Can the US handle an epidemic?

[MorkandMindy]

If an actual epidemic is handled in the same way as everything else in the for-profit medical system then:

A doctor's appointment would be required, each dose of vaccine would be discussed, a diagnosis of disease required, and with 'informed' consent an individualised treatment would be agreed.

A prescription most likely would be written and the injection delivered at the chosen pharmacy.

After the billing process with the built-in profit margins the cost would end up with a certain amount paid by the insurance company from the monthly premiums and the deductible would be paid by the patient.

Medicaid for the 29-64 age range apparently does not cover screening as a rule, so it claims, just treatment, so the person would have to get ill first.

 

[MorkandMindy]

Free market health care has the prime objective of making money, and doing things has to conform to that overall aim.

I took a simple cancer test in England and all together the cost would have been around 10 dollars, paid by the government. Here the same test was 600 dollars.

Then I learned that it is wise to shop around for prices and I could have got it for maybe just a few hundred. And that after a car accident patients should phone around for quotes for ambulances, blood transfusions, oxygen and so on rather than just accept treatment at the nearest hospital.

 

[MorkandMindy]

As you can see I don't know very much about this topic.

I applied for and was given last year medicaid by reason of my income, which I didn't use, and was then fined on my income tax because it was the wrong kind of medicaid.

I then spent a week investigating and found out the system was far more complex than I had thought, and for the cancer test it seemed nobody actually knew if it was covered by medicaid, I would just have to wait and see if I got billed or not.

IIR the US medical system costs 17% of GDP, more than twice the cost of the next most expensive (France) as a proportion of GDP, and gives results, well, a life expectancy of 3 months more than the average in Cuba.

Isn't there some way to fix it?

What happens if we get an epidemic? Do we use the system or just go around it?

 

[RDKirk]

If an actual epidemic is handled in the same way as everything else in the for-profit medical system then:

A doctor's appointment would be required, each dose of vaccine would be discussed, a diagnosis of disease required, and with 'informed' consent an individualised treatment would be agreed.

A prescription most likely would be written and the injection delivered at the chosen pharmacy.

After the billing process with the built-in profit margins the cost would end up with a certain amount paid by the insurance company from the monthly premiums and the deductible would be paid by the patient.

Medicaid for the 29-64 age range apparently does not cover screening as a rule, so it claims, just treatment, so the person would have to get ill first.

It's not that complicated. If an epidemic (or, say, a biological attack) was declared and the CDC advised everyone to be immunized, prescriptions and screenings would not be necessary. That was the case, for instance, with the recent shingles spin for older adults (now that I think of it...why did they stop running those PSAs? Did shingles disappear? Or did old folk?).

The problem, though, is that we would still be dependent on a for-profit logistics and delivery system that is only set up for profit. It would not be able to handle a sudden swell of requirements: Lines wrapping around the local Walgreen, and Walgreen isn't going to build new stores just to accommodate a one-time emergency.

IMO, immunization is one area of health care that should be totally nationalized for the sake of national security. Drugstores will not be able to respond to a biological attack.

 

[variant]

If an actual epidemic is handled in the same way as everything else in the for-profit medical system then:

It isn't.

 

[Petros2015]

Depends on the epidemic and what you mean by 'handle'. Something with a 10% kill rate (say SARS) would make a real mess of things if it was easily transmissible. It was not very transmissible out in the wild, but when they intubated patients at hospitals to put them on breathing machines, they inadvertantly aerosolized it. So when a SARS patient entered the hospital and that happened, lots of people including the doctors then became infected, and the hospitals were then quarantined and closed. This was pretty scary to watch. I started paying attention when WHO sent an infectious disease expert to see what was going on and he died too (always a bad sign). In addition they understated the kill rate many victims were being kept alive (so many people have it, but only a few have died) by breathing machines so they took longer to die.

A real epidemic will take down hospitals and doctors. Keep in mind that 'the big one', Spanish Influenza was only a 3% kill rate, and the fastest that the virus could travel at that time was on horseback. We have a global economy now. And some potentially transmissable viruses like H5N1 may have a MUCH higher kill rate, they just don't go human to human yet.

So... handle? I'm pretty sure we could survive one, but there would be some level of riots and quanantines and looting. Shutdown of mass transportation like metros and things. In a real epidemic I don't think you are worried about your medical insurance, you are just trying to avoid being infected.

It would be a mess.

You are also assuming that there will be some magic Hollywood immunization cooked up in advance, that is distributable to mass populations within a month of the outbreak? I don't think that's likely. Standard yearly flu vaccine is a 'guess' and prepped many months in advance. If the flu happens to be something different, it would take quite a while to get something effective going ready for mass production.

 

[blackribbon]

We already isolate patients while we are doing "rule out" diagnoses...which means assuming that a person is contagious until tests prove they are not. And most nurses I know wear masks when caring for a patient who has a cough because we don't even want a simple cold. We use "universal precautions" for all patients to prevent spreading any type of infection from patient to patient or patient to healthcare worker. And it doesn't take very long for a potential "outbreak" to be identified and then serious precautions kick in to stop it and prevent it from being spread. Worst case scenerio is that a unit is completely closed down and the unit is sterilized from top to bottom while it is researched what caused the breach. Hospitals have whole departments dedicated to preventing spread of infections...any infections.

As for a national outbreak of something that could be vaccinated for in the US, the states would most likely make it available at low or no cost and lots of healthcare facilities would be immobilized to vaccinate as many people as possible, as fast as possible. (People can get low cost vaccines at their county health facilities at all times...outbreak or not). As it is, most vaccines do not require a prescription ... I used to get my flu shot at the local pharmacy without ever seeing a doctor. (I now get it at the hospital where I work and it is amazing how many employees can be vaccinated in a very short time...it is basically an assembly line procedure.)

I will be the person taking care of the patients directly if there were to be such an outbreak .... but I believe that we will contain any outbreaks very quickly and very efficiently. I don't live in fear at all.

 

[blackribbon]

The problem, though, is that we would still be dependent on a for-profit logistics and delivery system that is only set up for profit. It would not be able to handle a sudden swell of requirements: Lines wrapping around the local Walgreen, and Walgreen isn't going to build new stores just to accommodate a one-time emergency.

IMO, immunization is one area of health care that should be totally nationalized for the sake of national security. Drugstores will not be able to respond to a biological attack.

Drug stores aren't the only place to get vaccines. I would expect that hospitals would set up clinics....even parking lot tents to handle a bunch of people very quickly. The state would probably also send teams of qualified personal to schools, churches, community centers, senior centers, etc... to set up quick vaccination centers.

 

[blackribbon]

Free market health care has the prime objective of making money, and doing things has to conform to that overall aim.

I took a simple cancer test in England and all together the cost would have been around 10 dollars, paid by the government. Here the same test was 600 dollars.

Then I learned that it is wise to shop around for prices and I could have got it for maybe just a few hundred. And that after a car accident patients should phone around for quotes for ambulances, blood transfusions, oxygen and so on rather than just accept treatment at the nearest hospital.

There is a big difference from being able to shop around before getting a cancer screening and a medical emergency. And even if the person having the medical emergency doesn't have any insurance or ability to pay, he will be treated and treated the same way as the person with all the money in the world...at least as long as the person is critical.

Out of curiosity, what basic cancer screening test are you getting that cost so much. PSA appears to range between $50 and $100. I am fairly sure you didn't get a mammogram...so what other basic cancer tests are common?

 

[MorkandMindy]

Greetings Blackribbon!

I am sorry a few years back I thought Obamacare (I'm not sure I recall the exact issue, it was a while ago) was better than I eventually discovered it was and it is just as you said. The problem was the terminology had a different meaning to me, I thought 'federal' meant 'free at point of delivery' , and I knew lots of liberals who all told me Obamacare was so good.

When I came to this country and had to apply for it, I discovered I was wrong and so were my friends, and you were of course right, and the situation was very complicated.

 

[MorkandMindy]

This point of this thread is to ask how the for-profit medical system in the US can cope with an epidemic or any situation where a lot has to be done quickly and efficiently

and if the way to for an efficient effective medical system to combat an epidemic is to simplify as much as possible the payments system then would that be the best way to run it for everything?

This topic is way out of my field, so I'm really looking for input on it

 

[RDKirk]

Drug stores aren't the only place to get vaccines. I would expect that hospitals would set up clinics....even parking lot tents to handle a bunch of people very quickly. The state would probably also send teams of qualified personal to schools, churches, community centers, senior centers, etc... to set up quick vaccination centers.

Remember Katrina? When struck with something big, expensive, and unexpected, the state always bows out.

And I remember the Keystone Kops response to the Ebola outbreak right here in my neighborhood in Texas not long ago.

Nope. Not if they haven't set up the system, exercised it, and keep it continuously ticking with low level activity.

"...Qualified personal to schools, churches, community centers, senior centers, etc... to set up quick vaccination centers." In response to, say, simultaneous Anthrax attacks in four or five different cities? That attempt would be total goat rope. There isn't even anyone with everyone's telephone numbers on file.

 

[blackribbon]

And I remember the Keystone Kops response to the Ebola outbreak right here in my neighborhood in Texas not long ago.

"...Qualified personal to schools, churches, community centers, senior centers, etc... to set up quick vaccination centers." In response to, say, simultaneous Anthrax attacks in four or five different cities? That attempt would be total goat rope. There isn't even anyone with everyone's telephone numbers on file.

Um.... EBOLA OUTBREAK??? Exactly TWO people got Ebola in the US. Both were nurses and had contact with the patient in the emergency room before the isolation need was identified. Both survived. I'd say our ability to contain a disease that we are not prepared for and didn't understand very well proved to be VERY good. That was not a failure. We still screen patients for foreign travel on every single hospital admission to be able to identify if a person may have been in any area of the world (or in close contact with someone) that maybe be having an issue with a known issue from another part of the world.

Hospitals and emergency personally are VERY prepared for unexpected mass emergency situations. We have teams that specialize in this and are always tweeking the system. We are very much in contact with the community considering the general health of the community. The rest of us are also trained and do annual reviews on what we are to do if there were a huge variety of potential internal and external disasters. I am sure that we could have a team together in a few hours ready to go out and assess in the community or give vaccines. I know I would volunteer after taking a minute to make sure my kids are safe. I might even bring them to help out if they wanted to. (My son is EMT trained and just one class short of being able to take his licensing exam and my daughter is very good at managing people).

As for Katrina...I think overall Houston did very good and figuring out how to manage a sudden arrival of over 250,000 now homeless traumatized people. This was not a pre-arranged plan or concept....it was a response made based on a sudden actual unexpected need. Many of those people were so satisfied that they stayed and made Houston their home.

I think that in the US we do very well with large unexpected disasters....and I do have faith that we would be able to contain an epidemic pretty quickly.

I think the only failure is in the sensationalization of situations by the news media and the way the general public likes to freak out based on rumors and lack of real knowledge.

 

[keith99]

Drug stores aren't the only place to get vaccines. I would expect that hospitals would set up clinics....even parking lot tents to handle a bunch of people very quickly. The state would probably also send teams of qualified personal to schools, churches, community centers, senior centers, etc... to set up quick vaccination centers.

Heck my last workplace set up a vaccination system for just the simple flu vaccine. All handled at absolutely no cost to teh employees.

It isn't difficult and the for profit system can handle that far more efficiently than a state system.

The real problem is what we have occasionally already seen with flu vaccines when the consensus on what the likely strains are for teh coming flu season, production of the correct vaccines. It does not happen by magic and just throwing money at it will not make biological processes go faster.

 

[MorkandMindy]

What I was thinking was it must be simpler and quicker for the government to pay out for a cure and the distribution of it,

than for every person to pay personally or not at all or usually part personally and part through their insurer

and for charges through the insurer to go through various different ones and for different parts of the vaccination procedure to be charged differently, some in the deductible, others not, and others partly deductible, and so on.

Basically I thought it must involve fewer people if there is one payer and no more, so nearly all the effort is in just the provision part of the chain.

 

[blackribbon]

What I was thinking was it must be simpler and quicker for the government to pay out for a cure and the distribution of it,

than for every person to pay personally or not at all or usually part personally and part through their insurer

and for charges through the insurer to go through various different ones and for different parts of the vaccination procedure to be charged differently, some in the deductible, others not, and others partly deductible, and so on.

Basically I thought it must involve fewer people if there is one payer and no more, so nearly all the effort is in just the provision part of the chain.

Why do you believe that anything handled through the government is cheaper or more efficient? Have you not seen the conditions of our VA hospital system? That is a nationally managed hospital system.

I had a friend from England who told me that the only people that use the national health care system and not private doctors are those who can't afford a private doctor. To go through the national system takes a long time. I will admit this was my only exposure to the British healthcare system. If it is anything like the Canadian system, then a melanoma patient can easily wait 6 months for a PET scan ... whereas, my husband was in surgery 10 days after he was first diagnoses...and he had seen 3 different doctors in that time frame. If he had to wait 6 months...well, he would have been dead several months short of that diagnostic scan....and would have never have received any treatments. In that same six months, my husband saw two surgeons and an oncologist, had 3 surgeries, 1 month of intensive chemotherapy and was on his regular treatment plan for 3 months...and returned to work at 6 months.

One payer also means that the government gets to make all of a person's health care decisions. That means if a treatment exists but it is very expensive or only works on a few people, it probably would not be made available in a one payer system to anyone. With a private insurance, we have to opt for more extensive coverage, have the right to appeal, or pay for these treatments out of our own pockets.

 

[blackribbon]

I think the US is just too big to for healthcare to be able to be handle on a national basis. I think that this should be run by the states, not Washington DC. The US has almost 350 million people. That is a lot of people to come up with a one-size-fits-all system.

 

[MorkandMindy]

I think the US is just too big to for healthcare to be able to be handled on a national basis.

Good point. There's a whole book 'Small is Beautiful' to back you on that one.

 

[blackribbon]

I believe that Harris County ( where Houston, TX is) has a very good county wide health care system. People who have lower income can qualify to participate in the county sponsored program. There are two major hospitals (each one tied to a Medical school) so they get the same doctors as the private hospitals. The difference is long waits, plain waiting rooms, and no pretty perks in the room (you prepay for your tv use if you want it). However, I watched the neighbor get the same quality cancer treatments as those with private insurance and the county even sent her to the specialized cancer hospital as my husband went to. Her payment plan was $25/month....most likely for the rest of her life but she lived and $25/month is affordable and reasonable for her limited income. The best trauma center is actually one of the county hospitals and I made it clear that if I ever needed it, I wanted to go to the county hospital for trauma care...just transfer me to a private hospital as soon as I was stable.

 

[loveofourlord]

well the thing that worries me is, you start with something like ebola getting into the country and some of those infected are the, "I will take homeopathy and vitamin C." and be fine, and they spread it because they don't go to the hospital or such. Just look at what happens with these measel outbreaks in areas unvacinated. Now imagine something more dangerous and just as contagious, but no vaccines for breaking out in such a comunity.