Are US hospitals in trouble?

Many hospitals, especially more rural ones, have been in trouble for some time. More on the rural hospitals later.

“More than 33% of all hospitals are operating on negative margins, according to the American Hospital Association,” per Michael Popke of Benefits Pro in a piece called “America’s hospitals facing ‘massive growth in expenses’.” Here are two select paragraphs from the piece that tell the gist of the story.

“Hospital employment is down approximately 100,000 from pre-pandemic levels, while hospital labor expenses per patient through 2021 were more than 19% higher than pre-pandemic levels. A new report from the American Hospital Association highlights the financial and operational toll the pandemic and inflation has taken on hospitals — concluding that more than one-third are operating on negative margins.

‘Hospitals and health systems have been nimble in responding to surges in COVID-19 cases throughout the pandemic by expanding treatment capacity, hiring staff to meet demand, acquiring and maintaining adequate supplies and personal protective equipment to protect patients and staff, and ensuring that critical services and programs remain available to the patients and communities they serve,’ notes the nine-page report released this month. ‘However, these and other factors have led to billions of dollars in losses over the last two years for hospitals.’”

Per an article called “The South’s health care system is crumbling under Covid-19. Enter Tennessee” by Daniel Payne of Politico, the demise of heath care in more rural areas has been exacerbated by COVID-19.

“Rural hospital closures have been accelerating, with 181 since 2005 — and over half of those happening since 2015, according to data from the University of North Carolina. But that may be just the beginning. Over 450 rural hospitals are at risk of closure, according to an analysis by the Chartis Group, one of the nation’s largest independent health care advisory firms.”

The rural hospital concerns predate the advent of the Affordable Care Act. Too many hospitals had high percentages of indigent health care costs, meaning people without insurance. If they were not funded by a county, the hospital was at severe risk of closing. Since fourteen states have still not expanded Medicaid under the ACA, the opportunity for getting paid did not increase and many have closed. And, the patients, employees and communities suffer.

Yet, a major part of this cost dilemma existed before COVID-19. The US has the most expensive health care system in the world, but we rank around 38th in health care quality. That is a pretty poor rate of return on one’s spend. Hospitals spent too much on technologies that need to be used. There exists a correlation between the ownership of a technology and its higher frequency of use. Yet, with COVID-19 and its aftermath, fewer elective procedures and tests were done in hospitals.

These issues need to be evaluated outside of the political lens and with data. Yet, that is not bound to happen. It would at least be helpful to see more people covered with full Medicaid expansion, but that has been politicized for zero-sum game reasons, not to actually help people. It would be helpful to see Medicare expanded, at least down to age 62 from 65. As Medicare works reasonably well, I would like to see it go lower, but whatever we do, it should be evaluated on its results, not a politician’s beliefs.

If people think I am unfairly picking on politicians, it would not be a stretch to say most politicians do not know a whole lot about health care. We saw this with the atrocious “throw stuff against the wall” repeal and replace discussion in 2017 by the thirteen Republicans, which came within one vote from passing the Senate. That would have screwed about 20 million Americans. Senator John McCain gave it a thumbs down vote for its lack of veracity and its poor protocols on evaluation.

And, we saw it with the discussions and passing of the ACA, which Republicans refused to vote for which is strange since it has several Republican ideas in it from Romneycare in Massachusetts, when Mitt Romney was governor there. The ACA is not perfect, but at least we should fully implement it and shore up its deficiencies. It is only people’s lives.

The Premonition: a Pandemic Story by Michael Lewis is a must read

“You cannot wait for the smoke to clear: once you can see things clearly it is already too late. You can’t outrun an epidemic: by the time you start to run it is already upon you. Identify what is important and drop everything that is not. Figure out the equivalent of an escape fire.” 

“James,” she asked, “who exactly is in charge of this pandemic?” “Nobody,” he replied. “But, if you want to know who is sort of in charge, it’s sort of us.” from a conversation between two members of an informal cadre of doctors trying to get to the bottom of things that had no orders to do so from their bosses.

These quotes are from Michael Lewis excellent book on the COVID-19 pandemic called “The Premonition: a Pandemic Story.” Lewis has written another well-researched book breaking down complex topics into a story the reader can understand. He has written about the housing financial crisis in “The Big Short,” baseball’s embracing of data to change the paradigm in “Moneyball,’ how we make decisions in “The Undoing Project,” and how unprepared we were during the Trump presidency in “The Fifth Risk,” among others.

From the inside flap to the book, “For those who could read between the lines, the censored news out of China was terrifying. But, the president insisted there was nothing to worry about. Fortunately, we are still a nation of skeptics. Fortunately, there are those among us who study pandemics and are willing to look unflinchingly at worst case scenarios. Michael Lewis’ taut and brilliant nonfiction thriller pits a band of medical visionaries against the wall of ignorance that was the official response of the Trump administration to the outbreak of COVID-19.”

The book highlights an informal cadre of doctors, data scientists, and epidemiologists who dig deeper into news and data to realize we have an exponentially growing pandemic which is akin to a wildfire. If you do not act early and with strong interventions, it is hard to contain. These folks are acting without permission from their various jobs in governmental health care positions, but share communications regularly even when those communications could get them fired for going against stated public stances.

Several in the group came together at the behest of President George W. Bush after he read a book about the risks of a pandemic to a country like the United States. He formed a pandemic planning team that pulled together resources who had a reputation for solving problems in health care, breaking down preconceived notions. And, they wrote a pandemic response plan after doing much research about the failures and successes in fighting the Spanish Flu outbreak. They actually used data to turn that story on its ear.

While a few stayed around in the administration during the Obama years and were of benefit during other pandemics, they were long gone during the Trump administration who felt the greater risk was from a military or terrorist action. So, they went back to their health care related jobs. That was until they started to see reports out of China and dug deeper.

They saw global exposure and used previous exponential pandemic growth to ascertain that we could be looking at 350,000 US deaths. The key is they made this observation in mid-January, 2020. What they learned later is the exponential growth factor from COVID-19 was higher than that of other diseases. Carter Mecher, the informal head of this group who called themselves “The Wolverines” after a Patrick Swayze movie called “Red Dawn,” noted by the time the president closed incoming travel from China, it was too late as the pandemic had already reached our shores. By the time the US had its first reported death on February 26, it was masking the fact 200 others were already dying.

Acting quickly without all of the data is key as per the quote above. A key data driven lesson from the Spanish Flu response is social distancing, especially with children, is essential. The first thing they would have done is shut the schools down. Why? Kids average a distance apart of only three feet, while adults have wider distance. Kids will transmit any disease faster than adults. This practice was done in some cities during the Spanish Flu outbreak and the data showed it worked, whereas other cities who did not act like this, had worse pandemic responses.

This cadre started getting attention of others beneath the president and in governor’s offices, including Dr. Tony Fauci. So, their informal calls and email chains kept growing. They were the only folks who seemed to know what they were talking about. We also learned the CDC is not the best agency to manage a pandemic, as it is more of a research and report writing entity, not a nimble management group. One of the members of the informal team worked for the CDC and her bosses did not know she did, e.g. Yet, the CDC and White House administration staff would not go against the public positions of the president. Perception mattered more than fixing the problem, so needed change and actions could not get done. In fact, some of these officials encouraged them to keep going, even though they knew the president was not the kind of person who they could contradict without repercussions.

So, at a time when we needed to move quickly, people in positions of authority stood in the way of those who were begging with them to act quickly. A good example is in a public health official named Charity Dean in California, who was used to acting quickly when she saw potential outbreaks, often risking her job in so doing. Her boss came from the CDC and was towing that party line, yet Dean had been drafted into this informal group “The Wolverines.” While her boss disinvited her from internal pandemic meetings, she kept learning and sharing information with the group. Eventually, her boss could not make a press conference with Governor Newsom, and Dean spoke for 45 minutes of her concerns answering many questions. The press said this is the first time they have heard this. The governor acted quickly.

The book is a must read, in my view. It shows how important leadership is in welcoming information from reliable sources to make their decisions. It also shows how important courage is to tell leaders what they need to hear, not what they want to hear. As I read this book, I kept thinking how the former president craves being seen as a good leader, but at the time when we needed him to be one, he whiffed at the ball on the tee. A key to pandemic responses is to tell people the truth – only then will they act. When the so-called leader is telling them it will all go away soon on the same day the first US death is reported or that this is a Democrat hoax, then people hear that and act accordingly. The problem is those statements were far from the truth.

That COVID thing bit us, but we are all OK

The end of 2021 and beginning of 2022 has been made interesting by our little COVID friend. I mentioned how my oldest son was exposed to a person with COVID two days before Christmas, who frustratingly told him they (I am not certain of the gender) had it after handing him a cup of coffee. While he initially tested negative, he later tested positive. As he was feeling fine between the two results, against my better judgment, he joined us for Christmas Eve dinner and present opening while my daughter was here.

On Christmas day, he let us know he was starting to feel poorly, so he stayed home. While he had his first two vaccines as have other members of my family, he had not had the booster yet. My sister, who lives close by, and I had the booster as well. She joined us for Christmas day and was here when we found out he was getting sick.

My wife, other son and sister tested negative and are feeling fine. My daughter and I tested positive. The good news is all three of us are feeling better and COVID is hopefully in our rearview mirror, although I am still quarantining to avoid infecting others in and out of the house. The vaccines and booster helped us stave off the worst effects, plus we did read the Omicron variant is less severe, even though it is more easily spread.

The symptoms varied a little for the three of us. My throat was sore and I did have a little chest congestion, but mostly because of head congestion draining. I took Acetaminophen and Mucinex (I did speak with a nurse) and drank lots of water and rested. Even though I was little more tired, I was able to continue light exercise which helped with being stir crazy. I started feeling better about two days after being tested positive and a week after exposure. Now, I am taking the occasional Acetaminophen, but stopped the Mucinex after two days as I hate the way it makes me feel. (note some Mucinex has Acetaminophen in it, so don’t overdose).

My son was feverish, had some chest congestion and a sore throat. He did take some Mucinex, but focused on the Acetaminophen. My daughter was feverish, had head congestion, and sore throat as well. She did the same treatment. And, they both are on the upside of the equation now and are feeling fine.

My other son who tested negative postponed his booster for about a week so as not to infect others, just in case. He and my wife avoided any of the symptoms and felt fine throughout. He got the booster last night. My wife is getting her booster on Friday.

I again encourage folks to get vaccinated and/ or get the booster when and if due. I saw an ER doctor in an interview who said we are only seeing patients come in with COVID who were not vaccinated. That is telling. And, I shared earlier my frustration with an acquaintance of my oldest son’s who went into work sick and only told him after an interaction. We must take care of ourselves and each other to keep this thing from taking more than 800,000 Americans and 5.4 million people around the world it has.

Best wishes to all for the New Year and be safe.

Be kind, be safe, be wise

With a new holiday season upon us as well as a new variance of COVID, we must remain cautious. My wife and I just learned her cousin and her cousin’s husband have now contracted the virus, with her cousin in the hospital getting treatment. Both were naysayers and neither got the vaccine. This makes us sad and concerned, and we are hoping for a recovery.

Since we Christians are celebrating the birth of Jesus in a few days, let me take a few minutes to encourage the deployment of the following three “wise men.” In my story, these three magi are kindness, safety and wisdom. Be kind, be safe, be wise.

Be kind. One of my favorite quotes is do not mistake kindness as weakness. As we travel and intermingle with others, do what Baby Jesus taught us later in life – treat others like you want to be treated. This rule is so important, Jesus called it “golden.” Jesus had no caveats regarding being selective or discounting those who are perceived enemies. And, Jesus was no weakling, as he agreed to be tortured to save us from ourselves. Please think of these golden words when you are considering being a jerk to someone because you do not like the rules you should have known beforehand.

Be safe. There is no plan B. You and your family only have one life. So, be safe. The best piece of advice I heard is you are better protected against COVID if you practice all of the layers of protection. Be vaccinated, get the booster, wear a mask indoors, practice safe distancing, and wash your hands. If not for you, think of your children. I would hate to have a loved one die from COVID. I would hate it even more, if they chose not to get the vaccine only to realize too late, they were just being stubborn as six naysaying radio shock jocks realized. It is akin to the people who died from AIDS who chose not to use condoms after clearly learning how it was transmitted.* It makes you sad.

Be wise. There are many people smarter than me. Full stop. But, I do know when people realize how much they still don’t know, they have reached a stage of enlightenment. I see way too many people speak with certainty about things they should not, me included. Please do not take my word for anything. I am sharing my opinion. Do your homework through reputable sources. Speak with your doctor. This is especially true if you have other medical issues you are dealing with. We will continue to restrict our travel. We have not been on plane since before the pandemic. Yet, we do drive and take day trips.

So, during this holiday season and even afterwards, be kind, be safe, be wise. That is the best gift you can give you and your family. Peace be with you.

* Note: It should be noted for the longest time, it was unclear how AIDs was transmitted. Because of this, there was a lot of confusion and misinformation bantered about and people died. Lessons were learned and eventually communicated, but once it became clear that using condoms helped, it would have been a community service for the wider dissemination of that information and free condoms – these last two tools were deployed in Third world countries to much success.

Vaccine Booster Done – no worries

Yesterday, I received my COVID booster shot, a third shot from Pfizer. So far, there have been no worries except some expected arm pain, but I will provide any updates later, if circumstances change.

I am aware of several folks who have received the booster, with two experiencing some tiredness. As with the first two vaccines, I encourage folks to get the booster. If people have not gotten the first vaccines, I urge folks to move forward.

Too many folks have died from COVID. And sadly, too many vaccine naysayers have passed away, recognizing only at the end their error in judgement. Are the COVID vaccines perfect? No, as are all other vaccines, medicines and surgeries – just read the possible side effects on any drug description.

Yet, those who have had issues with the COVID vaccines, may seem like a lot, but when compared to the number of vaccines given are a very small percentage. That does not diminish the angst or poor experience of those folks. But, we need to keep these results in context, noting the huge percentage of positive experiences.

As before, please do not take my word for it and check with your own doctor. Be safe. Be healthy. Stay alive.

I am thankful (a reprise)

The following post was written nine years ago. We are up to 36 years of marriage and are now retired, my mother has since passed due to Alzheimer’s complications, our children are now adults, my sister moved up here to be close by and the summer moments have subsided for the most part, we think.

In the quiet before we continue our preparations for the feast and family arrivals this Thanksgiving, I wanted to share a few thoughts to my blogging friends. Please feel free to respond with your own as we have a nice community that comes together on-line from around the planet. I have seen other comments and stories on their blogs, but always welcome the company here. I am thankful for….

– my bride of 27 years. We ying and yang pretty well together on our journey. We are both dealing with her extended “summer moments” as she calls this phase of her life. I end up wearing more sweaters as she freezes us all to stay cool, but she in turn deals with my many issues and imperfections and has for years.

– my healthy family of five; we are far from perfect, but we do the best we can. And, when we fail, we help each other up and encourage us to do better. I tell people who are expecting their first child, you never know how much your parents truly love you until you have a child of your own. My cup runneth over with three.

– my mom. My dad has been gone for six years and is remembered well. She is teacher for life, both to her former students, bible study class and her children. Mom, you are the best.

– my sister who moved back to live with my mom. For adult daughters who can envision living with a parent as an adult, you can appreciate my thanks to my sister and wish for her the patience of Job, wisdom of Solomon and the space for her time.

– my new teammates at work. I left a bigger company with many bureaucracies and listmakers who wanted to tell people who knew what they were doing, how to do their job. I am now with a small company who has people who know what they are doing and we try to do something unique – provide the opportunity to do their job.

– my former colleagues at my old job in my office and around the world. You are the company, not that bureaucratic mess. Good people over come bad structure, but it should not be so hard. I miss the ones who gave a damn about serving our clients and each other.

– my friends and relatives. It will be great to see many of them today. And, although I am not in touch with friends like I should, I remember them well. Plus, my new job allows me to see more work related friends and colleagues. That is very nice.

– and, finally, my new blog friends. I enjoy reading what you think, how you think, what you believe and your life based context for these perspectives. I very much enjoy your reflections on your history and current joys and challenges. Keep on writing and I will keep on reading and offering a comment or two.

Happy Thanksgiving. This holiday is truly what is best about America. The others pale in comparison. I hope people around the world have something similar they can call home.  Best regards to all.

Quick update from Jill

With Jill’s permission, here is an update she sent me earlier today. Please keep her in your thoughts and prayers. She is a true gem and her words and spirit are missed.

“Despite all the docs, all the medicine, I seem to be getting worse rather than better.  I have an appointment with a different cardiologist next Monday and we’re desperately hoping for some answers and a solution.  I miss my blogging friends and keep trying to write a post, but after just a few minutes on the computer I’m thoroughly exhausted. 

Thanks so much for caring …”

Here is a link to the next to last post on Jill’s blog where she gave an update about two weeks ago.

Really?

Just a few very puzzling things that require some response.

While I am not a huge fan of Senator Lindsey Graham, I did call to thank him for being on the side of the Angels. I try to call to thank legislators to balance out when I call to ask them to change a position. What did the Senator do? He stood up in front of a Republican gathering in his state of South Carolina and recommended that folks consider getting vaccinated for COVID. And, he was booed. He tried to water down his recommendation and was still booed. He tried a third time and was still booed. Really?

This followed on similar recommendations by Reverend Franklin Graham, another person I am not a huge fan of due to his bigotry, but who nonetheless has done some good things in the world. Graham wrote about getting the vaccine online and he was promptly vilified by his primary audience for so recommending. The retorts were less than Golden-rule like from this religious audience. Really?

Now, I have read that teachers are getting death threats for being worried about teaching when their is no vaccine requirement for the school. Death threats. Teachers. Really?

I recognize that people have been led to tap their innermost feelings for something which should be so simple. I also realize that only a small group of people would actually be troll-like enough to offer death threats – these folks being hateful. But, it is the folks booing people for having the temerity to try to save their lives by suggesting getting the vaccines which stymies me. Booing. Really? Why?

A brief thought – err on the side of caution

I am off to a doctor’s appointment in a few minutes, but wanted to capture a brief thought. I am reading several school boards in Florida will be ignoring Governor DeSantis’ rule that there will be no mask or vaccine mandates. In response, the governor has said he will hold back pay of superintendents who violate his rules.

The lesson that continues to be failed to learn by governors like DeSantis and Abbott over in Texas among others, is with respect to community health, we must err on the side of caution. With respect to children’s health, we must err on the side of caution.

Of course, they took their lead from the former president who put people in danger after he knew of COVID-19 danger inviting them to events, calling it a hoax, and naysaying its severity. And, these were his biggest fans.

Now, we have a rising COVID Delta variant that is plaguing the unvaccinated, primarily. The risk of exposure exists now as much as ever. We must be mindful of these risks.

The military is mandating vaccines, but over 1 million military members have already been vaccinated, which us a huge start. Speaking of military, I have quoted my veteran US Air Force brother-in-law who simply said, “You are not being asked to storm the beach at Normandy. Wear a mask. Get a vaccine.”

This is not a civil liberties issue, this is a public health issue. We must err on the side of caution. It is only your health and that of your family.

A Tuesday tale

I met with an old friend last week for lunch. He was visiting his daughter and we decided to get together, masked appropriately. He shared a wonderful story that I hope will warm your heart, as it did mine and my wife’s when I told her.

He said his daughter is a specialized nurse. He and his wife had adopted both of their children in their first week. For medical history reasons, his daughter wanted to find out about her birth parents. He gave a nice piece of advice to be prepared for the consequences which may not turn out like you want.

He went on to say she was adopted when they lived in Ohio, who changed their laws to allow for open records, provided the birth parents did not specifically say no during the transition form sealed records.

After much legwork given a common name, they found the birth mother and father. It turns out the birth mother was also a nurse and her father was the doctor her mother worked for. It was the mother who turned down the doctor’s proposal to be married, so they put the child up for adoption.

So, if that does not give you enough tingles that people she never met were also in the medical field, the next item might. We live in North Carolina, not Ohio. And, the daughter does not live in her home town having moved within the state. It turns out the birth mother lives nine miles away from the daughter.

The rest of the story remains to be told. I will add the mother who raised her is in medical research, so her daughter’s interest is most likely due to her influence and example, but DNA to help others might have also been a factor.

The story is not intended to judge anyone’s motives or reasons for placing a child in adoption. We do not know the circumstances or history of those involved. I would only surmise decisions like this must be difficult.