Effect Measure

Thinking about hospital surge

Posted by revere on July 26, 2009
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The Reveres have been around a long time and we know a lot of public health people in different states. Recently we were talking with a colleague about the problem of hospital surge capacity — the ability to handle a sudden demand for services — and she described her first job working for a state health department in the early 1980s. Her job was to compile a health resources report, essentially a yearly compilation of licensed and operating beds for all manner of health facilities, including hospitals, nursing homes, psychiatric facilities, outpatient clinics, rest homes, group homes and license levels for each. Collecting this information annually was required by state law. Within a few years that activity abruptly stopped. The law is still on the books but it isn’t being carried out. The excuse was that the private sector was already collecting the information. It’s probably true that with some time and effort most of that data could be cobbled together from various sources. But the facility-centered nature of that earlier effort would be especially convenient and timely for pandemic flu planning at this moment. We (members of the public and local health planners) would then be able to see, almost immediately, what kind of demand and reserves were available for facilities in our area and start making contingency plans for various scenarios (doubling or tripling of demand, for example). Abandonment of this legally required activity in the 1980s is just one more example of penny wise and pound foolish public health disinvestment, helped considerably by a “Reagan Revolution” wrecking ball approach to any kind of state services, especially those that the private sector wished to keep private.

Those same tendencies have been sharpened as the cost of health and hospital care has risen dramatically. With pressure on reimbursement rates, hospitals and other facilities are looking everywhere for ways to cut costs, and one of the first places to do that is by eliminating bed redundancy. An empty hospital bed costs money; an empty hospital bed that is staffed costs even more money. Neither is offset by any income or medical benefit to a patient. So we got rid of them. The result is that there is very little redundancy in the hospital and clinic system. For a flu pandemic, that means the most severe pressure points are the emergency department and critical care beds and facilities. However many they are. Wherever they are. It’s not so easy to know, these days.

But not knowing exactly isn’t the same thing as not knowing at all. We know — for sure — that it will take very little to overtop the gunwales (that, I am told is called whelming in ship talk; so you can whelm and you overwhelm, but you can’t underwhelm). That’s because we no longer have any redundancy. Redundancy is expensive. It’s capacity you don’t use, so it’s wasted. Like an insurance premium you don’t cash in because your house didn’t burn down. In profit-driven privatized health care, where burning down the house only costs other people, not the house owners, we don’t invest in insurance.

We could have. We used to have reserve capacity in our medical system. Now all we have is the most expensive medical care in the world in the US. That’s enough for some people. The ones that can pay for it. Now. But in a pandemic, even money won’t be enough to get some people medical care.

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Comments

  1. #1 cicely
    July 26, 2009

    And those of us without money are so screwed.

  2. #2 walrus
    July 26, 2009

    I am currently graphing cases and outcomes in Australia where we seem to have reasonably accurate (if limited) statistics.

    Current experience are that at least 10% of cases require hospitalisation. (latest data 16,000+ cumulative confirmed cases, cumulative 1924 hospitalisations)

    Assuming that most hospitalisation occurs because of life threatening conditions associated with the lungs requiring oxygen delivery or more invasive procedures, what is the CFR of H1N1 going to look like when there are no longer available hospital beds??

  4. #4 Stephen
    July 26, 2009

    Walrus: You’re hospitalisation rate is inflated because the 16k cases is only lab-confirmed – as of a few weeks ago now everyone with ILI is assumed to have swine flu and treated appropriately. The actual number of cases is certainly 1 and probably pushing 2 orders of magnitude bigger than that; thus the hospitalisation rates are correspondingly smaller.

    Currently there are about 550 people in hospital with ‘flu in NSW; I very much doubt that there are only about 5.5k cases around at the moment, with the peak of infections expected in the next 4 weeks…

  5. #5 Curious
    July 26, 2009

    Speaking of actual cases: Can someone in the know explain this to me:

    http://cryptome.org/h1n1/cdc-071709.pdf

    As I read it — I’m not a scientist nor that great with numbers — it seems like kids get sick the most, but seem to make up a smaller percentage of hospitalized or fatal cases? While their parents aren’t catching it as often, but when they do … look out?

    Or is this just based on too little data? Anyone want to chime in?

  6. #6 River
    July 26, 2009

    Revere,

    The dismantling of America’s healthcare system by miserly and misguided politicians and taxpayers from the Reagan administration through W’s two heinous terms is a regular drumbeat here — and a valid one — though a bit monotonous.

    However, if you could for a moment stop pointing fingers and denouncing everything that’s wrong with our healthcare system, what would be most useful to me would be some guidance based on your public health expertise.

    How do we create and implement a healthcare system that actually works, given America’s particular givens? Is it even possible? What do you think of Obama’s healthcare plan? Do you support it? Should the average citizen? If not, do you have an alternative that congress and the president could pass?

    As an average American with a serious health issue, looming surgery, and no insurance, I would appreciate your thoughts on possible solutions.

    Thanks.

    PS. Renouncing my US citizenship and moving to Great Britain or Canada is not an option.

  7. #7 revere
    July 26, 2009

    Curious: You are looking at different kinds of numbers on these slides. The highest risk (number of cases per population) is in the youngest age group, but there are only about 1000 of them. There are lots more in the next age group (which is also a much bigger population). And so forth for the other age groups. So on the one hand the denominator is all hospitalized, while on the other it is the number of people in each age group.

    river: Yes, it is tiresome to say the same thing. We do it because new people come here; because it is true; because we are making new decisions every day and it is important to be constantly reminded of the old decisions and what they have produced; and because we are so goddamn mad at the way our public health system, not the best to begin with, got destroyed. But you also raise another important point. Beyond blaming, what do we do? I can give you two kinds of answers (besides the real one: I don’t know). The first, on practical level, I am a single payer advocate. Most people in this country and most doctors also prefer single payer. When politicians say it is not politically feasible, they are saying that it is not possible for them to defeat the insurance industry. The second answer is not an answer but relates to something we have tried to do several times here, which is start a conversation on progressive public health. We tried a couple of times on the old site and at least once, maybe twice here and over at The Pump Handle. Progressives (aka, “the Left”) in this country have been terribly lazy intellectually in doing the heavy lifting and intellectual struggle needed to really figure this out. We/they think that repeating the slogans of the past (e.g., “prevention pays”) is enough. It isn’t. We need to do some tough thiniking and it isn’t happening. Some of us do it in our “real lives” and our hopes for the blog was that it would entrain many to do it here as part of a Big Conversation. But people want to talk about flu, the tail that is wagging the dog. So we do it and keep inserting comments about how we got here, but not, as you rightoy point out where we should be going. Not entirely. We’ve talked a lot about regional international vaccine institutes to deal with the IP issues involved with vaccines. But not much else. The bigger issues have gone to anti-war issues, our major passion. Not a very good answer, but the only one I have for you at the moment. I’m open to suggestions.

  8. #8 albatross
    July 26, 2009

    Has the swine flu pretty much displaced the other seasonal flu strains in Australia? Or are they running along side-by-side, presumably with some very unlucky folks getting both at the same time?

  9. #9 davidp
    July 27, 2009

    Swine flue is reported to have 99% displaced seasonal flu in Victoria, Australia, which was the first state severely affected.
    The Age 8 July

    Head of epidemiology at the Victorian Infectious Diseases Reference Laboratory, Heath Kelly, said that of the 73 people who tested positive for influenza at clinics monitoring flu viruses during the last week of June, 99 per cent had H1N1 swine flu

    Two weeks ago in New South Wales, which was affected after Victoria, Swine Flu was reported to be about 60% of the flu, and increasing. National Radio 10 July

  10. #10 Sherrie
    July 27, 2009

    Cell phones, etc:
    Far be it for me to deprive an audience of folks already “blessed” with more than our share of evolved(all things being relative, ha) level of interest & concern, with another urgent issue– so:-and Undoubtedly this is in your radar already, pun fully intended…
    Please have a look, Especially Revere. What on Nature’s still fairly Green Earth can we do.Other than advocate for disclosure, keep on lawmakers, what? Please look:
    1.http://www.env-health.org/r/58 (Found while seeking to substantiate post sent by friend(#2 below)

    2.http://www.wirelesswatchblog.com/ TRy not to be turned off by edgy appearance, the links are informative, plus go ahead, Google…

    While this doesn’t suggest the immediacy of, say, the flu now, think of our kids, their kids…

  11. #11 floormaster squeeze
    July 27, 2009

    The number of licensed and staffed beds is well known for acute hospitals, rehab hospitals, and a whole host of other facilities from federal (Medicare licensing) and state (Medicaid and Public Health) licensing. I assume you are lamenting the weakening of the latter in some (many?) states. Or are you lamenting (also) not knowing number of physically available beds (where definitional and informational mysteries that make things difficult).

    I disagree strongly with the excess hospital bed approach. Hospital Beds create their own demand. It has been shown countless times that the more beds in an area the higher the hospital costs. There is also evidence from the Darthmouth Atlas stuff that hospital beds per capita helps explain excessive costs in regional variation. An empty bed does not just cost money, it is correlated with general health care inefficiency.

    It seems to me that emergency and surge capacity be treated differently than having a wasteful use of hospital resources. It seems that rapid mobilization for emergencies makes more sense (and would make use of the increasing military knowledge of mobile intensive care). The key to that mobilization idea is flexibility (whether the flu, a natural disaster, a bridge collapse, etc.). Having lots of concentrated and narrow interests at the table generally does not lead to flexibility.

  12. #12 River
    July 27, 2009

    Revere,

    Yes, folks here want to talk about the flu. But they also want to talk about religion and atheism. And really good music. And the dangers of BPA in food containers. And the joys of indoor science reading, and the surprising amount of bacteria on the beach… Your forum is as wide as you make it, and to the benefit and enjoyment of many, you’ve made it pretty wide.

    Suggestions? How about this: Keep pounding in the fact that our healthcare system has been dismantled, ransacked by politicians and taxpayers over the past 25 years, but balance that by adding a new drumbeat, a “therefore, …” as in “therefore the Reveres endorse doing X, Y and Z” to rebuild it. Start pounding in the need for a single payer health plan. Repeatedly endorse the US National Health Care Act (HR 676) or any another that you see as a solution. Make that voice as loud as the one that’s so angry about the pillaging. Help us help you make the healthcare system more effective.

  13. #13 Magpie
    July 27, 2009

    We (in Australia) have stuff like Hospital At Home, and procedures pre-flagged as delayable, to free up beds in a pandemic or other mass-casualty situation. That’s flexible, but needs coordinated planning and preparation, and yes, resources.

    Ultimately, though, if you need to put someone on a ventilator, you need to have a ventilator. You can’t magic one up, you can’t be flexible and build one out of sandbags.

    Then the whole “build it and mothball it” approach seems great, until you realise the bottleneck is likely to be trained personnel to operate all of that stuff, compounded by the fact that those staff will be hard hit by a pandemic. “Excess” hospital beds ARE expensive – because you’re paying for staff who need wages, not just stuff that sits there waiting. But how else do you do it? Who’s going to operate your ventilator? Experienced personnel need to be employed to keep their skills. They need to be paid. And we need both the personnel and the resources in a pandemic.

    Yes, in a big way it comes down to how much money you spend. At a certain point, money spent will translate directly into lives saved. You can’t just deploy a field hospital to the pandemic area, because a pandmic is everywhere.

    Oh, and more beds create more demand? So people get sick more often, injured more often, when there are more beds nearby? No. More like: with more beds, more of the need is met. Quality of life is improved. Mortality rates decreased. Of course there is a limit to what you’re willing to pay, you can’t expect a hospital bed for every person – but greater capacity is always good, budget willing.

  14. #14 raven
    July 27, 2009

    Bloomberg Argentina pandemic:

    More than 3,000 people have caught the bug in the country, with the biggest surge in cases occurring in the first two weeks of July.

    To cope, hospitals such as the Federico Abete, on the outskirts of the capital, Buenos Aires, converted halls and waiting areas into treatment rooms to double the number of beds to 200. At the peak, 120 swine flu patients were hospitalized at Federico Abete with a death rate of four a day. It now has 90 patients confirmed or suspected to have the virus.

    Argentina has an unusually high death rate with 130 dead. A lot for a small country.
    They also seem to have run out of hospital beds unless you count hallways.

    This might explain why they have an unusually high death rate as well. I don’t know much about the state of Argentinian health care but their infectious disease and serious flu case care might not be as common or good as North America.

  15. #15 floormaster squeeze
    July 27, 2009

    In no sense of the word has the US Healthcare Delivery System been “ransacked”. Healthcare spending in the US is $2.5 TRILLION dollars and now is 17.5% of GDP. REAL (inflation adjusted) National Health Expenditures has grown 80% in the last 15 years alone. Incomes for physicians have increased 20-90% (depending on specialty or lack thereof) in the last ten years alone.

    This is the opposite of “ransacked”.

  16. #16 River
    July 27, 2009

    Foormaster Squeeze,

    I beg to differ. While the expenditures and profits may have gone up,way up, America’s healthcare system’s ability to actually care for its citizens has plummeted. I live in the pastoral Heartland and here, 45% of the citizens don’t have health insurance, can’t afford health insurance, and rely solely upon Emergency Departments and charity for healthcare.

    Ransacking doesn’t imply that no one gained, just that far more lost.

  17. #17 River
    July 27, 2009

    Floormaster Squeeze,

    More arguments suggesting the US healthcare system has been ransacked: The US has the most expensive healthcare in the world. However, according to the Physicians for a National Healthcare Program (1), WHO (2), and US Census Bureau (3), all that money spent (1/3 of it paying for paperwork alone) also leaves 45.7 million people without healthcare (1), our infant mortality ranked somewhere between 28th and 42nd in the world, depending upon the year and methodology (2), and folks living in Canada, France, Germany, Spain, Finland, Israel, Greece, Italy, Great Britain, Switzerland, Sweden, Norway, and Japan expected to live longer than folks in America (3).

    Huns probably didn’t see their efforts as “ransacking” either.

  18. #18 M. Randolph Kruger
    July 27, 2009

    It would seem that the facts dont square with opinions about the surge. Just a short few years ago the Baptist hospital group decided to demolish their 50 year old and freshly renovated facility. Why? Because TennCare here, the much publicized UHC for Tennessee was bust and there were no admissions. 35% empty because the people who had been on Medicaid were on TennCare and they couldnt get admitted.

    We were limited to 1.5 million people on it by law. Good, because instead of costing the 2 billion we were told for UHC, it went up to 8 billion in four years. It accounted for 100% of the entire budget of the state. The docs quit getting paid, the hospitals quit taking it, the dentists quit taking it. Then the state (Dems) said they would sue to force them to take it and threatened medical practices with accreditations.

    So the docs fought back, brought the light onto the cockroaches of costs and sued government themselves. Turns out that it was destined to die from the beginning. It saved costs for only 3 years. Went insolvent in 4, was boosted at 5 with taxes, flamed out at 8 and gone in 10. Seems that illegal aliens, people with chronic illnesses all were showing up for care. Huh? Care in UHC?… Cant have that else you go insolvent.

    Oh, we saw it all. First everyone joined. Then the costs touted to be less ended up being more. They started stretching payments to the docs out 2,3,4 and finally 8 months. The practices were holding bag on millions. Then the hospitals. After year four and those stretch outs, the hospitals started billing the people directly with the caveat that if TennCare didnt pay up by month three…The bill was theirs. Phones began to ring in Nashville. Ah…Rationing began for these people.

    Helloooo…Dr. So and So’s office… You are whom? Our next available appointment is about a year out………Dr’s would simply look to see if you had insurance or TennCare. So, the percentages were 70% insurance, 30% TennCare. Mostly because not only did they get stiffed, they were “negotiating” prices that were 40% below fair market value on procedures and visits.

    My brother was one of the chronic care people with post polio syndrome and he is a mess at best. In 98 he went to the hospital for a test at 8 a.m., then at 3 was told he would have to come back the next day. Back in at 8, at 3 was told to come back the next day again. Three days afterwards he got in to get his test. Then, he needed another test. That took another four days. Then a week later a four hour wait in the office of the soul specialist that was still taking it. Six weeks later he gets a bill for 23,000. He ignored it of course, it was 100% TennCare’s bill.

    Then at 8 weeks a please remit, and then at 12, sent to collections. Mind of course this was the big UHC program that the entire nation was to use as “A shining example” according to one William Jefferson Clinton – President of the United States. 2 billion dollars to 8 billion dollars in just 10 years. And it still wasnt enough money. We only have 6.5 million people in the state. So that was 13,000 bucks per person as a new bill. But we got all of these new relatives that we didnt know to pay for. A bill for 1230 bucks for 1.5 million in healthcare sent to every man, woman and child in the state. We know of course that the kids had only IOU’s to pay with… Interest too on that debt. EVERY UHC country is in big money trouble for the bills of UHC. 8 billion stated in the legislature of Australia for instance.

    Put in UHC and there will be a revolt..Especially when you are talking about fining people for healthcare or making it a condition of employment. Not Constitutional, no matter how many HR’s this or Waxman Waxjobs that are put in. The southern states will simply tell DC to go pound sand and sue. |37 states are now in the middle of sovereign states movements or have passed the measures. Tennessee has. Waiting for the governor to sign it. Texas has, Oklahoma has. Pretty soon the ring of reality will be surrounding the NE states.

    You can disagree or agree, but one thing is sure UHC for all is only going to be paid for by a select few in this country with it being touted as being FREE! This will put 1/3rd of all the money in the country into the hands of healthcare bureaucrats. Forget the paper, forget the costs. The bottom line is that it is not a right in this country to have healthcare, it is a privilege that has to be paid for.

    Make a million and then give 1/2 of it to the government as your “fair share”. I could end the ills of the country if everyone in America paid 50% of their income to the government as a flat tax. You put that in Revere and I’ll vote for UHC. Then I wont have to worry about anyone but the illegals who ran up a 1 billion dollar tab in healthcare costs this year alone in my county alone, without recourse against the federal government.

    Put that flat tax in. No card, no bennies, no illegals and I will also know that the poor are paying 1/2 of their income to the government. Else dont come and tell me that someone else has a problem. I dont owe anyone else in the US healthcare, a living, college, or a mortgage payment. And ESPECIALLY illegal aliens who are the single most important reason that California is tanking and a good part of this country.

    River, your evidence is flawed because you havent asked the proper questions. We are first in medical response here. The questions are also being asked by the WHO who will ultimately become the new UHC caregiver of the world in a totally socialist world government. If you are right then WHY are people leaving the UHC countries to get care here. Square that one up bubbie. Really hard to do that when people fly thousands of miles just to have procedures done and at their costs.

  19. #19 M. Randolph Kruger
    July 27, 2009

    Amongst taxing procedures… You also should read this below.

    There are all sorts of goodies in there to screw the people that work in this country. Everything is being spent and sent in the largest redistribution of wealth in history. Not to the taxpayers… Oh no, we cant have anything approaching sense in this. Look at page 425… Assisted suicides if you want to check out or more so… If they think you need to check out.

    Every 5 years you get a physicians review whether you are fucking viable or not? Too old to spend money on? Hmmmm….. even Medicare doesnt do that. This is truly “Medi-scare” and its not to be incorrectly interpreted. They will just have your physician tell you that you are too old, we aint gonna spend the money on you so you get palliative care, and certainly nothing that will keep you alive.

    Kind of like the UK now.

    Wake up folks and read this stuff because its not Republicans that are doing it. Its a takeover, pure, plain and simple. Revere is pure in his heart and thoughts…But its the politics and politicians that are going to screw this up and over.

    I bet that ACORN will be a registered healthcare provider after this.

    http://www.freerepublic.com/focus/f-chat/2300451/posts

  20. #20 Paul
    July 27, 2009

    One very significant factor in the increase in medical costs, which will never be addressed in any Congressional bill is tort reform (most in Congress have law degrees, and the ABA is a high contributor to both parties).

    It isn’t the resultant high malpractice premiums that are the main driver in this issue. Most folks don’t comprehend how “defensive medicine,” is virtually built into every single physician/hospital – patient encounter: the extra tests, the extra referrals to specialists, the hours of extra documentation (chart work and legal forms). The tests, beget tests, because the pathologists and radiologists, (just as an example) suggest even further tests, based on those that were originally ordered, since they must CYA themselves.

    People can no longer rely on their physicians’ judgment, because their physicians will no longer offer any. So many health decisions are left to the patients (eg., hormone replacement therapy in women) because doctors just list the risks vs. benefits, and tell the patient to decide. The docs don’t want to get pinned down on anything that could be legally actionable.

  21. #21 River
    July 27, 2009

    M. Randolph Kruger,

    Much of the healthcare that is available in the US is exceptionally good — some, the best in the world. And yes, folks come from countries far and wide to seek treatment. But they can pay for it — big bucks. BIG! Almost half of all Americans have no health insurance and many of them cannot afford to go to the local clinic to get a stitch or antibiotic or Pap smear or prostate exam or any other regular medical treatment, much less be seen at one of the preeminent healthcare providers in the country. Unless they are children, blind, over 65, or totally disabled for at least one year, they are outside of the healthcare system

    As for the “proper questions…who will ultimately become the new UHC caregiver of the world in a totally socialist world government”… Well, the Middle East has yet to resolve the Palestinian-Israeli conflict, or tamp down reckless Iran, or stabilize disintegrating nuclear Pakistan, or neutralize the Taliban or Al Qaida. Then there are the saber rattling, nuke building North Koreans and the keep-your-nose-out-of-our-Human-Rights-violating-business Burma (Myanmar) who would rather be completely isolated than participate in a rational, dignified world. Russia is currently mad dogging almost everyone (and has Georgia to deal with), Venezuela’s off-kilter Chavez is doing all he can to generate anti-American sentiment and is actively building anti-American alliances, and China doesn’t seem overly eager to turn over the reigns of it’s thundering newfound power and influence — unless, of course, they ARE the totally socialist world government. (They’re too busy riding roughshod over Tibet and the planet’s natural resources).

    A “totally socialist world government,” Bubbie? I think the question is a bit premature.

    I stand by my assertions.

  22. #22 Lea
    July 27, 2009

    I stand by my assertions.River

    LOL, you have no idea how much fuel you’ve given the MRK machine. Duck bubba, you’re about to get slammed !
    And,     Russia is currently mad dogging almost everyone (and has Georgia to deal with

    Huh ??? Georgia needs Russia to get the hell out of their lives !! Jeez ………….

  23. #23 revere
    July 27, 2009

    Paul: How about the cost of medical negligence and error:

    The IOM report estimates that medical errors cost the Nation approximately $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. About half of the expenditures for preventable medical errors are for direct health care costs.

    From the Agency for Health Care Research and Quality (DHHS).

  24. #24 River
    July 27, 2009

    Lea,

    I’m well aware of MRK’s enjoyment of dialogue… I’ve had my say and won’t likely engage further.

    As for the situation between Russia and Georgia, you placed emphasis where I didn’t. Georgia is a flea on Russia’s hind end, Russia a mad dog to Georgia. But they are still nipping at one another, something Russia wouldn’t be engaged in if it was whole-heartedly focused on establishing a “totally socialist world government.” That was the point I was trying to me.

    Be well.

  25. #25 M. Randolph Kruger
    July 27, 2009

    Yup, but dont you know them SOB’s will take the government program and insulate it from lawsuits…Cause we are all equal in the eyes of a Democrat Congress.

    River, you ALWAYS go after the big dog first. Then the others trot in line when the new Alpha male is in place.

    I care but I dont care about the people with no insurance unless they are cripples and cant work. I would gladly give them all insurance if there was a way to pay for this. But this is a payoff, a scheme for the Dems to steal money with and satisfy their re-districting agenda and they are blatantly planning to use tax money to do it.

    The USGOVT is in the tank for now 165 TRILLION dollars in funded and unfunded mandates from our Congress. And now we come up with this that will generate deficits from day one and once they figure it out which will come quickly will be when the Chinese do our economy having dumped their USD bonds into a new reserve currency. Constant state of roll over of money and then… We go and put it into a pine box after 72 years on average.

    And about that life expectancy…Seems we have a shit load of old people in their 90′s and 100′s..So River, again… Ask the questions right.

    Zimbabwe bucks!

  26. #26 River
    July 27, 2009

    Meant: That was the point I was trying to make. Sorry. Long day. I’m tired.

    G’night.

  27. #27 Paul
    July 28, 2009

    revere,
    I said, tort *reform,* not abolition. Mistakes are inevitable in this profession, given the tension, pressure, stakes (lives). I don’t have stats, but IMO, having worked in the trenches, most physician/nurse/pharmacy errors are not due to arrogance or ignorance – they’re due to the human factor under the conditions just mentioned.

    When these errors occur, and injuries are suffered, of course, the patients and their families should be “made whole.” I’m referring to the astronomical *punitive* damages that are awarded by sympathetic juries; I’m talking about the shark/schesiter/parasite lawyers who will sue where they very well know they have no case, but also know the insurance companies will often just settle out of court to avoid the more expensive litigation. It’s a very well known racket.

    There’s one more factor that is very substantial, but doesn’t show up in any monetary statistics. If you’re a practitioner in a small community, it’s a nightmare to see your name in the paper associated with the defaming, legalistic hyperbole of a shit-hole lawyer, making you look and feel like Willie Sutton. Most folks don’t go into the practice of medicine (in any healthcare-related profession) with criminal intent. But I’ve seen colleagues demoralized, destroyed by such happenings.

    And many patients have turned into venal opportunists. Suing a doctor, because of the inevitability of death or uncured illness in a family member, gives them better odds of making it rich, than playing their states’ lotteries.

  28. #28 Cosmoskitten
    July 28, 2009

    “the hospitalisation rate is inflated” How expensive would it be to get accurate hospitalisation rates, by making a survey of the general population to see if they have been infected or not by swine flu AH1N1v ? It seems to me that this variable is quite important for planning. Are there any studies that have started?

    Magpie wrote: “Ultimately, though, if you need to put someone on a ventilator, you need to have a ventilator.”

    I wonder how much a CPAP (continous positive air pressure) a device used in the treatment of sleep apnea would help if there develops a shortage of ventilators. There are quite advanced models out there, and some only cost about 1000 dollars.

  29. #29 revere
    July 28, 2009

    Cosmokitten: It’s not so easy. How would you do this? Ask someone? How would they know? Flu infection is often asymptomatic and flu like symptoms (because they are the product of a non-specific response of the innate immune system) are seen with many other viruses. So asking someone if they’ve had flu wouldn’t work. You’d have to test your sample (which would have to be representative, itself a problem), which is both expensive and for which there is no highly accurate test. It will likely be done based on looking to see if people had an immune response to this virus but that takes time to develop and itself isn’t completely accurate. It can only be done afterward. If it were easy, we’d know the answer already.

  30. #30 M. Randolph Kruger
    July 28, 2009

    River-That flea had control of the gas supplies to Europe. That makes it a pretty big flea. Control the gas, you control Europe.

    It was the first thing out of the NATO mouth when they built it. Guess we all know the answer as to why they went after the transfer point in the town. Russia is pretty lucky that NATO didnt respond. Those guys riding on the T72′s were on the outside because to get hit with a missile is an automatic death sentence inside. We made their main battle tank obsolete.

    But this is about the surge capacity of the US in hospital beds. There isnt any that a full day of swiney wont fill up.

  31. #31 robd
    July 28, 2009

    Are there no military reserve beds in the US?
    Must have been standard in the cold war, no?

  32. #32 Paul
    July 28, 2009

    Paul: How about the cost of medical negligence and error:

    revere,

    This may, by now, may be a little too late or irrelevant, but I have an honest question for you (not trying to make any point here). Do you know if the costs of medical errors you cited included the malpractice awards, or just the actual medical costs associated with addressing the deleterious effects of the errors?

  33. #33 Paul
    July 28, 2009

    I wonder how much a CPAP (continous positive air pressure) a device used in the treatment of sleep apnea would help if there develops a shortage of ventilators. There are quite advanced models out there, and some only cost about 1000 dollars.

    Cosmoskitten: if I remember correctly, I don’t believe the CPAP machines can generate adequate pressure to overcome the resistance of the fluid filled and inflamed lungs to deliver adequate volume for respiratory support. They’re just designed to overcome the upper airway resistance responsible for obstructive sleep apnea, which is of a much lower order.

  34. #34 revere
    July 28, 2009

    Paul: No, these are the out of pocket costs, not the malpractice awards. In general, the amount of compensation given to patients for genuine malpractice (as judged by panels of medical experts after the fact) is a only a fraction of actual costs anyway. Juries award punitive damages because of the “Oh My God” factor in cases. The McDonald hot coffee case is a good example (although it isn’t med mal). McDonald’s culpability is what caused that. The issue of extra costs for defensive medicine is a genuine issue, however, although it’s hard to say how it nets out in the long run. But the runaway costs of medical care have little to do with the liability issue, except in the minds of our colleagues (and understand, I have colleagues and relatives who have been wrongly dragged into lawsuits because everybody on the team got sued or because the patient didn’t like the outcome; but juries don’t give punitive damages for things like that and those cases are usually failures and only work for unscrupulous lawyers because insurance companies cave in to save money; they are shakedown schemes).

    The AMA and many practicing docs are holding health care reform hostage to a parochial interest of theirs, liability immunity. But then who will make the victims whole? If we had a national health system that indemnified its doctors as in the British UK (not the GPs, though) and didn’t force desperate patients to pay unpayable medical bills we’d have a lot smaller problem.