Author: philg

Tele-primary care costs during the Coronapanic: $1,220 per hour

by philg

I had called my primary care doc at the end of March to see if something should be done about the 5-week dry cough (Covid-19? Some other Massachusetts plague?).

The bill arrived today for “Phone evaluation and management by physician or other qualified health care provider, 11-20 minutes” (the cruel enemies of medical billing nirvana at Verizon Wireless unreasonably recorded this call as having lasted 10 minutes)

The cost billed to insurance? $305.

I hadn’t seen this doc for a while so they tried to get my old policy to pay, thus resulting in an unexplained disallowance and a bill to me for $305. If we assume that the doctor can do four of these “11-20 minute” calls per hour, that’s $1,220 per hour. A physician working from home full-time solo, therefore, could make $2.44 million per year.

(And, here in Massachusetts, the enterprising child support plaintiff who has sex with that physician, could make roughly $400,000/year, tax-free, for 23 years; no need to target a specialist!)

If you have no familiarity with the U.S. system, you might ask whether I received a diagnosis in exchange for $305. The good news is that I got at least two diagnoses: (1) asthma, (2) some sort of dripping from back of nose down into throat that might go away after two weeks of twice daily pumps (not to say “injections”) of Flonase. I did actually buy Flonase and managed to get in a day or two of treatments before the cough disappeared.

Keep in mind that I am being billed by a not-for-profit enterprise…

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Use testing and tracing infrastructure to enforce alcohol Prohibition?

by philg

Back in 2016, I wrote “Reintroduce Prohibition for the U.S.?”, pointing out various advantages for American society if we could reduce alcohol consumption. This proposal was not well-received!

What about in the Age of Corona? Technocrats are gearing up for a massive testing and tracing operation. Example: “Here’s A Way To Contain Covid-19 And Reopen The Economy In As Little As One Month” (Forbes, by a Boston University econ professor). Excerpts:

The solution is PCR group-household testing of all American households every week. … If a household tests negative, each household member would be notified to go to their local pharmacy to receive a green wristband coated to change to red after one week.

This system is voluntary. But if you choose to have your household tested and receive your green wristband, you’ll be permitted by your employer to return to work, by your teachers and professors to return to school, and by proprietors to enter their restaurants, shops, cafes, etc. You’ll also be allowed to frequent the beach, attend concerts, go to the movies, …

Any household that tests positive will be required by the local board of health to quarantine in place for two weeks and then be re-tested. Households that don’t voluntarily get tested will be free to come and go as they wish. But without their green bracelets, they will have a hard time entering into workplaces and other establishments. Employers who hired the untested could face legal liability. The same holds for any business serving the public who lets someone onto their premises without a green bracelet.

My Dutch friend: “This will be just like it was for Jews after the Nuremberg Laws and similar. They were perfectly free, but couldn’t run a business, buy a movie ticket, or go to school.”

Electronic bracelets can also work: “People-tracking wristbands tested to enforce lockdown” (BBC). See also “US, Israel, South Korea, and China look at intrusive surveillance solutions for tracking COVID-19” (zdnet)

Covid-19 is a pernicious disease. It has killed nearly 300,000 people worldwide so far. But what if we could use the above technology and infrastructure to stop a much more destructive killer: alcohol. WHO says that 3 million deaths worldwide are attributed to alcohol. The average age of a death with/from Covid-19 in Massachusetts is 82 and more than 98 percent of those who died had “underlying conditions.” Alcohol often kills people who could have lived for another 40-100 years. In terms of life-years, therefore, we could save many more by discouraging alcohol consumption.

(Is Covid-19 different because an alcohol-related problem is due to a failure of personal responsibility? Consider the child of an alcoholic or a passenger in a car struck by a drunk driver.)

Given that people can brew their own beer or distill their own vodka, presumably it is not possible to achieve a 100 percent reduction in alcohol consumption. But if restaurants, bars, and airlines (to the extent any are left) were not offering alcohol to every customer and there were no convenient liquor stores (“essential”!), wouldn’t it be fair to expect at least a 10 or 20 percent reduction in alcohol-related deaths? (marijuana consumption increased following legalization in Washington State; shouldn’t we expect alcohol use to be reduced following prohibition?)

Since Americans have now decided that “saving lives” is more important than what used to be considered individual rights… If we succeed with alcohol prohibition using test/trace tech, why not use the same technology to attack HIV/AIDS, which has killed more than 700,000 Americans? (Covid-19 would have to kill 7 million Americans to take away a comparable number of life-years, due to the much younger age at which HIV/AIDS victims perish.) There continue to be 6,000 deaths annually here in the U.S., which is roughly comparable to the life-years lost from 60,000 Covid-19 deaths.

None of these public health interventions were doable in the 20th century. Epidemiologists predicted that HIV/AIDS would spread beyond the LGBTQIA+ community and kill millions of Americans. White upper-middle-class single Americans were terrified in the 1980s by this disease that merited cover stories of TIME magazine multiple times. Nobody would have tolerated the criminalization of sex outside of marriage in order to “save lives”. Today, however, there is no limit on the power of the government when there is a public health goal. (Maybe outlaw all sexual activity? If people want children they can be imported via immigration and/or produced locally and without HIV risk via IVF.)

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Massachusetts enters its third month of shutdown

by philg

Our schools and cubicle farm offices shut down more than two months ago. Our “non-essential” stores a little less. So I think it is fair to say that today is roughly the day that we in Massachusetts enter our third month of shutdown.

Charts of new cases and new deaths don’t suggest that whatever we did during the first two months of shutdown had much effect on the virus.

How are we doing compared to the Swedes? Our death rate thus far is up to 2.3X what they are suffering in “let the virus burn through the younger than 65 population” Sweden (see “Number of new COVID-19 cases worldwide is declining now?” for my tracking of the numbers).

How about compared to the states with no income tax? Our death rate is 20X that of Texas and Tennessee, 10X Florida’s, 7X Nevada’s, 75X what they have in Wyoming and Alaska.

With the virus failing to live up to its dramatic exponential promise, but also failing to go away, we’re grasping at straws such as a recent governor’s order to fine people $300 who don’t put masks (that are impossible to purchase) on 6-year-old children (who will probably not follow WHO guidance regarding proper use of the mask!).

The current IHME prophecy for Massachusetts is 9,629 deaths through early August on a slow decay:

How does this compare to a country with no lockdown? The IHME prophets predict 5,760 deaths for Sweden during the same time period:

Tough for me to discern a dramatic difference in these shapes (though of course there will be a higher death rate, adjusted for population, in Massachusetts, roughly 2.4X Sweden’s if IHME proves correct).

The slow/steady curve seems to be the virus’s plan for the entire world:

Maybe there is a downward trend visible in deaths, though? The flat graph for new cases is an artifact of increased testing?

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Don’t get the antibody test yet

by philg

I had a physical checkup scheduled for March (the U.S. health care system had so much spare capacity prior to coronaplague that it took only 3 months to get on the schedule). As part of this, the doc ordered some bloodwork. Of course, everything has been pushed back until at least June. But I thought I would call the doc to see if he would add a coronaplague antibody test.

“Don’t do it yet,” he told me over the phone. “Everyone is waiting for the Mount Sinai test, which should be available in a couple of weeks.”

He said that even the best of the existing tests, such as the one from Roche, suffer from being triggered by previous infection to unrelated coronaviruses, e.g., due to a common cold a year previously. This is at variance with the Roche press release, so I am not 100 percent sure that he is correct, but since there is nowhere to go right now maybe waiting a couple of extra weeks doesn’t matter.

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Modern buildings are LEED-certified plague factories?

by philg

One of the arguments advanced by citizens of our Boston suburb (Lincoln, Massachusetts) in favor of a $600/square foot renovation/reconstruction of the K-8 school (about $250,000/student, making it perhaps the most expensive school ever built in the United States) was that the 25-year-old windows in the classrooms and the exterior door from every classroom to the outside grass (single-story building) were leaky and prevented the building from reaching Net Zero nirvana. Without A/C in the classrooms, teachers had windows completely open for much of the year.

The construction project, contracted for at the very peak of the Boston real estate market, will commence in June 2020. (One argument by project proponents was that the vibrant local real estate economy would continue to expand forever, thus construction costs would rise at 5 percent forever, so we would be saving huge $$ by spending $110 million now.) The building shell will be sealed as tightly as possible and fresh air will be kept to the absolute minimum. Students will have to funnel in through one of a handful of exterior doors and funnel out through those same doors when school ends. Obstructing direct student egress from individual classrooms was sold as a defense against mass shooting. Apparently students are safer when trapped into their classrooms than they would be if they’d run 1/4 mile away.

I wonder if we have been and are building ourselves into a plague-friendly environment. Even with energy recovery ventilators, we still need to minimize fresh air in order to achieve Net Zero Nirvana. Green building advocates claim that somehow indoor air quality is actually higher in the latest green buildings, but perhaps they are comparing them to the failed Jimmy Carter-era energy crisis sealed office buildings (complete with plastic carpet emitting toxic fumes for decades!).

It is tough to believe that the new school, in which air gets in and out primarily via a handful of central pipes, will be as plague-resistant as the old school, in which every group of students had direct access to fresh air via a massive window bank and/or an open door.

As the U.S. population grows, thus packing a higher percentage of us into multi-family housing, and an ever-larger percentage of our buildings are designed for minimum energy consumption, will viruses end up being the primary beneficiaries?

Related:

  • “LEED Building Standards Fail to Protect Human Health” (Yale): One of LEED’s major accomplishments — saving energy by making buildings more airtight — has had the paradoxical effect of more effectively trapping the gases emitted by the unprecedented number of chemicals used in today’s building materials and furnishings. … Programs such as LEED place relatively little emphasis on indoor air quality.
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Masks for airline passengers: now the Danish are telling us how stupid we are

by philg

From Denmark:

Professor in microbiology, Hans Jørn Jepsen Kolmos, thinks that facial masks will be a solution to protect ourselves from the coronavirus on multiple segments of the journey. Just not on board the aircraft.

It is important to underline, that only surgical masks and certified respirators are effective. Fabric masks are more permeable for drops and particles, and one should therefore ensure that only masks of documented quality is used.

Infections do not care about rituals, and masks are only helpful in situations with a high likelihood of being exposed to infections. Those could, for instance, be during boarding, while visiting the lavatory, or when leaving the aircraft. During the flight, the mask, however, can cause more damage than it helps.

Masks do not only lose their protective properties by getting wet. Another way to bring down the protectiveness is when you touch the mask or your face. Doing that, bacterias can in even more ways find their way into your body:

When touching the mask – for instance when drinking coffee, repositioning it, etcetera – you can pollute your fingers with virus particals from the mask itself. That way, you neutralise the effect of the mask, in the best case scenario. Therefore masks cant be the only protective equipment used and should be limited to rationally selected tasks and timeframes.

In other words, according now to both the Swedes and the Danes, we are responding to coronavirus in the dumbest ways imaginable!

From Facebook today:

Righteous Person #1: I’m getting used to wearing a mask when I go out. They are not fashionable – but they perform a vital Function to keep other people from catching what I might have.

Righteous Friend #1: more and more, here in Montana where we are down to our last 20 active cases, the mask has become a public symbol of solidarity and neighborliness — and a reminder that lack of vigilance in large public gatherings still holds the threat of a second wave of infection.

Righteous Friend #2: It’s the opposite of a MAGA cap.

Expert advice from WHO that should be rejected (while “listening to the experts”):

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Ebola vaccine: 43 years after first outbreak

by philg

A righteous Church of Shutdowner on Facebook regarding the infidels of the frozen north:

The Swedish approach makes sense if and only if you are certain that everyone is going to get the virus in the end. If you think there is going to be a vaccine available within 18 months, it means far more deaths than necessary.

[“far more deaths than necessary” in Sweden to date translates to half as many as in Massachusetts (adjusted for population size). Their failure with continuity looks pretty good compared to our success with shutdown!]

I asked why he was confident regarding vaccine development:

We produced a vaccine for Ebola within months of the disease appearing. And right now we have every vaccine lab in the world and more looking for the COVID vaccine. The question hasn’t been time, it has been whether immunity was possible. If you have thirty world class labs each taking a shot at producing a vaccine that has a 10% chance of success, you are pretty much certain to succeed if it is possible with that approach.

I certainly hope that he is right (he’s a computer programmer, not a virologist, so he is guessing just like the rest of us!), but I decided to check out Wikipedia on Ebola and discovered that it first broke out within humans in 1976 and an approved vaccine become available 43 years later, on December 17, 2019 (i.e., we were perfectly set up to fight the last war almost to the day that the next war broke out).

(The press release might have to be walked back a bit, given recent events: “The first-ever FDA approval of a vaccine for the prevention of Ebola is a triumph of American global health leadership.”)

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The Swedes actually did have Covid-19 models

by philg

I had searched in vain to find the Swedish equivalent of the IHME model that Americans love. Surely there had to be an academic in Sweden who wanted to be interviewed by hysterical journalists about the forthcoming doomsday. Yet I couldn’t find anything in English, at least. I thought that maybe Swedes simply didn’t care how many people would get sick, when peak deaths would occur, or how many of their fellow citizens would die. They seemed to be content to let the 15 epidemiologists on the governor’s team be their only soothsayers (example).

As usual, I was dead wrong! “Can we trust Covid modelling? More evidence from Sweden” (The Spectator) shows that Sweden had its PhDs willing to make a few assumptions and then stick them into a simple model. And the ones who came up with the most dramatic forecasts of doom got some media attention. Demand for critical care was going to be “16,000 patients per day” in early May:

Another team upped this to over 20,000:

The government team thought Sweden would have 1,700 patients in the ICU right now. The actual number is around 500.

The doomsayers thought that doom was inevitable even if the Swedes converted to the Church of Shutdown:

And obviously, there is an argument that these models scared us into changing our behaviour and ramping up capacity, and so helped us to avoid a disaster. But they were also clearly based on faulty assumptions that would always result in absurd predictions. We know this, because both models actually assumed that it was already too late, and estimated that ICU capacity would be exceeded by around 10 times even if Sweden switched to strong mitigation.

The need for ICU beds in Sweden will be ‘at least 10-fold greater [than capacity] if strategies approximating the most stringent in Europe are introduced by 10 April’, wrote Gardner et al.

Those strategies were never introduced in Sweden, and yet, additional ICU capacity is 30 percent and the number of patients in intensive care has been declining for two weeks. The newly constructed field hospital in Stockholm, with room for hundreds of patients, has still not received any patients. It will probably never have to open. Here’s a zoomed-in graph of eventual ICU: numbering in the hundreds, not the predicted thousands.

(i.e., the Swedes also built a temp hospital that was never needed!)

I’m kind of curious as to why Americans have placed such faith in the prophecies offered by epidemiologists given that epidemiology is primarily a retrospective activity and there is no historical data on how virus transmission is affected by a Western-style “porous lockdown”. It is as though people in the 1980s had decided that the “complexity” theorists of the Santa Fe Institute, who also could spin a few assumptions into an interesting tale, could be relied upon as reliable oracles. People don’t have the same faith in models of the future stock market. Nobody says “I’m going to hire three PhDs, download R, and become fabulously wealthy starting next week after my team’s model tells me the future prices of stocks.”

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Elizabeth Warren wants to fight inequality with a $3 billion ferry for the nation’s richest people

by philg

Are you a lower-middle class taxpayer in Iowa or Arkansas? Elizabeth Warren wants you to buy $3 billion in ferry tickets for the nation’s richest people, i.e., folks who can afford summer houses on Martha’s Vineyard, Nantucket, and similar island retreats: “Markey, Warren, Keating Seek Federal Aid for Steamship Authority”:

With the financially strapped Steamship Authority in mind, the Massachusetts Congressional delegation is requesting $3 billion in aid to keep the country’s ferry industry afloat.

In a letter sent to Speaker of the House Nancy Pelosi and senate leaders Mitch McConnell and Chuck Schumer on May 7, Sens. Elizabeth Warren and Ed Markey, and Cong. Bill Keating pleaded for additional dollars for ferries, citing the SSA’s plummet in passenger traffic and the fiscal strains caused by the pandemic.

What else can middle-class taxpayers in the mostly plague-free “flyover” states buy for us?

(How much does $3 billion buy when it is not a U.S. state government spending the money? Indonesia has a Navy with roughly 140 vessels and 55 aircraft to patrol its 3,000 x 1,100 mile territory, which includes 17,504. islands. The total military budget of Indonesia is about $9 billion (Wikipedia), so presumably the Indonesian Navy spends close to $3 billion per year.)

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