bankrupt from not being able to pay medical bills. Maybe in large cities there may be a "healthcare Market", but in most of America it is a monopoly. Anyway it is irrelevant as the healthcare system in the US is nearing collapse. Without huge government direct payments or a direct takeover many hospitals will just close. It is already happening in rural areas with hospitals closing. COVID almost closed our local hospitals in May when they had gone 7 weeks with no elective procedures. Talk about a wait list. And COVID isn't the end of pandemics.

I was on a Healthcare panel for my then Congressman a couple years ago along with insurers, union reps, area medical providers, all the hospital chains and even a Libertarian physician. The Congressman a Democrat was against Universal Healthcare and we were told upfront that wasn't an option. We were charged with coming up with suggested changes to the ACA to make it work better and be more affordable. Everyone but the Libertarian acknowledged that the only solution to bringing costs and quality of care under control was Universal healthcare. Even the health system that also was a major health insurer was ok with it as long as they could be capitized based on volume of patient care. Even the Libertarian was supportive of most of our other recommendations which included many ways to rein in pharmaceutical costs, especially patents and even a public option for the ACA exchange. I was shocked that the union reps were willing to give up their Union negotiated insurance plans which they said were becoming unsustainable. You need to get out of your bubble.

All of this was fine until the "you need to get out of your bubble" comment. Was that necessary? Seriously.

I don't live in a bubble, I've practiced medicine and seen both Medicaid/CHIP (kids don't get Medicare) and private pay patients. There are headaches with BOTH, and all your post did was re-emphasize that the current system is broken. With Medicaid/CHIP the reimbursement was so low it didn't cover the cost of my front office staff, forget overhead, nurse, etc. With private pay the insurers put you through the ringer before they will cut you a check.

We will have to agree to disagree on how to fix it, because the US Gov has NEVER shown competence at running anything except warfare. Perhaps that's the solution, put universal healthcare under the control of the US military?

USPS . . . nope.
VA medical system . . . nope.
IRS . . . ha ha ha.


I just keep failing to see why people would give the government so much extra power over their day to day lives, for an inferior product. Everything in the US run by government is the antithesis of efficiency. The pandemic has made that even more clear. Forget comparisons to foreign countries, that's clickbait, and won't work here the same way, and your comment below is EXACTLY why:
"Also every Canadian I know (all two of them) loves their health care plan and wouldn't change it. They accept waits as the cost of covering everyone."

There is no way US citizens will accept increased wait times. We are the most impatient people on the planet. And to be frank, increased wait times = increased mortality. Your wife will tell you that straight up, and the stats on both the Canadian and UK health systems bear that out. Again, it's just another way of rationing care, and the US population just won't accept that.

 

[JRP3]

Again, it's just another way of rationing care, and the US population just won't accept that.

So we just ignore the "wait times" we have for people who can't afford treatment until it ends up being an emergency room visit?

 

[madodel]

All of this was fine until the "you need to get out of your bubble" comment. Was that necessary? Seriously.

I don't live in a bubble, I've practiced medicine and seen both Medicaid/CHIP (kids don't get Medicare) and private pay patients. There are headaches with BOTH, and all your post did was re-emphasize that the current system is broken. With Medicaid/CHIP the reimbursement was so low it didn't cover the cost of my front office staff, forget overhead, nurse, etc. With private pay the insurers put you through the ringer before they will cut you a check.

We will have to agree to disagree on how to fix it, because the US Gov has NEVER shown competence at running anything except warfare. Perhaps that's the solution, put universal healthcare under the control of the US military?

USPS . . . nope.
VA medical system . . . nope.
IRS . . . ha ha ha.


I just keep failing to see why people would give the government so much extra power over their day to day lives, for an inferior product. Everything in the US run by government is the antithesis of efficiency. The pandemic has made that even more clear. Forget comparisons to foreign countries, that's clickbait, and won't work here the same way, and your comment below is EXACTLY why:
"Also every Canadian I know (all two of them) loves their health care plan and wouldn't change it. They accept waits as the cost of covering everyone."

There is no way US citizens will accept increased wait times. We are the most impatient people on the planet. And to be frank, increased wait times = increased mortality. Your wife will tell you that straight up, and the stats on both the Canadian and UK health systems bear that out. Again, it's just another way of rationing care, and the US population just won't accept that.

Again way off topic but the USPS is run by a government appointed independent board that has for the past 4 years done what it could to destroy the USPS. They stopped all postal sorting locally and required all mail to go to centralized sorting facilities which added days to local mail delivery, then they removed the sorting equipment which was used as the reason to send the mail to centralized sorting places originally. Also the USPS has been operating with a Congressional mandated requirement to prefund all potential retirement costs which no business is required to do. That alone is a $5 billion a year albatross it is saddled with. Both the IRS and the VA are under constant cuts. My wife hated her rotation at the VA hospital in Philly as it was always limited resources but that was 35 years ago so I have no idea where things stand with the VA now. The IRS is also hindered by byzantine laws that are drafted to preserve loopholes for rich people and corporations. I wish we had a simple graduated tax system with minimal deductions that applied to everyone with maybe income caps.

As to your last comment there are some people who will never be happy no matter what. I will grant you that. My wife is always dealing with patients who have COVID complications and still deny it causes any of their problems and blame everything else. I just think that in a few years the whole bizarre private insurance system will bring the healthcare system here to a complete disaster. The one thing my wife likes about working for a hospital is that she no longer has to deal with insurance companies who like you said will do anything to delay or not pay at all. I just don't understand the appeal. And don't get me started with the in network "stuff". I look forward to Medicare next year. And while Medicare in fact uses private intermediaries to process claims, the regulations running the system come from CMS which is the federal government, and those intermediaries who are private insurers pay what is due on time and without games and at a significantly lower cost than the very same private insurers say it costs them to process their own insureds. Medicaid is administered by each state and interprets the regulations the way they want. That is a nightmare. I use to deal with hospital billing systems so I'm extremely familiar with how they work. Another thing you don't want to get me started on.

 

[wdolson]

I appreciate this opinion, and see the merits of some of the argument, but you are completely glossing over the following:

1) In the HISTORY of mankind, we have NEVER been able to contain an airborne, pandemic-level pathogen. Ever. The "playbook" referred to has nothing new that would have prevented that.

2) The above would have mitigated this ONLY if we wanted to COMPLETELY close off and enforce the closure of our borders. Is that something you were willing to do? Even with this, given the size of our borders (we are not a New Zealand - where this has worked), I doubt we could have managed it.


The R-value for this pathogen (which is HIGHER now than it was at the beginning because of the new mutations) means that it is virtually impossible to contain. You would ONLY be able to slow the spread, and there I 100% agree we could and should have done a better job.

Bear in mind that 1 in 6 infections in the US are of Healthcare providers and their families. These are the people that KNOW how to use PPE properly, and this data is a STRONG indication that PPE measures are insufficient alone to stop the spread of this virus.

Places that are in the "corners" of the world have been able to virtually eradicate the virus, but they have a limited number of people crossing their borders. New Zealand and Australia are among the most successful.

South Korea and Taiwan are not in the middle of nowhere, but they have also been very successful in controlling the virus. Both countries have populations that are more cooperative with government recommendations than the US, both are smaller, and they also have better border control than the US can.

Some countries were able to control the virus for a while like Germany, but having land borders with several other countries, outbreaks in neighboring countries eventually caused worse outbreaks in Germany too.

But government leadership and public trust in the government does play a role in outcomes. The US and UK are among the worst run democracies in the world right now and they have had two of the worst outcomes. Most democracies with competent leadership have fared much better, but everyone is worse off now that 6 months ago. A combination of new strains, public fatigue and people getting lax, and it being winter in the northern hemisphere.

Except for all the countries which are able to provide good health care for their citizens. You are literally denying reality.

All industrialized democracies than the US have some form of universal health care. But it varies from country to country. Some countries have a centralized, government run system, but some just have universal insurance that is government regulated. Germany has private insurance and a requirement everyone gets a minimum basic level of insurance, but can pay for more if they want. They regulate the cost of the basic plan and the price is pegged at the point where the companies just break even. They make their money upselling people.

There was a documentary on PBS/NPR (they did both a video and radio version) about 1 years ago where an American went around the world to see how healthcare was run in each country. The documentarian had shoulder reconstruction surgery several years before and had ongoing pain. He saw doctors in each country about his condition and then interviewed them about how healthcare worked. He also spoke with government officials in each country about their system.

Every system has strengths and weaknesses. The expenditure for healthcare on a national level was cheaper in every country by a wide margin. The average outcomes were generally better in every country too. The US is a great place to get healthcare if you can afford it or you have some rare condition that requires some kind of exotic treatment. For most things people experience on a regular basis, the US fares worse than other developed countries.

The problem with the healthcare debate is the whole thing is very complicated. Healthcare ranges from common things that most people need at some point to complex things that only a few people in the world have any knowledge about. This includes many different facets like in person healthcare, support services, and medications. And then there is paying for it all.

Nobody does it all perfectly. Every system in the world has some problems. That was evident from the documentary I mentioned above. The US system is by far the most expensive in the world and while the US does lead the world in specialist medicine, delivery of common medical help is more spotty than any other developed country. Way too many people in the US fall through the cracks.

 

[Oil4AsphaultOnly]

You must still believe in Santa Clause, the Tooth Fairy, and the Easter Bunny, right?

Yep, call me jaded.


I view an open market as a nice check to a corrupt government, but I'm sensing that I'm in the minority here . . .

I find it highly fascinating that I agree with you in many other aspects, except for healthcare.

NO ONE has advocated for government run Hospitals. What we (at least I think so anyway) want is government run health insurance. Whether or not that degrades down to government run health _care_ (where government provides the medical staff) is yet to be seen, yet you've determined that it's fait accompli?! You're beating a strawhorse.

And I now consign my post to purgatory where the mods might eventually send this.

 

[madodel]

Another advantage of Medicare over private insurance is that you are only responsible for 80% of the Medicare allowable charge which is what Medicare allows the provider to charge. You can't be balance billed. Got a bill for a PCP checkup with a $140 charge of which our health insurance (which is the hospital's best plan and the PCP works for the same hospital) the insurance only paid $47.32. I was balance billed for the difference $92.68 because I haven't met our deductible for the year yet. And this is in network and the hospital's best Blue Cross plan that my wife pays $175 every paycheck for (and extra for dental and eye). We've been screwed by out of network in the past, and my wife and I are very knowledgeable about healthcare and insurance. Only takes being seen by one out of network provider (in our case the anesthesiologist) and you can be billed thousands of dollars which the insurance company in our case only paid a few hundred dollars for. So before they put you under make sure to ask the anesthesiologist if they are in network. Our system is crazy.

My daughter is in medical school in Germany. Her government health insurance plan costs her 100 Euros (about $120) a month and covers everything including eyeglasses and dental. So far she has paid nothing for seeing doctors or a trip to the ER. They don't know what a deductible or a co-pay is. Downside is that providers are mostly independent and can refuse to take government insurance like here in the US. Also her fellow students ask if she is going back to the US to practice so she can make money. In Germany the pay is decent but it is not going to make you rich, but enough for her to be able to stay there.

 

[uujjj2]

Mrs. Uujjj(an emergency doc) has been the more pessimistic of the Uujjj's throughout the pandemic. Mrs. Uujjj correctly predicted, back in January 2020, that COVID-19 was going to be a pandemic and that the US in particular would utterly fail to contain it. But now Mrs. Uujjj is saying the worst is over. She also believes that while we will continue to have COVID outbreaks here and there, they'll have vaccinated enough of the high risk people by this spring that there won't be any more "waves" of COVID here in California or most of the US.

 

[bkp_duke]

Mrs. Uujjj(an emergency doc) has been the more pessimistic of the Uujjj's throughout the pandemic. Mrs. Uujjj correctly predicted, back in January 2020, that COVID-19 was going to be a pandemic and that the US in particular would utterly fail to contain it. But now Mrs. Uujjj is saying the worst is over. She also believes that while we will continue to have COVID outbreaks here and there, they'll have vaccinated enough of the high risk people by this spring that there won't be any more "waves" of COVID here in California or most of the US.

I concur. Confident enough we booked a vacation this week for 2 months from now.

 

[AlanSubie4Life]

Bear in mind that 1 in 6 infections in the US are of Healthcare providers and their families. These are the people that KNOW how to use PPE properly, and this data is a STRONG indication that PPE measures are insufficient alone

I disagree with this. It does not take much analysis of pictures published in news outlets to see that people working in healthcare in non-COVID wards are not using N95s or using adequate PPE, in general. This behavior is completely inconsistent and inappropriate for the pandemic.

My understanding is that the extreme measures used in COVID wards are very effective, and my guess is most of the cases are being acquired in areas of the hospital where known best methods are not being followed.

Healthcare facilities are high contact, crowded, and closed places, so if you don’t use proper PPE properly and consistently, you are going to see spread, even with pre-screening (due to asymptomatic spread). You also cannot have lunch areas inside, etc. I am fairly sure none of these precautions are being taken, so failure is assured.

It’s a contagious virus, but we’d be doing much better if we all wore N95s and followed best practices, especially in high contact settings like this (every single worker, including the ones not in contact with patients). I think that the idea that proper PPE is not sufficient to contain the pandemic is not supported by the evidence.

It would be nice to have some studies though. One difficulty is that since there is no sequencing done as a matter of routine, there is no way to determine the source of the infection.

 

[AlanSubie4Life]

https://www.nejm.org/doi/full/10.1056/NEJMc2027040

An interesting paper which ties together Ct value (for one of the nucleocapsid proteins), RT-PCR result, and whether virus can be cultured.

Gives an idea of how long after onset of symptoms people are likely to be infectious and provides a rough idea for this particular marker how Ct value behaves (obviously there is a lot of randomness to Ct value as it depends on sample quality). Looks to me like Ct value alone is too noisy an indicator to draw firm conclusions, but of course it is correlated with infectiousness.

Additionally: Note that depending on the assay & particular marker in question, there are different Ct values (I read this a while back). It’s apparently all defined in the instructions provided in the analysis kit. In other words, a Ct value of 35 doesn’t always mean the same thing. It might be equivalent to a Ct value of 30 for another type of PCR test, for example.

 

[uujjj2]

I concur. Confident enough we booked a vacation this week for 2 months from now.

Yeah the Uujjj family could use a vacation too! Get the vaccine before your trip. Domestic vacations for the April timeframe. Mrs. Uujjj predicts by May or June, things in Europe will be better. For less developed countries, she recommends deferring until the fall.

 

[Jeff N]

Manaus, a city in the Brazilian Amazon with a population of 2 million, was hit hard last spring and supposedly had a measured population antibody prevalence of 75% —high enough for herd immunity.

But, in December it was hit with a new wave of COVID cases.

“Manaus was hit by what scientists call the P.1 variant. This time, it didn’t take 10 days to overwhelm Galvão’s hospital. It took 24 hours.

Even in a city as traumatized as Manaus, the horror has been unlike anything doctors have seen. The oxygen quickly ran out. Dozens of hospital patients have died of asphyxiation. Scores more, unable to get care, have died at home. Every half-hour, one doctor said, a funeral procession rumbled toward the cemetery.”

https://www.washingtonpost.com/world/2021/01/27/coronavirus-brazil-variant-manaus/

 

[AlanSubie4Life]

Manaus, a city in the Brazilian Amazon with a population of 2 million, was hit hard last spring and supposedly had a measured population antibody prevalence of 75% —high enough for herd immunity.

But, in December it was hit with a new wave of COVID cases.

“Manaus was hit by what scientists call the P.1 variant. This time, it didn’t take 10 days to overwhelm Galvão’s hospital. It took 24 hours.

Even in a city as traumatized as Manaus, the horror has been unlike anything doctors have seen. The oxygen quickly ran out. Dozens of hospital patients have died of asphyxiation. Scores more, unable to get care, have died at home. Every half-hour, one doctor said, a funeral procession rumbled toward the cemetery.”

https://www.washingtonpost.com/world/2021/01/27/coronavirus-brazil-variant-manaus/

Yeah, really have to hope those antibody estimates were way off! The death rate was low, but it’s also a younger city. Number of deaths applied to the age distribution, with the known IFR for that time period is probably the most reliable way to estimate the actual number of infections. Of course, the “known” IFRs are also based on antibody studies and similar. However, the meta-analyses done using data from multiple locations, to estimate IFR by age, are probably better than using a single result of an antibody study from one area.

 

[CSFTN]

Another advantage of Medicare over private insurance is that you are only responsible for 80% of the Medicare allowable charge which is what Medicare allows the provider to charge. You can't be balance billed.

Huh? I'm pretty sure you are incorrect in the detail but correct in the bottom line.

First, any provider can charge whatever they want, in most jurisdictions. Second, Medicare does establish allowable for most things under most circumstances, but those only apply if your provider is participating in Medicare - which, admittedly, essentially all US hospitals and >90% of US doctors do. Third (and here's your error), Medicare pays - most times - 80% of the allowable and you are responsible for the remaining 20%. You are correct in that providers are forbidden from going after you for anything more. Some private insurers do the same thing, some don't. Lastly, you can contract with a 3rd party co-insurer to pay up to the remaining 20%, so theoretically you may owe nothing.