Right, because no one has stepped up to write a check. Hospitals are businesses, they're not going to do this on their own. GM is a business, they're not donating those ventilators, they're trying to make a sale into a new market. States, most of them, can't do it because their budgets are fixed by their constitutions and they can't take a loan or write a bond without a referendum.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
Whoever thought that running your healthcare system in a commercial fashion was the right idea in the first place? A lot of fundamental decisions are going to be re-thought in the aftermath of this virus' impact, but for now we can ignore all that and focus on what matters: eradicating the thing. And if GM making ventilators on a war footing is what it takes I'm all for it, let's divert some of those funds to them and give the hospitals what they need.
The US has more intensive care unit beds per capita than any other country. Among developed nations they will not come out of this with the highest COVID death toll per capita. The Italian healthcare system is closer to the not for profit ideal and it’s not doing great right now.
I’m not sure where you’re getting that from. There is no universally accepted definition of “intensive care unit bed“ due to fundamentally different approaches to healthcare in different countries.
What you can easily compare are hospital beds for acute care - this is a much bigger pool than just icu.
You can also easily compare number of doctors per capita.
In both of these measures the US system lags behind places like Italy.
I agree with the parent. There are a number of places in these comments where the number of ICU beds per capita seem to be justification for personal viewpoint; all cite the same sources.
In the interest of avoiding possible hubris, I think it's worth noting that the numbers in the Statisica chart on ICU beds/100k persons (included in the oft cited link [1]) counts in its data for the USA all ICU beds, while the European numbers come from a study that explicitly exclude [2]:
"...private healthcare providers, neonatal and paediatric intensive care beds, coronary care, stroke and pure renal units"
The 34.7/100k number for the US does not exclude the above. According to [1] the US has:
"There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds."
Attempting to match the criteria of both studies gives the USA about 46,795 beds. Assuming 320 MM people gives 14.5, not 34.7, per 100k. I haven't looked at the sources for other countries, but we can expect differences in methodologies of ICU bed counting.
I think this casual sort of comparison of national capabilities (like [3]) which lacks rigor is more dangerous than useful. I hope one will take a deeper dive if they're evaluating risks based on the numbers that have been posted.
There are many factors to why Italy isn't do great. Including their population skews on the older side and they have the oldest population in Italy...which unfortunately has a 1 in 5 chance of dying if they catch the virus.
I think the healthcare system and medical supply chain are two separate things. A universal healthcare system (for E.g. Sweden) still has a normal supply chain. The only difference is the profit motives are not present and the government can effectively pump money in without violating economic principles of supply/demand and pricing.
A commercialized health care system has lots of perverse incentives leading to price increases and profiteering. This sets the weakest fraction of the population up for losing all they've built up in the last 3 months of their life while barely impacting the strong. It also means that those hospitals don't care about overpaying for their supplies and medication (but not their workforce) because they get to pass those costs on to those already weakened people.
FWIW: Gall bladder operation in NL all in: 1500 euros, non-subsidized and paid for out of pocket because I wasn't paying into the local healthcare system when it happened. Same procedure in the USA: $24000!
The US has had a private healthcare system for its entire history. Economics and incentives were the same throughout that history. Meanwhile prices only became stupid very recently.
A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal efficiency point, which essentially is very close to "no unused resources in the nimal situation". But societal resiliency requires that health care, utilities, food supply, etc, has some excess capacity just because at some point something will happen. A public system can at least be responsive to the value society puts on resiliency.
Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives.
Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place.
Open the March update pdf here and look at the "excess" column on page 4:
> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies.
I disagree, I'd say it's the opposite.
A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity.
Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
this assumes that health care scales in the same way that an online retailer does, no?
the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in.
scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
>A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense.
>ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
You're right. A private company would just fire the nurses instead.
As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers.
It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
Are these included in the count of the other countries? This is exactly what I mean: Without the same definitions for all countries, the numbers per se are not really comparable.
Yes, definitely, American healthcare system needs a reboot - this might be a good time to do that. The only difference is that I would be paying about the same but the insurance would cover the rest. The problem being - if you're well off, you pay $1500, if you're not, you pay $24000 and potentially go broke. That is the problem with the American healthcare system.
it may have been mentioned already but in the US healthcare prices are negotiable. It's strange because you can't go to a US grocery store and haggle over the price of cucumbers like you can in many other nations but you can do that with healthcare.
So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.
To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.
There are a couple possible re-thinkings. The disturbing one is where it is noticed that we are essentially sacrificing a bit of the economy to reduce fatalities. So next time it is decided that company valuations are worth the extra deaths[1]
I submit that rethinking needs to be started early rather than late so the discussion isn't dominated by euphemisms for some very dark path.
[1] As we know, social isolation is to spread out the pace of acute cases so as not to overwhelm hospitals. But it obviously slows the economy considerably. The alternative would be to not to isolate, keeping businesses wide open and allow the medical system to be overwhelmed with its accompanying higher mortality rate.
America has been on the dark path where lives are equated to money for a long time now. It will take something quite dramatic to shock the system to the point where people are willing to re-think it from the ground up. Maybe this is that shock. If not now, then probably never.
Except that quality-adjusted life expectancy changes due to side effects of drugs are valued much more higher than people dying due to being too broke to get any non-ER-care for acute, but not yet emergency-posing illnesses.
Even within the drug certification process there is an issue with relatively niche drugs wasting a lot on overly-extensive studies, if you calculate how many people would get how much benefit from getting/affording these niche drugs. IIRC there is about an order of magnitude higher weight on side-effect deaths compared to lack-of-medicine deaths for niche drugs.
It's too early to evaluate the tracing approach. The problem is what happens when other people come in from the outside. This is now a major problem in Beijing; not internal transmission but cases brought by arrivals.
It is perfectly possible to rapidly buy things in a commercial setting. You just need a good credit rating and someone to sign the purchase order or contract. Why should the vendor care if the customer is breaking an internal rule about purchasing?
To be clear: I'm certainly not opposed the idea of air-dropping GM-manufactured ventilators to needy hospitals (though I'll admit I don't see how it's ever going to work in time and genuinely think this sounds like marketing on GMs part more than a serious idea).
I'm just saying that the person that needs to get off their ass and move on these ideas isn't Mary Barra but Donald Trump (and McConnell and Pelosi of course).
You need to start thinking of this as a logistics problem, not a tech problem. Ventilators is a solved problem. What is needed is a stream of parts and manufacturing capability. I'm not sure if car manufacturers are the right partners but they do have a lot of people that know how to put stuff together. They can put an assembly line for ventilators together; get a stream of parts going and start manufacturing long before we reach the peak of this epidemic. Their workers are not going to be doing anything else so let's let them have their shot. Meanwhile, other companies could start on parts manufacturing. Some design should be chosen; standardized and then we need to start moving. Everywhere. Ditto portable ICU units, negative pressure environments and training for people to help others during this epidemic. If not many more more lives will be lost.
Those are closer to nanomachine fabrication tasks, but different. Lots of specialized, uncommon, high-precision machines: everything is a one off, there is no bulk, and it's all expensive and fiddly.
Ironically the way to make this stuff cheaper would be a three-fold attack.
* Make MORE things that use the same parts, so that making the raw materials is commodity.
* Reduce waste in use (if sterilizing the filters for reuse / etc is possible, etc).
Part 3: Look for alternatives that are feasible.
A hot-zone (book) style line supplied breathing air positive pressure suit that can be scrubbed clean on the outside, OR a similar glove-box (negative draw?, scrubbed inside?) style phone-booth like I think I saw on TV from South Korea (IIRC) would be much better replacements.
As for actual air-dropping - this is actually not that far from reality here in Europe. Two days ago Czech army transport aircraft (nothing fancy, just a A319) got back from Shenzen with 100k quick-tests for the virus, that can give results in about half an hour for a symptomatic infected person. Then the test were distributed to main hospitals via police helicopters.
Reportedly the Hungarian government learned about this operation & are likely to do something similar in the next days.
Also in parallel, Czech Airlines aircraft have been pretty much drafted and sent to China for more stuff - like more tests, respirators and personal protective equipment. And one of the huge Ukrainian AN-124s has been chartered and is already on way for ~100 tons of medical supplies in one go, with more likely to follow.
Basically any classical goods transfer methods are far too slow for this and time is of essence.
the people that are most likely to need the ventilators aren't exactly hospitals' profit centres either.
are those businesses really going to want to fill all their space with Medicare patients? with fewer ventilators, I imagine they can decline care to more people?
Yes and no, some states are constantly on the border of being insolvent. California has a big 'rainy day fund' but this recession is projected to eat into a significant chunk of it. The way hospitals are funded and administered may make it tricky for a state to buy a bunch of ventilators with state funds and then donate them to a hospital... if you "lend" them then after the crisis the state owns a bunch of used ventilators it needs to offload.
Because the equipment requires very sensitive measurements on the order of tenths of cmH2O and tenth of a milliliter of air, a very small leak in any one of the seals can cause a significant inaccuracy in ventilation and especially in the alarms which govern whether the equipment isn’t overinflating your lungs. This isn’t like a car where you can just start it up periodically to keep seals lubricanted. You need to maintain them or to have a plan for how you’ll check them before putting them into service. And you need biomedical technicians who are trained to repair them and clean them. If you mothball the equipment there is a very real danger that without re-qualifying the equipment it will kill or injure patients.
The biggest effect GMs announcement seems to have had is convincing people that a car company that builds to PSI tolerances can build anything to the kind of tolerance needed to safely ventilate patients. I think this is a PR move and GM and Tesla will study the problem enough internally to determine they have no idea what they’re doing. Worst case we get ventilators from Tesla with the same manufacturing defects and quality issues which their cars have had. I personally would not feel safe on a Tesla or GM ventilator built without FDA oversight.
In some cases, it's complicated, yada yada. I'm certainly no expert on state-level budgeting in the US. In the case of NY specifically, I know it's been reported that Cuomo specifically asked the federal government for help getting ventilators and was rebuffed.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.