Well, that response is subject to discussion (I guess my ability to protect my home is "rationed" if I can't afford home insurance, too -- and there are indeed people who lose their homes in various ways who are interviewed on television: "we don't have insurance, so it's all gone...".) Ability to pay for insurance of any kind has stratified those able to pay from those who can't, as is the case for lots of other things. The need for good insurance is not easily perceived as a reasonable expense when you have other demands on your expenditures, and you're healthy, or your house is not on fire.
Public aid for health insurance is available to some, with limits of course, but not for everyone in every circumstance. Being poor sucks; no doubt about it, and not just because there are fun things you can't do; sometimes you are limited in the ability to eat, or to choose what you eat, as just one example. When my mother had her stroke, she went on Medicaid in order to have the state pay for her nursing home "care" -- which, I assure you, was inferior to what is provided in facilities that don't accept Medicaid, but require large expenditures by their "residents" -- the nursing staff were well-meaning and very kind, but the care was definitely second-tier at best -- but I suppose, reasonable when considering she wasn't paying for it.
But would you feel better if you had a public health system that covered everyone, equally, but which didn't provide enough care or quick enough care because of the cost to the system? Or that provided a lower quality of care based on being forced to utilize less expensive materials or facilities, regardless of what the physicians might prefer to use? That's what you see in countries with such socialized medicine systems, and then, there it is again ... those who can afford it go outside the system and pay for care through private facilities and doctors.
The underlying problem to any approach to solving access to good healthcare is that good healthcare is very expensive and that everyone wants the best for themselves and their families, no matter how expensive. It's a real problem without any very good solutions, no matter what your politics are. Happily, when people are at their sickest, and COVID patients mostly qualify, once they get to the hospital, they are admitted and cared for without regard to their personal ability to pay -- and there is the promise, if delivered on, of payment for all COVID-related care, so that ability to pay will not likely be the limiting factor in determining who gets care. There are definitely other inequities contributing to less than equal care for all, but payment is probably not one of them. On the other hand, the inability to socially distance due to the need to take a crowded bus or subway to get to work is another way that economics impacts the spread of the disease.
Life is complicated, and now it's more complicated. And not always fair.
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On Thursday, April 16, 2020, 11:26:41 PM EDT, BP bjbigplayer@gmail.com [vpFREE] <vpfree@yahoogroups.com> wrote:
The US has had rationed Healthcare for decades now. Instead of rationing based on need and availability like most of the rest of the world the US rations based on ability to pay. Can you pay the price and have the right insurance policy? If so you get your care/procedure right away. Can't afford that $2000 copay for your diagnostic colonoscopy that you thought was free preventative care? Maybe you can get it next year, hope you don't get colon cancer while you wait.
On Thu, Apr 16, 2020, 8:17 PM Barry Glazer b.glazer@att.net [vpFREE] <vpFREE@yahoogroups.com> wrote:
We probably need to remember that when we talk about "overwhelming hospital resources" we are talking about specific situations: (1) health care workers (not just physicians and nurses, but every employee with patient contact, including housekeeping and food service) get sick and die, too -- leaving the hospital with less "resources" -- and that occurs even if there IS sufficient protective equipment, which there is for the most part NOT -- and (2) "resources" include the ventilators you keep hearing so much about. Ventilators are machines that give support to people who can't breathe adequately on their own, until the disease is so bad that even the ventilator won't help (the lungs are too damaged) or until the disease is recovered from (which apparently is usually a pretty slow process once it's bad enough to require a ventilator). If there aren't enough ventilators, some people who need one will not get one -- and other than getting more ventilators where needed, the "solution" is what we've heard about -- deciding that some patients do not have enough chance of recovery, compared to others, to have access to one of the limited number of ventilators.The U.S. has discussed rationing of expensive and/or advanced health care for years, and the concept of doing this does not sit very well with U.S. citizens -- who would fuss if they needed a hip replacement or a kidney stone removal and had to wait six months to several years, as occurs in some countries with socialized medicine (which can lead to reduced resources). We had a friend in England who waited six months for a kidney stone treatment and then was further delayed from his scheduled procedure when more urgent / emergent procedures had to be done on others.==================On Thursday, April 16, 2020, 03:47:52 PM EDT, harry.porter@verizon.net [vpFREE] <vpfree@yahoogroups.com> wrote:
Dunbar - You're undoubtedly one of the most rational and quantitatively-oriented individuals I've had the privilege to correspond with.
I'm sure that you're aware that if COVID-19 were permitted to spread unfettered, we're ultimately talking about 1 to 2 million deaths in the US, conservatively. So, yeah, in terms of projected accelerated mortality, I find the numbers "truly alarming".
In my mind, the most important measures to take are those that will slow the spread until such time as widespread inoculations are possible and feasible. Those same measures will also ensure that peak case loads don't overwhelm healthcare resources.
I keep seeing testing referred to in a rather nebulous sense, without a targeted goal specified. It seems to me to be critical as a means to keep tabs on the state of the infection spread, allowing us to predict peak infection and steer resources accordingly. If the testing involves deep penetration into the population, then I guess there's a second benefit of identifying asymptomatic individuals and directing them to isolate. (However, I expect that statistical sampling/testing will yield the most critical results right now.)
The recent discussion re a need for contact tracing/tracking betrays an area of my ignorance. I can't quite envision the form this will take in practice, simply because individual contact from one person to another takes such a broad form (or does it ignore most very casual contacts and focus on only those we spend significant, more intimate time with?) I understand tracing/tracking when it comes to STD's.. Most people don't engage with multiple partners throughout each day. Further, when a potential STD infectee is contacted, not only can they test for infection, but they can immediately treat it. (Is there a treatment protocol at this time for an asymptomatic COVID-19 infection?)
In answer to your last question, "Yes", once measures to slow the spread of COVID-19 (which I don't necessarily see as including tracing/testing) are lifted, a spike in infections is inevitable (until such time as we've achieved a significant degree of "herd immunity"). It's this simple fact that should be the driving rationale behind whatever strategy we pursue hereon out.
-----Original Message-----
From: 'H. Dunbar .' h_dunbar@hotmail.com [vpFREE] <vpFREE@yahoogroups.com>
To: vpFREE@yahoogroups.com <vpFREE@yahoogroups.com>
Sent: Thu, Apr 16, 2020 2:01 pm
Subject: Re: [vpFREE] Z
I, too, have been thinking along these lines. With over 2.3 million dying each year in the US prior to Covid-19, are the current Covid-19 death projections truly alarming? Especially when 'unintended consequences' are factored in, like economic hardship and food shortages.
It's hard to imagine a successful short-term exit strategy. I understand the immediate goal is to keep hospitals from being overwhelmed, but is this country ready to deploy the huge resources necessary to do full contact tracing and tracking? Without that, isn't another spike inevitable, once restrictions are lifted?
Also, I want to echo Jersey Stu's remarks about how refreshing it is that this discussion is taking place without political finger-pointing. A rarity.
Dunbar
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Posted by: Barry Glazer <b.glazer@att.net>
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