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I'm Married to an ER Doc in NYC

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Re: I'm Married to an ER Doc in NYC

#181

Post by Spooky23 »

akiselev wrote: post #72
40four wrote: post #63

Earlier quoted context omitted.

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serio…

> At this point, nobody wants to go in for routine examinations or non-emergency procedures. For-profit hospitals (almost all of them are) as a business, depend on providing these non-emergency services/ surgeries/ procedures. Hospitals across the country are laying off health-care workers en-masse. Nitpick: Over half of US hospitals are nonprofits or government owned [1] though I believe hospitals are vastly outnumb…

Government owned or Non-profit isn't as meaningful as you might think. End of the day, hospitals live on Medicare admissions for cash flow (ie. old people) and surgery for profit. Old people are staying home, people aren't hurting themselves on the couch, etc.

Government owned is only meaningful with the Federal government, which has unlimited resources.

Re: I'm Married to an ER Doc in NYC

#182

Post by rscho »

majewsky wrote: post #168
rscho wrote: post #145

Earlier quoted context omitted.

Maybe "saved the world" and "invented" the internet? Because yeah of course, the internet has been "invented"! It was absolutely not a natural evolution of local networking based on known technology...

Through that sort of reasoning, computers have never been invented. They are just a natural evolution of mechanical calculators. I mean, sure, but that definition of "invent" is so narrow as to be meaningless.

Internet is a US invention as much as lightbulbs are a US invention.

Re: I'm Married to an ER Doc in NYC

#183

Post by Spooky23 »

skybrian wrote: post #102
40four wrote: post #63

Earlier quoted context omitted.

I think it is more complicated than that. Almost all states very early on had some level of 'lock-down', stay at home order, or what have you. This has limited movement of people, and as a side effect, or maybe even direct order from governors, closed down/ limited many business. Including hospitals. Hospitals in America, believe it nor not, are for profit businesses. It is un-intuitive, but many of them are in serio…

It seems like the root financial problem isn't for-profit versus non-profit, it's pay-per-procedure? This is like paying the fire department based on how many fires they put out. Medicare seems no better. (I would guess that Kaiser might be doing somewhat better since they're paid monthly but their finances aren't easy to find.)

There are four scenarios at a very high level. It an uber complex system and the amount of time and money wasted in optimizing and managing revenue cycles is almost incalculable. If you compare it to any complex large scale system it's sickening to look at the waste -- even the military looks like an efficient machine in comparison. (In some ways)

Medicare pays on a set scale for performance. If you have a heart attack, they pay a fee for the surgery and x days of hospitalization and x days of rehab. If the hospital gets you home in x-3 days, they make money. If the hospital fucks up and you get an infection and stay for x+10 days, they eat it.

Medicaid is a PPO that pays on a per procedure basis. Their rates suck, but they don't care about quality for the most part. There's a billing optimization process to maximize revenue for poor old people. (Some things are better billed to Medicare, others to Medicaid)

Private insurance pays for whatever they cover at a rate of y+z% over the Medicare rate. The patient gets the bill for whatever else happens.

Uninsured get whatever treatment is legally necessary. They patch you up, take a loss, kick you out and do it again when you come back.

Re: I'm Married to an ER Doc in NYC

#184

Post by 9nGQluzmnq3M »

gizmo wrote: post #175
adrianN wrote: post #158

Earlier quoted context omitted.

You are blatantly wrong. There are of course many things we don't understand about the new virus yet, but of course the experts on infectious diseases know a lot more than the average person. Why is is such a common trope to discredit whole fields of research just because they can't provide all the answers, or gasp revise their answers as more data comes in?

Your suggestion that there is any kind of scientific consensus at this point is wrong; the experts are still very much divided. And right now the most prominent and most frequently cited experts are those that made one wrong prediction after another. Sometimes the media cites the wrong experts. Like with "Iraq has weapons of mass destruction" and "Hillary has a 99% chance of winning the general". In those cases, too,…

Whether a non-medical mask protects the wearer is still up for debate. But the fact that they help protect others from droplet dispersion is elementary physics.

Re: I'm Married to an ER Doc in NYC

#185

Post by davycro »

klmadfejno wrote: post #164
davycro wrote: post #81

Earlier quoted context omitted.

We can put a patient on oxygen without intubating them. High flow oxygen can provide up to 60 liters per minute. We can prone patients, and provide them with nutrition to help support their immune system. We save many patients with supportive care. We can’t however cure the virus. And if it progresses far enough then no amount of oxygen will save a patient. These cases are hard because we have to watch someone die wi…

I'm hoping this doesn't come off as snarky but, why can't / don't we tell people to prone at home? As I understand, it's literally just lying down on your stomach. I first encountered the concept in a new york times article where the interviewed nurse was saying the problem was people got bored and stopped doing it. That sounded... dumb. And as though being prone should be plastered all over the public health recomme…

Good question. Proned patients are too sick to survive at home. As soon as the roll onto their back or sit upright they start suffocating and must work for their breath. Because of this they need help caring for themselves. They also are at risk of becoming much worse and needing more oxygen.

Re: I'm Married to an ER Doc in NYC

#186

Post by myk9001 »

adrianN wrote: post #158
mkagenius wrote: post #66

Earlier quoted context omitted.

Lets just say every one is just as clueless about this virus as WHO or CDC or Fauci or whoever. Its just a failure of our not so advanced research in this field that we are in this situation. I can't believe everyone is just so clueless.

You are blatantly wrong. There are of course many things we don't understand about the new virus yet, but of course the experts on infectious diseases know a lot more than the average person. Why is is such a common trope to discredit whole fields of research just because they can't provide all the answers, or gasp revise their answers as more data comes in?

Sure, experts do know a lot more about the virus than an average person.

But, AFAIK, experts don't really have answers to these questions:

- How long does the immunity last?

- How much do asymptomatic people transmit?

- How much do pre-symptomatic people transmit?

- Related to the previous two questions, what percent of cases got infected from symptomatic people?

- What percent of cases got infected from contaminated surfaces, what percent -- from aerosols, what percent -- from droplets?

To a non-expert like me the questions above sound super essential. It's been more than half a year since the virus spread began. How come we still don't know? And so, while calling experts clueless is not polite, does it sound like such a stretch? Maybe it's OK, if experts actually admit they have no clue at the moment?

"... revise their answers as more data comes in?"

This should be a totally normal thing to do, I agree.

Re: I'm Married to an ER Doc in NYC

#187

Post by somewhereoutth »

ansible wrote: post #135
afiori wrote: post #110

Earlier quoted context omitted.

> the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2 two of those are in part result of propaganda

>> the US - the country that went to the moon, that invented the internet, that built a military capability that literally saved the world in ww2 > two of those are in part result of propaganda Eh, no. We (the USA) did really go to the moon, though I know some USA citizens dispute that. It was really USA universities and corporations (with DARPA funding) that built the foundations of Ethernet, TCP/IP and the Internet…

In addition - regarding the European theater, the most important contribution of the US was keeping the USSR to the Elbe, otherwise the entirety of continental Europe would have fallen under communist rule.

Re: I'm Married to an ER Doc in NYC

#188

Post by pedrocr »

redis_mlc wrote: post #167
pedrocr wrote: post #146

Earlier quoted context omitted.

So do available resources. This go to argument that things that work in smaller countries don't work in the US is bizarre. It's used in all these discussions of how things that work in the EU couldn't possibly work in the US, even though the EU has a larger population.

Nobody is talking about the EU - we're talking about NZ and Taiwan.

New Zeland hasn't tested more per population size than the US or the EU. If the argument is scale the EU is a counter-example. If the argument is management there are literally dozens of countries that have managed things better than the US. NZ and Taiwan are just examples of where things were done particularly well, but there are plenty of others.

Re: I'm Married to an ER Doc in NYC

#189

Post by pedrocr »

redis_mlc wrote: post #157
pedrocr wrote: post #147

Earlier quoted context omitted.

At this point in Europe we have private accredited labs doing tests for under 100€ on-site whenever there's an outbreak. Testing the entire US population once would cost ~30B$. Do it three times and spend 100B$ which would be incredible overtesting, and yet well below the other measures your congress has already passed in terms of cost.

Not enough labs, corona is too contagious to test only 3 or 4 times.

You're somehow assuming that doing things properly in the US requires a testing rate that's 1000x larger than everywhere else. I was just putting numbers to the absurd scale of testing everyone 3 times, which is far far beyond what is actually needed given examples of everywhere else.

Re: I'm Married to an ER Doc in NYC

#190

Post by gvjddbnvdrbv »

ThomPete wrote: post #154
gvjddbnvdrbv wrote: post #67

Earlier quoted context omitted.

Everything you wrote is weird and simply shows that you need a proper health care system over there.

Americas healthcare system has it's flaws but the benefits amongst others is that it keeps being able to afford to invest in new research and methods and to specialize. It's the advantage of being a profit center. This is much harder in universal healthcare systems that are cost centers and thus can't just decide to change to a newer better method. Furthermore, the universal healthcare system have to budget who gets…

I recently had a successful experimental surgery in this countries nationalised health service. Interestingly the idea had come from a study where the surgery I had was a control group and the 'real' group had a stem cell therapy as well. My problem was resolved, the single payer system didn't waste $100,000 on stem cell therapy. Good result. In the privatised system that carried out the original study the additional stem cell therapy is being done. It seems like optimising for profit optimises for cost.
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