COVID, care rationing, and consequences thereof

Hospitals in Idaho, Alaska, Alabama, Montana and other states are rationing care – a painful decision necessitated by unvaccinated patients suffering from severe COVID infections overwhelming available facilities.

In Idaho, the State Department of Health and Welfare now “allows hospitals to allot scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients.

  • In Kootenai Health’s ICU, one critical care nurse might be supervising up to six patients with the help of two other non-critical care nurses. The usual ratio is one ICU nurse for one ICU patient.
  • “nearly 92% of all of the COVID-19 patients in St. Luke’s hospitals were unvaccinated. Sixty-one of the hospital’s 78 ICU patients had COVID-19.”

A Montana hospital “was also forced to implement crisis standards of care amid a surge in COVID-19 patients” when all critical care beds were already occupied.

In Houston Texas, a military veteran died when no hospitals near him had space or staff to treat a sudden case of gallstone pancreatitis.

A 73 year old Alabama man died of a cardiac condition when the hospital in his hometown of Cullman, Ala., contacted 43 others in three states — and all were unable to give him the care he needed. Three weeks ago there were 60 more ICU patients than beds in ICUs.

There are many. many more examples.

This. Should. Never. Have. Happened.

And wouldn’t have if not for COVID deniers, anti-vaxxers, and the media channels that gave them a megaphone to spread their nonsense.

Getting anti-vaxxers to change their views is incredibly difficult; the media is replete with stories of COVID patients telling their doctors they don’t believe they have the virus (look them up).

Medical providers’s option is stark indeed – treat the patients with a self-inflicted disease, or send them home…and treat the heart attack, car crash, pancreatitis, stroke, burn, asthma attack and other patients.

It has come to this.

What does this mean for you?

With personal choice comes personal responsibility. 


Yesterday’s post

Did exactly what it was intended to do – engaged with a lot of people, bluntly stating what many are thinking.

Some of the willingly unvaccinated are very good friends, people I admire, respect, and care about. It grieves me to no end that we are so far apart on this issue, and that it has come to this.

The title and some of the language offended a few (out of 2567 subscribers, 21 unsubscribed). While I absolutely do not apologize for my language I do understand why you may have been offended. Long time readers know that I almost never curse on MCM (although I am more profane in person); I think I’ve used profanity fewer than 5 times in over 3500 posts.

On the other side, 8 new subscribers signed up and comments and private emails were overwhelmingly supportive.

What is apparent is this.  Anger with the willfully unvaccinated is growing, and for very good reason. Unless you are a Native or Black American or have a legitimate medical issue, you have no valid reason to put your family and friends and the rest of us at risk because you don’t want to get the vaccine.

(Native and Black Americans should absolutely get vaccinated; however knowing how we killed millions of Native Americans and infected Blacks in the name of science one can certainly understand vaccine fears, fears we must overcome.)

You have already been vaccinated to protect you from polio, mumps, measles, rubella, and many other childhood ailments. Many of us have vaccinations protecting us from the flu, tetanus, rabies, shingles and myriad other diseases.

You didn’t rebel, protest, or demonstrate when your kids had to get those vaccinations to attend school.

You didn’t scream and shout when you asked for a shingles vaccine to protect you from this painful and debilitating infection.

No one was outraged when we effectively ended small pox and polio infections through mass vaccinations.

So ask yourself – why are you so angry about COVID vaccines?  And be honest. Do not spout meaningless nonsense you read somewhere on Facebook about VAERS or breakthrough infection issues or other blather. We are done refuting arguments that don’t stand up to the most cursory examination.

And I will publicly call out commenters who spout such idiocy.

The reason is tribalism. You and your friends and family have been duped into making COVID a divisive issue, to separate us and push us apart. After 20 months of attempting to educate, inform, discuss and debate, the majority of Americans are fed up with your intransigence, your willful ignorance, your refusal to accept the science.

I have tried and tried and tried again, writing over 120 posts about COVID only to be met with the same tissue-thin arguments based on nothing but a Facebook post.

So, we are done with you.

If you refuse to get vaccinated, then you get to own the consequences of your decision. You tout personal responsibility, you teach your kids to be responsible, you demand it of your elected officials, then fine – you get to:

  • lose your job,
  • pay for all your COVID-related medical care, and
  • be sued for the care of others you infect.

What does this mean for you?

Your decisions have consequences. Own them.


Get a goddamn vaccination and wear a goddamn mask.

Warning – I am really pissed off.

We are very close to several clinicians that work in medical facilities. They are overwhelmed with COVID patients – almost all of whom are unvaccinated. It is devastating to talk with these medical professionals, to hear their pain and immense frustration and anger and fear.

There are no more beds in the Pediatric ICU, no more ecmo machines available for anyone – covid patients or not. Many procedures are being postponed indefinitely because unvaccinated COVID patients are occupying all the beds, Unvaccinated COVID patients are sucking up all the care, all the energy, all the will and desire and expertise and passion and patience and resilience.

All because many Americans allow themselves to be duped into believing somehow COVID isn’t a problem, that kids won’t be affected, that vaccinations are dangerous, that bullshit from right wing pundits is more believable than facts from scientists or pleas from physicians.

And this is just one hospital, albeit a very big one that serves a very large area. Hospital beds in eastern Washington are full to beyond capacity because idiots in Idaho aren’t vaccinated. Hospitals in Florida, Mississippi, Missouri, and many other states are also overwhelmed, all because total assholes who know better are lying to people.

Hospitals in several states are doing battle triage – meaning if you are in a horrendous car accident, have a stroke or an embolism or fall off a ladder, if your baby falls in a pool or your mother falls down the stairs you/them are gonna die because the facilities and doctors you need are too busy caring for fucking idiots who refused to get vaccinated and are now dying of COVID.

This isn’t a short term problem.

Nurses doctors and other staff are running away from patient care because they cannot stomach treating yet another idiot for a dangerous disease because they were too lazy, too willfully ignorant, too willing to listen to some asshole on Facebook and not believe science, facts, nurses, doctors.

This is deeply personal for many. If your baby has a respiratory problem, good luck finding a facility with room and time and facilities needed to care for your baby – they are full with kids who got infected because assholes refused to get vaccinated.  Same thing with ICUs and CCUs, cath labs and operating rooms.

Republicans in many states are trying to pass laws allowing people to not get vaccinated, to not wear masks, in the name of “freedom.” I am done being politically correct when describing these pandering assholes.

They are the real baby-killers.

Through their willful ignorance, their calculating refusal to serve the people that elected them because they want more votes, their shameless pandering, more babies will die. more kids will be infected, more grandparents will be lost, more hospitals will close, more doctors and nurses will abandon their work.

The rightwing conspiracy-fomenting media decries the lack of “science” behind vaccinations, while touting a goddamn horse pill. These assholes recommend breathing in bleach – an incredibly stupid and dangerous idea with NO basis in science.

Personal freedom my ass.

We conquered polio, measles, chicken pox, small pox, mumps, diphtheria and countless other diseases by vaccinating people. You have had many vaccinations, and you are doing just fine.

If you don’t want a vaccine, fine.

You don’t get healthcare when you get COVID.

So goddamn confident in your beliefs and so committed to your “personal choice”? Fine.

You won’t need healthcare, and neither will your kids, mom, or grandparents, so the rest of us can get our heart bypasses, kidney transplants, cancer treatment, hip replacements, and emergency surgery.

Don’t be a goddamn hypocrite. Either get vaccinated and wear a mask, or stay the hell away from the rest of us, take your ivermectin, breathe in bleach, and bury your relatives by yourself.

Oh, and tell the mom with the sick baby who can’t find a Pediatric ICU bed that your personal freedom to be a complete idiot is more important than her baby’s life.

And I don’t want to hear any bullshit from COVID deniers and vaccine opponents. I am done trying to be polite, to explain, to use reason and facts and logic.






Help me understand…

Why some people refuse to get vaccinated, but are fine with taking large doses of drugs commonly used for horse de-worming.

Out of 163,000,000 people fully vaccinated, there have been 1,263 COVID deaths…yet anti-vaxxers still refuse to do the easy, safe, and smart thing.

Yep, in just one state, Missouri, there’s been a big jump in calls to the poison control center due to people in distress from taking ivermectin; at least two Mississippians have been hospitalized due to overdosing on the drug…. and 7 out of 10 calls to the center have been for ivermectin.

Ivermectin is also a big problem in Texas…

Ivermectin “tablets are approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms.”

News flash – COVID is NOT transmitted by parasitic worms. Nor is there ANY credible evidence it protects against COVID or has any meaningful effects.

Yes, there is a research paper based on a meta-analysis authored by several scientists but these “scientists”:

  • didn’t disclose they are members of a group promoting ivermectin;
  • ignored the fact that most of the studies cited had “incomplete information and significant methodological limitations, which make it difficult to exclude common causes of bias,”
  • views were rejected by the leading scientific society focused on infectious diseases; and
  • another meta-analysis rejected the ivermectin-supporters’ “conclusions.”

Oh, and “The few existing higher quality clinical trials testing ivermectin against the disease uniformly have failed to find a positive result. It’s only the smaller, lower-quality trials that have been positive. This is a good indication that the drug probably doesn’t work.”

Double Oh, and the rest of the scientific world isn’t having their BS.

Triple Oh... after internet sleuths raised concerns about plagiarism and data manipulation, the preprint server Research Square withdrew the paper because of ‘ethical concerns’.”

And one more Oh…

Not only is ivermectin very much unproven, it is also dangerous when taken in large doses. From the FDA:

You can also overdose on ivermectin, which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death.

There are multiple reports of people taking horse-level doses of ivermectin;

Again the FDA:

animal drugs are often highly concentrated because they are used for large animals like horses and cows, which can weigh a lot more than we do—a ton or more. Such high doses can be highly toxic in humans.

Moreover, FDA reviews drugs not just for safety and effectiveness of the active ingredients, but also for the inactive ingredients. Many inactive ingredients found in animal products aren’t evaluated for use in people.

Meanwhile, reality is “less than 0.004% of fully vaccinated people had a breakthrough case that led to hospitalization and less than 0.001% of fully vaccinated people died from a breakthrough Covid-19 case…”

So we have knuckleheads overdosing on horse de-worming drug while they refuse to get vaccinated because…why?

They’re suicidal?

No – it’s actually because their “tribe”/”clan’s” views are more important to those individuals than ANYTHING else – including their lives and the lives of their loved ones, babies, grandmothers and spouses.

What does this mean for you?

Belonging to the tribe, and being accepted by the tribe, is the dominant force in the life of anti-vaxxing ivermectin-takers – and no amount of science, marketing, education, compassion or reason is going to get most of them to change.


Hypocrisy and Hippocrates

A physician posting on MedPage blamed many of the problems in healthcare on private equity…and for-profit insurers.

That takes some…[insert anatomical reference here]. While his assault on Private Equity does have some merit, I can’t let his assertion that the profiteers are insurance companies stand.  What makes me nuts is Liu’s mindless and demonstrably false assertion, coupled with his complete inability to see that he is part of US healthcare’s cost problem.

Dr Mitchel Liu stated “For-profit insurance companies have long been regarded as the ultimate offenders in medical profiteering.”
Wow. Coming from a physician, who make more than docs in any other country, that is ballsy indeed.
Reality is physician compensation is a key driver of healthcare costs, and one of the reasons our healthcare costs are so much more expensive than other countries’. For-profit healthplans do make billions…but their margins are tiny compared to healthcare providers.
Liu also says:
“It’s time for medicine, including individuals and professional societies, to restore the integrity of the physician-patient relationship by taking a strong stand against all forms of corporate greed.”
Well, docs are often partners in Ambulatory Surgical Centers and hospital outpatient surgery centers.  Many docs belong to big multi-specialty groups that are quite profitable.  And, docs make a lot of money.
What does this mean for you, Dr Liu?
How about taking a stand against physician greed, Dr Liu?


It doesn’t matter

if you think COVID is overblown, just the flu, not going to hurt you, came from a Chinese lab, or part of some bizarre plot by the New World Order.

it doesn’t matter if you haven’t been vaccinated because you haven’t had the time, don’t believe it works, think it contains a tracking chip, don’t trust science, think it needs more study, or are just lazy.

What matters is the unvaccinated are dangerous as hell. The more of us who get infected, the greater the chance COVID morphs again into something far deadlier and far more infectious.

Let’s talk freedom for a second. The old argument about where our freedom of speech stops is “you can’t yell “fire!” in a crowded theater.

Well, you don’t have the “right” to set a fire in a crowded theater. That is exactly what the unvaccinated are doing.

Even if COVID doesn’t get more dangerous, it is crystal clear the unvaccinated are why we may be headed back to lockdowns, mandatory masking and physical distancing, remote “learning” and all the awfulness that we are just now starting to leave behind us.

Not getting vaccinated is a “personal choice” to:

  • expose yourself and your loved ones to COVID,
  • tell your employer you don’t want to work,
  • tell first responders and healthcare workers you don’t care about them, and
  • make the rest of us pay for your healthcare if/when you get sick.

Those of us who are vaccinated can also make a “personal choice”;

  • you don’t get to work around us,
  • we won’t pay for your healthcare, and
  • you will be held liable for infecting others.

What does this mean for you?

Get vaccinated.



You bet your life.

For my friends out there who remain unconvinced COVID vaccinations are a good idea, please think again.

Breakthrough infections – fully vaccinated people contracting COVID – accounted for only about 1 in every 700 hospitalizations.

Put another way, people who haven’t been vaccinated accounted for 699 out of 700 hospitalizations.

A similar dichotomy holds for COVID-related deaths; fully-vaccinated people account for less than one out of a hundred COVID-related fatalities.

Not surprisingly states with lower vaccination rates are seeing higher infection, hospitalization and death rates.

Great source for tracking state-specific data

Arkansas, Oklahoma, and Missouri are among those states likely to experience increases in COVID infections, hospitalizations, and deaths.

There is another factor in play here – unvaccinated people are far more likely to get infected, become a COVID host, and pass their germs on to others. So not only do they risk their own health, they also endanger many more people.

And – and it’s a BIG and – the more people infected, the more likely COVID will mutate and become more transmissible and deadlier. We’ve already seen this with the Delta variant; transmission rates are increasing rapidly especially in the South.

What does this mean for you?

Please – get vaccinated.


The Delta Variant

You are as done with COVID as I am.

COVID is not done with us.

Here in New York’s Finger Lakes everything is open; had a great family night out yesterday, no masks required for those of us fully vaccinated, hiring signs are all over, and the joy that is upstate NY in summer is in full swing.

While we are blissfully enjoying life, the Delta Variant is:

That’s the bad really bad news.

The good news is vaccinations – especially the ones based on mRNA (e.g. Pfizer) are still “spectacularly effective” against the Delta variant. 

As in 96% effective in preventing hospitalizations.

However, that’s after both doses; a single dose is just 33% effective at preventing symptomatic illness.

Here’s the thing. The more of us that get infected, the greater the chance that the damn virus morphs into a deadlier, more transmissible, and thus even bigger problem. So far the vaccines we have are working.

But – and it’s a damn big “but”, far too few of us are vaccinated. That’s particularly true of southern states, where a combination of misinformation,  awful treatment of minorities by some governmental entities and segments of the medical community (the Tuskegee experiment being a prime example) and resulting mistrust, and difficulty with the J&J vaccine have combined to drastically slow vaccination rates.

click here for detailed state-specific data

Here’s a great graphic detailing state progress towards full vaccination…

All this is to say that the fewer vaccinated people there are, the more likely COVID will mutate into something even worse.

What does this mean for you?

Get vaccinated.

Note – if you want to debate or disagree, cite credible sources for your statements. Period.


Thursday catch-up

Doing my best to avoid work on Fridays…so moving this occasional catch-up post to Thursdays…


Promising news on the effectiveness of a drug to help infected patients fight off the virus was reported by the Economist. The good news – Regen-Cov:

saved the lives of many of those unable to make their own antibodies in response to SARS-CoV-2. Such “seronegative” individuals constituted about a third of the 9,785 hospital patients in the study…compared to a control group given standard treatment … 20% more patients survived

The bad news – it’s stupid expensive, and supply chain issues are hampering production.

A study conducted by the National Institutes of Health indicates COVID may have been in circulation earlier than originally thought. Blood samples from Illinois, MassachusettsMississippi, Pennsylvania and Wisconsin indicate the virus was in those states in December 2019. An earlier CDC study found similar evidence in California, Oregon, and Washington.

These findings indicate a better and more thorough process to identify disease outbreaks may well be warranted.

Comp drugs

WCRI is hosting a timely webinar on Interstate Variations and Trends in WC Drug Payments on June 24. Register here. Gotta say I’m darn impressed by the researchers’ ability to obtain, analyze, and report on payments as recent as Q2 2020. This makes WCRI’s information much more actionable for regulators, clinicians, and payers alike.

Dr. Vennela Thumula and Dongchun Wang of WCRI will be guiding us thru their findings; the webinar is free.

I am finishing up the latest Annual Survey of PBM in WC which will have 2020 and 2019 data; last chance to participate and receive a detailed, respondent-only version of the report. If you want to participate let us know in the comment section below (there’s no cost to participants).

Couple interesting – and very preliminary – takeaways…

  • growing interest in transparency, along with an increased awareness that this isn’t a simple issue.
  • spend continues to decrease, with respondents attributing some of the decrease to COVID.
  • opioid spend continues to drop, but most respondents are still struggling to help chronic pain patients/long-time users of opioids reduce usage.
  • there’s a growing awareness that the PBM pricing model needs to change. With spend declining and a push for transparency, knowledgeable payers understand that paying PBMs less year after year is not sustainable.

Previous public versions of the Survey Report are available here for download at no cost.








Hospital pricing

Hospitals are supposed to be publishing their prices – at least Federal regulations require them to. But those smart, sneaky administrators are figuring out all kinds of ways to avoid telling you how much it will cost for that MRI, drug, band-aid, or lung transplant.

From JAMA:

hospitals must publish discounted cash prices (applicable to uninsured patients) and payer-specific negotiated rates. Second, hospitals must display price data, including expected out-of-pocket costs, for “shoppable services” that can be scheduled in advance (eg, office visits) in a consumer-friendly manner that facilitates service-specific comparisons across hospitals (eg, price estimator tools). [emphasis added]

As of early March, only 17 of 100 randomly selected hospitals were complying with the regulations. The penalty for non-compliance is…wait for it…

$300 a day.

Perhaps if the Feds charged hospitals the same way hospitals they charge us, we’d have a bit more compliance. 

How about…the Feds tell the hospitals after the fact what the cost will be, based on a “compliance chargemaster” that takes into account the hospital’s margin, quality scores, number of collection suits it has filed, and medical error rate.

Thanks to the estimable David Deitz MD PhD for the head’s up.

Wellness works

Finally, HealthAffairs reports wellness programs don’t really improve population health, reduce healthcare spending, or improve employment outcomes. 

Almost 40 years ago, I was halfway through a Master’s of Science in Health/Fitness Management when it became obvious this was NOT going to be a lucrative career…quite the opposite. Not saying I was prescient, just that employers sensed this was a nice-to-have and not a got-to-have, and that lack of importance showed in salaries.

Dodged that bullet.

And really finally, congratulations to my favorite baseball team – the White Sox have the best record in baseball after taking 2 of 3 from Tampa Bay. I

know my friends in the Bay area will be heckling me when the Rays surge again…hey, you gotta take advantage of good news when it comes!