For-profit entities should not be involved in the delivery of healthcare.

Healthcare is simply too important to be left to profit-maximizing corporations that, far too often, put revenue generation above the prerogative of patient care.
Yet corporations increasingly own and operate our healthcare facilities — our hospitals, hospices, dialysis facilities, nursing homes, home health agencies, surgical facilities etc. are more and more owned and operated by investor-owned firms ...
... So how can we push for-profits out, given that so many patients now depend on these for-profit facilities ?
We can do it — but we need to buy out these facilities as part of a transition to Medicare for All, and convert them to not-for-profit entities. It would cost money up front, but would save in the long run — and more importantly would protect patients.

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More from @awgaffney

18 Jan
You probably heard: "We don't know if COVID-19 vaccination protects against transmission."

It's an odd statement! Presumably what is meant is: "It almost certainly protects against transmission, but we don't know by exactly how much, and we do know it's less than 100%."
You might think, what's the difference? It's a big difference!

Would you say: "condoms don't protect against HIV"

If you actually meant: "condoms do protect against HIV, although they are not 100% effective."

Hopefully not! You'd confuse people.
We already know for sure COVID vaccination is not 100% effective against transmission because it's not 100% effective against symptomatic infection. Insofar as any of this debate is about 100% efficacy in preventing transmission it should end. There's zero uncertainty.
Read 8 tweets
16 Jan
Arguably, healthcare services are inevitably “rationed”. The relevant question is whether they are allocated by the relative medical need of patients, or by some metric of their status, advantage, or resources.
An ICU doctor taking care of 12 critically ill patients will not divide her/his time perfectly equally among the patients. She/he will, inevitably, allocate the finite hours of their day based on patients’ relative medical need - the sickest will tend to take the most time.
Such “rationing” is inevitable, but it is also just. Injustice enters when factors beyond medical need — e.g. patients’ race, insurance status, income, wealth, language — distort the prioritization of time & services.
Read 10 tweets
29 Dec 20
Eric, with all due respect, this paper describes a web-based survey of a sample recruited from online support groups — but more importantly the vast majority of participants had no evidence of prior COVID-19 infection?

82% had negative serology?

Am I misreading?
15.9% had positive PCR, and 18.2% had positive antibodies. Even if you assume zero overlap (and why would you?), that means that the majority of these participants, whose demographics are opposite those who typically face severe COVID, never seemed to have COVID?
Make no mistake — COVID is the pandemic of a century — a horrifying, unprecedented plague. But the "long covid" narrative needs revision, rapidly.
Read 6 tweets
29 Dec 20
We should fight for healthcare that is free at point of service. Imposing payments serves two purposes, both harmful.

First, ideologically, it reinforces the notion that healthcare is a commodity.

Second, practically, it distributes the use of services by means, not needs.
Until we understand the fundamental political, economic, and ideological function of cost-sharing, we will never abolish it.
I could cite dozens of studies showing the medical harm that cost-sharing inflicts, but the reality is that this is a philosophical and political question more than an empiric one, one that I will rephrase as crudely as possible:
Read 7 tweets
29 Dec 20
OK, so I'll now tweet out the articles I wrote this year, and research projects where I took the lead, in case any of it may be of interest to folks.

It feels odd because so much has changed over the course of this year — politically, medically, everything!
In January, we published a study suggesting that people with VA coverage (where drug copays are non-existent or minimal) forego medications because of cost much less often than those w/ other forms of health coverage.

Imho, drugs should be free for all.…
In February, a brief editorial for BMJ made the case that "illness should not inflict financial ruin".

Medicaid expansion matters, but it is not enough — transformative financing reform is essential.…
Read 21 tweets
28 Dec 20
When someone develops fatigue, headache, or diarrhea after the first dose of the Pfizer COVId vaccine, it is more likely than not a “nocebo effect”.…
... reinforcing my borderline-crank belief in the importance of more public health messaging about nocebo and placebo effects I’m general !
*in general
Read 9 tweets

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