COVID-19

[dogears]

And at the end of the urgent / 'can't be refused' treatment, is the individual presented with a bill?  If they are, i think your point is moot.

Isn't his point that someone who knows they can't afford 1k / 10k / 100k for medical treatment chooses not to present themselves at a hospital because they don't want to become indebted for an amount of money they can't afford?

Why is it moot? Should the doctors, nurses, and other staff work for free? Do you work for free?  Where do you think hospitals come from? Or medicine that treats these diseases?

That's fine, I am happy with a person voluntarily choosing to not accept medical treatment. They're free to assign whatever value to their own life they choose - just like you and me. If their life isn't worth 1k / 10k / 100k to them - almost every hospital will offer interest-free payment plans! - why does it become my responsibility to bear that?

This entire idea is selfishness and hypocrisy masquerading as virtue. Do you see the ethical sleight of hand that happens? It's quick, you have to be watching closely.

When you encourage people to accept the wellbeing of others as intimately related to their own wellbeing, that's fantastic. That is amazing, and virtuous. It is the height of virtue for us to love and care for our fellow men as our own selves. 

When you force other people to accept your idea of virtue or ethical behavior, that's bad.  It's most especially bad when you are forcing people to do collectively what you or they are not willing to do individually. It's doubly especially bad when you are presuming on the irrationality, incompetence, selfishness, or stupidity to justify your actions - because you're not setting yourself up as a lover of your fellow man (as an equal) but as a ruler.

We always have to guard against this. Lurking under every statist is a person really wanting to force others to do what he thinks is best for them.  :

Sorry for the derail.

On topic - if the government is forcing you to take a COVID19 test I think the government should pay for it. On the other hand, if you refuse the test I have no problem whatever with a judge getting a restraining order against you to force you to house arrest.

And if you have COVID19 and you're under the age of 60 there's like a 99.5% chance you will be just fine after a nasty week. There's no treatment for it, only gatorade and rest, and symptomatic treatment for aches and fever (i.e., ibuprofen or acetaminophen.). So again, what's the issue? Refuse test, stay home, get better. 

 

[Bo Deadly]

What about glasses and contacts? What about vitamin supplements? What about food? What about clothes? What about shelter?  What about entertainment - that contributes to "basic wellness". When does it end?

When did personal wellness cease being a personal responsibility or a social one by borne by individuals exercising charity and virtue and become the responsibility of the government to force on people?

As a civilized society, we have a responsibility to provide everyone with things that everyone needs in a fair way. This is not the wild-west. Everyone needs food, shelter, fire services, justice, security from crime and foreign invaders, etc. But of course this doesn't mean the government is going to give people all of these things. If they are services that are provided by non-gov entities, gov just has to do enough to stop businesses from exploiting people or excluding people based on race, religion or sexual orientation. So you should not be able to refuse to sell people food or charge an extra fee if you're a minority, or incarcerate people to increase profits. Then there are services that must be handled entirely by gov like fire prevention and fighting because if one business or individual is negligent, it can have catastrophic results for others.

In the case of heath care, the system in the US is not fair. The cost of a procedure is significantly inflated to compensate for high costs and losses from uninsured and to pressure the insurance companies to pay more. The insurance companies are always trying to pay less (to maximize their profits being corporations with stock-holders). If you don't have insurance you don't have the power to "negotiate" the price and just get an even more inflated bill.

So if you're going to say things like people should get eye glasses for free or medical staff shouldn't work for free, then I must conclude that you are not thinking critically.

 

[dogears]

I simply disagree with your premise. Human beings have individual responsibilities. Societies are aggregates of individuals, not actual entities. Society has no responsibility to anyone. Humans have responsibilities to others. Individual human beings have a responsibility toward their fellow man. But this responsibility also extends to respecting other's right as free individuals to live their life as they see fit. The concept of a classically liberal government is to referee the overlap between these - not force one individual or group of individuals to live the way another individual or group of individuals decides.

I think "fair" is an extremely under-defined concept - it is dangerous.  What is considered "fair" to one person isn't fair to another.  Fair could be ensuring equitable opportunity. Fair could be driving to equitable outcomes. Fair could be survival of the fittest.

I think you're backwards on the insurance model.  I pay cash for nearly all of my family's medical expenses. In my experience cash payment results in a lower cost than the negotiated insurance rate (because the doc doesn't have to wait for ?? months to get their payment). At any rate the entire reason our system is so fouled up is because regulatory intervention has made it nearly impossible for the consumer of the service to understand what the cost for the service actually is - up front - and not three months later. Next time you go to the doc or (God forbid) to the hospital, actually try to find out what your treatment costs before they administer it. They'll look at you like you're an idiot. No wonder costs are out of control. We don't treat any other aspect of our lives like this.

Insurance isn't the problem. You can tell because we have insurance in all kinds of different markets that doesn't have these problems (home, auto, business interruption, whatever). The reason health insurance is a problem is because it has morphed from insurance to something else entirely. Insurance is based on risk - on unknown but actuarial predictable outcomes. Routine medical expenses shouldn't be part of insurance, any more than gasoline or oil changes are part of auto insurance.

My point is that advocating that well-being is a government responsibility creates a never-ending cycle of extension. A reduction of responsibility for oneself and a reduction of individual responsibility for others. It's such a vague idea. It's irresponsible. You say glasses and contacts aren't for well-being, but the same arguments that are put forward for more severe medical requirements work here as well, if the standard is well-being. Not having glasses is literally crippling if your vision is bad enough. It'll never end.  8)

 

[dogears]

Nevermind that the NHS in the UK is not equipped to handle this compared to Germany or the USA.
https://www.theguardian.com/commentisfree/2020/mar/03/icu-doctor-nhs-coronavirus-pandemic-hospitals

Germany has 4x ICU beds per capita compared to UK NHS. USA has 10x. Why do we think that is?

 

[hodad]

Again.  In the United States doctor or a hospital absolutely cannot refuse to treat a person with life-threatening or serious injuries or illnesses - regardless of payment status or whether they have insurance, race, religion, nationality, ethnicity, residence, citizenship, or legal status.

This is false.  A quick internet search will tell you that only emergency rooms cannot refuse treatment.    Further, even if you have insurance, hospitals and doctors can currently charge you more for their services if the insurance  reimbursement is deemed inadequate (I have firsthand experience with this.)  And if you're worried about folks not having enough money to survive w/o work for 1-2 weeks, maybe you should be worried about a hike in the federal minimum wage, rather than pointing a finger at all those unthrifty poor people. 

 

[dogears]

This is false.  A quick internet search will tell you that only emergency rooms cannot refuse treatment.    Further, even if you have insurance, hospitals and doctors can currently charge you more for their services if the insurance  reimbursement is deemed inadequate (I have firsthand experience with this.)  And if you're worried about folks not having enough money to survive w/o work for 1-2 weeks, maybe you should be worried about a hike in the federal minimum wage, rather than pointing a finger at all those unthrifty poor people.

?? Strange. A person with life-threatening or serious injuries or illnesses... where else would they go? The reason I specifically said doctors and hospitals is because the law (Emergency Medical Treatment and Active Labor Act) applies to both individuals and doctors. Some 55% of emergency room visits are unpaid now by the people who consume the service. You know who pays for that? All of us who actually pay our medical bills. And doctors... to the tune of 30 hours a week for emergency room docs and something like $125k per year on average. I personally am glad the federal government isn't forcing me to do 75% of a full time job schedule for free.
https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/

Why shouldn't they be able to charge you more if the insurance doesn't cover it? The service costs what it costs. They have negotiated reimbursement with the insurance company. You have negotiated a payment agreement with the insurance company. Why is it the hospital's responsibility to negotiate with your insurance on your behalf for who pays for their services?

Less than 3% of workers are earning minimum wage. Total non-sequitur. And you know what? Even if a person is on the minimum wage I think having enough cash for 2 weeks on hand is a pretty manageable feat and a fairly low bar for being a responsible adult. That's $580. There's not a person in the world who can't save $580 over time if they care to. Know how I know? Because average cost of a TV is around that, and 96.1% of American homes have at least one.

 

[dogears]

Sorry for the derail. My fault. Only intended to object to the idea that people in the US are dying in the streets because they can't get help, that simply isn't the case.  I'll not muck this thread up any more with my opinions.

 

[JohnRoberts]

Sorry for the derail. My fault. Only intended to object to the idea that people in the US are dying in the streets because they can't get help, that simply isn't the case.  I'll not muck this thread up any more with my opinions.

Thank you for your thoughtful comments.

In today's political climate is all but impossible to discuss anything calmly without it getting corrupted by political talking points.

===

Indeed "emergency" rooms are the venue that cannot deny medical attention, so they get abused for non-emergency concerns causing even more waste of our limited health resources. These costs do not go away but get absorbed and paid by all consumers of health services. This is why hospital aspirins cost $100.

There have to be better solutions than the current status quo, but the "free everything" offered as recent campaign promises seem unworkable, and unlikely to pass muster in congress. I have tried to engage in thoughtful discussions about healthcare reform right here for over a decade.  Discussion in today's hyper political climate is unlikely to be very productive.

We can probably all agree that it needs work. I don't think anybody thinks it is OK as it is. My local clinic doctor that I liked retired because of burdensome ACA regulations, and because she could.  8) I think there is some reform going on but there is not enough cooperation in congress to do anything impactful.

JR

 

[dmp]

Good summary of what's known here:
https://ourworldindata.org/coronavirus

The difference in mortality for older people shows the huge difference from the flu.

It's starting to look like more people are infected in the US than is being acknowledged and it's getting out of hand. Exponential growth.

 

[ruffrecords]

Nevermind that the NHS in the UK is not equipped to handle this compared to Germany or the USA.
https://www.theguardian.com/commentisfree/2020/mar/03/icu-doctor-nhs-coronavirus-pandemic-hospitals

Germany has 4x ICU beds per capita compared to UK NHS. USA has 10x. Why do we think that is?

Well it all boils down to money. Germany has no more money per capita than the UK unless its taxes  and/or healthcare charges are higher. It is the usual choice as to what you spend it on and how you get it from the people. Except in the US it is only those who can afford it get it.

Cheers

Ian

 

[dogears]

Well it all boils down to money. Germany has no more money per capita than the UK unless its taxes  and/or healthcare charges are higher. It is the usual choice as to what you spend it on and how you get it from the people. Except in the US it is only those who can afford it get it.

Cheers

Ian

Again, this is simply not so. You show up to an ER and need to go to an ICU it’s treat first ask questions later. There is NO variance in treatment for emergency care based on ability to pay. I do not understand why this is so persistently misunderstood.

 

[matriachamplification]

Again, this is simply not so. You show up to an ER and need to go to an ICU it’s treat first ask questions later. There is NO variance in treatment for emergency care based on ability to pay. I do not understand why this is so persistently misunderstood.

News Media, Social Media, Hollywood... have all done a fantastic job of furthering misinformation during the information era.

Persistently Misunderstood, I feel sums up reality.

 

[Scodiddly]

I'm totally fine with giving everybody free health care and education, simply because I don't want to live in a country full of diseased idiots.

 

[Bo Deadly]

It is interesting that South Korea's numbers for deaths and serious / critical people is exceptionally low relative to total cases:

Total Cases:	6,284
Deaths:	40
Active Cases:	6,109
Total Recovered:	135
Serious, Critical:	52

The Diamond Princess numbers are similar:

Total Cases:	696
Deaths:	6
Active Cases:	478
Total Recovered:	212
Serious, Critical:	35

I believe it was reported that S. Korea have been very aggressive with testing. The Diamond Princess is like a case study because they were all isolated on the ship and processed quite a while ago. If these numbers are correct, it suggests that:

Bad News) there are far more cases than those reported around the world. A back-of-napkin calculation for the USA might be 6284 * 13 / 40 = 2042 which is almost 10x the current 224 for USA cases.

Good News) the actual mortality rate is < 1%. Of course this is of little consolation to the elderly and other vulnerable groups.

A middle-aged gent on CNN described COVID-19 infection as a 103F+ fever for a few hours and then it was gone.

 

[JohnRoberts]

Well it all boils down to money. Germany has no more money per capita than the UK unless its taxes  and/or healthcare charges are higher. It is the usual choice as to what you spend it on and how you get it from the people. Except in the US it is only those who can afford it get it.

Cheers

Ian

Don't ask me why I know this*** but Germany only spends around 11% of their GDP on healthcare..  so a lot less as a percentage of GDP than we do.

Do we need a new thread for this?



JR

*** funny story(?), one of my way too many friends on social media left over from decades in a live sound career was claiming that the US military set up Germany's healthcare system after WWII... Oops, he kind of missed that Otto von Bismarck began socialized healthcare in Germany back in the 1880s.

 

[dogears]

It is interesting that South Korea's numbers for deaths and serious / critical people is exceptionally low relative to total cases:

Total Cases:	6,284
Deaths:	40
Active Cases:	6,109
Total Recovered:	135
Serious, Critical:	52

The Diamond Princess numbers are similar:

Total Cases:	696
Deaths:	6
Active Cases:	478
Total Recovered:	212
Serious, Critical:	35

I believe it was reported that S. Korea have been very aggressive with testing. The Diamond Princess is like a case study because they were all isolated on the ship and processed quite a while ago. If these numbers are correct, it suggests that:

Bad News) there are far more cases than those reported around the world. A back-of-napkin calculation for the USA might be 6284 * 13 / 40 = 2042 which is almost 10x the current 224 for USA cases.

Good News) the actual mortality rate is < 1%. Of course this is of little consolation to the elderly and other vulnerable groups.

A middle-aged gent on CNN described COVID-19 infection as a 103F+ fever for a few hours and then it was gone.

Case study published in New England Journal f Medicine of 1099 Chinese cases said time from symptoms to death was average ~12 days if I recall.

For S Korea numbers you should use the numbers from 4-12 days ago and see what the death rate is. I agree that because of their testing they are establishing a likely lower bound to the figure.

Italy looks brutal. 10% of their current cases are severe / requiring ICU.

If the local epidemic isn’t controlled there’s a real risk of hospital overload. That starts having knock-on effects to base load / typical patients as well as increasing mortality due to drop in care.

But I don’t think mortality is the real story here to be honest. Economic disruption is going to be crazy. Here’s hoping for a v shaped recovery.

 

[Bo Deadly]

Case study published in New England Journal f Medicine of 1099 Chinese cases said time from symptoms to death was average ~12 days if I recall.

For S Korea numbers you should use the numbers from 4-12 days ago and see what the death rate is. I agree that because of their testing they are establishing a likely lower bound to the figure.

True. On Mar 3 (almost 4 days ago), the total cases where more like 4800. If we use that, the under-testing multiple is only 7x but mortality is still < 1%.

 

[dogears]

Yes I think the outside of Wuhan in China number is 0.7%. That’s probably representative. On the other hand, what happened in Wuhan is cautionary tale for the impact of overloading hospitals. If there’s not enough ventilators for the numbers of serious cases, that number absolutely can get worse.  :-\

 

[dogears]

https://twitter.com/nbcnews/status/1235786467420581888?s=21

 

[dmp]

I've seen some reports there are two varieties of covid-19 now, a severe and mild version. Maybe this is just conjecture that Italy has a severe version and SK has a mild version...