Vaccination nation

[ciao_yall]

I've been seeing news reports and also hearing from people I know locally that a lot of nurses are refusing to get vaccinated and are willing to be laid off rather than get the vaccine. Today is the deadline for the federal mandate for health care workers, and it is a big problem for many places that rely on nurses, because there is already a nursing shortage.

Is the USA the only country to be going through this insanity of health care workers refusing the vaccine?

Good riddance. Most medical professionals believe in the vaccine. Those that do and get vaccinated will probably be glad that they no longer have to work with anti-vaxxers.

I guess there are some concerns about actual shortages when you combine this with burnout and already existing nursing shortages. I am pretty much in agreement with this though. When I end up in the hospital someday, I don't want to be treated by someone who is uninterested in avoiding infecting with me a dangerous disease.

How do you feel about ending up in hospital with a serious staffing shortage of nurses and other workers?
https://www.npr.org/sections/coronavirus-live-updates/2021/09/27/1041047608/vaccine-deadlines-hospitals-fear-staffing-shortages

not as uncomfortable as getting treated by un-vaccinated nurses

Let this play out.

Perhaps this will also result in improved funding and access to medical training for all health care workers, from nurses to PAs, NPs and even MDs. Spaces are limited in programs due to cost, and then practical training is limited again, due to limited resources available to train new employees.

Mercy, friends! Total health care spending in the US amounts to about 18% of total income or output.  That's about half more as a share than in civilized countries. How much more do you want?

How much of that healthcare spending goes to...

• Insurance companies for overhead?
• Prescrition drugs at "full retail" expense, including the advertising campaigns?
• Specialty care because people put off routine care until it becomes a crisis?

[dismalist]

I've been seeing news reports and also hearing from people I know locally that a lot of nurses are refusing to get vaccinated and are willing to be laid off rather than get the vaccine. Today is the deadline for the federal mandate for health care workers, and it is a big problem for many places that rely on nurses, because there is already a nursing shortage.

Is the USA the only country to be going through this insanity of health care workers refusing the vaccine?

Good riddance. Most medical professionals believe in the vaccine. Those that do and get vaccinated will probably be glad that they no longer have to work with anti-vaxxers.

I guess there are some concerns about actual shortages when you combine this with burnout and already existing nursing shortages. I am pretty much in agreement with this though. When I end up in the hospital someday, I don't want to be treated by someone who is uninterested in avoiding infecting with me a dangerous disease.

How do you feel about ending up in hospital with a serious staffing shortage of nurses and other workers?
https://www.npr.org/sections/coronavirus-live-updates/2021/09/27/1041047608/vaccine-deadlines-hospitals-fear-staffing-shortages

not as uncomfortable as getting treated by un-vaccinated nurses

Let this play out.

Perhaps this will also result in improved funding and access to medical training for all health care workers, from nurses to PAs, NPs and even MDs. Spaces are limited in programs due to cost, and then practical training is limited again, due to limited resources available to train new employees.

Mercy, friends! Total health care spending in the US amounts to about 18% of total income or output.  That's about half more as a share than in civilized countries. How much more do you want?

How much of that healthcare spending goes to...

• Insurance companies for overhead?
• Prescrition drugs at "full retail" expense, including the advertising campaigns?
• Specialty care because people put off routine care until it becomes a crisis?

I appreciate any thoughts that don't just say I want more.

-Unnecessary overhead, probably, yeah, something not trivial, but not too big.
-New drugs are unnecessarily expensive for regulatory reasons. And one can have all the cheap old drugs one wants.
-Putting off, sure for the non-insured, the 9% of the population.

Fascinating in policy discussions is that overhead or the uninsured are not addressed except for the request for more. Idiotic regulations, including for new drugs, are never addressed.

So, in international comparison, I am sure it's not a question of money. Yet everyone wants more, just like two year olds.

[ciao_yall]

I've been seeing news reports and also hearing from people I know locally that a lot of nurses are refusing to get vaccinated and are willing to be laid off rather than get the vaccine. Today is the deadline for the federal mandate for health care workers, and it is a big problem for many places that rely on nurses, because there is already a nursing shortage.

Is the USA the only country to be going through this insanity of health care workers refusing the vaccine?

Good riddance. Most medical professionals believe in the vaccine. Those that do and get vaccinated will probably be glad that they no longer have to work with anti-vaxxers.

I guess there are some concerns about actual shortages when you combine this with burnout and already existing nursing shortages. I am pretty much in agreement with this though. When I end up in the hospital someday, I don't want to be treated by someone who is uninterested in avoiding infecting with me a dangerous disease.

How do you feel about ending up in hospital with a serious staffing shortage of nurses and other workers?
https://www.npr.org/sections/coronavirus-live-updates/2021/09/27/1041047608/vaccine-deadlines-hospitals-fear-staffing-shortages

not as uncomfortable as getting treated by un-vaccinated nurses

Let this play out.

Perhaps this will also result in improved funding and access to medical training for all health care workers, from nurses to PAs, NPs and even MDs. Spaces are limited in programs due to cost, and then practical training is limited again, due to limited resources available to train new employees.

Mercy, friends! Total health care spending in the US amounts to about 18% of total income or output.  That's about half more as a share than in civilized countries. How much more do you want?

How much of that healthcare spending goes to...

• Insurance companies for overhead?
• Prescrition drugs at "full retail" expense, including the advertising campaigns?
• Specialty care because people put off routine care until it becomes a crisis?

I appreciate any thoughts that don't just say I want more.

-Unnecessary overhead, probably, yeah, something not trivial, but not too big.
-New drugs are unnecessarily expensive for regulatory reasons. And one can have all the cheap old drugs one wants.
-Putting off, sure for the non-insured, the 9% of the population.

Fascinating in policy discussions is that overhead or the uninsured are not addressed except for the request for more. Idiotic regulations, including for new drugs, are never addressed.

So, in international comparison, I am sure it's not a question of money. Yet everyone wants more, just like two year olds.

So you think that medical professionals can just do more with fewer people?

[dismalist]

I've been seeing news reports and also hearing from people I know locally that a lot of nurses are refusing to get vaccinated and are willing to be laid off rather than get the vaccine. Today is the deadline for the federal mandate for health care workers, and it is a big problem for many places that rely on nurses, because there is already a nursing shortage.

Is the USA the only country to be going through this insanity of health care workers refusing the vaccine?

Good riddance. Most medical professionals believe in the vaccine. Those that do and get vaccinated will probably be glad that they no longer have to work with anti-vaxxers.

I guess there are some concerns about actual shortages when you combine this with burnout and already existing nursing shortages. I am pretty much in agreement with this though. When I end up in the hospital someday, I don't want to be treated by someone who is uninterested in avoiding infecting with me a dangerous disease.

How do you feel about ending up in hospital with a serious staffing shortage of nurses and other workers?
https://www.npr.org/sections/coronavirus-live-updates/2021/09/27/1041047608/vaccine-deadlines-hospitals-fear-staffing-shortages

not as uncomfortable as getting treated by un-vaccinated nurses

Let this play out.

Perhaps this will also result in improved funding and access to medical training for all health care workers, from nurses to PAs, NPs and even MDs. Spaces are limited in programs due to cost, and then practical training is limited again, due to limited resources available to train new employees.

Mercy, friends! Total health care spending in the US amounts to about 18% of total income or output.  That's about half more as a share than in civilized countries. How much more do you want?

How much of that healthcare spending goes to...

• Insurance companies for overhead?
• Prescrition drugs at "full retail" expense, including the advertising campaigns?
• Specialty care because people put off routine care until it becomes a crisis?

I appreciate any thoughts that don't just say I want more.

-Unnecessary overhead, probably, yeah, something not trivial, but not too big.
-New drugs are unnecessarily expensive for regulatory reasons. And one can have all the cheap old drugs one wants.
-Putting off, sure for the non-insured, the 9% of the population.

Fascinating in policy discussions is that overhead or the uninsured are not addressed except for the request for more. Idiotic regulations, including for new drugs, are never addressed.

So, in international comparison, I am sure it's not a question of money. Yet everyone wants more, just like two year olds.

So you think that medical professionals can just do more with fewer people?

Nope. They can do more with more doctors, driving down their wages. :-) The control of doctor supply by the Council on Graduate Medical Education, a cartel of the AMA and the US government, restricts supply. Imagine that for plumbers, or lecturers!

Giving medical professionals without a medical school degree rights to do stuff on own account would be a real boon. [Their wages would rise, by the way.]

The political problem is us: Most people are quite happy with their health insurance, thank you very much.

[Hegemony]

Boy, if most people are happy with their health insurance, they're not the people I know. Most people with some kind of health insurance are very aware of how lucky they are not to be completely unprotected, but everyone I know is appalled at the cost, infuriated by the bureaucracy, and terrified of being denied coverage when something expensive comes up.

[kaysixteen]

And many of those who are happy with their health ins do not actually know how bad that ins is, largely because they have never had a significant health issue whilst on it.

[Hegemony]

After I first graduated, before I headed back into academia, I worked at one of the big health insurance companies. The company occupied a huge building in a major city. i found that an entire floor of the building was dedicated to people whose entire job was figuring out how to deny people coverage when they made claims. Finding loopholes, obfuscating, etc. For-profit health insurance — well, I believe the technical term is "evil in action."

[Kron3007]

 I grew up in Canada and lived in the US for a while.  I was pretty shocked when I went to the doctors and got a prescription, then got a bill.  I naively assumed that since I had insurance it would be covered, but apparently I went to the wrong hospital or had a co-pay, or something.  It was a very nice hospital, but the diagnosis and treatment were pretty standard.

I think what is missing from this discussion about health care costs is the extra price incurred by delayed treatment and stress.  If people are not seeking treatment early for fear of bills, the ultimate cost to them and the system are greater.  After my experience with my co-pay or whatever it was, I can see how it would discourage early diagnosis and treatment.  Likewise, a patient recovering from cancer surgery or the like, should be focussed on recovery, not stressing about the bill

So, my point is that money can be saved without actually investing "more", simply by changing the mindset.  Now that I am back in Canada, I do not hesitate to get things checked out early and this is key to efficient medical outcomes and cost reductions.  In fact, I have a minor surgery coming up that will cost me nothing.  If I were in the IS, I could see delaying this particular surgery and only dealing with it when it actually causes problems for me, which would be a worse outcome for me and the system.

[downer]

I grew up in Canada and lived in the US for a while.  I was pretty shocked when I went to the doctors and got a prescription, then got a bill.  I naively assumed that since I had insurance it would be covered, but apparently I went to the wrong hospital or had a co-pay, or something.  It was a very nice hospital, but the diagnosis and treatment were pretty standard.

I think what is missing from this discussion about health care costs is the extra price incurred by delayed treatment and stress.  If people are not seeking treatment early for fear of bills, the ultimate cost to them and the system are greater.  After my experience with my co-pay or whatever it was, I can see how it would discourage early diagnosis and treatment.  Likewise, a patient recovering from cancer surgery or the like, should be focussed on recovery, not stressing about the bill

So, my point is that money can be saved without actually investing "more", simply by changing the mindset.  Now that I am back in Canada, I do not hesitate to get things checked out early and this is key to efficient medical outcomes and cost reductions.  In fact, I have a minor surgery coming up that will cost me nothing.  If I were in the IS, I could see delaying this particular surgery and only dealing with it when it actually causes problems for me, which would be a worse outcome for me and the system.

That's a good point. I've had a pain in my knee for the last 1.5 years which isn't very significant. I thought it would go away on its own but it hasn't. My deductible is $4500 so I'm not getting it checked out until it actually starts disabling me.

There are problems when it is very easy to visit the doctor. UK doctors do get quite a few patients who come for no good reason. They are basically lonely or hypochondriacs. They go because it is free to visit and someone pays attention to them. That cuts down on efficiency.

[Kron3007]

I grew up in Canada and lived in the US for a while.  I was pretty shocked when I went to the doctors and got a prescription, then got a bill.  I naively assumed that since I had insurance it would be covered, but apparently I went to the wrong hospital or had a co-pay, or something.  It was a very nice hospital, but the diagnosis and treatment were pretty standard.

I think what is missing from this discussion about health care costs is the extra price incurred by delayed treatment and stress.  If people are not seeking treatment early for fear of bills, the ultimate cost to them and the system are greater.  After my experience with my co-pay or whatever it was, I can see how it would discourage early diagnosis and treatment.  Likewise, a patient recovering from cancer surgery or the like, should be focussed on recovery, not stressing about the bill

So, my point is that money can be saved without actually investing "more", simply by changing the mindset.  Now that I am back in Canada, I do not hesitate to get things checked out early and this is key to efficient medical outcomes and cost reductions.  In fact, I have a minor surgery coming up that will cost me nothing.  If I were in the IS, I could see delaying this particular surgery and only dealing with it when it actually causes problems for me, which would be a worse outcome for me and the system.

That's a good point. I've had a pain in my knee for the last 1.5 years which isn't very significant. I thought it would go away on its own but it hasn't. My deductible is $4500 so I'm not getting it checked out until it actually starts disabling me.

There are problems when it is very easy to visit the doctor. UK doctors do get quite a few patients who come for no good reason. They are basically lonely or hypochondriacs. They go because it is free to visit and someone pays attention to them. That cuts down on efficiency.

Yes, it isn't perfect, but I suspect the in efficiency from lonely patients is a drop in the bucket (cost wise) compared to the savings of early diagnosis and preventative health care (something no one is great at).  This is one of those points that I feel gets overblown.

This is similar to vaccinations.  They have calculated that a Covid patient that gets hospitalized costs the system about $23,000 here.  Even just from a financial standpoint, vaccines make sense.  This is the argument they should be making to the anti-vax conservatives...

[downer]

COVID treatment is no longer free in the US, I believe. Or at least I heard something like that. I am not sure if it ever really was, but it was meant to be.

One issue is whether insurance rates should be higher for those who choose to be not vaccinated -- and what about people have have immunity because they already had COVID and recovered? And whether Medicare and Medicaid should provide full coverage for those who choose to remain vulnerable to infection.

[marshwiggle]

This is similar to vaccinations.  They have calculated that a Covid patient that gets hospitalized costs the system about $23,000 here.  Even just from a financial standpoint, vaccines make sense.  This is the argument they should be making to the anti-vax conservatives...

I hadn't heard that number. Even if the hospitalization rate of people who get covid is 1/20, then that averages out to $1000 per person cost of getting covid, versus 20$ (?) for two vaccinations. A 50x ROI isn't bad.

[dismalist]

COVID treatment is no longer free in the US, I believe. Or at least I heard something like that. I am not sure if it ever really was, but it was meant to be.

One issue is whether insurance rates should be higher for those who choose to be not vaccinated -- and what about people have have immunity because they already had COVID and recovered? And whether Medicare and Medicaid should provide full coverage for those who choose to remain vulnerable to infection.

It's always good to be able to charge more for insurance on those who take more risks. It charges more to those who create more costs and it deters. It's been done successfully with smoking, with the extra health care costs covered in the higher tax, and the rate of smoking declining significantly. Higher rates for the unvaccinated should be easy to implement [though not instantaneously, in the middle of a contract period] by offering lower rates for the vaccinated.  But then I would do the same for other life choices that add to costs. Obesity is probably top of the list. Also easy to implement. Health insurance premia would depend on BMI.

[downer]

Except that BMI is only very loosely correlated with health, that that is inherently unfair. You need an accurate measure.

[dismalist]

Except that BMI is only very loosely correlated with health, that that is inherently unfair. You need an accurate measure.

Like smoking and vaccination. :-)