Tag 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.

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

COVID-19 and America’s Social Safety Net

Friday’s HuffPost published an article by Emily Peck on the Coronavirus (COVID-19) and its impact on the country’s broken social safety net.

The article indicates that millions of working Americans do not get paid sick days. It also states that a stunning 70% of low-wage workers and one of three workers in the private sector, have no access to paid sick time.

According to Ms. Peck, the US is one of the few countries in the world without a national paid sick leave policy. In addition, she adds, millions of Americans do not have health insurance, or their policies are designed to keep them away from doctors with high co-payments and deductibles.

Both these issues, Ms. Peck writes, highlights how coronavirus, or COVID-19, could test the US’ uniquely weak social safety net.

Kristin Rowe-Finkbeiner, the executive director of MomsRising, a nonprofit advocating for paid leave is quoted in the article, “Right now we’re looking at a situation where we have a lack of policies that most other countries take for granted that protect their public health.”

This isn’t just a “coronavirus” problem, Ms. Peck says. Even though the CDC warned Americans earlier in the week, so far there have been very few case reported in the US. (Note: As of this writing,  there have been 74 reported cases in the US, and two men have died in Washington State, and one case was recently reported in Rhode Island, and one in Manhattan)

Yet, fears of an outbreak has put a spotlight on the public health system. With cuts to many agencies by Trump, many experts fear that we will be unable to deal with the crisis, especially since the Trump called it a hoax at a recent political rally.

He also appointed his evolution-denying Vice President, Mike Pence to coordinate the Administration’s response after gagging several Administration personnel from appearing on the Sunday talk shows. It was mentioned after the announcement that Pence did not believe that smoking causes cancer when he was Governor of Indiana.

For the Democrats, says Ms. Peck, coronavirus makes the case for policies like universal health care and paid sick and family leave.

Some key points to consider:

First, flu rates are higher without sick leave. What about coronavirus?

In the US, the article reports, just 10 states, 20 cities and three counties have some kind of paid sick leave. This is compared with the rest of the world, where more than 145 countries have this benefit. People who live in those places, research shows, are less likely to get sick, Ms. Peck reports.

And lack of paid sick leave is certainly a “risk factor”, according to Nicolas Ziebarth, associate professor in health economics at Cornell. Professor Ziebarth’s 2019 paper in the Journal of Public Economics, looked at Google data on flu rates, compared cities with leave policies with those without, and found that flu rates were 5% lower in places with sick leave.

An upcoming paper of Professor Ziebarth’s, based on CDC data, has found that the rates are actually 11% lower.

For those workers in low-wage jobs, if they get sick, they cannot afford to take time off of work because they are barely getting by. So, they end up going to work, and they get their co-workers sick.

Working from home isn’t an option.

Many companies are telling employees to work from home with the threat from coronavirus. However, for low-wage hourly workers, says Ms. Peck, this just isn’t an option. Many work in industries that have contact with the community — such as food servers, people who care for children, clean offices and homes.

As stated above, it is not just sick leave, The US also lacks any kind of comprehensive paid family leave policy, according to Ms. Peck, which would enable workers to take time off to care for a close family member’s health issues. This issue first came to light in 1993 when Bill Clinton signed into law, the Family and Medical Leave Act, which required covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons.

An example of just how needed is paid family leave, comes from the experience of Ericka Farrell, a mother of three in Maryland, who lost her temp job in the early 2000s because she had to take so much time off to care for her young son. She did not regret staying home, but now works with MomsRising to advocate for paid leave herself, writes Ms. Peck.

Millions are uninsured. Many more have terrible insurance.

According to Ms. Peck, even if you take time off when you are sick, you might not be able to afford to see the doctor. Slightly more than 10% of Americans. she mentions, or about 30 million people, don’t have health insurance. This is because their employers do not offer it, or it is too expensive.

Things to consider regarding the uninsured:

  • Far less likely to go to the doctor
  • Americans with insurance face obstacles to getting care due to high co-payments
  • Then there are the deductibles, which have been going up for decades
  • Most people haven’t come near clearing those deductibles at the beginning of the year

John Graves, associate professor of health policy at Vanderbilt University Medical Center was quoted as saying, “If we as a society are going to face a spreading infectious disease, the worse time of the year is the beginning of the year.”

Graves added that the US health care system is simply not designed to deal with a potential pandemic.

First, he says, the US relies on employment-based insurance. If people are thrown out of work due to an economic downturn, they lose coverage.

Second, insurance is designed to encourage people not to see the doctor through so-called “cost-sharing.”  Co-payments and deductibles exist to discourage people from visiting the doctor or going to the hospital for every “cough and sniffle.” Graves said.

Lastly, in 2018, the Administration made it easier for people to buy insurance plans with less generous coverage, and don’t always cover expenses stemming from preexisting conditions, the article says. Experts have said that these plans they consider junk policies, have even higher out-of-pocket costs.

So what does this all mean?

It means that cuts to the social safety net guarantees that should the coronavirus get out of hand, the US is not prepared to deal with it effectively, and many more people will probably die who shouldn’t because of politics and ideology.

Hospital closings in rural areas, the firing of hundreds of health care personnel at the federal level, silencing the experts in infectious diseases, and the appointment of a man who rejects evolution and says smoking does not cause cancer to coordinate the Administration’s response, is a recipe for a catastrophe of unimanigable proportions. Calling it a hoax in front of your ardent supporters who believe everything you say, will only lead to more confusion and more deaths.

But this crisis also proves that it is high time those on social media sites like LinkedIn who are part of the health care industry, whether they are physicians, in the pharmaceutical industry, work in hospitals, are device manufacturers, or are consultants and researchers, accept the fact that single payer, universal health care (Medicare for All) is not just an economic necessity, but a public health necessity as well.

Is your big, fat five or six figure incomes more important than human health? It’s your call.