American Healthcare Post-Covid

[Monty Python]

After Covid is behind us, and after all the finger pointing, political grandstanding, societal outrage, rational analyses (financial, clinical, logistical, etc), and doctoral dissertations are completed, will the US:

* continue with the same pre-Covid patchwork of for-profit + non-profit + boutique + university academic healthcare

* morph into essentially socialistic nationalistic healthcare a la UK, France, Germany? ”You get what you ’need’, not what you want.”

* something entirely different (what)?

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[deleted126335]

Depends on how much printed money that we throw at hospitals and what the consequences of bailing out almost everyone are.

 

[Mikkel]

Why would it change at all?

 

[deleted126335]

Why would it change at all?

1. healthcare systems may collapse.
2. Millions of people may lose their jobs and private health insurance and be financially devastated.
3. Millions more will struggle even harder to meet their ever increasing copays and deductibles.


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[Mikkel]

1. healthcare systems may collapse.
2. Millions of people may lose their jobs and private health insurance and be financially devastated.
3. Millions more will struggle even harder to meet their ever increasing copays and deductibles.


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Healthcare systems are making more money with this and getting a 20% increase in Medicare payments related to coronavirus.

Millions of people who lose their jobs because of coronavirus were unlikely to have been provided health insurance through their employer anyway. And if they did have health insurance, why wouldn't they be able to get their jobs again post coronavirus?

It's a temporary blip in the healthcare economy.

 

[deleted126335]

Healthcare systems are making more money with this and getting a 20% increase in Medicare payments related to coronavirus.

Millions of people who lose their jobs because of coronavirus were unlikely to have been provided health insurance through their employer anyway. And if they did have health insurance, why wouldn't they be able to get their jobs again post coronavirus?

It's a temporary blip in the healthcare economy.

Disagree. ORs are the financial life blood of hospitals. Increased payments for Covid are unlikely to make up the difference. Also clinics are not seeing very many patients. This will devastate lots of hospital systems absent major money printing that doesn’t create worse problems short-intermediate term.


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[chocomorsel]

Depends on how much printed money that we throw at hospitals and what the consequences of bailing out almost everyone are.

First, please stop feeding the troll. You know he’s a troll.

Second, I hope this makes people wake up and realize that we need universal healthcare for EVERYONE. Not just people with decent paying jobs that can afford it and the very poor who meet Medicaid limits. There are a lot of people in between that cant afford insurance.

Third, I hope this sinks insurance companies and some hospitals systems who engage in some serious price gouging. Yeah, Mom was in hospital three days, non ICU and was billed 78k. Bull crap. I was charged $1200 to biopsy a nevus on my foot.

Fourth, yes I am willing to pay more taxes for universal healthcare instead of giving hundreds a month to selfish insurance companies who are always trying to deny my family and I necessary care and have high deductibles on top of premiums.

 

[deleted162650]

So to paraphrase:

“The government really f**ked up the response to this pandemic. We should put the government in charge of ALL healthcare.”

 

[Monty Python]

First, please stop feeding the troll. You know he’s a troll.

Second, I hope this makes people wake up and realize that we need universal healthcare for EVERYONE. Not just people with decent paying jobs that can afford it and the very poor who meet Medicaid limits. There are a lot of people in between that cant afford insurance.

Third, I hope this sinks insurance companies and some hospitals systems who engage in some serious price gouging. Yeah, Mom was in hospital three days, non ICU and was billed 78k. Bull crap. I was charged $1200 to biopsy a nevus on my foot.

Fourth, yes I am willing to pay more taxes for universal healthcare instead of giving hundreds a month to selfish insurance companies who are always trying to deny my family and I necessary care and have high deductibles on top of premiums.

From Harvard Business Review.

The Role of Private Equity in Driving Up Health Care Prices

While private capital is bringing innovation to health care through new delivery models, technologies, and operational efficiencies, there is another side to investors entering health care. The impact of their common business model of buying, growing through acquisition or “roll-up,” and selling...

hbr.org

 

[vector2]

So to paraphrase:

“The government really f**ked up the response to this pandemic. We should put the government in charge of ALL healthcare.”

I'm sure your post was half in jest, but in actuality the problem was (is) having a patchwork of a healthcare system with various oversight authorities including federal and state not knowing who's in charge, combined with having to treat a populace that randomly has coverage provided for by private, state, federal or some combination thereof. Just consider for a moment that we currently have states competing with other states and the feds over the price of ventilators cause no one knows wtf is going on.


Long story short, like it or not, the countries who have tackled C19 the fastest have been those with robust and authoritative centralized national power.

 

[deleted162650]

I'm sure your post was half in jest, but in actuality the problem was (is) having a patchwork of a healthcare system with various oversight authorities including federal and state not knowing who's in charge, combined with having to treat a populace that randomly has coverage provided for by private, state, federal or some combination thereof. Just consider for a moment that we currently have states competing with other states and the feds over the price of ventilators cause no one knows wtf is going on.


Long story short, like it or not, the countries who have tackled C19 the fastest have been those with robust and authoritative centralized national power.

I just find it a bit odd that someone like yourself who despises the current executive branch as much as yourself is in favor of giving them even more “robust and authoritative centralized national power.”

 

[Justice4all]

Would this federal response be different under a different administration? Maybe. We need to have an honest assessment of our healthcare system once we survive this pandemic. But once that concludes, it will be business as usual where quarterly profit reports trump everything else. I hope we change for the better in which insurance companies, pharmaceuticals and hospitals actually put human lives over the almighty dollar.

 

[chocomorsel]

So to paraphrase:

“The government really f**ked up the response to this pandemic. We should put the government in charge of ALL healthcare.”

No, we should all give a crap enough about each other to put someone in charge of healthcare ultimately regulated by the government. Even if it isn’t the government. Basic and essential healthcare for all and Luxury healthcare for for those that can and want to afford it.

And all pool all our resources to make sure that EVERONE has access to care.

Because we are supposed to be First World. We sure look First World right now wearing Hefty and all.

Right?

 

[vector2]

I just find it a bit odd that someone like yourself who despises the current executive branch as much as yourself is in favor of giving them even more “robust and authoritative centralized national power.”

I'm not going to throw out the baby with the bathwater. The right executive with appropriate congressional oversight can do wonders. Throw in some term limits for good measure. A bumbling, corrupt executive with an equally corrupt congress....not so much

 

[deleted162650]

No, we should all give a crap enough about each other to put someone in charge of healthcare ultimately regulated by the government. Even if it isn’t the government. Basic and essential healthcare for all and Luxury healthcare for for those that can and want to afford it.

And all pool all our resources to make sure that EVERONE has access to care.

Because we are supposed to be First World. We sure look First World right now wearing Hefty and all.

Right?

For the record, I would not be opposed to a 2 tiered system similar to that of the Australians.

 

[VA Hopeful Dr]

I'm not going to throw out the baby with the bathwater. The right executive with appropriate congressional oversight can do wonders. Throw in some term limits for good measure. A bumbling, corrupt executive with an equally corrupt congress....not so much

That's the problem though, odds are good this isn't the last bumbling, corrupt executive we'll have

 

[deleted162650]

I'm not going to throw out the baby with the bathwater. The right executive with appropriate congressional oversight can do wonders. Throw in some term limits for good measure. A bumbling, corrupt executive with an equally corrupt congress....not so much

Unfortunately you’re always gonna get some of the latter mixed in with the former. I’d prefer not to grant either excessive power.

 

[Southpaw]

our options are miserable. greedy MBA type corporate executives. greedy MBA type hospital administrators. trump. I'm pretty sure we're all screwed!

 

[chocomorsel]

I'm sure your post was half in jest, but in actuality the problem was (is) having a patchwork of a healthcare system with various oversight authorities including federal and state not knowing who's in charge, combined with having to treat a populace that randomly has coverage provided for by private, state, federal or some combination thereof. Just consider for a moment that we currently have states competing with other states and the feds over the price of ventilators cause no one knows wtf is going on.


Long story short, like it or not, the countries who have tackled C19 the fastest have been those with robust and authoritative centralized national power.

Exactly. I said this in my blog. Socialist healthcare has something to do with it.
I think it’s the lack of just caring for me, me, me and my, my, honestly.

The government actually seems to give a crap about its people and people care more for other people.

There’s a reason that they are the happiest centuries in the world even though most are gloomy and dark without sun and don’t have the wealth disparities we have. And they have better outcomes in health.

I think the lack of wealth disparities and access to basic healtchcare for all has a lot to do with their happiness.

 

[chocomorsel]

For the record, I would not be opposed to a 2 tiered system similar to that of the Australians.

And why the hell have we not passed that bill/law yet?

 

[vector2]

That's the problem though, odds are good this isn't the last bumbling, corrupt executive we'll have

Unfortunately you’re always gonna get some of the latter mixed in with the former. I’d prefer not to grant either excessive power.

There's been plenty of administrations and congresses that have gotten plenty of good things done for the American people. Even for all the faults of the ACA, there are still a lot fewer people uninsured in 2020 than in 2008. I also don't want to grant either institution "excessive power," but since the states have shown they are unable to 1. Provide healthcare for everyone 2. Manage a nationwide pandemic, it is only reasonable that the feds need to manage both.

 

[vector2]

Somewhat relatedly, I was fascinated to learn the story of how rugged American individualism and the love of federalism led to us using a card that was never meant to be a national ID card as a national ID card

 

[deleted162650]

There's been plenty of administrations and congresses that have gotten plenty of good things done for the American people. Even for all the faults of the ACA, there are still a lot fewer people uninsured in 2020 than in 2008. I also don't want to grant either institution "excessive power," but since the states have shown they are unable to 1. Provide healthcare for everyone 2. Manage a nationwide pandemic, it is only reasonable that the feds need to manage both.

Ok, but careful what you wish for. If you’re gonna empower the federal government even further, I don’t wanna here any crying the next time the people give you another Trump.

 

[GravelRider]

The argument that politicians use for some kind of universal health coverage has always been it costs too much money. I’m just not sure how the government continues to use that line when they just printed $2 trillion dollars and earmarked a few billion of that for cruise ships. When people go bankrupt because of their medical bills, why don’t they get a bail out?

 

[nimbus]

I just find it a bit odd that someone like yourself who despises the current executive branch as much as yourself is in favor of giving them even more “robust and authoritative centralized national power.”

The problem is that we need a coordinated response and the federal government is the only one with the power to do that. It doesn’t matter if any particular state manages this crisis well because the virus doesn’t recognize any borders.

 

[nimbus]

Healthcare systems are making more money with this and getting a 20% increase in Medicare payments related to coronavirus.

Millions of people who lose their jobs because of coronavirus were unlikely to have been provided health insurance through their employer anyway. And if they did have health insurance, why wouldn't they be able to get their jobs again post coronavirus?

It's a temporary blip in the healthcare economy.

Nobody makes money when ten of thousands unexpectedly end up in the icu for 2-3 weeks. I worry that there is not enough money to pay for any of this.

 

[chocomorsel]

Ok, but careful what you wish for. If you’re gonna empower the federal government even further, I don’t wanna here any crying the next time the people give you another Trump.

Who did a majority of the people vote for?

 

[deleted162650]

The problem is that we need a coordinated response and the federal government is the only one with the power to do that. It doesn’t matter if any particular state manages this crisis well because the virus doesn’t recognize any borders.

The problem is that the government hasn’t shown me that it can competently do anything.

 

[deleted162650]

Who did a majority of the people vote for?

The popular vote is irrelevant in our current system. Apparently no one told the Dems this go ‘round.

 

[deleted697127]

Who did a majority of the people vote for?

The election isn’t a popular vote. Campaigning would be different it were. This is like talking about how many points a team scored despite losing a tournament.

 

[VA Hopeful Dr]

The election isn’t a popular vote. Campaigning would be different it were. This is like talking about how many points a team scored despite losing a tournament.

The 49ers rushed for more yards than KC in the Super Bowel, why didn't they win?

 

[chocomorsel]

The election isn’t a popular vote. Campaigning would be different it were. This is like talking about how many points a team scored despite losing a tournament.

And that’s another problem with this country.

Using a system of voting that in a past time counted blacks as part of a person and not a whole person.

Whatever the case, the majority of us didn’t elect this narcissist who doesn’t give one iota about anyone but himself. Doesn’t mean we didn’t try to not elect him.

 

[Monty Python]

We sure look First World right now wearing Hefty and all.

Outstanding quip!

 

[deleted162650]

I do think this crisis will push us in a leftward direction.

I kid, I kid.

 

[vector2]

Ok, but careful what you wish for. If you’re gonna empower the federal government even further, I don’t wanna here any crying the next time the people give you another Trump.

No, actually cause this is America I'm gonna complain bigly. And then do everything in my power to make sure he (or she) is defeated in the next election.

 

[vector2]

The election isn’t a popular vote. Campaigning would be different it were. This is like talking about how many points a team scored despite losing a tournament.

Yep, you're absolutely right. And each passing cycle the system gets more insane. I've posted on this before, but when the electoral college was created there were approximately 30,000 people for each representative. Now there are over 700,000 per rep- a number which has ballooned with every census since the 1910s. Any argument based on "what the founders wanted" is naive at best and disingenuous at worst. People try to say "wahhhhh, well what about wyoming and north dakota?" It's unfortunate about those states truly. But are you watching the news? I'm much more concerned with the fact that Trump can treat NY and CA, aka 60 million people, like garbage during this pandemic cause of electoral college math.

All right, so say you're fine with the fact that "just" 3m more people voted for the candidate who currently isn't president. More and more people flock to cities each year, more people are migrating from rural areas....so that number is inevitably going to go up as urban population density increases.

Presumably there is some margin for you where a candidate winning the popular but losing the electoral becomes unacceptable, right? Is 3m ok but 5m too far? 10m? 50m? If there is any number where it becomes unacceptable to you, then based on principle alone the popular vote winner should be president.

National Popular Vote Interstate Compact - Wikipedia

en.m.wikipedia.org

 

[nimbus]

I do think this crisis will push us in a leftward direction.

View attachment 300110

I kid, I kid.

Reminds me of the joke...

Q: What does it take to turn a libertarian into a socialist?

A: $1200

 

[deleted59964]

For the record, I would not be opposed to a 2 tiered system similar to that of the Australians.

People will still bitch and whine, but at least they’ll be complaining about

1. Waiting a few hours in ED
2. waiting 6 months for a knee replacement
3. The quality of the food, during their free stay in hospital.
4. An out of pocket charge of maybe $1-2000 on top of their insurance premium if they go private for the knee operation

our system is not perfect, but no one wants to change it dramatically in either direction ( toward the UK’s NHS or toward your user pays system),

hopefully the country isn’t broke after this, and we can maintain the status quo.

 

[deleted697127]

Yep, you're absolutely right. And each passing cycle the system gets more insane. I've posted on this before, but when the electoral college was created there were approximately 30,000 people for each representative. Now there are over 700,000 per rep- a number which has ballooned with every census since the 1910s. Any argument based on "what the founders wanted" is naive at best and disingenuous at worst. People try to say "wahhhhh, well what about wyoming and north dakota?" It's unfortunate about those states truly. But are you watching the news? I'm much more concerned with the fact that Trump can treat NY and CA, aka 60 million people, like garbage during this pandemic cause of electoral college math.

All right, so say you're fine with the fact that "just" 3m more people voted for the candidate who currently isn't president. More and more people flock to cities each year, more people are migrating from rural areas....so that number is inevitably going to go up as urban population density increases.

Presumably there is some margin for you where a candidate winning the popular but losing the electoral becomes unacceptable, right? Is 3m ok but 5m too far? 10m? 50m? If there is any number where it becomes unacceptable to you, then based on principle alone the popular vote winner should be president.

National Popular Vote Interstate Compact - Wikipedia

en.m.wikipedia.org

My point was that discussing the popular vote is simply irrelevant in a system that isn’t based on the popular vote.

Election reform is another discussion and one that i don’t particularly have any interest in.

 

[vector2]

My point was that discussing the popular vote is simply irrelevant in a system that isn’t based on the popular vote.

Election reform is another discussion and one that i don’t particularly have any interest in.

We talk about all kinds of "should" things even if things "are" a certain way at the moment....that's in fact pretty much the basis of all aspirational political speech. And you're certainly entitled to your opinion, just like I'm entitled to my opinion that you're dead wrong in thinking the EC vs PV isn't relevant to Salty's statement that "the people" might give us another trump.

 

[iqe2010]

The 49ers rushed for more yards than KC in the Super Bowel, why didn't they win?

Because Kyle Shanahan is a grade A choker.

 

[NicMouse64]

Why not....just create a really crappy public system encroached with NPs/PAs that everyone hates but at least gets people basic care in times of crisis (gunshot wounds, injuries, etc.), and a private system (cash/insurance based) where the costs aren't so extravagant that 90% of the populations isn't drooling at the really crappy care that they would get for "free" from the government.

 

[iqe2010]

I'm personally in favor of a two tier system. But people still need to pay for the public option, based on age, health status or whatever.

At this point I think we all know that insurance works best when everybody pays into it, young, healthy, rich, poor.

And don't say we can't afford it. Our country taxes people who receive unemployment and gives tax breaks and loopholes to those who own private jets. C'mon now.

 

[pgg]

We talk about all kinds of "should" things even if things "are" a certain way at the moment....that's in fact pretty much the basis of all aspirational political speech. And you're certainly entitled to your opinion, just like I'm entitled to my opinion that you're dead wrong in thinking the EC vs PV isn't relevant to Salty's statement that "the people" might give us another trump.

The reason it annoys me when people like @chocomorsel bring up b-b-b-b-but Trump lost the popular vote is the implicit, illogical, naive, almost childish assumption that Clinton would have won the election if presidents were elected by popular vote. She may have, but it's by no means certain. Campaigns would've been run differently if the rules were different. Maybe Trump would've picked up a few million votes if he'd campaigned in California and NY and Massachusetts, at the expense of losing a few thousand (and a meaningless state majority) in PA, WI, MI ...

Clinton knew how the EC works, and she still blew off campaigning in the states that were the EC tipping point. There's an entire Democrat vocabulary that denigrates and shuns flyover states, baskets of deplorables, people clinging to guns and religion, people too stupid to realize they're voting against their best interest, on and on.

Republicans have their own vocabulary that sneers at urban coastal elites, Matt Damon and Arec Baldwin and the Film Actors Guild, academics, etc. The difference is that, under the rules of the game, the Democrats talk **** about people they need to win, and Republicans talk **** about people they don't need to win.

I don't condone the impolite rudeness of any of it, but I get it. What I don't get is why people think the popular vote is relevant to the 2016 election. chocomorsel's frustration would be better applied to a party whose people and process nominated a candidate so bad she lost to Trump. She might even get somewhere with that complaint, since it's surely easier to change how a party selects a candidate than it is to change the Constitution.

 

[Ronin786]

Honestly, I don't see how this doesn't lead to an explosion in NP/PA independent practice. Regardless of the fact that states are already expanding scope of practice laws, this brings the fact that we don't have enough physicians into glaring focus.

Sadly, many physicians will die and it's going to make our national shortage even worse. I fear this might have been the death of MD only practices.

 

[Mman]

Healthcare systems are making more money with this and getting a 20% increase in Medicare payments related to coronavirus.

My hospital is currently hemorrhaging money from this. Elective procedures in OR, GI lab, cath lab, etc have ground to a halt and they are having to pay OT all over the place to staff. Their only hope is getting bailed out after the fact.

 

[GravelRider]

I think the healthcare systems will have to do a complete re-examination of how they use money. First of all, the amount of waste that occurred before this was appalling and not just from an environmental standpoint. I think hospitals and the ridiculous organizations that accredit them are going to have to change their practices when it comes to being wasteful of supplies. The days of wearing multiple layers of paper gowns around the hospital are over.

I also think that any business that receives a government bailout should be required by law to keep X number of months of operating expenses in cash on hand. That includes hospitals. My minimum X would be 6 months and that would be audited every 12 months. Any business that fails to comply will pay a penalty that goes into a “bailout fund.” The days of living hand to mouth are over. If that means the hospital CEO takes home a little less or the hospital lobbies have no fancy plants then so be it.

 

[Straight2eight]

I'm personally in favor of a two tier system. But people still need to pay for the public option, based on age, health status or whatever.

At this point I think we all know that insurance works best when everybody pays into it, young, healthy, rich, poor.

And don't say we can't afford it. Our country taxes people who receive unemployment and gives tax breaks and loopholes to those who own private jets. C'mon now.

Did you observe the cost estimates on the various Democrat Medicare for all plans? While private jet tax breaks sound juicy in theory the idea that we can just tax the rich to pay for our dreams doesn’t seem to hold up to an ounce of mathematical scrutiny.

 

[VA Hopeful Dr]

My hospital is currently hemorrhaging money from this. Elective procedures in OR, GI lab, cath lab, etc have ground to a halt and they are having to pay OT all over the place to staff. Their only hope is getting bailed out after the fact.

The big teaching hospital here just announced massive furloughing of employees because of this.

 

[vector2]

The reason it annoys me when people like @chocomorsel bring up b-b-b-b-but Trump lost the popular vote is the implicit, illogical, naive, almost childish assumption that Clinton would have won the election if presidents were elected by popular vote. She may have, but it's by no means certain. Campaigns would've been run differently if the rules were different. Maybe Trump would've picked up a few million votes if he'd campaigned in California and NY and Massachusetts, at the expense of losing a few thousand (and a meaningless state majority) in PA, WI, MI ...

Again, I was responding more to Salty's rhetorical flourish about "the people" because I took that to mean that Trump almost had some kind of real popular mandate that fueled his victory. Which very clearly was not that case.

But I disagree with your assertion that Trump would've had a good chance at a PV victory even if those were the known rules of the game beforehand. I feel relatively confident saying that because most presidential candidates, even if their home state usually goes for the other party, typically get a native son bounce. Trump got absolutely demolished in liberal strongholds including NY (improving on Romney by only 1 pt there) by someone who was without a doubt the worst D nominee in modern presidential history. Trump lost ~60-36 in CA, MA, and NY. There is no amount of campaigning in those states that would've allowed someone as despised as him to swing 3 million votes the other way. But hey, that's just my Monday morning qb'ing