Coronavirus (Sports-Related and General)

LoneStarPhan 2020-06-15 22:08:27 UTC #1305

I did read that some states were limiting sales to "essentials" but really that just causes tremendous headaches for everyone. Customers get mad and stores may not be consistent in what is and is not essential. Every supermarket these days sell things that are not food. Where do you draw the line?

One thing we saw here in Texas was the laying off of health care workers and closing of clinics and small hospitals, some in areas not experiencing much COVID activity. With a ban on much of what these facilities rely on to pay the bills and the reluctance of people to go to emergency rooms even with conditions that could be legally treated, business was way down for some medical facilities.

Regardless of what is or is not done, there will be many who disagree and there will be unforeseen consequences. I am afraid we will see more difficult times in the months (and years) ahead.

zambonir 2020-06-15 23:15:48 UTC #1306

This all comes back to the fact that people weren't supposed to be out shopping for non-essential items anyway. You were not supposed to go to the toy store. And most of the big stores were offering pick-up, delivery and shipping, so your kid wasn't going to go giftless.

Shipping is a whole other ethical quandary, putting warehouse and delivery workers at risk, but it is what you were supposed to do, while not running errands at all more than once a week. (Only exception, if you're really not able to cook for yourself or your family.)

The real reason things shouldn't be opening so fast is people should still be able to get their unemployment benefits instead of going back to work. The rules that are in place for most small business are still untenable for both the owners and the employees. Not enough profit, not enough money to pay all the employees, not enough space for them, and ultimately not enough customers even if there were no other restrictions. That's not going to change any time soon.

The health care issue itself is fascinating. On the one hand, some people couldn't get very necessary attention, and all those workers were laid off just as surely as if they were bartenders. On the other hand it highlighted how broken the for-profit health care model is, and the fact that unnecessary treatment is also a problem.

julio 2020-06-15 23:31:21 UTC #1307

Isn't it remarkable that so much of our society's health care system relies on elective procedures in order to maintain profitability?

"Elective" is a synonym for "unnecessary." Just so there's no confusion. Hospitals, which have been swallowed up by for-profit conglomerates (or officially "not-for-profit" conglomerates that pay their executives and behave as if they were for-profit), cannot survive by delivering necessary critical care. Their survival is dependent on lucrative "elective" procedures - largely surgeries - that may contribute little to peoples' actual health. Heck of a health care system we've got here, eh?

Living in greater Philadelphia - how much of our various world-class hospitals' budgets gets spent on advertising? On competing with one another to persuade patients to "choose us" for an elective surgical procedure?

It's seriously broken. Frankly, apart from the short-term problems if hospitals close and essential care cannot be obtained, a lot of these companies (that's what they are) can just as well go under. That's an appropriate outcome for businesses that are run rapaciously, that spend inordinate amounts of money on advertising and executive pay, that compete with one another to sell people things they don't need. The investors who have been milking this system? If they lose their investments... I can't say that troubles me.

LoneStarPhan 2020-06-16 00:52:14 UTC #1308

No doubt we have room for improvement in health care in this country.

For the 80 days between my store outings, we had a daughter that did a grocery run for us each week. I also did order a number of items to be delivered and about two weeks ago, we had a small order from Kohl's that we picked up at the local store (pull into parking spaces for pick ups and worker in mask comes to car and puts order into back or trunk. My daughter did the same thing for something from Best Buy. Some stores were limited to only pick ups or deliveries until the limited reopening started in late May.

I am not sure what the guidelines were on buying at the big box stores but I do know that they did not restrict the items people could buy, so toys and tools and everything else was available.

As for baseball, each day with no agreement or plan makes it a little harder to do anything meaningful this year. I don't know what happens when players test positive for the COVID. Reports here are that E. Elliot and some other Cowboys tested positive. Probably same group seen partying and working out together during the heavy lock down period. Too many people just don't think they need to follow the guidelines/rules. If the NFL goes forward toward the normal season, they may need expanded rosters and taxi squads to fill in if players have to be isolated for a couple weeks.

zambonir 2020-06-16 01:04:26 UTC #1309

The plan for sports really does seem to view positive tests as an inevitability. I just don't see how they can actually stop spread (even if all the young healthy athletes don't get sick) or protect the non-players.

bkox 2020-06-16 02:18:55 UTC #1310

This isnt always true. I'm morbidly obese. If/when I ever get this weight off I will need skin removal surgery. Even though that approximately 40 extra pounds of skin will affect my walking (especially with a prothesis) and can cause other issues... I've been told that this surgery is elective and cosmetic and will not be covered by insurance unless I can prove it to be life threatening.

Even my hernia is considered elective unless something happens with it.

julio 2020-06-16 02:35:40 UTC #1311

Fair points, bkox.

Jeff05 2020-06-16 02:54:56 UTC #1312

Does the US public healthcare system have levels of elective surgery like we do in Australia? It's effectively a system of triage. According to a Parliamentary Library paper,

Elective surgery is not, as its name may imply, non-essential or cosmetic surgery. It is surgery that a doctor or health professional believes to be clinically necessary, but which can be delayed for at least 24 hours. Much elective surgery, for example, coronary bypass surgery is therefore important to maintain health and well-being. In contrast, emergency surgery, for example, for critical cases such as a car accident, poisoning or heart attack, is undertaken when the patient s life or physical integrity is in immediate danger.

In reality, surgery is triaged regardless of whether it is classed as emergency or elective. Waiting lists in Australia's public healthcare system are also long! If you've got private health insurance in Australia - as my family does - and you require elective surgery, you are usually better off seeing a surgeon who works at a private hospital to speed up the process. Fortunately, many leading surgeons (and gastros!) in Australia work in both the public and private sectors.

zambonir 2020-06-16 03:21:18 UTC #1313

Yeah, elective includes a lot of legit stuff. Removing a lump that may or may not be cancerous, torn ACL, stents for heart disease. For sure some people have suffered without it. But the larger point also remains about the profit motive in American medicine. And some people don't actually need to get that ACL repaired (if they are not athletes). A lot of studies show stents don't do anything. So it's all very complicated really. There will certainly be studies done to see what impact the last three months had - both people who suffered and people who realized they didn't need the care.

Lawman 2020-06-16 03:23:32 UTC #1314

Not entirely true, although I get the point you're making. Cancer hospitals - not elective treatments by any stretch of the imagination - constantly run ads to tout their services. And, elective can mean unnecessary or it can mean, as I understood it to be used in the context of CV-19, as not needed this minute as life threatening (i.e. knee replacement)>

schillingfan 2020-06-16 03:25:56 UTC #1315

I can’t go anywhere in public without a shirt because I have breasts. That’s an infringement on my freedom and sex discrimination /sarcasm. At my age the sight of my naked breasts might be unpleasant, but not deadly to others.

zambonir 2020-06-16 03:33:22 UTC #1316

You could in most of the cities I've called home!

Purduke 2020-06-16 12:48:21 UTC #1317

Lawman:

julio:

"Elective" is a synonym for "unnecessary." Just so there's no confusion. Hospitals, which have been swallowed up by for-profit conglomerates (or officially "not-for-profit" conglomerates that pay their executives and behave as if they were for-profit), cannot survive by delivering necessary critical care. Their survival is dependent on lucrative "elective" procedures - largely surgeries - that may contribute little to peoples' actual health. Heck of a health care system we've got here, eh?

Living in greater Philadelphia - how much of our various world-class hospitals' budgets gets spent on advertising? On competing with one another to persuade patients to "choose us" for an elective surgical procedure?

Not entirely true, although I get the point you're making. Cancer hospitals - not elective treatments by any stretch of the imagination - constantly run ads to tout their services. And, elective can mean unnecessary or it can mean, as I understood it to be used in the context of CV-19, as not needed this minute as life threatening (i.e. knee replacement)>

Not true at all. An elective procedure\surgery is simply one that can be scheduled -- it is not an emergency. Think knee replacement, as you mention. Not unnecessary -- just so there's no confusion. A semi-elective procedure is one that can be scheduled, but without which the patient will die. Think triple-bypass surgery. Definitely not "unnecessary" I would think.

The rest of Julio's offering is equally off beam. The reason hospitals rely so much on the "elective" procedures they perform is because they need "third party insurer" volume to survive. It's widely accepted that Medicare re-imbursement rates are so low that they effectively shift a sizable portion (I've read up to 60%) of elderly healthcare onto working third party insurers\employers. The CBO did an analysis of reimbursement rates in 2017 that indicated that on average third party insurers were paying 200% to 350% of Medicare reimbursement rates for about 20 or 30 of the most common "high cost" hospital procedures. Things like heart surgeries, knee replacement, cranial MRI etc. Compound that with the fact that all Covid work is reimbursed to the hospitals at Medicare rates, and you put a huge hole into hospital econ.

Which also likely explains the economics supporting the advertising -- it is all about yield management. When you are in a high fixed cost business it is all about throughput. If you are an airline it is about filling the seats; run a hospital and it is all about filling the beds. But that doesn't mean hospital economics are an attractive investment. When's the last time Blackstone bought a hospital?

andyb 2020-06-16 12:58:05 UTC #1318

Not quite as simple as that as the desire for profitability drives this behavior too, not necessarily the imperatives of public health.

Lawman 2020-06-16 13:40:17 UTC #1319

There's an off color joke to be made in here somewhere, but I'm too polite to make it.

Lawman 2020-06-16 13:43:06 UTC #1320

I used to work at Memorial Sloan Kettering in NY. The hospital was always against a single payer insurance system, although did advocate for universal coverage. The reason being was that MSK is a no-for-profit w/ their biggest income coming from donations - in fact the hospital business unit with the largest budget was marketing. They really needed insurance payments to cover cost of treatment so they can use donations to fund the cancer research operations. The payments from government were too low to fund the cost of treatments.

donaldorc 2020-06-16 17:26:59 UTC #1321

With all due respect, CD, blaming the spike in those states on Mexico is not looking at the total picture of where the spikes are occuring. ALL the southern states, MOST without a border with Mexico are showing spikes in COVID cases. https://graphics.reuters.com/HEALTH-CORONAVIRUS/USA-TRENDS/dgkvlgkrkpb/index.html

California_Dreamin 2020-06-16 18:07:20 UTC #1322

donaldorc...thats not me talking, thats California, Arizona and Texas talking. And believe me, our Governor Newsome has no reason to suggest this if its not true because of his big support for immigration from Mexico into California. And while positive cases in California are climbing the percentage of positive tests isn't...its still 4.1 per 100 tests, a solid number. And again, thats not me speaking, thats the Governor, per his press conference yesterday.

I have also been following the Arizona cases closely and while they are growing, the state continues to say that its a combination of more testing, dual citizens coming to and from Mexico, the opening of the state and people now going to the hospital for elective surgeries and getting tested and coming out positive while not being sick.

By the way, another excellent day yesterday, death number was 417 on a day [Monday] that normally sees very high numbers because of slow walking the count on weekends. Of even better note, one month ago [May 15] we saw a total of 2700 unfortunate souls pass, a terrible number. One month later, the numbers have dropped by 75%. And the numbers of recovered patients world wide vs active cases has now exceeded 800,000, a + rate that is growing by 100,000 a day. And as I mentioned, not even 3 weeks ago that number was in the negatives.

How anyone can not acknowledge this is all exceedingly good news would be so very strange to me if this was merely about the virus, which I do not believe. The press finds a state/states that fit their narrative and continue to sound like Chicken Little while almost never presenting the good news, of which there is much.

Again, look, I understand that the virus is still with us, care will still have to be taken that things continue to move in a positive direction and that Citizens Bank Park is not close to ready to welcome back 45,000 fans. I get it. But to be unwilling or unable to see all the good news surrounding this virus nation wide seems sad and unnecessary to me. Virologists throughout the world say the virus is weakening, just like all past coronavirus strains have.

I believe its time to put the umbrellas away, the black cloud is dissipating.

Purduke 2020-06-16 18:48:11 UTC #1323

I'll have to admit that this isn't my industry, so my thinking probably tends towards being superficial. But I think that the public health imperative thing has the ring of many public-service or public-union shields -- namely, the "We're pure because we're non-profits" and "they're evil because they make profits" credo. I think the non-profit thing these days is just another part of the advertising budget intended to inure themselves to a particular part of the population and perhaps ceratin politicians too. You're probably aware of the joke "What's the difference between a non-profit hospital and a for-profit hospital?" One pays property taxes and the other doesn't.

The following is from Healthcare Deep Dive:

**A study by researchers at Yale, University of Pennsylvania, Carnegie Mellon and the London School of Economics looked at how nonprofits charge, and found they don’t price any less aggressively than for-profits, a finding that prompted study co-author Zack Cooper, of Yale, to write: “We subsidize not-for-profits to the tune of $30 billion annually, in the form of tax exemptions, and we have to ask what that money is getting us?
** Not much.**
** But it could. A few years ago a business columnist at the Orlando Sentinel looked into what Advent Health (formerly Florida Hospital) and Orlando Health, another nonprofit hospital in the same community, would pay in property taxes in just five Central Florida counties. The reporter found that if these institutions paid property taxes alone, the community would net an additional $45 million a year. **
** In a mid-sized metro like Orlando, $45 million would pay for a lot of schoolteachers, police officers, and, yes, community health care and financial aid for those who need it.**
** But instead the community has seen medical costs go up, property taxes increase, health systems get bigger, and healthcare executives get richer.**
** Nonprofit hospitals also use their tax-free surplus in more insidious ways. They use it to buy up independent medical practices in their communities, and turn independent doctors into employed physicians. This consolidation decreases market competition and increases the hospitals’ market power, meaning they can negotiate higher payments from insurers. It also allows them to layer in facility fees, which independent doctors don’t charge. These added fees cause costs to increase three to five times. Oh, and the taxes those previously independent medical practices used to pay into the community? They all come off the tax rolls. **
** One way nonprofits hospitals get away with this is by using Chargemaster prices when filling out the charitable contribution section on their 990-tax forms. These are made up prices that nobody actually pays that are many times higher than what commercial insurance or Medicare would pay for the same service or procedure. Because nonprofits can make this number up, they can inflate how much they “give back” to the community as much as they want.**

I post this because that is what has been happening in the Hartford market. All six of my physicians used to be in independent practice, say 8 years ago. Four of their practices are now owned\operated by Hartford Healthcare, a local non-profit and now negotiate their rates under their umbrella. Three years ago HHC was locked in a dispute with Anthem about billing rates. Anthem wanted lower rates and therefore didn't renew their contract, effectively shifting all of their customers to out-of-network with HHC. HHC responded by not scheduling any appointments for out-of-network patients. The soccer moms went nuts, and of course, our Senators and Governor stepped in for every photo op for a month. The outcome: the contract was renewed under threats of legislation preventing TPIs from not renewing health contracts. So what is the value of a network -- how does a TPI even remotely try to control healthcare costs, even if they wanted to? Even if they are willing to incur the wrath of their customers to try to lower costs -- politics says they can't.

There may have been a day when being a non-profit hospital meant something different, something about "mission." But I don't think there are any Little Sisters of the Poor operating out there anymore.

andyb 2020-06-16 19:06:29 UTC #1324

I don't disagree with the cost pressures that you note, especially on non-profits. It is a more complicated discussion, but this crisis has not only created financial pressures, but also exposed some of the weaknesses in our current system. Without getting into a longer discussion about universal coverage, we clearly have a system where there are many holes in coverage, everything costs too much, and the incentives are mostly wrong.

There should not be a higher profit margin on some of these "elective surgeries", talking more about stuff like hip replacements than cosmetic surgery. But that is the system we have. Within the system it is biased towards people with better coverage (the corporate world which is healthier than the blue collar/gig economy world). When a health crisis like this happens these holes get exposed. We should not have a system where we weigh the ability to pay in the equation of whether to cover something, but we do.

The only reason we funded all the COVID coverage was because it was a public health emergency where people without good coverage would make people with better coverage sick if we did nothing. It was the right thing to do, but it just exposed lots of the weaknesses in the current system.