Tag Archives: Healthcare

We Need a Centralized Medical System Too

Is there a central database for medical records in the U.S.? - Quora

The coronavirus pandemic has laid bare two fundamental flaws in the American healthcare system.

Number one: There’s a reason that other rich countries treat healthcare as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford to buy private healthcare.

The second inherent flaw in the U.S. approach is that it’s for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.

When your insurance company issues a denial, they don’t merely pocket that payment. They also add to future profits. Even if you’re insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. “Visits to primary care providers made by adults under the age of 65…dropped by nearly 25% from 2008 to 2016” due to routine denials by insurers, reports NPR.

Denials also create a societal effect: news stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.

There’s another, third structural problem exposed by the pandemic—but it’s not receiving attention from public policy experts or the media. I’m talking about America’s lack of a centralized healthcare system.

A centralized healthcare system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for-profit. In such a scheme all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you’re on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.

The current system is primitive. Data is not transferable between doctors or medical systems without a patient’s directive, which inexplicably is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that’s it’s not a weekend or national holiday or a Wednesday, when some doctors like to golf.

Unless a patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether an unconscious victim is allergic to a drug, has a chronic illness or that there’s a treatment regimen proven to be more effective for them. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter one-size-fits-all treatment.

A few months ago I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in LA. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. “We do not treat viral infections with antibiotics,” the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.

This would not have been a issue back home in New York, where both my general practitioner and my pulmonologist know my medical history. Either doctor would have prescribed a strong antibiotic and a codeine-based cough syrup.

Because I happened to be in LA, I left CVS empty-handed.

I declined.

It got to the point that I couldn’t walk 100 feet without pausing to catch my breath.  I felt like I was going to die.

I called my doctor back in New York. She called in a prescription to the same CVS. It helped arrest my decline. But I wasn’t getting better.

I visited a different walk-in clinic, in West Hollywood. It was a better experience. They tested me for flu (negative), X-rayed me (diagnosis was early stage- pneumonia) and put me on a nebulizer. I began a slow recovery.

A centralized system would have been more efficient. The CVS nurse would have seen my history of non-response to treatment devoid of strong antibiotics. He also might have taken note of my pulmonologist’s effective use of a nebulizer to treat previous bouts of bronchitis and pneumonia. I might have been prescribed the proper medication and treatment as much as a week sooner.

COVID-19 almost certainly would have been detected in the United States sooner if we had a centralized medical system. “One example of a persistent challenge in the early detection of health security threats is the lack of national, web-based databases that link suspected cases of illness with laboratory confirmation. This leaves countries vulnerable, as they cannot accurately and quickly identify the presence of pathogens to minimize the spread of disease,” according to the U.S. Centers for Disease Control. Algorithms can automatically scan massive volumes of information for signs of novel infectious diseases, help identify potential problems and focus responses where they are needed most.

How many people’s lives could have been saved if lockdown procedures had begun earlier? If public health officials had seen the coronavirus coming back in December—or November—they might have been able to protect vulnerable populations and avoid a devastating economic shutdown.

There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized healthcare system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.

We can’t pretend to be a first world country until we join the rest of the world by abolishing corporate for-profit healthcare and decouple insurance benefits from employment. But reform without centralization would be incomplete.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie,” updated and expanded for 2020. You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

5 Things the Government Must Do Now to Avoid Collapse and/or Revolution

London riots - Photos - The Big Picture - Boston.com          The COVID-19 medical and economic crisis remains mostly unaddressed by both the Republican and Democratic parties. They have only passed one piece of legislation that significantly helps workers: supplementing existing state unemployment benefits by $600 per week. Those additional payments expire in four months. Until then many people who are out of work will receive about $1000 a week. If the past is precedent, Congress is likely to renew the law.

            Aside from expanded unemployment checks, the government has been useless.

            Here are the essential basic things Congress and President Trump must do in order to avoid economic collapse, mass starvation, an epidemic of violent crime reminiscent of “A Clockwork Orange” and political unrest up to and including revolution.

            They must do it now.

            A Universal Basic Income is the smartest fastest way to stimulate the economy by keeping money flowing from consumers. Neither political party seems to care enough about the prospect of street riots to pass a UBI. But they need to do it yesterday to avoid catastrophe tomorrow. Flat UBI payments are unfair to people who live in expensive cities and states; the cost of living in my hometown of Dayton, Ohio is half of Manhattan. Weight UBIs according to living costs.

            COVID Care

            At bare minimum, medical treatment for COVID-19 and related ailments (bronchitis, pneumonia, etc.) should be free from a patient’s first test to their last breath in a ventilator. It should be free for everyone: insured, uninsured, homeless, prison inmate, undocumented worker for an obvious reason: if an illegal immigrant contracts the coronavirus, they can transmit it to you. It’s to everyone’s advantage that everyone have access to medical care.

            Theoretically, the new Families First Coronavirus Response Act does that. Not in reality. “Our health care system is a mess and the law does not explicitly prohibit charging you if you go to an out-of-network provider. It also doesn’t address other ‘surprise billing’ problems,” Time reports. Treatment for COVID-19 can easily run $35,000 or more—not only should Americans not have to pay, they can’t pay.

            Whether you go to your physician or urgent care or the ER, no one who suspects she has COVID-19 should be asked for their insurance card. Healthcare providers should bill the federal government.

No leading Republican or Democrat — Donald Trump, Joe Biden, Mitch McConnell, Nancy Pelosi — wants to do this. Why? Because they’re stupid, crazy or both.

            Draft the Immune

            The Centers for Disease Control are rolling out a pilot program of a testing kit that can show if you have been exposed to the novel coronavirus and thus have the antibodies to resist a repeat infection. Authorities are considering issuing “immunity cards” to citizens who have had COVID-19. The idea is that people who are cleared could return to work. So far so good.

            As much as I’d like to believe that political cartoonists and columnists are essential workers, if I have had and recovered from COVID-19 I could probably be more useful delivering food to the elderly, volunteering at a hospital, or performing some other essential task currently going undone because the person who usually does the job is either sick or home trying to avoid getting sick. Waiting tables could help save my local restaurant.

            The government should retool the Selective Service System to draft recovered COVID-19 victims to perform services needed to help people and restart the economy.

            Ramp up Distance-Learning

            Parents, school children and college students in many cities are finding online instruction to be woefully inadequate at best. The most pressing issue is unequal access to the Internet. This is a huge problem. Fortunately, it’s easily fixable.

            There are about 75 million students in the U.S. 17% don’t have home Internet access. That’s 13 million kids. A Wifi hot spot costs $50 a month. A Chromebook is $300. $4 billion, roughly the cost of occupying Iraq for a week, buys a home computer for everyone who needs one; $10 billion a year covers Wifi access. That’s the worst-case scenario; the government could get a volume discount.

            Unfortunately, neither Democratic nor Republican politicians care about our kids enough to act.

            Rent and Mortgage Holidays

            31% of apartment dwellers failed to pay April rent. Expect that number to soar in May and June. Idiotically, the only relief offered by even the most progressive mainstream politicians is a moratorium on evictions and foreclosures. Moratoriums end. Courts reopen. When they do, millions of people could be thrown out onto the streets.
            Even if you don’t care about them, think about your own property values. During the 2008-09 economic meltdown, mass foreclosures left millions of homes empty. These eyesores dragged down the values of their neighbors’ homes. We really are in this together.

            People who can’t pay their rent or mortgage shouldn’t have to. And at the end of all this, they shouldn’t bear the burden of accumulated debt, interest or late fees. Congress should declare a rent and mortgage holiday until the end of the crisis.

            To mitigate the hardship on landlords and lenders, real estate and other taxes should be waived during the same period. So should utilities like gas and electricity. Congress should consider a tax credit for property owners. Banks should receive Federal Reserve funding at zero percent.

            So far, no mainstream politician is talking about this.

            A War Holiday

            Secretary-General António Guterres of the United Nations is calling for warring parties in the world to lay down their arms for the duration of the COVID-19 pandemic. “The fury of the virus illustrates the folly of war,” he said, emphasizing the fact that war makes it hard for humanitarian assistance to reach victims of coronavirus.

            War is a tremendous waste of lives, resources and money that could be better spent elsewhere, and that has never been more evident than today. Yet at this writing President Trump has ordered the U.S. Navy off the coast of Venezuela in a classic demonstration of gunboat diplomacy. His administration is continuing Barack Obama’s benighted proxy war in Yemen. American drones are slaughtering innocent people in Somalia.

            This is all monstrous BS and should stop forever but, at minimum, wars of choice can wait until the end of the coronavirus crisis. Yet here again neither party, Democrat or Republican, has endorsed the Secretary-General’s idea.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

Would You like Some Coronavirus with Your Wealth?

The coronavirus crisis is laying bare massive inequities in society. What’s interesting though is that because we are dealing with a contagious virus, even the rich and powerful can no longer hide from the effects of their perfidy and greed.

3 Things the Government Must Do to Avoid Economic and Social Collapse

Image result for coronavirus closed sign

Americans don’t expect much from their government. But even by the standards of a nation with one of the flimsiest social safety nets in the Western world, the inability and unwillingness of both major political parties to manage and solve the crisis caused by the coronavirus pandemic is shocking.

President Trump’s lack of leadership is well documented elsewhere so I won’t go into detail here. Democrats aren’t blameless; the DNC-engineered pre-Super Tuesday soft coup against Bernie Sanders replaced a frontrunner whose prescient ideas were tailormade for this crisis with a babbling dolt without an original thought in his foggy brain.

Congress is squabbling over an economic stimulus package as if they had all the time in the world. My favorite part was Mitch McConnell letting the Senate take the weekend off. Hey, Japan, not cool about Pearl Harbor but we’ll get back to you about declaring war in a week or whatever. Meanwhile, experts predict that unemployment could go as high as 30%, significantly worse than the depth of the Great Depression.

But now is not the time to cast blame. The ship is sinking. We can make the captain walk the plank later. Right now we have to fix the problem.

First, we have to save lives.

Trump says he doesn’t want to “nationalize” American companies. Actually, no one’s suggesting that. But they should. This is still a spectacularly wealthy nation with incredible resources and brilliant entrepreneurs. Shortages of face masks, testing kits, ventilators, rubbing alcohol and so on are inexcusable. The federal government must immediately requisition factories, hire workers directly and place manufacturing of needed supplies on an emergency war footing. If a company is already set up to make something we need yet refuses to do so, it should be nationalized and put to work for the American people.

In the fight against COVID-19, the biggest danger to the privileged is the poor health of the underprivileged. You can hunker down in the Hamptons but your newly-purchased freezer full of hoarded steaks won’t protect you from infection as long as others are too vulnerable to protect themselves. Some of the 17 million vacant homes in the United States should be immediately seized to house America’s half a million homeless and other vulnerable populations. The vast majority of prisoners, many of whom are awaiting trial, convicted of minor offenses or convicted of serious crimes but safe to release, should be immediately released from facilities whose conditions create cesspools of contagion.

Healthcare must be free. Hospitals and doctors should send their bills to the government. That debate, along with the canard that we have the best healthcare system in the world, is obviously over.

Second, we have to save the economy.

I’m not normally one to agree with Thomas Friedman, but he’s right when he points out that economic collapse will kill people on a scale on par with COVID-19: “Either we let many of us get the coronavirus, recover and get back to work—while doing our utmost to protect those most vulnerable to being killed by it. Or, we shut down for months to try to save everyone everywhere from this virus—no matter their risk profile — and kill many people by other means, kill our economy and maybe kill our future.”

I don’t think we really need to “let” many of us get the coronavirus. That has already happened.

News coverage that emphasizes test results is an idiotic distraction. Roughly 1/10 of 1% of American citizens have been tested. We know nothing about the COVID-19 status of 99.9% of the population. We don’t call elections based on 0.1% of the poll results and we can’t draw real conclusions from the testing so far.

However, there is reason to believe that many, many people have already had it.

Roughly one out of five people who get the coronavirus will never know it because they are asymptomatic. COVID-19 was first identified in early December in Wuhan, China. Although the median incubation period is 5 days, it can be as long as 11 days. That means we are talking about a pandemic that dates back to late November 2019.

When did it arrive in the United States? Probably in a day or two, the amount of time it took for one asymptomatic and/or incubating carrier—people like this account for about 10% of new infections—to board a plane and fly across the Pacific Ocean. Roughly 10,000 people a day flew from China to the United States at that time.

This is not a new thing—and you should feel good about that.

Let me explain.

The number of new cases in the U.S. has been doubling about every three days. Get a calculator and start multiplying by two: 2, 4, 8, 16, 32, 64, 128, 256, 512, 1024. That’s 10 three-day periods, aka the month of December. Keep going. By the end of January you’re at over a million. By February, a billion. The U.S. population is about 330 million. So when New York governor Andrew Cuomo says that 40 to 60% of the population is going to get the coronavirus, he’s being conservative.

The rate of transmission will stop increasing exponentially at some point. Some patients will die. The virus will run out of new Americans to infect. But mostly, we are going to recover and emerge with full or partial immunity to COVID-19. Many, many Americans have already had coronavirus, recovered, and are now fine.

Must they stay at home too? Maybe not. The U.S. government must pull out all the stops to test everyone, not just for current infection, but for past infection. A team at Mount Sinai Hospital in New York has developed a promising test for acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that lets you know if you’ve ever had it. We don’t know if it’s possible to be reinfected by coronavirus or, if so, whether a second bout would be equally or less severe. But there are promising signs that the human immune response can tackle COVID-19.

If COVID-19 patients can emerge with total or near total immunity to the strain, they can help people who are sick. There’s no risk of them transmitting the infection or of contracting it. They are the key to restarting our economy. We can’t waste a moment finding those people and getting them back to work.

Third, we have to save people’s individual economies.

As we saw after the 2008-09 Great Recession, there’s not much point saving banks or corporations or the stock market without targeting individual American citizens for direct relief. Bernie Sanders has proposed that the United States Treasury pay out $2000 per person per month until the end of the coronavirus crisis. Sounds right.

Republicans want an absurd regressive form of means testing—the poorer are you are, the less you would receive. Saying they don’t want to subsidize millionaires, Democrats like Nancy Pelosi also want means testing but from the other direction.

Both are ridiculous. There’s no time for detailed analysis or a new government bureaucracy to determine who gets what. Checks and wire transfers need to go out yesterday. So what if Bill Gates gets one?

It’s time to act, not to blame. But if there’s no action or if the action is late and/or insufficient, there will be plenty of blame to go around. And there will be no limit to the rage of the survivors who are suffering against politicians who did not do what was needed to be done.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

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