Mar
21

We are out of time.

The time to shut the country down is now. The infection rate just increased 5-fold in 4 days; if that continues, by Wednesday – 4 days from now – there will be 125,000 confirmed cases.

A week from tomorrow there will be 625,000.

Four days later 3 million of us will be infected.

By mid-April, 20 million will have tested positive for coronavirus, and hundreds of thousands will be dead.

Think that’s nuts?

If anything, the actual infection rate is higher than reported – because we still don’t have enough testing capacity.

We do not have the medical facilities, staff, or supplies to handle several million COVID-19 cases simultaneously.  Our government has failed catastrophically, leaving every medical provider from the VA to major hospitals to nursing homes desperately short of everything.

No cure, medication, or vaccine exists – and none will be here until this time next year at the earliest, there’s been lots of media from irresponsible blowhards.

The latest – chloroquine – has been touted as a “cure” despite a) extremely thin evidence that it is effective in humans; b) it can be fatal; and c: according to National Institute for Allergy and Infectious Diseases Director Anthony Fauci MD, None of the evidence has been collected through a controlled clinical trial, “so you really can’t make any definitive statement about it.”

This guy is NOT a medical doctor, he is NOT an “adviser” to Stanford University, the “research” was self-published and does not meet ANY standards for credibility.

All this is why we have to flatten the curve. If not, tens of millions more will be infected, the death rate will rapidly increase, and over a million will die.

If you detect more than a bit of anger here, you’re right. Two family members are nurses, both desperately struggling to prepare for the coming tsunami of cases. One is quarantined because there isn’t enough protective equipment, the other exhausted from days of overtime. And both know it will get a whole lot worse before it gets better – and that is terrifying.

The government won’t take responsibility, so we have to. Stop socializing. Go out only when you absolutely have to – and then act like everyone else has Ebola.

Wash your hands. Check on your neighbors, shop for those who are high-risk, call your family members and friends, and don’t panic.

It’s not all bad.  The response from regular people looking to do whatever they can to help out has been nothing short of wonderful. A local business here is using 3-D printing to manufacture face shields because there aren’t enough in emergency stocks (the owners are good friends).

And keep working at your regular job. It’s hard to focus…it’s also essential.

 


Mar
19

Hey workers’ comp – stop the legal BS and do your part.

Yesterday’s WorkCompCentral featured an interview with an attorney discussing whether or not COVID-19 is a covered condition under North Carolina’s work comp regs.

Couldn’t figure out why the piece bothered me so much until I woke up this morning, where it had crystallized in my sleep-befogged brain.

The article was so BC (Before COVID-19). The world has fundamentally, dramatically, and permanently changed, and now is not the time to engage in academic and frankly dangerous discussion over what constitutes “occupational exposure to Novel Coronavirus.”

Because while this assuredly endless debate goes on, the US infection rate is doubling every 2.5 days, (it doubled overnight here in New York state) and workers will:

  • not get tested because they can’t afford it;
  • won’t stay home because they can’t afford to;
  • will therefore expose others to the virus, infecting more of us;
  • and won’t get treated, infecting even more people.

This is not the time to debate arcane points of law and precedent. This is the time for insurers, regulators, and employers to Do The Right Thing – which means treating COVID-19 infections as covered by workers’ comp for healthcare workers, first responders, hospitality staff, airline employees, and others who may have contracted the disease thru contact on the job.

Some insurers are saying they will investigate each case to determine whether a particular workers’ coronavirus/COVID-19 will be covered. Yeah, that was the right policy – before COVID-19 came along and may kill millions of Americans.

Today, it’s just nuts. Not only is it impossible, it’s irresponsible. The confirmed infection rate is growing logarithmically; unless these insurers hire a gazillion investigators they won’t finish these “investigations” for decades.  Meanwhile, those undiagnosed, untreated workers will infect others, and more people will die.

from Statista

Some states – California, Michigan, Pennsylvania among them – have moved quickly to address the issue albeit not always comprehensively. Other states must clearly and immediately ensure COVID-19 is a covered condition for broad categories of workers and jobs

Yes, following the law is important. Precedent is important. Principled debates are important. Advocating for your client is important.

Or rather, was important. 

Now, what is overwhelmingly more important is stopping the pandemic – and workers’ comp must do its part.

What does this mean for you?

Do NOT quibble, cite arcane legal theories or case law, hide behind legal opinions, or waste time discussing the legal niceties and complexities.

Just accept the claim and get the patient treated. You can afford it; insurers are flush with cash, have billions in surplus/excess reserves, and the vast majority of infected workers will recover at home at minimal cost.

And when this is over, you will know you did the right thing.


Mar
18

COVID-19 update – what’s the real death rate?

Quick take – we don’t know.

Before you read this – don’t freak.  Yes this is worse – much worse – than I thought, but panicking and reacting without thinking is NOT helpful.

First, the facts.

That’s because the number of cases is expanding rapidly but people don’t die immediately.  This from the Lancet, based on data from China (as with any early assessment the numbers are rough)

patients who die on any given day were infected much earlier, and thus the denominator of the mortality rate should be the total number of patients infected at the same time as those who died. [emphasis added]

The blue line is the more accurate figure and indicates a death rate of 5.7%.

But…

  • Because of the lack of testing (especially early on in China and for far too long in the US), there are a lot of people with mild symptoms or no symptoms that are undiagnosed. Therefore, the denominator (the number on the bottom) is too low. This means the estimated death rate quoted above is likely too high.
  • Anecdotally, I’ve heard from healthcare workers that some patients dying of respiratory failure were not tested for coronavirus – thus these deaths aren’t counted as related to COVID-19.  Anecdote is NOT data…that said due to the lack of tests, I’m betting the actual number of deaths is higher than reported.

Okay, pretty scary stuff.

What’s scarier is doing stupid stuff – and there is nothing stupider than hoarding toilet paper.

Coronavirus will NOT destroy the supply chain – it will lead to disruptions and delays, but anytime people hoard stuff, that means they won’t need to buy it for a long time. So, while shelves may be empty today, when the supply chain catches up – which it will – there will be lots of pasta, rice, canned food, and yes, TP on those shelves.

What does this mean for you?

Let’s take a lesson from our friends in Italy; be kind and thoughtful, smile at everyone, say hello, and remember we are all in this together.

Oh, and do a lot of takeout and tip generously!


Mar
16

Covid-19 update and fact check

This is way worse than we thought even a week ago. The death rate remains much higher than the flu, while we continue to get confusing and contradictory messages from the White House.

Facts.

  • In the US, the number of diagnoses has tripled over three days.
  • The death rate is just shy of 2 percent – about 20 times greater than the regular flu.
  • Italy remains the worst-affected country, with almost 25,000 confirmed cases and 1800 deaths – a death rate of 7.2 percent.
  • Contrary to what you may have heard, Italy’s population is NOT the oldest in Europe – Germany’s people are slightly older – and many other countries are almost as old as Italy.

What will protect us?

Not this…

  • face masks.  those regular face masks are useless. Unless the facemask is specifically designed to eliminate most airborne moisture – and you have been trained specifically in how to fit the mask – it won’t protect you.
  • Unless you are already ill – in which case those regular masks help limit others’ exposure.
  • A vaccine. There will NOT BE A VACCINE for at least a year.
  • Drugs – THERE ARE NO MEDICATIONS TO TREAT COVID-19.

This.

Wash your hands. Use alcohol-infused wipes.

Stay home.

Avoid any close contact with anyone you do not KNOW.

Sorry, grandma…I didn’t mean to kill you.  For anyone younger than 30  or older than 60 reading this – forgive me for generalizing, but please stop doing stupid stuff. Going to St Patrick’s Day events, senior dance parties, concerts, beach parties, and bars won’t hurt you much (unless you are diabetic, asthmatic, have pulmonary issues, are obese, or have an immune deficiency (which you may find out the hard way) – but it will kill others who get Covid-19 from you.

Finally, what’s with this obsession with toilet paper? 

If this is the beginning of the zombie apocalypse – which it most definitely is not – I’m thinking we should be ensuring there’s enough nutrition to go into our bodies – if there isn’t, we will not have to worry about taking care of what exits our bodies.

Okay, after ten days of nothing but Covid-19 blog posts, we’re going back to our regularly-scheduled focus on healthcare, healthcare policy, and workers’ comp stuff.

 


Mar
13

Covid-19 update

Here’s where things sit today.

What we know:

  • Italy is getting hammered, especially the northern regions. The death rate is over 7%, healthcare facilities are overwhelmed, and there aren’t enough ventilators and oxygen to go around.
  • The number of reported cases in the US hasn’t increased much overnight – but that is likely due to complete failure by the government to get testing started quickly, and to develop an accurate test to begin with. And, yes, even now there aren’t enough test kitsthank goodness the Chinese are going to send us a half-million.
  • It looks like test kit availability will ramp up in the coming days – but we are weeks behind when actually needed them. Without testing, officials have no idea what’s actually happening, can’t allocate resources, make intelligent decisions about closures and travel bans.
  • Our healthcare “system” is uniquely problematic; there are north of 18 million who don’t have insurance, and among those who do, folks with high deductible plans will have to pay for treatment and many don’t have adequate funds to do so. The result – the disease will spread in part because victims can’t afford testing or treatment.
  • Social isolation and basic handwashing are the cure for the pandemic. 
  • My beloved Syracuse rowing teams won’t be racing this year; my heart goes out to the men and women who have trained like the champions they are for 8 months only to be sent home.  Same goes for every other athlete in every other sport at every other institution.

Please – be thoughtful, don’t travel or mix in with large groups, and don’t panic.

And, you now have time for an “at home date” with your significant other, hang with the kids, catch up on those home chores, read those books stacking up on your night stand, clean the windows, finish your taxes, and be forever grateful for important stuff.

Finally, I encourage you to read this – and thanks to reader Paul Meyer for the tip.


Mar
12

An Abundance of Caution

That – along with social distancing – is the phrase that will mark 2020.

So here’s where we are – typed as I wait to board a plane home.

This is from Johns Hopkins University; best site I’ve seen for current infection rates and locations.

What we know about Covid-19:

  • It is most dangerous for the elderly and those with underlying health conditions such as COPD, asthma, and other chronic conditions.
  • It is MUCH less dangerous for the rest of us.
  • The overall fatality rate appears to be between 1% and 2% – but may well be lower as we do NOT know how many of us are walking around with the disease and no symptoms
  • Most of the deaths in the US occurred in a nursing home in Washington state.
  • The epidemic appears to have peaked in parts of China, with fewer and fewer new cases appearing
  • Italy is hardest hit; the death rate appears to be about 8% – again that may be distorted due to inadequate testing.

What works

Social distancing – defined as staying a few feet away from others wherever and whenever possible.

Washing hands, covering coughs and sneezes, using sanitizers containing alcohol.

What we have to do

Be realistic. There’s a ton of happy talk out there about how this isn’t that bad, it’s a made-up crisis, and somehow all will be fine and it will disappear in April and a vaccine will be here shortly and .

That’s crap. A vaccine won’t be here for at least a year, hot and humid Singapore has a persistent outbreak, and Covid-19 is much deadlier than the flu.

But, Chill. This isn’t Ebola, SARs, or MERs. Yes it may be 10+ times worse than the flu, but it isn’t the black plague.

Tip service workers. Baristas, Lyft drivers, Uber Eats and Instacart workers, bartenders, maids are getting crushed financially. Help them out.

Be kind and thoughtful and nice.  We will get thru this, and we’ll be wiser for it.

 

 


Mar
9

Coronavirus/Covid-19 update

WCRI’s annual meeting was well attended…timing is everything. Many other events have been cancelled or postponed, especially those on the west coast – not to mention Italy, Iran, and Asia.

Here’s what we know about Covid-19 (the disease caused by the coronavirus) so far.

Those are the facts – here’s stuff that may be true, or is uncertain as of now.

  • the death rate for confirmed cases appears to be between 2% (apparent rate in China) and 1% (researchers speculating). Note the italics; it is possible, if not likely, that there are many more unconfirmed cases or untested patients that are not dying, thus the death rate may be significantly lower. Also, note that the death rate derived from the number above is significantly higher; that may well be due to lack of testing that would have identified many patients early on who did not die.
  • if these figures hold up, Covid-19 will be much deadlier than most other flu varieties which have a mortality rate of 0.1% – again much higher in vulnerable populations
  • the growth in the number of confirmed cases varies greatly by country – in general, it is doubling every week or so.

What does this mean for you?

Don’t over-react.  This isn’t Ebola or the Black Death – and may be significantly less deadly than the Spanish Flu of a century ago.

Travel isn’t a no-no.  I’m headed to Florida today  – so it’s not just happy talk from your loyal reporter.  And the WHO agrees.

What IS stupid/irresponsible/selfish is engaging with other people or being in public spaces if you feel ill.  A jackass did just that last week – he happens to work at Dartmouth Hitchcock, where our eldest daughter is also employed. Needless to say, he’s on the poop list.

Mostly, chill. 


Mar
2

Coronavirus, Monday update

Until things calm down we’ll do an occasional post on the biggest health story out there – coronavirus.

Thanks to Larry – here’s the latest numbers (as of 10 am EST 3-2-20) on cases, recoveries, and mortalities by nation. Source link here.

Note that all views/opinions/takes are based on what we know nowwhich will change as time goes on.

First, how afraid should you be?

Quick take – it’s worse than the flu, but way less dangerous than other diseases.

This isn’t Ebola – which has an 80% death rate.  It’s not MERS (death rate of 34.7%) or the plague (death rate of 15% if patients are effectively treated).

Based on very incomplete data, it looks like the death rate is equal to or less than the Spanish Flu – somewhere less than 2 percent. No question – that is a relatively high death rate – but it is based on very preliminary data.

Here’s a datapoint – in the US 18,000 people have died from the flu in the current flu season – and over 300,000 have been hospitalized.

So far, logic says you should be a heckuva lot more afraid of the regular flu.

More to the point, it appears those with compromised respiratory systems, or in poor health, or with other serious health problems are at much higher risk than healthier folks.

BUT – and it’s a big but – that mortality rate may be much lower, because:

  • a significant percentage of people that test positive for corona don’t have any symptoms
  • tests  – especially the one initially used in the US – weren’t very accurate

How contagious is it?

Probably about the same as a “regular” flu; again initial reports indicate corona is more contagious, but that may be because it was a brand new disease, wasn’t managed well at the outset, and started in a very densely populated area.

What are the symptoms?

Initially, fever and a cough; some victims go on to contact pneumonia.

Will corona go away when it gets warmer?

We have no idea. There is no scientific basis for President Trump’s claim that warmer weather will end the epidemic; this is a brand new virus and no one has any idea if or how it will be affected by weather.

Lastly – be very careful about information sources.

The World Health Organization is the best I’ve seen.

One that pops up at the top of google searches is RT. RT is funded, staffed, and written by the Russian government.  RT highly exaggerates death rates, here’s one example: RESEARCHERS DISCOVER MERS HAS A 65% FATALITY RATE

This is categorically false.

To date, White House announcements about corona haven’t been much better. White House statements have downplayed the risk of corona, the number of cases, how fast it is spreading, and claimed the flu’s death rate is the same as corona (it isn’t; so far corona looks to be 14 – 20 times more deadly than the flu).

What does this mean for you?

Science is important.

 


Feb
17

Could Medicare for All solve your healthcare cost problem?

You can’t afford other stuff because healthcare is so expensive. Would Single Payer/Medicare for All fix that?

I’m revisiting the topic so we can better understand the many variations of SP/MFA, how they are different, how those variations might work, and whether some version is a) politically viable and b) would solve the cost/access/quality conundrum.

Last week I made the case that voters want healthcare solved, and they don’t much care about the details and nuance. We also showed that employer-sponsored health insurance is a mess.

Can private insurers solve the healthcare cost problem? Well, on one level they get dinged if they control costs. A key point about for-profit insurers – the stock market loves and rewards revenue growth. In health insurance, revenue growth is overwhelmingly driven by higher medical costs. So, medical cost inflation = higher revenues = higher stock prices (yes, this is simplistic, but also mostly true).

Over the last two years insurers have kept premium increases low, but that’s due in large part to cost-shifting to members. In contrast, Medicare can’t cut costs by shifting them to you – benefits are set by law and rarely change significantly.

The big increase in Medicare 2000s was largely drive by the new Part D drug program; focus on per capita costs to account for changes in membership

 

As we’ve noted previously, facility prices are the biggest driver of cost inflation – and that’s where Medicare outperforms commercial payers. Of course commercial payers will say that’s because Medicare can force payers to agree to its prices – which, although true, begs the question – why can’t commercial payers do the same?

One main reason – in many areas, provider consolidation has given health systems market power – health providers have more leverage so they have an advantage in negotiations.

In 43% of markets, providers are super-concentrated, vs only 5% of markets for health insurers

But – in over half of the markets, insurers are highly concentrated – which means they have significant market power.

Reality is health insurers have failed to control members’ healthcare costs. There are lots of reasons – including provider market consolidation, but as one of my rowing coaches once said to me; “I don’t want to hear why you can’t, I want to hear how you will”.

What does this mean for you?

If for-profit health insurers had done their job – controlling costs and delivering better outcomes and patient satisfaction – you wouldn’t be reading this.

Medicare has a better track record controlling cost – which is by far the most important issue in healthcare.


Jan
29

Private health insurance has failed.

If you had “government” health insurance for the last decade, your costs would be 20 – 25% lower today.

That’s because private insurers have not controlled spending nearly as well as Medicare and Medicaid have.  This from KFN via Axios.

Doesn’t matter what your economic or political ideology is – that’s a fact.

You and your insurance company pay your doctors and hospital more than twice what Medicare does. Yes, the Feds can exert pricing power – but why can’t United Healthcare, or Aetna, or Blue Cross?

Those healthcare giants should be able to negotiate better deals with providers; they have massive buying power and millions of members to leverage. They should be able to use that power to give you lower insurance costs – but they can’t.

Those private insurers are (theoretically) more nimble, smarter, better run, and more efficient than the government. And they have hundreds of billions of healthcare dollars to leverage.

Yet they’ve failed to outperform a bunch of bureaucrats.

I won’t dive into the “whys” today, because that would take away from the over-arching truth – government has been much more effective than private insurers.

What does this mean for you?

Cutting your health insurance costs by a quarter = more dollars you could have spent on other stuff.

note – happy to hear other thoughts; please use citations to back up any assertions.