Thread by @kurteichenwald

1. The deep, near-undeniable flaws and stupidity in many American systems that would worsen any significant epidemic.

PART ONE: Medical....

a. Refusal of Red States to Expand Medicaid Under ACA

Because of this refusal, hospitals throughout red states have been cutting back on medical staff and equipment, even for the insured.

Under the system in red states, hospitals still provide uncompensated care. But, if they..

...have expensive equipment and large staffs for the insured, these must also be provided to the uninsured. Pre-ACA, we paid more in taxes to compensate. Now, no.

The result: Red state hospitals have been cutting back on many expensive diagnostic equipment and staff because...

...otherwise, they would go under. (I know this because I have a family member who was chief medical guy at a major hospital in a red state. He grew sick of cutting, cutting, cutting to keep hospital afloat; resigned, took a job in a blue state where few cuts are needed.

Also..

...because of the failure to expand medicaid in red states because a democrat and black guy advanced a GOP plan, rural hospitals lost significant amounts of revenue and have gone under. I have said for years - red states stuck a gun in their citizens mouths just for politics...

...
b. Poorly controlled for-profit hospitals

To consolidate revenues, for-profit hospitals have been buying up multiple hospitals in large regions and shutting down the smallest ones, thus driving more revenue to a single place and cutting expenses. They got more profits but...

....now we have significantly lower numbers of facilities in large regions, meaning if many people in that region get sick, the place will be overrun quickly. Right now in Italy, hospitals are deciding who gets intubated and who doesnt based on age/health. Some people they...

...must choose to let die, because they do not have enough beds, enough equipment or enough staff....

...
c. Uninsured

This is slightly different than red state refusal to expand Medicaid. There are many pieces to this. To start, people without insurance are the most likely to delay treatment or testing. For the self-centered, that means YOU are at higher risk of infection...

...the uninsured, just like the people who dont believe COVID-19 is serious, walk among everyone, infecting people. They dont need to be near you. In other words, delays will escalate spread of virus.

Then there are the people who refuse to buy insurance, either to give...

...the finger to the black man who tried to get them protected, or because they were stupid enough to say "I'm healthy. I dont need insurance." Now, these "freedom" people will be a drain on the system, depending on all of the rest of us to help them....

...for the non-sociopaths, the people who delay testing and treatment because of insurance will be most likely to infect their families and have a higher incidence of death....

...

4. Antibiotics.

Yes, antibiotics do nothing to help a viral infection. SO DONT USE THEM FOR IT OR STOCK UP. However, viruses like the one that causes COVID-19 can lead to influenza and then to secondary bacterial infection....

...unfortunately, because of the decades of abuse of antibiotics - people taking them for the flu, the cold and other viruses without influenza, as well as mass usage for beef and hog production - the number of variants of antibiotics available have been shrinking as more...

...bacteria become resistant as a result of unnecessary overuse.....

....

e. People are fucking stupid.

Just like the idiots who say "I don't need insurance because I am healthy" there are those who say "Meh, we only have a couple of people infected in our state. No big deal. Everything is fine"....

....could they end up being right? Certainly not on the eventual numbers - they will get bigger. The problem is, these people don't understand the concept of an epidemic. A month or so ago, Italians were biking around, having fun, unconcerned. Now, hospitals are overrun...

...and doctors are being forced to make decisions about who has the chance to live and who must die because there simply aren't enough supplies. Could we be that way in a month? No idea. But people who claim to know, so we dont need to have plans in place, are frigging idiots....

...

f. Internists, pulmonary specialists, virologists.

Those are the three types of doctors needed for this kind of health care crisis. The two specialties do not have enough physicians to treat everyone. Internists would be front line on this. But....

...the combination of for-profit insurance and for-profit healthcare has been crushing the internal medicine side of physicians. Insurance companies have been drastically cutting reimbursement, which the for-profit healthcare systems are demanding more profits. They also have...

...been buying up a huge percentage of hospital practices. The result is that internists have been hit with "more more more more!!!!" demand on seeing patients. It is complicated to explain, but we also passed a law in 2005 requiring electronic medical records in 2010, and the...

...unforeseen results have been horrific. Both insurance and for-profit healthcare systems have been crunching down on those in ways that make records both incredibly time consuming and less accurate. So physicians are seeing "more more more" which means more more more charts...

...which in turn means less less less of a personal life. The result? The number of internists has been dropping. They have been jumping out of their practices and either retiring, going into concierge medicine, or finding some other gig related to medicine.....

...now, will all of these things combine into disaster? No way to know yet, although the experience in Italy is reason to be concerned here.

And if it doesn't lead to disaster, if we are just standing on the precipice, looking into the cavern, but don't eventually fall?...

..no doubt we will go back to "The for profit systems will take care of everything, cows need antibiotics, blah blah" And, if it is not this one, when the big pandemic that virologists have been warning us about for decades finally hits, we will still face the same problems....

...this is the end of PART 1 of how America's systems and policies are setting us up for disaster.

Part 2 probably tomorrow.

fin

FIX: I just read back what I wrote, and made a stupid brain-fart error. Was writing too fast.

Whenever i said influenza, I meant Pneumonia. Influenza can cause pneumonia. It is flu.