The Omicron variant appears somewhat less severe than previous strains of COVID-19, but it is still landing plenty of Americans — especially the unvaccinated — in the hospital.
Capitalism stands in the way of equitable health care in America. We are a laughing stock among European democracies. I feel for the doctors who are caught between hospitals, insurance companies, and Medicaire. We can do better than this.
Excellent and true article. Ive watched it all unfold during my 35plus years as a physician with the takeover of corporate and profit driven medicine. Venture capital and private equity have no place in healthcare, yet here we are.
Yes, my hospital system has the highest Covid admits of the entire pandemic right now. Care givers are burned out and disillusioned and the anti-science, political divide is responsible. We could have the greatest healthcare in the world. We have the resources. We have the commitment from health care professionals. Unfortunately we have the worst political system, driven by money and profit. Americans are suffering because of our political system. The demise of voter rights last night has sent many into despair. But we can’t give up. Yes it CAN get worse.
Thank you Dr for your invaluable testimony, and can-do attitude. We the people simply must get off our collective butts & advocate, organize, inform for change.
You need to understand that our US healthcare system is a major competitive disadvantage in the global economy. You cannot fight this issue on moral grounds but on business competitive grounds.
Healthcare like utilities needs regulation by setting baseline standards and setting profit rates.
So well said. Hospitals are also shoving patients out the door too quickly. An elderly friend was sent home too soon after her stroke and couldn't even walk or eat without assistance. She relapsed and was back in for another week to more fully recover. I'm old enough to remember when hospitals didn't do this...didn't send mothers home the day after delivery or a couple of hours after surgery. Patient care is based on the hospital's finances, not the patient's needs. Will we ever be able to go back to hospitals being public entities like 30-40 years ago?
My grandmother got breast cancer in her mid 70s. She had a double mastectomy and was sent home THE SAME DAY with a drain & instructions on how to clean it and little else. She was authorized for 2 aide visits per week. This was about 25 years ago when they experimented with mostly outpatient surgery in order to maximize profits. It was appalling,.
The US is a predatory capitalist environment with insufficient regulation because the predators own the legislatures. In Missouri, the 20-year gerrymandered one party legislature is owned by the insurance industry and today yet another bill is being crafted that will gut the funding for Medicaid expansion that the voters just approved via a hard-won ballot initiative and that would help keep rural hospitals open. Another bill kills ballot initiatives altogether, the only way Missouri voters have had to circumvent the one party legislature. Having just lost a court challenge to their defunding of Medicaid expansion they keep trying to persuade voters that we didn’t know what we were voting for. You couldn’t make this shit up.
And the great irony is that the poor rural whites who would benefit from Medicaid expansion are the ones opposing it. Because they'd rather see their own hospitals close down than see *their* tax dollars used to provide health care to Those People in the cities.
I worked for months as a volunteer gathering signatures for Medicaid expansion to be on the Missouri ballot. Our messaging was very clear and non-partisan and in personally speaking to poor rural whites, many understood the benefits when explained to them in a way that wasn't patronizing. The initiative passed with a 6-point margin in August 2020 but the gerrymandered Missouri legislature is well on the way to eliminating it through a budgetary device. Poor rural whites are not stupid, but they are also being cleverly manipulated on other divisive issues such immigration, abortion, gun rights, etc. etc. Sometimes it seems hopeless, but the pandemic has thrown all the traditional playbooks into the air and the new found willingness of poor rural whites not to put up with employer abuse and poor wages is encouraging. If I was a GOP strategist I would not take for granted that even gerrymandering will save them longer term because they are offering nothing of substance.
I have to wonder - is there any thing that private equity does that is good - the firms only seem to exist to prey on weak businesses and then kill them.
Sometimes private equity funds new businesses/ideas that go on to provide essential (not meaning COVID-“essential” just normal “essential”) services/products, and jobs, faster than they could get there on the capital otherwise available.
I appreciate that you’re tackling this, as lack of choice impacts in other ways, too. There are two primary providers in my metro area, and my health care coverage is only in network at the one that is religious, and moreso the last few years. They used to have a “sin room” for family planning before. Now they just wont do it unless there’s a separate medical reason for a type of care. And apparently this has been increasing at Catholic-run care facilities that many patients have to go to due to insurance or access requirements.
I had a "missed abortion" at 16 weeks. (Fetal death but failure to expel the fetus and placenta). This calls for a hospital procedure due to general anesthesia. Fetal death had been confirmed by ultrasound in my doctor's office. My network hospital was a Catholic run facilty. When my doctor called to set up the facilty, they wouldn't schedule until I had a second ultrasound by their facilty, as if my doctor and I were trying to sneak an abortion in. Fetal death was confirmed again, but they refused to schedule until one week later after a third ultrasound. By the time they finally did the procedure, I had a terrible uterine infection and had to stay 2 days to deal with that. Afterwards my insurance refused to pay for the 2nd and 3rd ultrasound as they were not medically necessary and they were duplicates. I filed appeals basically telling them that if they don't want to pay for these multiple procedures they need to contract with a nonzealot entity for reproductive services. I also refused to pay the copay for my 2 day stay as it was directly caused by the hospital. I won my appeal, but all of this was completely unnecessary and had to be endured while mourning a loss. Yet another societal example of religious adjacent businesses of all types being allowed to force their views on public consumers or deny services entirely.
My goodness, and I thought my experience (with infertility treatment that didn’t quite work - what a roller coaster) was bad. SO IMPRESSED/grateful that you pushed your case and won it.
Thank you for a well-researched article on this subject. I've been telling people to consider why hospitals were so close to the edge in the first place. While I believe strongly in vaccination, blaming unvaccinated people for the shortage of hospital beds ignores the underlying problem (and it's mean).
There are many reasons why people do not get vaccinated and I support your point. The main problem is disinformation about vaccines propagated by those who profit from it via social media. Alex Jones and his ilk would not be multi-millionaires if they pedaled truth.
This problem is not only limited to rapacious capitalists, however. I spoke recently with my friends in the Netherlands, who enjoy universal health care. They tell me that hospitals are overwhelmed there too, but one of the reasons is because bureaucrats reduced the number of ICU beds to six for all of the south of Holland. Therefore, draconian rules about gathering and even going outdoors have been implemented on and off throughout the pandemic.
I see this as a fundamental error in understanding public health and an over-reliance on a business-oriented world view. Human beings are biological organisms, not running shoes. The "laws" of supply and demand that may apply very well to factory-made objects simply don't apply to people.
I've always thought that it is immoral to make profit off of illness. Somewhere I read that it until the 70s there were regulations (laws?) that constrained hospitals from making money. Is that true?
Allowing health entities to profit from innovation is essential to the evolution of medicine and is not inherently a bad thing. However, the US health system is fundamentally flawed as shown in this article and has no prospects for change while the US population is at war with itself. The UK system, while far from perfect, is a hybrid system that delivers the best of both worlds and limits the scope for rapacious profiteering by design. All citizens have access to the NHS which is free from cradle to grave, but a thriving private health system operates alongside it and offers services to the NHS and an individual physician often works in both systems to everyone's benefit. The UK NHS was a product of the bombed-out wreckage of WW2. I cannot see any circumstances for the US to adopt such as system except as a product of a catastrophe that none of us wants to see happen.
Although, as the article suggests, we may already be seeing such a catastrophe happening in some parts of the US. (And we’re also already seeing a centralized response, namely 45000 troops being mobilized to shore up private hospital personnel in 24 states).
All healthcare institutions that deliver care directly to patients should be non-for-profit entities. But we don't actually have a healthcare system. We have a wealthcare system masquerading as one. It's too fragile to handle even a pandemic with a relatively low death rate. What happens when one comes along with a fatality rate of (say) 5%? I don't want to be around to find out.
We’ve seen this issue up close nationally since the pandemic rage began, and the problem can be as much about beds as equipment like ventilators or qualified medical personnel. I don’t discount the problem, the politics, the economy, the Capitalism, etc., but I’d like to take up the topic of variants. I’m healthy, vaxxed and boosted, and while I had relaxed my mask usage, since Omicron I wear N95’s exclusively and always when I’m in an indoor public place. With the rise of Omicron, I have heard it’s not as serious as Delta. I have also heard and read that we don’t track the Covid variant hospital patients have, we aren’t contact tracing, nor are we distinguishing patients in the hospital for reasons other than Covid who then test positive - they’re just lumped in with people admitted due to Covid. I try to stay in tune with the issues that create doubt in the science, and these things do. How can we accurately say anything about Covid hospitalizations, spreading, severity, etc., if we don’t have more precise data?
It’s off topic but yeah, the statistics we’re seeing seem pretty unreliable. There was an npr piece yesterday about the difference between medical examiners (predominate in cities, must be MDs I think) and coroners (elected, predominate in rural areas, no MD required). Made me wonder about the “COVID deaths” numbers I’m reading - given that people who have to stand for election may be more likely than appointments to try to tell voters what they think voters want to hear. Meanwhile the living are shielded by HIPAA requirements, so if anyone doesn’t want to admit they got COVID they won’t.
Many years ago, I read that "extra" hospital beds were being eliminated. I thought then, and I think now, that that was a really stupid move; what would we do if we needed more beds than we had? If all we can think about is money, we deserve what we get. Trouble is, the ones who suffer most are not the greedy ones squeezing the hospitals dry and then throwing them away, like the CEO in this article. He will always be able to find a hospital bed if he needs one.
Capitalism stands in the way of equitable health care in America. We are a laughing stock among European democracies. I feel for the doctors who are caught between hospitals, insurance companies, and Medicaire. We can do better than this.
Not with the current political system…Rs and Ds in the pocket of the corporations. Must get rid of these people. Please consider the Forward Party.
Thank you!
Can we also End Citizens United?
Excellent and true article. Ive watched it all unfold during my 35plus years as a physician with the takeover of corporate and profit driven medicine. Venture capital and private equity have no place in healthcare, yet here we are.
Yes, my hospital system has the highest Covid admits of the entire pandemic right now. Care givers are burned out and disillusioned and the anti-science, political divide is responsible. We could have the greatest healthcare in the world. We have the resources. We have the commitment from health care professionals. Unfortunately we have the worst political system, driven by money and profit. Americans are suffering because of our political system. The demise of voter rights last night has sent many into despair. But we can’t give up. Yes it CAN get worse.
Thank you Dr for your invaluable testimony, and can-do attitude. We the people simply must get off our collective butts & advocate, organize, inform for change.
You need to understand that our US healthcare system is a major competitive disadvantage in the global economy. You cannot fight this issue on moral grounds but on business competitive grounds.
Healthcare like utilities needs regulation by setting baseline standards and setting profit rates.
In fact, hospitals and health insurance carriers should be non-profits by law. As the latter once were.
The failure to expand Medicaid in North Carolina is a huge reason why rural hospitals have closed.
Ditto Missouri.
ditto Georgia
And South Carolina.
So well said. Hospitals are also shoving patients out the door too quickly. An elderly friend was sent home too soon after her stroke and couldn't even walk or eat without assistance. She relapsed and was back in for another week to more fully recover. I'm old enough to remember when hospitals didn't do this...didn't send mothers home the day after delivery or a couple of hours after surgery. Patient care is based on the hospital's finances, not the patient's needs. Will we ever be able to go back to hospitals being public entities like 30-40 years ago?
My grandmother got breast cancer in her mid 70s. She had a double mastectomy and was sent home THE SAME DAY with a drain & instructions on how to clean it and little else. She was authorized for 2 aide visits per week. This was about 25 years ago when they experimented with mostly outpatient surgery in order to maximize profits. It was appalling,.
The US is a predatory capitalist environment with insufficient regulation because the predators own the legislatures. In Missouri, the 20-year gerrymandered one party legislature is owned by the insurance industry and today yet another bill is being crafted that will gut the funding for Medicaid expansion that the voters just approved via a hard-won ballot initiative and that would help keep rural hospitals open. Another bill kills ballot initiatives altogether, the only way Missouri voters have had to circumvent the one party legislature. Having just lost a court challenge to their defunding of Medicaid expansion they keep trying to persuade voters that we didn’t know what we were voting for. You couldn’t make this shit up.
And the great irony is that the poor rural whites who would benefit from Medicaid expansion are the ones opposing it. Because they'd rather see their own hospitals close down than see *their* tax dollars used to provide health care to Those People in the cities.
I worked for months as a volunteer gathering signatures for Medicaid expansion to be on the Missouri ballot. Our messaging was very clear and non-partisan and in personally speaking to poor rural whites, many understood the benefits when explained to them in a way that wasn't patronizing. The initiative passed with a 6-point margin in August 2020 but the gerrymandered Missouri legislature is well on the way to eliminating it through a budgetary device. Poor rural whites are not stupid, but they are also being cleverly manipulated on other divisive issues such immigration, abortion, gun rights, etc. etc. Sometimes it seems hopeless, but the pandemic has thrown all the traditional playbooks into the air and the new found willingness of poor rural whites not to put up with employer abuse and poor wages is encouraging. If I was a GOP strategist I would not take for granted that even gerrymandering will save them longer term because they are offering nothing of substance.
From your mouth to G-d’s ears mr Clark❤️
I have to wonder - is there any thing that private equity does that is good - the firms only seem to exist to prey on weak businesses and then kill them.
Private equity in the predatory form it wears today is an artifact of changes to the tax code over the past 40 years.
Sometimes private equity funds new businesses/ideas that go on to provide essential (not meaning COVID-“essential” just normal “essential”) services/products, and jobs, faster than they could get there on the capital otherwise available.
Good to know!
I appreciate that you’re tackling this, as lack of choice impacts in other ways, too. There are two primary providers in my metro area, and my health care coverage is only in network at the one that is religious, and moreso the last few years. They used to have a “sin room” for family planning before. Now they just wont do it unless there’s a separate medical reason for a type of care. And apparently this has been increasing at Catholic-run care facilities that many patients have to go to due to insurance or access requirements.
I had a "missed abortion" at 16 weeks. (Fetal death but failure to expel the fetus and placenta). This calls for a hospital procedure due to general anesthesia. Fetal death had been confirmed by ultrasound in my doctor's office. My network hospital was a Catholic run facilty. When my doctor called to set up the facilty, they wouldn't schedule until I had a second ultrasound by their facilty, as if my doctor and I were trying to sneak an abortion in. Fetal death was confirmed again, but they refused to schedule until one week later after a third ultrasound. By the time they finally did the procedure, I had a terrible uterine infection and had to stay 2 days to deal with that. Afterwards my insurance refused to pay for the 2nd and 3rd ultrasound as they were not medically necessary and they were duplicates. I filed appeals basically telling them that if they don't want to pay for these multiple procedures they need to contract with a nonzealot entity for reproductive services. I also refused to pay the copay for my 2 day stay as it was directly caused by the hospital. I won my appeal, but all of this was completely unnecessary and had to be endured while mourning a loss. Yet another societal example of religious adjacent businesses of all types being allowed to force their views on public consumers or deny services entirely.
It's awful that you had to go through all that.
My goodness, and I thought my experience (with infertility treatment that didn’t quite work - what a roller coaster) was bad. SO IMPRESSED/grateful that you pushed your case and won it.
I am sorry for your suffering, but grateful you fought the charges. These practices only add to the pain.
Cerberus committed extortion -- right there -- out in the open.
Thank you for a well-researched article on this subject. I've been telling people to consider why hospitals were so close to the edge in the first place. While I believe strongly in vaccination, blaming unvaccinated people for the shortage of hospital beds ignores the underlying problem (and it's mean).
There are many reasons why people do not get vaccinated and I support your point. The main problem is disinformation about vaccines propagated by those who profit from it via social media. Alex Jones and his ilk would not be multi-millionaires if they pedaled truth.
No one should be surprised by the actions of a financial firm named Cerberus
Well said.
Very valuable reporting, thank you!
This problem is not only limited to rapacious capitalists, however. I spoke recently with my friends in the Netherlands, who enjoy universal health care. They tell me that hospitals are overwhelmed there too, but one of the reasons is because bureaucrats reduced the number of ICU beds to six for all of the south of Holland. Therefore, draconian rules about gathering and even going outdoors have been implemented on and off throughout the pandemic.
I see this as a fundamental error in understanding public health and an over-reliance on a business-oriented world view. Human beings are biological organisms, not running shoes. The "laws" of supply and demand that may apply very well to factory-made objects simply don't apply to people.
I've always thought that it is immoral to make profit off of illness. Somewhere I read that it until the 70s there were regulations (laws?) that constrained hospitals from making money. Is that true?
Allowing health entities to profit from innovation is essential to the evolution of medicine and is not inherently a bad thing. However, the US health system is fundamentally flawed as shown in this article and has no prospects for change while the US population is at war with itself. The UK system, while far from perfect, is a hybrid system that delivers the best of both worlds and limits the scope for rapacious profiteering by design. All citizens have access to the NHS which is free from cradle to grave, but a thriving private health system operates alongside it and offers services to the NHS and an individual physician often works in both systems to everyone's benefit. The UK NHS was a product of the bombed-out wreckage of WW2. I cannot see any circumstances for the US to adopt such as system except as a product of a catastrophe that none of us wants to see happen.
Although, as the article suggests, we may already be seeing such a catastrophe happening in some parts of the US. (And we’re also already seeing a centralized response, namely 45000 troops being mobilized to shore up private hospital personnel in 24 states).
All healthcare institutions that deliver care directly to patients should be non-for-profit entities. But we don't actually have a healthcare system. We have a wealthcare system masquerading as one. It's too fragile to handle even a pandemic with a relatively low death rate. What happens when one comes along with a fatality rate of (say) 5%? I don't want to be around to find out.
"We have a wealthcare system masquerading as one."
You misspelled "wealth extraction".
We’ve seen this issue up close nationally since the pandemic rage began, and the problem can be as much about beds as equipment like ventilators or qualified medical personnel. I don’t discount the problem, the politics, the economy, the Capitalism, etc., but I’d like to take up the topic of variants. I’m healthy, vaxxed and boosted, and while I had relaxed my mask usage, since Omicron I wear N95’s exclusively and always when I’m in an indoor public place. With the rise of Omicron, I have heard it’s not as serious as Delta. I have also heard and read that we don’t track the Covid variant hospital patients have, we aren’t contact tracing, nor are we distinguishing patients in the hospital for reasons other than Covid who then test positive - they’re just lumped in with people admitted due to Covid. I try to stay in tune with the issues that create doubt in the science, and these things do. How can we accurately say anything about Covid hospitalizations, spreading, severity, etc., if we don’t have more precise data?
It’s off topic but yeah, the statistics we’re seeing seem pretty unreliable. There was an npr piece yesterday about the difference between medical examiners (predominate in cities, must be MDs I think) and coroners (elected, predominate in rural areas, no MD required). Made me wonder about the “COVID deaths” numbers I’m reading - given that people who have to stand for election may be more likely than appointments to try to tell voters what they think voters want to hear. Meanwhile the living are shielded by HIPAA requirements, so if anyone doesn’t want to admit they got COVID they won’t.
Many years ago, I read that "extra" hospital beds were being eliminated. I thought then, and I think now, that that was a really stupid move; what would we do if we needed more beds than we had? If all we can think about is money, we deserve what we get. Trouble is, the ones who suffer most are not the greedy ones squeezing the hospitals dry and then throwing them away, like the CEO in this article. He will always be able to find a hospital bed if he needs one.