Medical Discussion of Coronavirus

[Dont_know_mind]

Yes - Just like bag charges for air travel.

Still coming and staying if clear cost differences remain. $20 vaccine vs $1000 MAB infusion resulting in a 10:1+ attack rate differential. Bean counters will do the math on that

And the bean counters usually win!

[CordMcNally]

Yes - Just like bag charges for air travel.

Still coming and staying if clear cost differences remain. $20 vaccine vs $1000 MAB infusion resulting in a 10:1+ attack rate differential. Bean counters will do the math on that

I honestly don't think it'll really happen. If it does, I imagine we'll really hear an uproar from the 'healthcare is a right' crowd. If they want to do it then I'm all for it but let's do it for other things like smoking, obesity, etc.

[artemis]

Haven't posted in a while.Things are pretty bad in Eastern Iowa. The hospitals are full and pts are being held in the ED 24-36 hours waiting for a room. This of course increases the delays for non-COVID and non-urgent patients. I am seeing patients in the office that would normally have been admitted but we're trying to handle as outpatients. I would say 75% of admissions are unvaccinated but there is a significant number of vaccinated too.

We're still doing elective procedures except for ones where post-op ICU is likely. I am not involved with the inner workings of the hospital but my impression is we are limited more by lack of staff than lack of rooms. In past peaks the plan was to create more temporary inpatient and ICU rooms but that's not really being discussed now.

It's similar here in Omaha. About 1/3 of our COVID admissions are vaccinated, but 90% of the COVID patients in the ICU are unvaccinated. ER patients are having to wait for hours for a bed to open up, and we're not doing elective surgeries that might involve an inpatient stay. Like everyone else, we're short-staffed, which is not helping.

What I don't know but would like to know is what percentage of the vaccinated COVID admits have had a booster, and what percentage are very elderly or significantly immunosuppressed. My hunch is that the unboosted, the elderly, and the immunosuppressed are that majority of the vaccinated COVID admits, but that is just a hunch.

[StarTrekDoc]

I honestly don't think it'll really happen. If it does, I imagine we'll really hear an uproar from the 'healthcare is a right' crowd. If they want to do it then I'm all for it but let's do it for other things like smoking, obesity, etc.

It's happening both public and private. Delta $200. Nevada $55 pmpm.

https://www.aamc.org/news-insights/cost-being-unvaccinated-rising-will-people-be-willing-pay-price

https://www.shrm.org/resourcesandtools/legal-and-compliance/state-and-local-updates/pages/nevada-unvaccinated-state-employees-to-pay-health-insurance-surcharge.aspx

Yes, it is absolutely a right -- just have to bare the the cost of that right. Yes slippery slope. Continuing airlines analogy: Additional Fees: assigned seating, electronic checkin, some even tried to charge for toilet access (kid you not). Only bags has really stuck in mainline airlines.

This may play out the same way -- we shall see how 2022 shakes out.

As many throughout the spectrum as said, we have to learn to live with Covid. Yes, and there's a financial cost for our choices on how we choose to live with it.

[artemis]

I honestly don't think it'll really happen. If it does, I imagine we'll really hear an uproar from the 'healthcare is a right' crowd. If they want to do it then I'm all for it but let's do it for other things like smoking, obesity, etc.

We already do that in most places. A lot of employers require employees to undergo a yearly health screening if they want the lowest rates on their health insurance premiums.

As for the "healthcare is a RIGHT!!!" crowd, how does that work if not enough people are willing to work in healthcare? Do we draft people to fill those unfilled positions?

[jacoavlu]

https://www.latimes.com/california/s...id-vaccination

About 34,000 students have not yet complied with the COVID-19 vaccine mandate in the Los Angeles Unified School District — and there’s no longer enough time for students who have not gotten their first shot to be fully vaccinated by the Jan. 10 start of the second semester, portending significant disruption to their education as they will be barred from campus.

[StarTrekDoc]

https://www.latimes.com/california/s...id-vaccination

About 34,000 students have not yet complied with the COVID-19 vaccine mandate in the Los Angeles Unified School District — and there’s no longer enough time for students who have not gotten their first shot to be fully vaccinated by the Jan. 10 start of the second semester, portending significant disruption to their education as they will be barred from campus.

They can still do J+J.

[pysibal]

Yeah smoking already has a surcharge with my employer, and I believe my residency and med school did as well. I have to submit a yearly form for both my spouse and I. We get a discount on our insurance if we get enough "wellness points" yearly by having a waist circumference below a threshold, healthy BMI, LDL/HDL/TG in normal range, etc.

I have no problem financially incentivizing behaviors that lead to reduced costs.

Regarding healthcare being a right vs privilege, American culture has not yet decided on which option they want to go with. Health care exists as both simultaneously in different parts of the health care system at different times. Conflict arises sometimes when parts collide. This contributes significantly to the as-yet-to-be-optimized state of healthcare.

[jacoavlu]

They can still do J+J.

from the article:

The Pfizer-BioNTech vaccine is the only one available to students 12 and older.

[Kamban]

I honestly don't think it'll really happen. If it does, I imagine we'll really hear an uproar from the 'healthcare is a right' crowd. If they want to do it then I'm all for it but let's do it for other things like smoking, obesity, etc.

I think it already happens. Whether we call it a surcharge or a discount, the end result will be the same.

If you smoke, are obese and don't exercise, and now are unvaccinated - you will pay a higher premium than your colleagues.

[Kamban]

My hunch is that the unboosted, the elderly, and the immunosuppressed are that majority of the vaccinated COVID admits, but that is just a hunch.

Omicron is much less effective against the 2 dose vaccine unlike the initial virus or the delta variant. Booster is thought to help against Omicron but I have not seen any study yet except for small sample neutralizing lab studies, one from South Africa and another from Denmark I believe.

I think the current admits for delta are the very elderly. And all the instances of more than milder COVID in the vaccinated group that I have heard got well with antibody infusion and did not require prolonged hospital care or die. Yet today one of my patients is going to the funeral of her friend's spouse. 61 years old, healthy. No one asked but you can guess what his vaccination status is with 99.99 % confidence in accuracy

[Hatton]

I honestly don't think it'll really happen. If it does, I imagine we'll really hear an uproar from the 'healthcare is a right' crowd. If they want to do it then I'm all for it but let's do it for other things like smoking, obesity, etc.

I believe Singapore is doing this.

[StarTrekDoc]

It will certainly impact hospitals now Fed hasn't renewed huge financial supports to COVID impacted hospitals which ironically happens to be in Red heavy states. Those impacted hospitals are going to really feel it with high margin elective surgeries being deferred and going to make their own hard decisions on access/service to its citizens.

This is all playing out for most of 2022 and will be more a driving force in conversation than anything in Nov 2022 as that's when open enrollment happens. People vote their pocketbook first and foremost. Healthcare drove the conversation in 2018 mid-terms. It'll do it again for 2022 for different reasons.

[CordMcNally]

I think it already happens. Whether we call it a surcharge or a discount, the end result will be the same.

If you smoke, are obese and don't exercise, and now are unvaccinated - you will pay a higher premium than your colleagues.

Not necessarily. Everyone in our group pays the same as long as it's the same category of coverage (single, family, etc.). They do have some programs where you can earn a discount through the year but any smoker, obese person, or someone that doesn't exercise could easily get the same perks as someone who is healthy and exercises.

[CordMcNally]

We already do that in most places. A lot of employers require employees to undergo a yearly health screening if they want the lowest rates on their health insurance premiums.

As I replied to Kamban , that isn't the same everywhere.

As for the "healthcare is a RIGHT!!!" crowd, how does that work if not enough people are willing to work in healthcare? Do we draft people to fill those unfilled positions?

That would be an interesting scenario and should chop the healthcare is a right argument at the knees.