The most-contrary-to-human-nature COVID-19 distancing request (and one that, I sense, was far more widely ignored than others, like mask-wearing) was that people should not spend any time in the same room as loved ones or friends for over a year (unless you lived with them).
So much of our reopening debate has focused on commerce — things like bars & restaurants that while fun are not intrinsic to human nature itself — and almost none on the question of: “can I share a meal or spend some time indoors with a friend or family member”?
Governors emphasized that small-group indoor gatherings were the real problem as they re-opened socially unessential businesses despite growing data on the role of workplaces as sites of propagation.
When all is said and done, basic human socialization between friends and family inside homes may be one of the last things that we “re-open” in terms of what’s openly deemed socially acceptable, even though it’s happening everywhere.
Whatever one feels about the utility of strong social discouragement of any indoors socializing, no matter how small the group, I think many underestimated the enormity of the “ask.”
But at the end of the day, it may be the last “ask” standing because it generates no revenue, and doesn’t require redistribution (e.g. unemployment payments).

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More from @awgaffney

21 Feb
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 ?
Read 4 tweets
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.
healthaffairs.org/doi/abs/10.137…
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.

bmj.com/content/368/bm…
Read 21 tweets

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