COVID-19 & US healthcare system

[Dartz]

People like Mr. Freedman are why this video is a thing. And Why I'm going to hell.



Also, The State here nationalised the fuck out of every private hospital this week. Like, Free Covid treatment for everyone, unlocked a quantity of ICU beds and just sort of made it happen.

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HAd to run to the office.

I don't even know if we'll be allowed in on Monday so I raided it for everything not nailed down - and got the perisheables out of the fridge. They government was late as fuck announcing the closedown.

[Norgarth]

heh, yeah, that's kinda accurate (although the US bus should have been on nitro)

1 of the websites I've been checking on says the US has added over 31k cases since Wednesday, that's almost as many cases as Iran has total. O_O

[Matrix Dragon]

So, if state Governers publicly criticize Trump, or fail to kiss his orange tinted ass enough, he'll cut off communications with them.

Jesus Christ, there's gonna be a lot of bodies before this is over...

[Labster]

This is what a bus driven by Trump looks like.

Basically, in the future, I advise you not to listen to advice from the U.S. federal government. They've shown themselves to be untrustworthy, to continue to lie, when the stakes are the lives of thousands to millions of citizens. They are outbidding states for medical equipment, and withholding it from the states in the center of the outbreak for political payback. They have lied about the market recovering, while telling their friends to sell. They have a pattern of lying about public safety, all the way back to the hurricane and Sharpiegate. They have issued no orders for quarantine, and given almost no leadership or planning to deal with the crisis. They have, however, used the virus as an excuse to excite racism. Thousands have died from their lack of leadership already.

Do everything you can to comply with your state governors' orders, Americans. They are on the front lines, deciding how to implement social distancing, lockdowns, move medical supplies where they are needed, and cutting through regulations to ensure more medics and medical facilities are available.

But do not listen to Trump or the federal government guidance. The U.S. government cannot be counted on to protect your life or property, nor are they working in your interest. Please, don't listen to the federal government -- it may save your life.

[SilverFang01]

This is what a bus driven by Trump looks like.

Basically, in the future, I advise you not to listen to advice from the U.S. federal government.  They've shown themselves to be untrustworthy, to continue to lie, when the stakes are the lives of thousands to millions of citizens.  They are outbidding states for medical equipment, and withholding it from the states in the center of the outbreak for political payback.  They have lied about the market recovering, while telling their friends to sell.  They have a pattern of lying about public safety, all the way back to the hurricane and Sharpiegate.  They have issued no orders for quarantine, and given almost no leadership or planning to deal with the crisis.  They have, however, used the virus as an excuse to excite racism.  Thousands have died from their lack of leadership already.

Do everything you can to comply with your state governors' orders, Americans.  They are on the front lines, deciding how to implement social distancing, lockdowns, move medical supplies where they are needed, and cutting through regulations to ensure more medics and medical facilities are available.

But do not listen to Trump or the federal government guidance.  The U.S. government cannot be counted on to protect your life or property, nor are they working in your interest.  Please, don't listen to the federal government -- it may save your life.

Ronald Reagan would be so happy right now seeing his dream made real.

[LynnInDenver]

Yeah, definitely going to be lots of bodies. It's not being helped by the fact that, at this point, people who have no clue what this pandemic is really meaning for everyone are running the show, and they think what's actually a proper response isn't nearly the best option, that we should be willing to put our health (and our friends' and family's health) on the line instead of our economics, and ignoring that, if it's really as bad as it's showing, that the economic damage is coming for us regardless at this point, it's a matter of when and where we're taking that particular hit on the chin, and when we take it is going to have an effect on what it does to our health system and health care costs over the next five to ten years, if not longer. There's going to be serious casualties among the health care providers at this point, and then there's going to be the ones that completely and totally burn out and leave the industry when the crisis is finally over, especially if they have to start making hard choices about who lives and who dies when it gets desperate.

The only reason (literally the only one) I voted against creating a single payer option the last time one was presented in Colorado is that it looked like they were going to enshrine the whole structure of it into the state Constitution instead of just the "Colorado gets to run a single payer health system" - basically the entire way it was going to be run was going to require voters at the polls again to tweak it if there were any issues with it. I may be much more likely to vote for it the next time, even with that sort of problem attached, because it's definitely quite clear that we won't ever get it from the Federal level.

I'm also worried about what happens if they can't find a way to vaccinate, never mind the realistic "we now have a vaccine" timetable and the risks that come when they try to fast track a vaccine in an effort to end this sooner. That means more people dying of illnesses we've been able to treat before - cancer patients having to decide to forgo chemotherapy because they can't afford to be immunocompromised and the newly increased risk of infection meaning they won't get any additional years even with chemotherapy anyway.

[hazard]

There is also that there's uncertainty about whether or not you can get reinfected with COVID-19. If the answer's yes that can cause a whole lot of issues on its own, because most diseases that can reinfect a body do so only after many years of the first exposure, but right now the few cases where we see what looks like a reinfection is within weeks of mending, if not days.

Hopefully that's a relapse instead of a reinfection caused by massive churn at the hospitals due to the high pressure the hospitals are under right now to make sure there's beds available for the diseased who absolutely need care and them releasing those who are recovering but not recovered prematurely.

[robkelk]

Meanwhile, north of the border...

Self-isolation is now the law pretty much everywhere in Canada. (Health is a provincial matter, by the Constitution.) Parks are closed. Anyone in a group of more than 5 people in British Columbia who isn't working in a hospital or living in an existing family gets fined $1000. Anyone crossing the US border into Ontario (excepting doctors, nurses, and long-haul truckers) is required by law to go straight home and self-quarantine for 14 days - we got the equivalent of a Presidential Alert about that yesterday.

As of noon Monday, anybody showing any symptom of COVID-19 will not be allowed to get on an airplane or an inter-city train.

The Prime Minister's wife has cleared the required 14-day self-quarantine after possible exposure without any signs or symptoms of illness - it looks like she dodged that bullet. The Prime Minister's family is leading by example and remaining self-isolated.

[nocarename]

Meanwhile, over in Alberta the Health Minster took some time out of managing our pandemic response to drive over to the home of a Doctor and yell at him for saying things online about the Minsters wife.

Mean, meme-ish things.
https://globalnews.ca/news/6743661/alber...signation/

Federally we seem to have a steady hand but as Rob notes, health is a provincial matter, and there I am much less confident.

[LynnInDenver]

There is also that there's uncertainty about whether or not you can get reinfected with COVID-19. If the answer's yes that can cause a whole lot of issues on its own, because most diseases that can reinfect a body do so only after many years of the first exposure, but right now the few cases where we see what looks like a reinfection is within weeks of mending, if not days.

Hopefully that's a relapse instead of a reinfection caused by massive churn at the hospitals due to the high pressure the hospitals are under right now to make sure there's beds available for the diseased who absolutely need care and them releasing those who are recovering but not recovered prematurely.

That's the other issue... the question of, will vaccination actually keep us from getting it, or will we just become an asymptomatic carrier of it when exposed? And how quickly can we become asymptomatic carriers after getting it the first time? That would require a wholesale review of what constitutes things like realistic room occupancy in public accommodations compared to before (a review I don't think would occur in many parts of the United States give the rest of the political reaction to this nightmare), and possibly even a complete outright loss of certain types of public activities in areas where health is considered a greater right than other things, or on the other side, an additional mark against trying to treat certain illnesses because, again, the reduction in changes of treatment actually doing much to improve lifespan/quality of life.

[hazard]

Even if we become asymptomatic carriers, as long as we have a notably smaller number of days we can transmit the disease that might well be worth it, leaving aside the sheer benefit of vast sections of he population not getting sick despite being infected.

Yes, it would mean vaccinating everyone (you want to do that with most highly infectious diseases anyway), yes it means that the vulnerable can't be vaccinated unless the vaccine is safe for them. But with few exceptions, everyone will be in good enough health at some point so that they can be vaccinated. Hopefully the vaccination lasts years to decades to one's entire life, so that once vaccinated you won't get the disease or at least won't suffer severely from it even when your immune system falters for whatever reason.

But all of that are things that have to be considered and investigated over time. This is a disease we don't have a decades to centuries long record of the way we do with so many other highly dangerous diseases, and that lack of a record is what is causing most of the trouble right now.

[robkelk]

If we use the same learning curve we used for the "Spanish flu" (current name "H1N1 influenza"), it should only take us three years to get a handle on this.

Let's hope we've become smarter than that in the last century. Particular politicians in many countries will have to be worked around.

EDIT:
I became curious as to how good a job we're actually doing, and found some numbers at Wikipedia: 2019–20 coronavirus pandemic. I copied the reported cases and fatality numbers for the G7 countries at 13:00 Eastern Time March 28, and did the basic math to determine the fatality rate by reported cases by country.

Sorted by fatalities per reported cases:

Germany: 55,570 reported cases, 420 deaths - 0.756% fatality rate
Canada: 4,326 reported cases, 55 deaths - 1.271% fatality rate
USA: 105,006 reported cases, 1,715 deaths - 1.633% fatality rate
Japan: 1,499 reported cases, 49 deaths - 3.269% fatality rate
UK: 17,089 reported cases, 1,028 deaths - 6.016% fatality rate
France: 32,964 reported cases, 1,995 deaths - 6.052% fatality rate
Italy: 86,498 reported cases, 9,134 deaths - 10.56% fatality rate

Whatever Germany is doing, we should take a serious look at doing the same thing everywhere else. They're keeping people alive.

[Dartz]

Better ICU capacity and, probably, a younger infected. Italy has a much older population.

Deaths here jumped up after it got into a nursing home and we had it double in one day - before dropping to normal rates. The Government is not expecting over a thousand fatalities when it is over. Five hundred, to a thousand, is normal for an Irish flu season

Otherwise, it seems like things are going well here. 7 day average growth is at 18% - rather than the 30% predicted - and the public health measures taken two weeks ago are only just beginning to take effect. The pubs were closed this day two weeks ago.

[hazard]

The Netherlands have a fatality rate of about 6.5%, but the RIVM is very open about the fact that testing is not comprehensive. Patients presenting to the hospital with COVID-19 like symptoms get tested, but people who are not admitted rarely do. This is rather easily identified because the number of confirmed cases is only 3 times as high as the number of hospitalized cases. It's not helped by the fact that people who have been in contact with infected people do not as a matter of course get tested.

We most likely will not know here in the Netherlands how much of the population actually was infected by COVID-19 until the blood bank reports on how much of the donations carry antibodies for the disease. Once that is known I would expect the reported fatality rate to drop substantially.

[Dartz]

Daily Tally just came out.

All-island, it's now 2739. With 14 deaths today.

Median age of fatilities is 81. Probably because it got into a few nursing homes.

About 20% of cases are hospital and healthcare workers - mostly because they're overrepresented in tests.

Death rate is taking time to catch up mind. So far it's only 2%

[Black Aeronaut]

Ronald Reagan would be so happy right now seeing his dream made real.

Ronald Reagan was at least a decent enough man that if he knew for certain that this was the direction things would go in, he'd have backpedaled on some of his policies so hard that he'd have left skid marks.

EDIT: And possibly even gone and cleaned house on the GOP.

[Jinx999]

Can you clarify something for me.

According to the news, in order to get the $2Bil relief bill through congress, they had to put in special spending oversight to get enough democrats on board.

Trump promptly said that he wouldn't abide by this restriction.

Is this an accurate summation?

If so, has Trump EVER had to work with people when he wasn't in a position to bully them?

[Matrix Dragon]

Yes Jinx, that's accurate. He's declared he won't abide by the law once again, and no one will do anything about it.

[SilverFang01]

Ronald Reagan would be so happy right now seeing his dream made real.

Ronald Reagan was at least a decent enough man that if he knew for certain that this was the direction things would go in, he'd have backpedaled on some of his policies so hard that he'd have left skid marks.

EDIT: And possibly even gone and cleaned house on the GOP.

To be honest, I see how his administration responded to the AIDS epidemic and doubt it.

[SilverFang01]

Are we going to keep pretending that universal healthcare is not the solution to this utter madness?
Insurance premiums could spike as much as 40 percent next year, a new analysis warns, as employers and insurers confront the projected tens of billions of dollars in additional costs of treating coronavirus patients.

[hazard]

Also relevant, a spike of 40% in healthcare insurance premiums would mean an increase from about 110 euros a month to 150-160 euros a month. If they actually manage to push that through to the market, which is not that likely because the insurance system in the Netherlands is fairly well monitored and under government oversight.

Yes, I'm paying about 1 500 euros per year for my health care insurance and after the deductible (which is a yearly amount), as long as the (legally mandated for minimum but actually extensive cover) contract says the insurance has to cover it, it's covered. Which means that I could get the disease, end up in the ICU for several weeks, recover in a hospital bed for a few more weeks, require further weekly home care and/or medical supplies for months and still pay less than 2000 euros for my health care costs in total that year.

And no doing silly stuff with trying to transfer the costs of any treatment performed during 2020 to 2019 or 2021 either so the insurance company makes more money. The government has opinions on that.


Now, I'm not sure about the USA costs, but if you're uninsured IIRC 2000 dollars is what you'd pay for one day of care in a standard hospital bed to recover from minor stuff that needs no specific protective gear and protocols. And that's if the hospital is cheap.

And the social security laws would ensure that I'm not going to suffer majorly from loss of income due to lack of ability to work during my time spent ill or recovering either.

The USA could really use a universally covered health care system of any stripe, but it needs much, much more than just that.

[Dartz]

The Irish Government is paying for every Covid case.

Today's statistics

All island, 14 fatalities.
All Island, 3025 cases - an increase of 286. The increase was less than yesterdays.
All Island, the 7-day infection rate is now 16% instead of 30%.

Out of 5000 daily tests, 200 are positive. A rate of 4%
Appointed cases are 10,000
Cases waiting on test appointments, 5,000
Capacity is still to be added to the system.

A passenger aircraft filled with PPE equipment has just landed. There will be daily flights until the crisis is over.

[SilverFang01]

Also relevant, a spike of 40% in healthcare insurance premiums would mean an increase from about 110 euros a month to 150-160 euros a month. If they actually manage to push that through to the market, which is not that likely because the insurance system in the Netherlands is fairly well monitored and under government oversight.

Yes, I'm paying about 1 500 euros per year for my health care insurance and after the deductible (which is a yearly amount), as long as the (legally mandated for minimum but actually extensive cover) contract says the insurance has to cover it, it's covered. Which means that I could get the disease, end up in the ICU for several weeks, recover in a hospital bed for a few more weeks, require further weekly home care and/or medical supplies for months and still pay less than 2000 euros for my health care costs in total that year.

And no doing silly stuff with trying to transfer the costs of any treatment performed during 2020 to 2019 or 2021 either so the insurance company makes more money. The government has opinions on that.


Now, I'm not sure about the USA costs, but if you're uninsured IIRC 2000 dollars is what you'd pay for one day of care in a standard hospital bed to recover from minor stuff that needs no specific protective gear and protocols. And that's if the hospital is cheap.

And the social security laws would ensure that I'm not going to suffer majorly from loss of income due to lack of ability to work during my time spent ill or recovering either.

The USA could really use a universally covered health care system of any stripe, but it needs much, much more than just that.

In the US, receiving a bill for $40,000 would be on the low end, with supposedly good insurance plans. Adding a 40% increase in premiums on top? A lot of people--those who can actually get insurance-- are going to start considering going without.

Unfortunately, there are some people who wring their hands about all the people who work in the insurance industry who'd probably lose their jobs if we had a single payer system. I just want to own that I care as much about their jobs as they care about my life.
Others say that is about "choice". In practice you don't have that. You either pay for a plan out of pocket, which a lot of people can't, what you can get thru your employer (if they offer one), or diddly squat.
For others, well, they are bound and determined to lockstep off a cliff into oblivion rather than acknowledge that reality isn't in line with what they want it to be. That is how you get states rejecting the Medicare expansion and people seeing that as a good thing.

Universal healthcare would be one step into fixing what is wrong with our system, not the whole solution, but a start.

[robkelk]

Unfortunately, there are some people who wring their hands about all the people who work in the insurance industry who'd probably lose their jobs if we had a single payer system. I just want to own that I care as much about their jobs as they care about my life.

If I recall correctly, your Constitution guarantees "life, liberty, and the pursuit of happiness". It does not guarantee a job.

[hazard]

In the US, receiving a bill for $40,000 would be on the low end, with supposedly good insurance plans. Adding a 40% increase in premiums on top? A lot of people--those who can actually get insurance-- are going to start considering going without.

I think you are conflating several things here.

First, I was talking about the cost of a single day use of a hospital bed, and only the hospital bed without anything more than the standard check ups.

Second, you aren't noting the cost of the insurance premiums. It'd be useful for comparison.

Third, wait, 40 000 dollars? That's 2/3rd of the median income IIRC, and for the lower economic strata at least one year of income, when you already are in the situation where you have month left at the end of your wages. You aren't going to be able to pay that bill.

Unfortunately, there are some people who wring their hands about all the people who work in the insurance industry who'd probably lose their jobs if we had a single payer system. I just want to own that I care as much about their jobs as they care about my life.

My answer to the insurance industry falling over is 'good, then they may be employed in a more productive job'. Not to say that insurance isn't useful or without beneficial traits. But the manner in which it's organized? That's a massive burden on the man hour and financial efficiencies of the health care system. Also a sizable burden on other parts of the economy, but all those paper pushers do have to push all the paper the insurance system requires to be done.

There are at least parts of society where simplifying the insurance system simply by centralizing all coverage into a single entity and not having to deal with things like the costs of the massive marketing campaigns or fighting with insurance companies over the prices because the company wants to make the greatest profit it can instead of delivering its services for the lowest costs to the consumer possible is simply too useful not to.

Others say that is about "choice". In practice you don't have that. You either pay for a plan out of pocket, which a lot of people can't, what you can get thru your employer (if they offer one), or diddly squat.

Ah, the choice of getting screwed by your lack of insurance, or being screwed by your insurance company.