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  • Archive for the 'Medicine' Category

    Reopening — III (Theory ∧ Practice)

    Posted by Jay Manifold on 27th November 2020 (All posts by )

    “We should act incrementally as prudent risk minimizers and pursue any effective no-regrets options. We do not have to wait for the formulation and acceptance of grand strategies, for the emergence of global consensual understanding, or for the universal adoption of more rational approaches.”

    — Vaclav Smil (Global Catastrophes and Trends: the Next Fifty Years)

    This post is an attempt at synthesis; those just grazing in (Midwesterners don’t surf) are directed to Reopening — I (Practice) and Reopening — II (Theory) for accounts of my earlier action and contemplation, respectively. For my third installment, I can do no better than lead off with a quadrant diagram of my own devising:

    Read the rest of this entry »

    Posted in Bioethics, Civil Liberties, Civil Society, COVID-19, Current Events, Human Behavior, Management, Medicine, Miscellaneous, Science, Tech, Tradeoffs, USA | 9 Comments »

    Obamacare – The COVID-19 Virus of U.S. Healthcare Insurance

    Posted by Kevin Villani on 30th September 2020 (All posts by )

    It tricks its way in and infects the vital organs.

    Obamacare promised to reduce the cost and improve the availability of health care services in the U.S. without reducing the quality, generally considered the world’s best. By traditional metrics, e.g., the health of the American public, the cost, and the share of national resources devoted to healthcare, Obamacare is a total bust. As with any government program targeted to a single metric, a higher percentage of the population has insurance, whatever the cost or coverage, but even that has been declining since the enforcement mechanism, a grossly excessive individual mandate, was eliminated.

    Obamacare made some households feel more financially secure, others less so. But it’s an illusion from a broader perspective as federal, state, and local finances are virtually all unsustainable. The federal government spent about $1.5 trillion on health care in 2019 and states about $300 billion. Handing out stacks of newly printed $100 bills to assist households with medical bills would have been a much cheaper and simpler solution.

    The current Rube Goldberg monstrosity reflects the attempt to achieve the universal coverage and uniform quality of national health systems while maintaining private medical services and private health insurers under the misleading banner of “insuring the uninsured.” Many analysts believed Obamacare was purposely designed as a Rube Goldberg contraption intended to end with a “bang,” paving the way for “single payer” or “Medicare for all” – the current progressive goal. But like virtually all failed government programs, Obamacare whimpers on.

    To repeal and replace would admit the obvious. But the “single payer” and “Medicare for all” proposals aren’t an actuarial insurance fix, merely a progressive federal tax. Their perceived merit is eliminating insurance company administrative costs (and administration), profits and actuarial premiums with political premiums – payroll taxes that contribute to total Treasury tax revenue. Politicizing the premiums will further politicize provider payments, two steps toward nationalized healthcare, the likely goal of many proponents.

    Socialized national healthcare may be preferable to it. But politicians deny and mis-represent the European national healthcare systems’ inferior medical performance and deny the totalitarian necessity even while issuing multiple mandates and threats under Obamacare. The original separation of the private and public healthcare systems in the U.S. – the original “public option” – is another, arguably better option.

    The Winding Road to the Obamacare Dead End

    In a competitive market economy health expenses would largely be paid from personal precautionary savings or medical insurance, the premiums sufficient to cover actuarial claims according to the “law of large numbers” for unpredictable claims, with insurance reserves for worse than predicted experience, e.g., due to a pandemic. All insurance requires a degree of “assurance” to mitigate avoidable claims, a “moral hazard that the insured will take greater risks.

    The U.S. health insurance industry in the early twentieth century followed the path of the savings bank industry of the prior century. Individual not for profit (mutual) firms (Blue Cross and Blue Shield) started appearing during the Great Depression for employees (initially teachers). The big expansion came when during WW II, FDR, no stranger to fascist business methods, capped wages but not benefits creating a loophole for un-taxed employer health insurance benefits that persists today, an advantage over individual plans paid mostly with after tax income.

    Health care needs of the poor were addressed by a variety of public, civic and religious institutions. During the first half of the 20th century, driven largely by public health concerns, municipal hospitals provided health services but with independent fee for service doctors, whereas housing policies followed the fascist Wehrmacht model, paying private developers and builders to construct public rental housing.

    Public healthcare, like public housing, was definitely below average. But the World Health Organization (WHO) Constitution of 1946 declared “enjoyment of the highest attainable standard of health”—defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”—“is one of the fundamental rights of every human being,” reaffirmed in the 2020 Democratic Party Platform.

    Similarly, in market economies housing structures are considered a capital investment financed with debt or equity, owned or rented. But the United Nations identifies adequate affordable housing and secure tenure as a “fundamental human right.”These assertions followed the destruction of WW II and rise of European “democratic socialism,” but were foreshadowed by FDR’s New Deal policies during the Great Depression and his Second Bill of Rights in 1944.

    European national Healthcare systems reflected this uniformity, with one standard for all under Britain’s system, whereas the French system allowed about 10% of the population to opt for higher quality care with private insurance.

    The U.S. went in the opposite direction in the 1950s and 1960s. Federal expenditures for housing and health services were increasingly directly subsidized with federal progressive taxation, less intrusive to the private sector than prior methods or European systems, albeit more so than subsidizing income directly. The advent of federal Medicaid and Medicare subsidized insurance led to the decline of public hospitals (as did the movie “One Flew Over the Cuckoo’s Nest.” ) But the Budget Act of 1974 making expenditures more transparent shifted lobbying efforts to less transparent tax subsidies and to regulation by the Administrative State.

    So progressives targeted finance and insurance, where the subsidies are often opaque. The objective became achieving a socialist incidence of both cost and delivery of health services by subsidizing and manipulating the private insurance market. The problem with FDR’s freely granting of multiple “rights” including healthcare and housing during this “fireside chat” was that they were not his to dispense. Progressive “rights” are nothing more than meretricious socialist promises implemented with a totalitarian stick that violate the unalienable rights in America’s Declaration of Independence that are the cornerstone of a market system, the reason for multiple conflicting and confused Supreme Court decisions regarding Obamacare.

    The Clinton Administration first proposed Hillarycare, the precursor to Obamacare, in 1993. When that failed, it turned to housing, where it was too successful. These latent New Deal viruses later turned deadly. Some three and a half years ago I argued that the two legislative centerpieces of the Obama Administration, the “Dodd-Frank Act” (the Wall Street Bank Bailout) and the “Affordable Care Act” (Obamacare) had the same fatal flaw. Politicians basically intervened in finance and insurance markets to provide equality of home ownership and medical care across all incomes without transparently paying the price. The effects spread like a deadly virus, distorting all the incentives, checks and balances that kept the private system afloat, replaced by universal one-size-fits-all mandates. The sub-prime lending debacle, like the Wehrmacht, lasted a decade, the current age of Obamacare (see Appendix).

    The Building of a Rube Goldberg Contraption: Doubling Down on “Pre-Existing Distortions”

    Read the rest of this entry »

    Posted in Big Government, Economics & Finance, Health Care, Medicine, Obama | 17 Comments »

    In the Field

    Posted by Sgt. Mom on 8th September 2020 (All posts by )

    Sometimes, long after first reading a book or watching a movie and enjoying it very much, I have come back to re-reading or watching, and then wondering what I had ever seen in that in the first place. So it was with the original M*A*S*H book and especially with the movie. I originally read the book in college and thought, “Eww, funny but gross and obscene, with their awful practical jokes and nonexistent sexual morals.” Then I re-read after having been in the military myself for a couple of years, and thought, “Yep, my people!”

    The movie went through pretty much the same evolution with me, all but one element – and that was when I began honestly wondering why the ostensible heroes had such a hate on for Major Burns and the nurse Major Houlihan. Why did those two deserve such awful, disrespectful treatment? In the movie they seemed competent and agreeable enough initially. In the book it was clear that Major Burns was an incompetent surgeon with delusions of adequacy, and that Major Houlihan was Regular Army; that being the sole reason for the animus. But upon second viewing of the movie, it seemed like Duke Forrest, Hawkeye Pierce and Trapper John McIntyre were just bullying assholes selecting a random target for abuse for the amusement of the audience. Read the rest of this entry »

    Posted in Book Notes, Deep Thoughts, Film, History, Holidays, Korea, Medicine, Middle East, Military Affairs, Personal Narrative, War and Peace | 30 Comments »

    Virus Transmission Modes

    Posted by David Foster on 11th May 2020 (All posts by )

    Here’s an article with data…or at least assertions…about various ways in which Covid-19 spreads and their relative risks.

    To the extent that data at this level of detail can be obtained and verified, it seems a lot more useful than generic claims about lockdowns and social distancing, or the elimination of same.

    Mike K, any comments?

    Posted in COVID-19, Medicine, Science, USA | 25 Comments »

    Cytokine storms

    Posted by TM Lutas on 19th April 2020 (All posts by )

    Covid-19, as a virus, generally does not directly kill. Instead, it fools our own immune system into killing us via the mechanism of a cytokine storm.

    It is not the only disease that can provoke cytokine storms. We don’t know how to reliably stop cytokine storms. If we did, we wouldn’t have to shut down the economy. We could just treat those who are starting to get sick so they wouldn’t develop into a cytokine storm, pay the bills, however, and we would all come out trillions of dollars ahead with a death toll of no national or international significance as the only people who would succumb would be those already on death’s door.

    If nobody else will say it, I will. We don’t need to close down the majority of our economy just to change what’s written on a death certificate that was coming out anyway.

    Diseases will continue to emerge. Any disease that provokes cytokine storms while not killing many itself will be just as scary as Covid-19 and we’ll be back to the question of whether we have another economic shutdown.

    Cytokine storms are not just associated with infectious diseases. The first mention of the term in the literature was about graft vs host disease in a 1993 article. They entered into the general public’s imagination 15 years ago with the H5N1 flu. We don’t really understand why they happen and how to reliably stop them from taking a life. This is a public health issue deeper than how we pay for healthcare. It threatens us all and will continue to do so at irregular intervals as new diseases emerge that cause cytokine storms.

    So as we move past our currently unsustainable shutdown due to Covid-19, we all have to decide whether we’re going to let cytokine storms go until the next time some disease breaks out and kills significant numbers of people via this mechanism or whether we’re going to treat this seriously so that the next time we’ll be ready. It’s our choice.

    Posted in Medicine, Politics | 20 Comments »

    “A Fresh Perspective on the Covid-19 Numbers” – Part 2

    Posted by Jonathan on 17th April 2020 (All posts by )

    Robert Prost follows up his previous email (posted here):

    Plotted below are the covid-19 confirmed cases for Wisconsin. The data is graphed so that the first derivative plot is scaled up for better visibility. The fact that the graph has been jumping so erratically means that somebody is manipulating the data. This first derivative is the rate of change of the accumulation of new cases. That fact that it jumps around means that either someone is pushing the hospitals to change their definition of ‘confirmation’ or the virus has a mind of its own. If the changes were due to the sudden availability of additional testing, the increase should be all in one direction if additional cases were being detected. Someone is playing games in pursuit of a political agenda. Were I to hazard a guess, I’d say it is due to our addled governor, aka Tony Baloney.

    Wisconsin COVID-19 Confirmed Cases

    Robert concludes: “This data certainly does not give a good reason to extend the lockdown.”

    Posted in COVID-19, Current Events, Medicine, Politics, Science | 10 Comments »

    SARS-CoV2/COVID-19 Update, Easter 2020 edition

    Posted by Trent Telenko on 12th April 2020 (All posts by )

    There are lots of hopeful reports — despite the USA COVID-19 infections being over 1/2 million and the total deaths of over 20,000 people — that the pandemic will soon be “Over.”

    This is fantasy thinking at best.  SARS-CoV2/COVID-19 won’t be over, until it is over, for YEARS.

    “Over” being defined as world wide mass vaccinations to the tune of 70% of humanity or human herd immunity.  Assuming such a thing is possible, which it may not be, given this recent report from the UK Daily Mail on post SARS-CoV2/COVID-19 infection immunity —

    Blow to Britain’s hopes for coronavirus antibody testing as study finds a THIRD of recovered patients have barely-detectable evidence they have had the virus already

    .

    – Nearly third of patients have very low levels of antibodies, Chinese study found
    – Antibodies not detected at all in 10 people, raising fears they could be reinfected
    – Explains why UK Government repeatedly delayed rolling them out to the public

    .

    https://www.dailymail.co.uk/news/article-8203725/Antibodies-prove-difficult-detect-Chinese-coronavirus-survivors.html

    .

    Related studies:
    Wu F et al. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications. medRxiv 2020.03.30.20047365; doi: https://doi.org/10.1101/2020.03.30.20047365

    .

    and

    .

    Zhao J et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019, Clinical Infectious Diseases, , ciaa344, https://doi.org/10.1093/cid/ciaa344
    total by July 1st 51,197

    Or this South Korean story on coronavirus “reactivation” —

    South Korea reports recovered coronavirus patients testing positive again
    APRIL 10, 2020
    Josh Smith, Sangmi Cha

    .

    https://www.reuters.com/article/us-health-coronavirus-southkorea-idUSKCN21S15X?utm_campaign=trueAnthem%3A+Trending+Content&utm_medium=trueAnthem&utm_source=facebook

    The issue with most COVID-19 tests, like the ones mentioned in South Korea, is they detect SARS-CoV2 RNA. They do not detect whether the viral particles are active or not. The issue here is whether these people are shedding active viral particles that can re-infect people.  We don’t know if that is the case here from the story text.  Given how infectious it is.  This coronavirus will tell us in due course.

    There are some viral diseases like Herpes that hide inside your body and reactivate to make you infectious. We do not know enough about the SARs-CoV2 virus to say whether that is the case here.

    If the SARS-CoV2 virus is like Herpes in that once contracted, it never goes away and flares infectious several times a year.

    And there is no herd immunity for some people no matter how often they are infected.

    Then we will need multiple, cheap,  out-patient style “cure-treatments” as well as multiple vaccines, based on co-morbidities, and possibly to account for racial differences like sickle cell blood mutations, as SARS-CoV2 may well be more a blood disease than a respiratory infection in terms of it’s killing mechanism.

    See:

    COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism

    https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173

    There is not enough reliable data, d*mn it!

    Until we get to “Over,” our old economic world of Just-In-Time, Sole Source anywhere, but especially in China, is dead without replacement.

    The world is in the same position as Germany was from August 1944 – April 1945 or  Japan from August 1944 until August 1945 versus the Allied strategic bombing campaign.  We have entered the world of  End Run Production as world wide supply chains grind to a halt from various fiddly bits of intermediate parts running out without replacement.  The on-and-off hotspots world wide of COVID-19 at different times and places in the world economy is no different than WW2 strategic bombing in terms of causing random damage to the economic life support.

    See also  “End Run Production” here from this one volume WW2 history book The Great Crusade:

    https://books.google.com/books?id=5L-bwPZK7PQC&pg=PA420&lpg=PA420&dq=%22End+Run+Production%22&source=bl&ots=kc30FQflCj&sig=ACfU3U2kmF-kTPo0Tgr2A9_ESPKpEQAEOg&hl=en&sa=X&ved=2ahUKEwjfpurOnOPoAhUKA6wKHemwBMcQ6AEwAHoECC4QKQ#v=onepage&q=%22End%20Run%20Production%22&f=false

    Be it automobiles, self propelled construction equipment, jets, power plants or the latest electronic gadget, anything that has thousands of parts sourced world wide with lots of Chinese cheap/disposable sub-component content anywhere in the supply chain simply won’t be produced for the next 18 months to three years.

    This “random damage to the economic life support” effect is amplified by the unwillingness of Western private industry to invest in building the capitol equipment to produced those intermediate parts.  Because of the threat of China coming back with predatory pricing — using bought politicians to cover for them — means those parts won’t be built without massive cost plus contract government buy out of the investment risk like happened in the USA in the 1942 WW2 mobilization.

    The story of  one American n95 mask manufacturer’s experience with the Obama Administration in 2009 with the Swine flu is a case in point.  The n95 mask is a 50 cent item where China pays 2 cents a mask for labor versus 10 cents a mask for American labor.  When the American manufacturer geared up to replace Chinese mask production.  China came back on-line and the Obama Administration refused to keep buying the American mask producer’s 8 cents more expensive mask when the Chinese masks were available.

    Unlike almost 80 years ago, current Western and particularly American politicians are too corrupt to go too massive cost plus contract government buy out this private investment risk.  Mainly because these political elites  can’t be bothered to figure out their 10% cut.  Instead we are getting more “fiscal stimulus” AKA boondoggles that the elites will saddle the rest of us with high interest payments on huge public debts.

    It will take local small to mid-sized business to get the American economy going during the COVID-19 pandemic via making products and services that don’t use the intermediate products China threatens with when the pandemic ends.

    My read on what comes next economically is local/distributed production with limited capitol investment that is multi-product capable.  The name for that is additive manufacturing, AKA 3D Printing. Here are a couple of examples:

    1. The idea of 3D Printed Sand Casting Molds For Automobile Production

    voxeljet enters alliance to industrialize core tooling production using 3D printing

    2. And the replacement of physical inventory with 3D printers, print media and electronic drawings:
    Such “Make or buy” decisions have always been the key decision of any business.  The issue here is that middle men wholesalers and in-house warehousing holding cheap Chinese-sourced  intermediate parts are both set to go the way of the Doe-Doe Bird in a 3D/AM manufacturing dominated world.
    .
    Distributed production in multiple localities with 3D/AM vendors for limited runs of existing intermediate products to keep production lines going.  Or the re-engineering intermediate products so one 3D/AM print replaces multiple intermediate products for the same reason, will be the stuff of future Masters of Business Administration (MBA) papers describing this imminent change over.

    .

    But, like developing SARS-CoV2/COVID-19 vaccines, this new locally distributed manufacturing economy will take time.  The possible opening of the American economy in May 2020 will not bring the old economy of December 2019 back.

    .

    That economy is dead.  It cannot, will not, come back.

    .

    We will have to dance with both the sickness from SARS-CoV2/COVID-19 and the widening End Run Production product shortages that the death of the globalist  just-in-time, sole source in China economic model causes for years.

    .

    And this is a hard reality, not a fantasy, we must all face.

    Posted in America 3.0, Business, Capitalism, China, Civil Society, COVID-19, Culture, Current Events, Deep Thoughts, Entrepreneurship, Germany, Health Care, Human Behavior, International Affairs, Medicine, Miscellaneous, Politics, Public Finance, Science, Systems Analysis, Taxes, Tradeoffs, Uncategorized, USA | 64 Comments »

    One Million Health Care Workers

    Posted by Dan from Madison on 31st March 2020 (All posts by )

    As I was driving to work today I heard on Bloomberg that presidential candidate Andrew Cuomo requested a million health care workers to help with the crisis in New York. “A million!” I said to myself in my car.

    I looked at the population of New York City and it looks like there are around 8.5 million people there, where most of the problems are. Lets say ten million to make the math easy. So one health care worker per ten patients, assuming every single person in New York City gets sick. Really?

    Where would you put them all? Aren’t most of the hotels closed? That would be importing a city the size of San Jose or Austin into New York. Of course it is stupid, so my question is why does Cuomo say something like this?

    Posted in COVID-19, Current Events, Medicine | 17 Comments »

    “A Fresh Perspective on the Covid-19 Numbers”

    Posted by Jonathan on 29th March 2020 (All posts by )

    Robert Prost emails:

    I wanted to share with you, my take on the corona virus situation in the United States.
     
    But first, a brief introduction. I am professor emeritus at the Medical College of Wisconsin in Milwaukee.
     
    I have a PhD in Biophysics and spent my career in MRI-based research, mostly on brain tumors.
     
    I check the Johns Hopkins’ website every day for the progress of the epidemic and I had a feeling about the numbers I’ve been seeing.
     
    The website: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 is very good.
     
    The daily case number totals can be extracted by mousing over each plotted point in the graph in the lower right hand corner of the screen.
     
    The curve at first looks daunting, it seems to be shooting straight up. But being at least in part a mathematician, I wondered about the velocity of this upward move in cases.
     
    If the velocity was going up, the epidemic would be accelerating, the epidemic would be worsening. If going down, it would be getting better (slowing).
     
    So I plotted the data and took the first derivative with respect to time. What it shows is that the velocity of the epidemic in the US is definitely slowing, and quickly.
     
    While the number of confirmed cases continues to rise, it is rising more slowly. If there were a confounding effect from increased surveillance (more testing revealing yet more cases), the apparent velocity should be going up.
     
    Instead, it is going down. So I believe the effect to be real, and thus I believe we are witnessing the beginning of the end of the epidemic. While this data says nothing about the potential for re-emergence in the fall or following spring, it does suggest that we have in fact, flattened the curve.

    US Covid-19 Cases and Rate of Change

    UPDATE: A follow-up email from Robert is posted here.

    Posted in COVID-19, Current Events, Medicine, Science | 69 Comments »

    Stuff Is Going To “Fall Off The Truck”

    Posted by Dan from Madison on 29th March 2020 (All posts by )

    In my previous post I hinted that perhaps Mr. Cuomo doesn’t really need forty thousand ventilators for the Covid-19 crisis in New York. A lively and interesting discussion ensued and I thank the commenters for that.

    Today I had on the Trump presser and I was doing other things until Trump said the following, (speaking of mask usage per day at a certain hospital) – and my ears perked up:

    “How do you go from 10 to 20, to 300,000 — 10 to 20,000 masks to 300,000, even though this is different. Something’s going on, and you ought to look into it, as reporters,” Trump said.

    As an aside, he really does speak in stream of consciousness, no? Anyways.

    I love math problems and would like to see the actual numbers of staff/masks if those numbers exist – that could be interesting. Trump could have been fluffing the numbers a bit to make a point on something he has heard. But Trump isn’t stupid and brought it up for a reason.

    Of course the Washington Post can’t have Trump doubting for a second that anyone in a democratic controlled area would…well…maybe…”borrow” some of the supplies – and they said that Trump was touting a “conspiracy theory”.

    When the books are written about this episode, I am fairly confident that waste and fraud will be two of the more interesting aspects. Some of it will be on purpose, and some of it will be just because this is a large project run by the government.

    Posted in COVID-19, Crime and Punishment, Current Events, Medicine, Trump | 6 Comments »

    Dueling Doctors

    Posted by TM Lutas on 29th March 2020 (All posts by )

    In the blue corner, we have the joint statement on multiple patients on ventilators by the Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical‐Care Nurses (AACN), and American College of Chest Physicians (CHEST) which recommends letting people die when spare ventilator reserves run out. And in the red corner, we have the VESper by Prisma Health fresh off of its recent victory to get regulatory approval under emergency use rules to allow ventilators to be used by up to four patients.

    It is triage with its ugly logic of letting patients die vs hope and technical advancement to save everyone, live in the United States at Covid-19 virus hot spots across the nation. This may affect you personally so it is important that you know whether or not the hospital you might depend on to save your life has picked one side or the other in a thoughtful way.

    Everybody could ask the question but it would be better if our press did ask and broadcast the answers. At the time of writing, they’ve had two days to do so. Are you informed on the issue? Are your neighbors? Is your hospital?

    This lack of discussion is the death of journalism. This time ignorance can have deadly consequences for us all.

    Posted in Bioethics, Business, COVID-19, Medicine, Society | 9 Comments »

    Ventilator Math

    Posted by Dan from Madison on 27th March 2020 (All posts by )

    So Andrew Cuomo says that they need up to 40,000 ventilators in New York City.

    But “the number of ventilators we need is so astronomical,” Cuomo warned, pegging the “apex number” of ventilators that could be required in New York at 40,000.

    So, I like math and I enjoy trying to suss out these types of problems. I’m assuming that a normal “joe” can’t just wake up and intubate someone, and that probably your run of the mill nurse who checks your blood pressure can’t either. I found this list of physicians in New York State as of 2019:

    Psychiatry 6,759
    Surgery 4,293
    Anesthesiologists 4,262
    Emergency medicine 4,560
    Radiology 3,999
    Cardiology 3,149
    Oncology (cancer) 2,213
    Endocrinology, diabetes, & metabolism 902
    All other specialities 18,771
    Total specialty 48,908

    My guess is that at least half (more?) of these doctors probably aren’t able to intubate someone. So…I’m wondering (paging Dr. K), looking at these numbers of doctors that are up and running with their practice in the state of New York that are qualified, how would they even be able to use 40k ventilators? Maybe I am missing some legislation that would allow doctors from other states to practice in New York State right away. Perhaps it is easier than I think to intubate a patient and Joe Radiologist can do it. Anyone?

    Posted in COVID-19, Current Events, Medicine | 39 Comments »

    Texas Aggie Doctor Reports — Clinical Pearls Covid 19 for ER practitioners

    Posted by Trent Telenko on 26th March 2020 (All posts by )

    The following information is from a front line ER doctor using the handle of ‘nawlinsag’ on a Texas Aggie web site.  I’ve included the link below. I’ve also included the complete text of his post in full in hopes medical professionals and lay people could get the most benefit from his observations of the course of COVID-19 in a small front line Louisiana hospital.

    Short form: This is not the flu.  It is a horror show of death and disablement that is crowding out all other medical care including an immediate downgrade of life saving cardiac care.  Only on in seven people put on ventalators in this hospital is surviving, and then only after 10-t0-12 days of ventalator support.

    —–

    https://texags.com/forums/84/topics/3102444?fbclid=IwAR3s13SRnw7YNgtu-7LZyrMUSMIRRWScU67lwbuwZM8fna-6R8k4tqrtO3w

    I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

    I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

    Clinical course is predictable.
    2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

    Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

    Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

    81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

    Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT’s of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

    China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

    Diagnostic
    CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

    Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
    CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
    Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

    Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

    A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

    An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

    Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.
    Read the rest of this entry »

    Posted in COVID-19, Immigration, International Affairs, Law Enforcement, Management, Media, Medicine, Middle East, Military Affairs, Miscellaneous, Tradeoffs, Transportation, Trump, Uncategorized | 50 Comments »

    Ventilator manifold can quadruple number of people on ventilation

    Posted by TM Lutas on 25th March 2020 (All posts by )

    A paper published in 2014 documents the invention of a ventilator manifold which can lead to up to 4 people sharing a ventilator.

    Ventilator manifold for disaster surge usage

    You can find the paper here and an article describing the invention here.

    Does anyone know the regulation that is stopping us from printing these manifolds and reducing the death toll from a local overwhelmed medical system? A lot of people are rightly worried about our ventilator situation. Something that quadruples system capacity would be a godsend.

    Update: This is deemed a method of desperation with numerous problems that can lead to worse patient outcomes in this joint statement by six US medical associations. They really don’t like it.

    This is not stopping innovators like Prisma Health from developing ways to have multi-user ventilators.

    Update 2: New York has approved ventilator splitting as they purchase 7,000 more ventilators. Federal ventilators are also starting to arrive, all 400 of them.

    Posted in COVID-19, Medicine | 16 Comments »

    It is time to start the economy again.

    Posted by Michael Kennedy on 21st March 2020 (All posts by )

    I have previously described the COVID 19 virus, which is also referred to as Wuhan virus, to the annoyance of the China friendly US Media. The consequences for the US economy have been severe. The most affected states, New York, California, Illinois and Washington, have virtually shut down their population. Arizona is less affected with 78 positives cases as of today, and no deaths.

    Italy and China have had the most deaths. There are a number of factors that probably affect these cases. China is notorious for air pollution and smoking, especially men smoking. There has been a dearth, so far, of listing comorbidities but age has been a major one.

    One study lists mortality at age 80+ at 15%. The overall death rate in China was listed at 2.3%, which may reflect smoking and air pollution. South Korea, which has had a big spike as testing progressed much more rapidly than in the US, has a case mortality of less than 1%

    South Korea has the dubious distinction of suffering the second-highest number of Covid-19 infections after China – but can also boast the lowest death ratio among countries with significant numbers of cases.

    According to the WHO on March 6, the crude mortality ratio for Covid-19 – that is, the number of reported deaths divided by the number of reported cases – is between 3-4%. In Korea, as of March 9, that figure was a mere 0.7%.

    AS US testing finally gets going, after the FDA and CDC delayed matters for a month, we will see a big spike in number of cases but, I am convinced, a big drop in mortality rate.

    Telephone consulting services, drive-through test centers and thermal cameras – which, set up in buildings and public places to detect fever, swiftly came online. South Korea has undertaken approximately 190,000 tests thus far, according to KCDC Deputy Director General Kwon Jun-wook, and has the capacity to undertake 20,000 per day. Turnaround times are six-24 hours.

    Tests are highly affordable. “The test kit is about $130, and about half is covered by insurance the other half by individual,” Kwon said. Those who test positive get the test free, “So there is no reason for suspected cases to hide their symptoms,” he said.

    We should be doing the same.

    At the same time, we are risking severe economic damage to the country by shutting down business activity. I believe that much of the drastic steps taken by governors, especially in New York and California, is unnecessary. High density cities like New York City and Chicago may have more reason to fear spread of the virus. Most of the country, a source of annoyance to left wing politicians, is of low population density.

    Read the rest of this entry »

    Posted in COVID-19, Current Events, Medicine | 46 Comments »

    Crisis Remote Working: What Will be the Long-Term Effects?

    Posted by David Foster on 13th March 2020 (All posts by )

    A lot of people…office workers, students…are going to be getting their first experience of remote working, and a lot of organizations are going to be getting either their first experience or a greatly expanded experience in managing this kind of work.  What will be the long-term effects of this?…will people eagerly return to their brick-and-mortar working environment as soon as it is safely possible?

    Certainly, there are a lot of workers who would welcome the opportunity to avoid their daily commutes.  And there are a lot of employers who would be happy to save a lot of money on office space.

    And there are surely some parents who would welcome the opportunity to keep their kids at home…there are also more than a few who have arranged their lives and their work schedules around the assumption that their kids will be in school for several hours every weekday.

    Many of the remote working experiences are surely going to be suboptimal, however, given that there has been little if any leadtime to prepare systems, content, and procedures.

    So what do you think?..a return to things the way they were, or permanent change?

    Posted in Business, COVID-19, Education, Management, Medicine, Tech | 25 Comments »

    SARS-CoV2/COVID-10 Update 3-5-2020 — “As long as you remember to keep breathing and don’t fall asleep, it’s basically just like the flu.”

    Posted by Trent Telenko on 5th March 2020 (All posts by )

    Issues covered will be on COVID-19 spread, World Headlines, the 3-4-2020 Seattle Public Health Press conference, World Headlind Summary, Corruption at the WHO, Bad and good news COVID-19 medical developments. the Political/Demographic Implications of COVID-19 for the Gov’t Elites, and the social media and videos COVID-19 tracking source section.

    Top line, There are currently 97,138 confirmed COVID-19 cases worldwide, including 3,351 fatalities as of the March 5, 2020, at he 4:48pm ET time hack on the BNO News corona virus tracking site (https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/) There are 80(+) and growing umber of nations including China plus three “Chinese special administrative regions” (Macao, Hong Kong and Taiwan) that have reported COVID-19 infections. China, Taiwan, Hong Kong, Japan, Thailand, Singapore, Italy, Iran, Germany, R.O.K. and the USA all appear to have local, or endemic, spread of the disease. Russia, Egypt, and Columbia appear to have joined the endemic spread list as well due to airports in the UAE and elsewhere picking up air travelers originating from those nations as sick with COVID-19.

    WORLD HEADLINE SUMMARY (3/5/2020)

    o New Jersey confirms first presumptive case
    o NY state cases double to 22
    o Seattle closes 26 schools
    o Pentagon tracking 12 possible COVID-19 cases
    o Illinois reports 5 more cases
    o NYC reports 2 more cases, raising total to 4
    o Italy postpones referendum vote; death toll hits 148
    o WHO’s Tedros: “Now’s the time to pull out the stops”
    o Tennessee confirms case
    o Nevada confirms first case
    o New Delhi closes primary schools
    o EU officials weigh pushing retired health-care workers back into service to combat virus
    o Italy to ask EU for permission to raise budget deficit as lawmakers approve €7.5 billion euros
    o Beijing tells residents not to share food
    o 30-year-old Chinese man dies in Wuhan 5 days after hospital discharge
    o Cali authorities tell ‘Grand Princess’ cruise ship not to return to port until everyone is tested
    o Global case total passes 95k
    o Lebanon sees cases double to 31
    o France deaths climb to 7, cases up 138 to 423
    o EY sends 1,500 Madrid employees home after staffer catches virus
    o Trump says he has a “hunch” true virus mortality rate is closer to 1%
    o Switzerland reports 1st death
    o South Africa confirms 1st case
    o UK chief medical officer confirms ‘human-to-human’ infections are happening in UK
    o UK case total hits 115
    o Google, Apple, Netflix cancel events
    o HSBC sends research department and part of London trading floor home
    o Facebook contract infected in Seattle
    o Microsoft, Google, Amazon, Netflix cancel events and/or ask employees to work from home
    o Netherlands cases double to 82
    o Spain cases climb 40, 1 new death
    o Belgium reports 27 new cases bringing total to 50
    o Germany adds 87 cases bringing total to 349

    Read the rest of this entry »

    Posted in Big Government, China, Civil Liberties, Civil Society, COVID-19, Culture, Current Events, Dogs, Ebola, Economics & Finance, Iran, Medicine, Middle East, Miscellaneous, USA | 125 Comments »

    SARS-CoV2/COVID-19 Evening Update 2-25-2020: The Pandemic Hide the Name & Blame Games

    Posted by Trent Telenko on 25th February 2020 (All posts by )

    The themes of this update will be on issues of COVID-19 spread, World Headlines, border closings, the CDC news conference, developments with fomite spread, how American Public Health institutions build a liablity law suit proof diagnostic test and how that limits tests for community spread and a new recommended COVID-19 sites, social media and videos section.
     
    Top line, There are currently 80,420 confirmed COVID-19 cases worldwide, including 2,710 fatalities as of the 24 February 2020 at 5:24 p.m. ET time hack on the BNO News corona virus tracking site (https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/) There are 39 nations including China plus three “Chinese special administrative regions” (Macao, Hong Kong and Taiwan) that have reported COVID-19 infections. China, Taiwan, Hong Kong, Japan, Thailand, Singapore, Italy, Iran and R.O.K. all appear to have local, or endemic, spread of the disease. Italy has spawned further spread in Spain proper, it’s Canary Islands possession, Austria, Germany, and possibly Croatia. And now Brazil in South America and Algeria reporting a case signals North West Africa have added two new regions to the Pandemic spread list. The virus has spread from Asia to Europe, North America, Australia and Africa.
     
    All of the above meets the pre-COVID-19 WHO standard for a “Pandemic” that requiring endemic spread in multiple nations in multiple WHO regions. However, the WHO just decided that it was time to retire the term “Pandemic” because…something…[insert reasons here]. The WHO statement for doing so was a master piece of unintelligible double talk that boils down to “Lets not scare the “Normies” and set off more “Run, Hide & Hoard” panics like seized Italy, ROK and Singapore in the last few days. Meanwhile the WHO is cheering-on China’s “Hospice-Prison system for the infected” Quarantine as a “Model” in aiding China’s restarting the World economy.
    ITALY COVID-19 Confirmed Cases and Deaths 25 Feb 2020

    ITALY COVID-19 Confirmed Cases and Deaths 25 Feb 2020

     
    World Headline Summary
    o WHO warns the rest of the world “is not ready for the virus to spread…”
    o CDC warns Americans “should prepare for possible community spread” of virus.
    o San Francisco Mayor declares state of emergency
    o Later, CDC says pandemic not a question of it, but when
    o Brazil may have South America’s first coronavirus case
    o Germany confirms 2nd case on Tuesday, brings total to 17
    o Italy cases spike to 322; deaths hit 10
    o Japan’s Shiseido tells 8k employees to work from home
    o Trump Economic Advisor Kudlow tries to jawbone stock markets higher
    o HHS Sec. Azar warns US lacks stockpiles of masks
    o Italy Hotel in Lockdown After First Coronavirus Case in Liguria
    o Algeria confirms 1st case
    o First case in Switzerland
    o Kuwait halts all flights to Singapore and Japan
    o Iran confirms 95 cases, 15 deaths
    o First case in Austria
    o Spain reports 7 cases in under 24 hours, including in Madrid, Canary Islands, Barcelona
    o Iran Deputy Health Minister infected with Covid-19
    Pandemic Border Closures
    Turkey, Iraq, Kuwait, Afghanistan, Pakistan, Turkmenistan, Georgia, Armenia, and UAE blocked border crossings by Iranians.
    Russia, North Korea and Vietnam are blocking border crossings from China
    Austria and Switzerlan are blocking border crossings from Italy.
    El Salvador on Tuesday announced it would prevent entry of people from Italy and South Korea.
     

    Read the rest of this entry »

    Posted in Big Government, Bioethics, China, Civil Liberties, Civil Society, COVID-19, Current Events, Economics & Finance, Health Care, Iran, Medicine, Middle East, Miscellaneous, National Security, North America, Politics, USA | 28 Comments »

    COVID-19/SARS-CoV2 Update 2-23-2020 — When the “New Versailles Class” Meets Reality Without Privilege

    Posted by Trent Telenko on 23rd February 2020 (All posts by )

    The themes of this update will be on issues of COVID-19 spread, testing, public health institutional credibility, some e-mails evaluating the CDC and our elites, and my personal analysis of same after the top line infection numbers and headlines.

    The SARS-CoV2 virus and it’s COVID-19 virgin fields infection seems to have a top line R(0) of between three and 6.7 — that is one person infects near seven people on average — because there are repeated “super spreader” events where one person slimed an institution with a lot of close contact and then the fomite contamination of that institutional setting causes everyone present to get the disease. Examples thus far include the Diamond Princess Cruise ship, a pair of prisons in China, and multiple hospitals in China and now South Korea. The rate of growth of the COVID-19 pandemic is such that we will be fighting it on a very large scale in a few weeks (no more than 10) in every nation world wide with the public and private medical institutions, societal resources, and people we have right now, with all their flaws. And not what we wish they were, but will never have. There simply isn’t going to be time and energy for blame games when issues of daily survival break upon us all.

    Top line, there are currently 78,986 confirmed COVID-19 cases worldwide, including 2,468 fatalities as of 23 February 2020 at 11:52 a.m. ET on the BNO News corona virus traking site (https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/) China, Taiwan Hong Kong, Japan, Thailand, Singapore, Italy, and Iran all appear to have local, or endemic, spread of the disease. See multiple charts attached and headline summary

    Bar Chart of World COVID-19 Infections as of 23 Feb 2020

    Bar Chart of World COVID-19 Infections as of 23 Feb 2020

    Bar Chart of World Qide COVID-19 Infections Without China and the Diamond Princess Cruise Liner

    Bar Chart of World Wide COVID-19 Infections Without China and the Diamond Princess Cruise Liner

    World Headline Summary:

    o Italy confirms 3rd death and cancels last 2 days of carnivale in Venice as cases soar above 100
    o 4 more cases confirmed in UK
    o 200 Israelis quarantined
    o Japan confirms more cases
    o Japanese Emperor expresses hope for Tokyo Games (fat chance)
    o ROK Gov’t total cases above 600
    o Trump says US has everything ‘under control’ as he asks Congress for more money (I call B.S. below)
    o EU’s Gentiloni says he has ‘full confidence’ In Italian health officials
    o Turkey, Pakistan close borders with Iran as confirmed cases soar
    o Global Times (Chinese Gov’t news source) says virus may not have originated at Hunan seafood market
    o Axios reports shortages of 150 essential drugs likely. (Most source in China)

    Read the rest of this entry »

    Posted in Big Government, Civil Liberties, Civil Society, COVID-19, Current Events, Health Care, Iran, Medicine, Middle East, Miscellaneous, National Security, Uncategorized, USA | 42 Comments »

    COVID-19 Update Morning 2-14-2020

    Posted by Trent Telenko on 14th February 2020 (All posts by )

    There are currently 65,213 confirmed COVID-19 cases worldwide, including 1,486 fatalities. Of which 4,823 new cases and 116 new deaths were reported in Hubei province, China.
    .
    There are several trends in this update, as well as the headline summary. First Community spreading of COVID-19 is now established in Hong Kong (attached graphic), Japan and Singapore.
    COVID-19 in Hong Kong

    COVID-19 in Hong Kong

    .
    Second, the shut down of China as an economic power seems near complete. See the JP Morgan coal for electricity usage and the Goldman Sachs economic projection charts attached to this post. The JP Morgan chart shows that while traditionally daily coal consumption – the primary commodity used to keep China electrified – rebounds in the days following the Lunar New Year collapse when China hibernates for one week. This is not the case this now. There hasn’t been even a modest increase, indicating that so far there hasn’t been a return to work.
    .
    2020 Chinese Coal/Electrical Consumption

    2020 Chinese Coal/Electrical Consumption

    .
    Short Form — Lack of Chinese coal use/electric power generation indicates the scale of Chinese industries that are shut down…AKA near total.
    .
    And the “Just-In-Time/Sole-Source in China” world-wide, Multi-national corporation, economic shut down virus is gathering a huge economic momentum. Nissan has shut down auto production in addition to South Korea’s Hyundai for lack of Chinese parts. Rumor has it that Ford has the same issue — as their heater coils in their autos are sole sourced in China — and will soon shut down auto production.  Anything cheap or disposable in the world economy is sourced in China, and the Chinese economy is now off-line for the foreseeable future.
    Near Term Economic Projections for China

    Near Term Economic Projections for China

    .
    Third, China is again playing games with COVID-19 numbers and particularly the announced deaths to keep the death rate at 2.1%, saying deaths were “double counted”?!? (See JP Morgan graphic).
    .
    Dodgy Chinese COVID-19 Infection Numbers

    Dodgy Chinese COVID-19 Infection Numbers

    .
     This has been ‘officially noticed’ by the White House.
    .
    See:
    White House does not have ‘high confidence’ in China’s coronavirus information, official says
    .
    .
    Fourth, American COVID-19 are now officially 15 with a case in San Antonio, Texas from a Wuhan evacuation flight and no deaths. I say “officially” as there possible COVID-19 death in Boise, ID. See:
    .
    .
    The possible COVID-19 victim was a 71-year-old man found dead on Feb 9 in an advanced state of decomposition. He returned from China Feb 5. The initial testing came up negative, but additional tests are being run. The cause of death has not been released.
    .
    An idea of what “Community spreading” in Singapore means can be seen in the following report:
    .
    “Singapore Casino employee confirmed with COVID-19; symptomatic Feb 5, hospitalized Feb 9
    On February 13, 2020, the Central Epidemic Command Center (CECC) pointed out that the confirmed case of coronavirus disease 2019 (COVID-19) in Singapore announced on February 11 is an employee at the casino in Resorts World Sentosa Casino. The employee developed symptoms on February 5 and was hospitalized in isolation on February 9. Travelers who visited the casino during the communicable period (February 4-9) are advised to call 1922, put on a face mask and seek immediate medical attention as instructed if suspected symptoms develop within 2 weeks. Moreover, such travelers should inform the physician of any relevant travel history when seeking medical attention.”
    .

    .

    World Headline Summary:
    .
    o China says 1,716 medical workers have been infected
    o Singapore reports largest daily jump in cases amid increased human-to-human transmission
    o Hong Kong reports 3 new cases
    o Hubei’s new party boss orders quarantine tightened
    o President Xi touts new “biosecurity law”
    o Hong Kong Disney land offers space for quarantine
    o Chinese company says blood plasma of recovered patients useful in combating the virus
    o US mulling new travel restrictions

    -end-

    Posted in China, Civil Society, COVID-19, Current Events, Economics & Finance, Energy & Power Generation, Health Care, Medicine, Politics, Urban Issues, USA | 59 Comments »

    A Modest Proposal

    Posted by Jonathan on 12th April 2019 (All posts by )

    New ‘Medicare for All’ Bill Would Kick 181 Million Off Private Insurance

    Now might be a good time for new federal legislation requiring all members of Congress to use only Medicaid for their own non-emergency medical care. The plan’s features could include:

    -Doctors assigned randomly from a list of the Medicaid providers in each member’s district.

    -Penalties (fines? misdemeanor/felony? the posting of the member’s name in an online ledger?) for going outside of this system for treatment without prior approval.

    -Prior approval to require a unanimous vote by a panel of citizens selected randomly from a list of the registered voters in each member’s district.

    Of course this legislation would have no chance of passage. Its purpose would be to make Congressional single-payer advocates explain why they should be exempt from it, and then why the rest of us should be be subjected to their hare-brained socialized-medicine schemes.

    Make them live by their own rules, as a great man once said.

    Posted in Big Government, Health Care, Leftism, Medicine, Politics | 9 Comments »

    Some thoughts on what health care reform could look like.

    Posted by Michael Kennedy on 1st April 2019 (All posts by )

    I have previously posted some articles on the French healthcare system, which is the best in Europe.

    Here is an article on the French system.

    The French citizen or resident joins Caisse Nationale d’Assurance Maladie deTravailleurs Salariés (CNAMTS)—health insurance organisation for salaried workers. That covers about 80% of the population now and it pays 80% (often more like 70%) of a fee schedule for the doctor visit although specialists are allowed to charge more. French doctors are divided for payment and fee schedule purposes into three “sectors” after 1980. Sector 1 doctors agreed to abide by the fee schedule established in 1960, modified for inflation and technological changes. They are mostly primary care doctors although some had waivers from the fee schedule prior to 1971 because they were more experienced or had great reputations. Few are still practicing. Sector 2 doctors could set their own fees but reimbursement was still determined by the fee schedule. These two categories correspond roughly to Medicare assignment in the US. If you accept assignment, you agree to accept Medicare payment as the full payment (or 80% of it plus the Medi-Gap payment).

    The French have private insurance that acts like US “Medi-Gap” polices but for all.

    It seems unlikely to me that Democrats would accept a health plan that allowed balance billing, which is the only way to control costs, short of pure rationing. The French basically provide a fee schedule that is the same for everyone but which allows doctors to charge more if the patient is willing to pay. For example, I called the office of a new internist last week to schedule an appointment. The clerk required that I submit all my insurance information, not my health status, and the doctor would decide if he would see me. If he is that busy, perhaps he could justify charging more.

    Here is another article from that series explaining the French system.

    French primary care physicians are paid less than American but medical school in France does not require a college degree and is free. I suspect that system might be more attractive in the US than many realize.

    Unfortunately, such a radical reform is unlikely. There are other options under consideration.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine | 19 Comments »

    Russia to healthcare in one day. What now ?

    Posted by Michael Kennedy on 30th March 2019 (All posts by )

    Last Friday, the Mueller report was submitted to the DOJ. Monday, left wing media saw ratings collapse.

    What next ? Why Healthcare, of course.

    Obamacare, which is a form of expanded Medicaid, costs too much and provides too little care (high deductibles) unless you are a Medicaid recipient. It was designed to shift costs to the insured from the poor. It also was a gift to certain sectors of the healthcare industry. Ted Kennedy criticized healthcare as a “cottage industry” with lots of independent doctors doing their own thing as small businesspeople. That is why doctors have traditionally been conservative. Obamacare changed that. Healthcare is now an industry with doctors mostly on salary and controlled by administrators.

    I talked to a young ophthalmologist last week, who had treated a mild eye disorder. He told me he moved to Tucson to work at U of Arizona medical center, which used to be called “UMC” by everybody in Arizona. He explained that the UMC administrators had gotten deeply into debt installing a new “Electronic Health Record” system and sold the UMC to Banner Health. This is a chain that runs the former UMC and has seen an exodus of university faculty physicians. Even my barber noticed. He told me several weeks ago that his surgeon, who had operated on him, got tired of constantly being told he only had 15 minutes to see each patient and left for the VA. The ophthalmologist was disappointed as he had looked forward to working at the academic center.

    Traditionally, administrators hated doctors. We made their lives more difficult by advocating for patients. I once told an administrator that if the hospital did not reduce the markup on pacemakers, I would testify for the patient if they sued him for the balance of the bill. They didn’t like it but knew I could go elsewhere,and take my patients there. If I had been an employee, I would not have that choice. Several years ago, I explained how we started a trauma center in our hospital. Since then, the hospital has been sold to a non-profit run by nuns. The surgical group that ran the trauma center for 35 years was fired two years ago. They had declined to sell the group to the hospital. They were replaced by six female surgeons no one had ever heard of and who had never applied for privileges at the hospital or been evaluated by the Surgery Department. No one knew anything about them except one member of this new group had applied for a job at the trauma group and been turned down.

    There were a few comments about some less satisfactory results on trauma cases but that has quickly gotten quiet.

    Read the rest of this entry »

    Posted in Big Government, Health Care, Medicine | 2 Comments »

    A Critique of Electronic Health Records Systems

    Posted by David Foster on 22nd November 2018 (All posts by )

    …with extension to other kinds of application software.

    At the New Yorker, of all place:  Why Doctors Hate Their Computers.

    See also this 2012 article in the Atlantic.

    [Jonathan adds: See also this 2009 Chicago Boyz post and discussion.]

    Posted in Big Government, Business, Medicine, Tech | 8 Comments »

    Where is health care going ?

    Posted by Michael Kennedy on 28th August 2018 (All posts by )

    UPDATE: A new analysis of Obamacare’s role in the conversion of American Medicine to an industry with corporate ethics.

    The health system is now like a cocaine junkie hooked on federal payments.

    This addiction explains why the insurance companies are lobbying furiously for these funds alongside their new found friends at left-wing interest groups like Center for American Progress. The irony of this alliance is that the left-wing allies the insurers have united with hate insurance companies and want to abolish them. The insurance lobby is selling rope to their hangman.

    Hospital groups, the American Medical Association, the AARP and groups like them are on board too. They are joined by the Catholic Bishops and groups like the American Heart Association and the American Lung Association. (If you are donating money to any of these groups you might want to think again.) This multi-billion dollar health industrial complex has only one solution to every Obamacare crack-up: more regulation and more tax dollars.I practiced during what is more and more seen as a golden age of medical care. Certainly the poor had problems with access. Still, most got adequate care, either through Medicaid after 1965, or from public hospitals, many of which were wrecked by Medicaid rules and by the flood of illegal aliens the past 40 years.

    Obamacare destroyed, probably on purpose, the healthcare system we had. It had been referred to by Teddy Kennedy, the saint of the Democrats Party as “a cottage industry.” As far as primary care was concerned, he was correct. What we have now is industrial type medicine for primary care and many primary care doctors are quitting.

    So why is there waning interest in being a physician? A recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.

    There appear to be two main factors driving this anticipated doctor drought: First, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.

    “There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.

    There are several reasons, I think. I have talked to younger physicians and have yet to find one that enjoys his or her practice if they are in primary care. That applies to both men and women. Women are now 60% of medical students. This has contributed to the doctor shortage as they tend to work fewer hours than male physicians.

    A long analysis of physician incomes shows that 22% of females report part time work vs 12% of males.

    Physicians are the most highly regulated profession on earth. The Electronic Health Record has been made mandatory for those treating Medicare patients and it has contributed a lot to the dissatisfaction of physicians.

    THE MOUNTING BUREAUCRACY
    This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs “need a complete overhaul;” while 40 percent see “more challenges with EHRs than benefits.”

    If I remember my arithmetic, that adds up to 99% unhappy with the EHR.

    Most primary care physicians I know are on salary, employed by a hospital or a corporate firm. They are require to crank out the office visits and are held to a tight schedule that does not allow much personal relationships with patients. The job satisfaction that was once a big part of a medical career is gone.

    Posted in Health Care, Medicine, Obama, Politics | 43 Comments »