Thursday, November 18, 2021

Home (Safely) for the Holidays

One of the worst aspects of the Covid pandemic has been the isolation. Last year, many of us had to forego our holiday family traditions and get-togethers in the interest of safety. This year, with the widespread availability of vaccines, we hope to once again be with our loved ones around the holidays. At the same time, the Delta variant and the rising case count seen in many states makes us nervous, as do reports of break-through infections in vaccinated people. What can/should we do?

A few facts can guide our behavior. The first is that no activity in life is 100% safe. If you are travelling “over hill and dale to grandma’s house” in a car, you are accepting the risk of being injured or killed in an accident. You can of course minimize this risk by wearing a seatbelt, not driving under the influence of alcohol and obeying traffic laws. Second, while no vaccine is 100% effective, the current Covid vaccines are pretty darn good, reducing your risk of getting seriously ill by some 90%.

Here are some possible holiday scenarios and my suggestions for how to handle each:

Scenario 1: everyone attending your get-together who is eligible (is over 5 years old) has been vaccinated, including a booster where appropriate, and no one is immunocompromised or a frail elder. In this situation, I would feel free to socialize freely and not wear masks or require any tests. Go ahead: hug each other. [It goes without saying that someone who is sick should not attend!]

Scenario 2: everyone is vaccinated, but you will have a frail elder or someone who has a compromised immune system with you. In this situation you need to be more careful. Again, strictly advise guests to stay away if they are sick, but in addition, I would ask everyone coming, including children, to do an at-home antigen test the morning of the gathering and stay away if positive. [Any person testing positive should also follow through with their primary care doctor or local public health nurse.]

Scenario 3: at least some of your potential guests are not vaccinated. Here it gets sticky. If everyone else is fully vaccinated and in good health, you must decide if you are willing to accept the risk of getting infected, knowing that the vaccine you received will probably mean you will have nothing worse than a bad cold. Ask them to do a home test the morning of the event and stay away if the test is positive and/or they have any cold symptoms. You should warn all your invitees that there will be unvaccinated guests so they can decide if they want to attend.

3a: If you will have elderly grandparents or friends/family with compromised immune systems with you, I suggest you tell the unvaccinated that they would be putting others at risk and that while you hope to see them next year, they are not welcome this year. There is always Zoom.

Prescription for Bankruptcy. Buy the book on Amazon

Wednesday, November 3, 2021

Medical Debt

I have not yet seen a pig fly, but I did recently see something I would have felt just as unlikely: a front-page story in the Rupert Murdoch-owned Wall Street Journal that could have been written by Bernie Sanders.

The headline read “$100,000 in debt: arbitrary hospital prices hit some hard.” It was the story of a hard-working South Dakota woman who died of cervical cancer after a long series of tests and treatments who was forced to use up all her retirement savings to pay down her medical debt. (Unmentioned was why this woman did not have the routine medical care that should prevent most women from dying of this disease that is easily cured when found early.) (may be paywall)

The article described the random and arbitrary nature of hospital pricing and how people with different health insurance plans might have dramatically different out-of-pocket costs for the same tests at the same hospital. It also emphasized how little control most people had over their medical costs. Many hospitals charge their highest prices to patients when a procedure is not covered by their insurance plan.

Standard right-wing dogma is that health care is “just another consumer choice,” whose pricing should be left to the marketplace. Omitted from this thinking are such factors as limited choice (the woman in the story lived in rural South Dakota with only one hospital anywhere close), the fact that very sick people are rarely in a position to negotiate prices and the incomprehensible pricing structure used by most hospitals.

Couple this story with research published this summer showing that U.S. debt collection agencies held $140 billion in unpaid medical bills last year and you have to ask why people are not out in the streets demanding change.

In part this is probably because medical costs hit the poor hardest: 35% of people living in households with an annual income below $24,000 reported skipping medical care because of cost versus 7% of all those with incomes under $180,000. The poor, with day-to-day worries about paying for food and utilities, are the least able to work for political change.

In the long run, we all pay. One in six patients with heart failure reported skipped or delayed medical care because of cost, and this was associated with higher overall spending because of increased hospitalizations.

The mark of a healthy society is how it cares for its most vulnerable citizens. By this measure, we are failing. When the dust settles in Washington, it is time to take up the cudgel again and fight for affordable care for all.

Prescription for Bankruptcy. Buy the book on Amazon