Category Archives: Coronavirus

A Few Comments About Yesterday’s Post

After putting yesterday’s post to bed, I realized that there were some more things I wanted to say about COVID and the end of neoliberalism.

Recall that John McDonough had mentioned that the Orangutan’s war on trade and other economic policies, signaled the aging of the Neoliberal era. Well, over night, the baboon struck again when he asked the Supreme Court to overturn the ACA (Obamacare), which if it happens, will mean 20 million Americans will lose their health care during a global pandemic.

Their rationale — because it is unlawful. Really? From the most corrupt and unlawful Administration in US history. Could you try any harder to kill more Americans when the number of deaths has already passed 120,000?

In an Opinion piece in Wednesday’s New York Times, Charles Blow asked, “Can We Call Trump a Killer?” According to Blow, things are so bad, that the European Union is considering banning US citizens, and it is abysmal had Trump not intentionally neglected to protect American citizens.

In fact, several times since the pandemic began, he was quoted as saying the following about Corona, “Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away.”

Early on in the crisis, some have suggested that perhaps it is time to consider single payer health care. In fact, some have argued that single payer systems have coped with Corona better than for-profit systems.

Shortages of Personal Protection Equipment (PPE), ventilators, and the lack of enough ICU beds is proof that for-profit health systems cannot effectively handle a global pandemic. “Having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources,” according to David Fisman, epidemiologist at the University of Toronto.

One country that has been able to deal effectively with Corona has been South Korea, and despite recent setbacks, the following data and chart from a tweet by @hancocktom, highlights what Korea did right.

South Korea has done more than just “flatten the curve” of new Covid-19 infections. It bought the curve down through: – Aggressive testing (20,000 tests daily, “drive through” testing)/isolation – School holiday extended – Government advice to stay inside – large events cancelled

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“Unhampered government intervention into the healthcare sector is an advantage when the virus is spreading fast across the country,” said Choi Jae-wook, professor of preventive medicine at Korea University in Seoul.

Denmark also has a single payer system, and like South Korea, offered drive-thru testing. Jorgen Kurtzhals, the head of the University of Copenhagen medical school, told the Washington Post that the strength of Denmark’s single-payer system is that it has “a lot of really highly educated and well-trained staff, and given some quite un-detailed instructions, they can actually develop plans for an extremely rapid response.”

“We don’t have to worry too much about whether this response or that response demands specific payments here and there,” said Kurtzhals… “We are aware that there will be huge expenditure within the system. But we’re not too concerned about it because we have a direct line of communication from the national government to the regional government to the hospital directors.”

One nation that has a single payer system and has had a bad experience with COVID is Italy. Presumptive Democratic nominee, Joe Biden, in a primary debate with Sen. Bernie Sanders in March, said that, “With all due respect for Medicare for All, you have a single-payer system in Italy,” said Biden. “It doesn’t work there.”

HuffPost healthcare reporter Jonathan Cohn said in a tweet, “[Single-payer] isn’t the reason Italy is having problems,”…”Italy’s problem is health system capacity. Independent of health system design.”

Another critic said the following:

This is the dumbest point. No, single payer does not solve the problem of pandemics. But it definitely solves the problem of thousands and thousands of people going bankrupt because there’s a pandemic. It solves the problem of people not seeking out care for fear of bankruptcy. 

— Jill Filipovic (@JillFilipovic) March 16, 2020

There is no panacea for dealing with such a deadly and fast moving virus. Within a few short months it spread from China to Western Europe, the US (first cases found in a Washington State nursing home), and then globally.

Instead of going piecemeal to find a solution, all nations should have pooled their resources and worked to find a vaccine as soon as possible. Estimate recently said the world will hit 2,000,000 cases in the near future.

Single payer won’t cure it, but will make it easier to manage so that all infected will have the use of ventilators and ICU beds if needed, and medical personnel won’t have to reuse PPE that should have been discarded after treating one patient.

COVID-19 and the End of the Neoliberal Era in Health Care

The subject of neoliberalism has been discussed in this blog five times between 2018 and 2019, and is the focus of an article in The Milbank Quarterly, by John E. McDonough, professor of public health practice at Harvard’s TH Chan School of Public Health.

In the article, Professor McDonough points to a Commonwealth Fund chart (see below) that shows the growth in gross domestic product (GDP) for health care, comparing the US to 10 other high income nations. The chart shows that from 1980 to 2018, spending by the US was among the highest 40 years ago, but that in the early 1980s, US spending leapt above the others. and growing wider over four decades.

 

He then asks, “what happened to US health care in the early 1980s-and since then?”

McDonough responds by pointing to two New York Times columns by Austin Frakt, Medical Mystery: Something Happened to U.S. Health Care Spending After 1980 and Reagan, Deregulation and America’s Exceptional Rise In Health Care Costs.

McDonough suggested that a big part of the answer involves the broad economic and political trade winds of the late 1970s and 1980s, often called “Reaganomics” or “supply-side economics”, because Reagan ushered in a new era in the US. Some, like George H. W. Bush, running for President in 1980 for the Republican nomination, called it “voodoo economics.” However. as McDonough states, and as my previous posts on the subject calls it, it is “neoliberalism.”

This term evokes Adam Smith, but the 20th century version owes itself more to the works of Friedrich Hayek and Milton Friedman, among others. According to McDonough, the neoliberal agenda consists of cutting taxes, repealing regulations, shrinking or privatizing government (remember Grover Norquist’s desire to shrink government to fit in his bathtub and strangle it), suppressing labor, encouraging free-market trade, accepting inequality as price for economic freedom (something that has come under fire this year and since the 2016 election, making people receiving services and benefits pay as much as possible, and reorienting corporate thinking and behavior to promote return on equity as their only goal.

The New Deal era that was replaced by neoliberalism, McDonough states, lasted 48 years, from 1933 to Reagan’s inauguration in 1981. The neoliberal era, he points out, is 40 years old and showing signs of rust, cracks, and failing systems. Signs of this are Trump’s war on trade, deficit-exploding tax cuts for the wealthy and corporations,, anger over “deaths of despair” from opioid and other addictions and economic distress, awareness and revulsion about rising levels of inequality across society, and spreading rejection of absolutist “shareholder capitalism.”

In addition, recent protests over the deaths of African-American males at the hands of police, coupled with the Corona virus pandemic, are all signs that something is terribly wrong.

But what about health care, McDonough asks again?

Reiterating what he said above, US health care between 1980 and 2020 saw spending rise far above US economic growth, while growth in insurance premiums and cost-sharing increased well beyond advances in household incomes. On key indicators, he reports, the US performs worse than most nations on life expectancy, infant and maternal mortality, chronic disease mortality, levels of overweight and obesity, suicides, and gun violence, as well as glaring systemic health inequalities, as has been discussed during the BLM protests as one factor in people taking to the streets.

Despite the advances in technology and high spending, Americans give their system the lowest satisfaction ratings.

Yet, between 1965 and the 1980s, major infusions of investor capital has gone to all corners of our health care system, courtesy of shareholder-owned for-profit companies who often cut long-lasting ties with local communities, according to McDonough. It did not help that in 1986, the Institutes of Medicine, instead of convicting for-profits of “killing” health care, released a 600 page report on “For-Profit Enterprises in Health Care, that identified pluses and minuses that called for greater monitoring.

Finally, McDonough concludes that the US need to look outward, not inward, as is usually the case to solve big problems with health care. One such study, in 2018 from the William and Flora Hewlett Foundation, Beyond Neoliberalism, is a clarion call for a new policy sphere forming in think tanks, academia, advocacy and activist groups, and the legal community, as well as some Republican/conservative quarters as Marco Rubio, who rejects shareholder primacy. He says the search is on for a new paradigm, and hopes the election in November will bring it forth.

He doesn’t have to look far. Bernie Sanders, Elizabeth Warren, the PHNP, and others have the paradigm. It is Medicare for All/Single Payer. But first we have to rid ourselves of the baboon in the Oval Office and his economic minions, Mnuchin the Mieskeit, and Kudlow the Meshuggeneh.

Stay safe everyone.

Eligibility Waivers to Leave Many With Costs From COVID-19

One more reason, now that COVID is causing so much unemployment, that we desparately need Medicare for All, with no qualifications other than US citizenship. We can give corporations and wealthy people billions in tax breaks, but not one red cent for people’s health care in a nationwide, single payer system that would have responded rationally and logistically to a pandemic, instead of as a “chaotic disaster.”

Health Affairs Blog

May 8, 2020

Medicaid Retroactive Eligibility Waivers Will Leave Thousands Responsible For Coronavirus Treatment Costs

By Paul Shafer  Nicole Huberfeld  Ezra Golberstein

The coronavirus pandemic has led to record numbers of American workers being laid off or seeing their hours and paychecks dwindle. The economy is on the brink of a deep recession, and waves of coronavirus infections may continue for the foreseeable future. Medicaid will be a crucial piece of the puzzle that helps to ensure access to health care while protecting people from further financial ruin. Yet, one of Medicaid’s key provisions has been weakened by recently approved section 1115 “demonstration projects”, commonly referred to as waivers, that eliminate or reduce retroactive coverage. These waivers will diminish coverage for thousands of people seeking testing and treatment for COVID-19 and other medical care.

Retroactive eligibility is a long-standing feature of Medicaid that covers health care expenses for three months prior to the application date, provided that the beneficiary would have been eligible during that period. Before the Affordable Care Act (ACA), a handful of states imposed narrow restrictions on retroactive eligibility, but these limitations were paired with expansions of eligibility and had exemptions for vulnerable groups. Recently, however, many states—including Arizona, Arkansas, Florida, Indiana, Iowa, Kentucky, and New Hampshire—have gained Department of Health and Human Services (HHS) approval for 1115 waivers that drastically limit or completely eliminate retroactive eligibility, though four have been stayed by courts or halted by states as part of litigation challenging the legality of those waivers that include work requirements (Arkansas, Kentucky, Indiana, and New Hampshire).

A core purpose of Medicaid is supporting people when they need help, which is why Medicaid has continual open enrollment and retroactive eligibility to cover the cost of care when those who are eligible aren’t already enrolled before a crisis. States should restore full retroactive eligibility immediately to protect thousands of newly-unemployed workers from even greater health and economic suffering.

https://www.healthaffairs.org/do/10.1377/hblog20200506.111318/full/

The Sad Downside to Globalization: Economics Over Public Health In The Age of Covid-19

Tom Lynch of Workers’ Comp Insider posted the following yesterday about where most of the masks and other protective equipment worn by health care workers comes from, and in particular, one CEO’s experience with the beginning of a global pandemic.

Here is the article.

If you are wondering why there have been mass protests (mostly supported by, and instigated by, conservative groups and wealthy, libertarian right-wing families such as the DeVos, Dorr, and other families, and commentators such as Alex Jones and Fox News), it is because many of these people have been outsourced from jobs that were sent to China and elsewhere.

Some are just members of militia groups flexing their muscles, but thankfully, polls show more Americans support restrictions, rather than opening up the economy. Apparently, it is the economy of these families that are most affected by the shutdowns, and thus they are only interested in their economic interests, not public health.

Witness the statements of some GOP elected officials who stated that the economy was more important than living (Texas’ Attorney General, for one).

So, while Trump makes a clusterf**k of the response, let’s remember that we did not understand that there were consequences for shipping our manufacturing jobs to China, and COVID-19 is the result.

Richard’s note: The masks I use for my dialysis treatment come from China.

Another Reason for Medicare for All

While all of you are working from home, perhaps you can consider what Marcia Angell says below in between doing your work and playing with the kids.

Santa Fe New Mexican

March 21, 2020

Why the U.S. failed the coronavirus test

By Marcia Angell

The coronavirus pandemic is the best argument for “Medicare for All.” As it stands, most Americans get health care only if we have insurance that will pay for it. If we don’t or we can’t afford the deductibles and copayments, too bad. Every other advanced country provides universal health care in a predominately nonprofit system.

What happens, then, when Americans develop a fever and cough? Are they likely to seek medical help, despite the hefty bills they are sure to receive, particularly if, say, the radiologist is out of network or the insurance company refuses to pay for some other reason? The new coronavirus, while highly contagious, is usually mild, so people with minimal symptoms might simply take their usual cold remedies while they go about their business and spread the infection widely.

The problem is that we treat health care like a market commodity distributed according to the ability to pay in an uncoordinated system with hundreds of commercial insurers and profit-oriented providers. Some 30 million people have no access to health care because they are uninsured, and millions more don’t use their insurance because the deductibles and copayments are unaffordable. In addition, insurers usually require patients to get their care within a narrow network of providers and exclude certain services.

The shortage of test kits for coronavirus stems from a related problem. Since there was no commercial market for them, they didn’t get made immediately. While we’ve converted health care into a market commodity, we’ve hollowed out our public health system, so it couldn’t do the job.

For all we know, the coronavirus may already have spread widely within the United States. Although it has been in other countries for more than two months, we have not really looked for it here. Until the last week in February, our premier public health agency, the Centers for Disease Control and Prevention, limited its diagnostic testing to symptomatic patients who had traveled to China or had contact with someone known to be infected. This is akin to looking for lost keys only under a lamppost.

The CDC probably could not have done better, given its lack of funding and governmental support. But ignorance is hardly a good public health strategy. Right from the beginning, we should have made test kits available to state and local public health agencies (as was done in Italy and South Korea). The only way to deal with an epidemic of this scope is with a universal health care system like “Medicare for All” and a strong, well-funded public health network.

The political opposition to “Medicare for All” is puzzling, since Medicare is the most popular part of our current fragmented system. In fact, many 64-year-olds can hardly wait to be 65, so they will be eligible. Why, then, do opponents of “Medicare for All” seem to believe that extending this popular program to everyone would be a sacrifice? Would a 64-year-old really prefer private insurance, with its networks and variable benefits, to Medicare, with its free choice of doctors and guaranteed benefits?

It’s true that taxes would have to increase to pay for “Medicare for All,” but the taxes could be as progressive as we wanted. For most Americans, they would probably be completely offset by the elimination of premiums, deductibles and copayments. In addition, the system as a whole would be far more efficient, because of the reduction in our gigantic overhead costs and the elimination of most profits. Most important, cost inflation would slow greatly, so that in a few years we would come out well ahead.

But as important as cost control is, my reason for favoring “Medicare for All” is primarily moral. Health care is not like ordinary consumer goods that people can choose to purchase. Illness is not a choice; it’s a misfortune. So why should people have to pay for it, as if they wanted it? Providing health care, just like providing clean water or police protection or basic education, is simply what decent societies should do. And during an epidemic, it protects all of us. The coronavirus pandemic powerfully underscores the need for a coherent national health system, in which we all pull together.

Marcia Angell is a member of Harvard Medical School’s Department of Global Health and Social Medicine, and a former editor-in-chief of the New England Journal of Medicine. She will soon be a resident of Santa Fe.

https://www.santafenewmexican.com/opinion/my_view/why-the-u-s-failed-the-coronavirus-test/article_cb92b8a6-694c-11ea-80b4-078d871fd2e9.html