Vaccine Passports (domestic).

[D_W]

After the first shot, I'm a fan of the ***. Second one in a little over two weeks. We'll see how it goes. I often get complex migraines so the mild headache late evening after the first shot was kind of cute. Same vaccine knocked the mrs. out last month for a day and a half, though, and not much closes down her criticizing machine.

We call her "the ayatollah complainy" here, as she's a heel nipper (like a sheep dog always correcting the flock). She was totally out of commission after *** 2, but both of my parents (older) waited for something after the second shot and felt nothing.

 

[D_W]

You are right we should sell the NHS to the USA.

They will run it so much better. The ambulance may well drive past you if you cannot afford to pay and you might spend a huge amount on healthcare but at least you won't have to worry about false stories from the Mail and Express about immigrants exploiting the system.

Or you could have false stories about public ambulances driving past people. They'll pick you up here no problem. You figure out how to pay later.

We spend more public dollars on healthcare than the NHS does in total. The system is expensive on the purely private side, but the public part is HIGHLY subsidized by it. (2019 medicare and medicaid spending, which doesn't cover public medical spending at state and county level - there are public state level benefits and county benefits for low income - as in, free health care - $1.4T.

The reimbursement rates for public health care are subsdized by higher reimbursements from private, so realistically, the burden on the system for public healthcare is probably a good bit higher than $1.4T.

I was reminded by Jacob earlier that Cuba is really good though. Outcomes aren't as good as the US, but ideals are more important than outcomes.
It is true that it's easier to go bankrupt over medical things in the US than in Cuba, but you have to have some money first to go bankrupt and in cuba, if you're an individual, you're already there (despite all of the stories about medical bankruptcies in the US, I don't personally know anyone who has ever experienced such a thing. It's possible to have it happen, though, and it makes a better news story than "ghee, I like to go to the doctor a lot, wouldn't tolerate the waiting or allocation of resources in the UK, and I'd like to complain about the cost here".

We have a lot of "poor" people who expect the doctor to give them something easy to fix their issues. When self-care (like targeted exercises or physical therapy "homework") is involved, they tend to not do it (that applies to more than just the poor, but my wife treats a lot of folks on medicaid and compliance is very low among people who, for example, get three visits per week for wound care and need to change dressings daily - they get dressings from the clinic and who knows what they do with them (probably throw them away).) On the other hand, I tend to ask the doctor "would it be reasonable in this case to wait and see if medication is necessary and I can come back if it is?".

quite often, the answer is "that would be perfectly reasonable", with the unspoken bit about people not tolerating wait and see not admitted unless I ask.

 

[sploo]

I have no idea why we'd believe that someone who recovered would need the vaccine as we have no data suggesting difference in outcomes yet. Second infection of any significance is probably well less than first infection after vaccine (I have a few relatives who got covid post vaccine, but in fairness, they managed to catch it about two weeks after vaccine when efficacy is assumed to be pretty good, but not the "great" that it is after 3 weeks.).

They had relatively mild cases (which one would expect anyway for their age group and fitness levels (but had marital strife over it equivalent to much more severe cases!)

I ride public trans in a "normal" economy. if someone was vaccinated and didn't wear a mask, I wouldn't care. If they previously had covid and didn't wear a mask, I wouldn't care. If they had neither and sat on a bus, I'd expect them to wear a mask.

There's some interesting data on this in The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00501-8/fulltext

Consulting "Dr Wife" to ensure I understood the data presented on the graph - it's essentially showing that:

• People who have not had a vaccine shot AND have not been infected have basically no antibodies for the virus (which makes sense)
• People who have had a vaccine shot AND have not been infected show a good range of antibodies
• People who have not had a vaccine shot AND have been infected show a range of antibodies that is considered to be not statistically significant in difference to the "single vaccine shot + no infection" group
• People who have had a vaccine shot AND have been infected show larger levels of antibodies than any other group

It's good news; as it indicates a single shot of the Pfizer vaccine may give some good protection. Obviously this data is after the UK government's decision to take this path; which still means it was unethical, but it appears they (and the population) may be lucky.

 

[Mark Hancock]

Or you could have false stories about public ambulances driving past people. They'll pick you up here no problem. You figure out how to pay later.

We spend more public dollars on healthcare than the NHS does in total. The system is expensive on the purely private side, but the public part is HIGHLY subsidized by it. (2019 medicare and medicaid spending, which doesn't cover public medical spending at state and county level - there are public state level benefits and county benefits for low income - as in, free health care - $1.4T.

The reimbursement rates for public health care are subsdized by higher reimbursements from private, so realistically, the burden on the system for public healthcare is probably a good bit higher than $1.4T.

I was reminded by Jacob earlier that Cuba is really good though. Outcomes aren't as good as the US, but ideals are more important than outcomes.
It is true that it's easier to go bankrupt over medical things in the US than in Cuba, but you have to have some money first to go bankrupt and in cuba, if you're an individual, you're already there (despite all of the stories about medical bankruptcies in the US, I don't personally know anyone who has ever experienced such a thing. It's possible to have it happen, though, and it makes a better news story than "ghee, I like to go to the doctor a lot, wouldn't tolerate the waiting or allocation of resources in the UK, and I'd like to complain about the cost here".

We have a lot of "poor" people who expect the doctor to give them something easy to fix their issues. When self-care (like targeted exercises or physical therapy "homework") is involved, they tend to not do it (that applies to more than just the poor, but my wife treats a lot of folks on medicaid and compliance is very low among people who, for example, get three visits per week for wound care and need to change dressings daily - they get dressings from the clinic and who knows what they do with them (probably throw them away).) On the other hand, I tend to ask the doctor "would it be reasonable in this case to wait and see if medication is necessary and I can come back if it is?".

quite often, the answer is "that would be perfectly reasonable", with the unspoken bit about people not tolerating wait and see not admitted unless I ask.

Having just spent some time talking with a friend in the US where the subject of healthcare there came up I can only conclude you have a very blinkered viewpoint; one might even say privileged.

 

[D_W]

That's all fine and good, but we like to go on outcomes and not intermediary measures if outcomes data is available.

Antibodies fade fairly quickly. However, that doesn't seem to lead to many significant reinfections.

Apparently, reactivity to SARS Cov-1 remains (t-cell at least) almost two decades after the outbreak.

As common as covid is now, we ought to be able to see if there's a significant difference in outcomes between the cohorts and go based on that.

I'm at the bottom of the obese category (205 pounds today at 5'9"). My wife is bombarding me with news stories that fat people have half as many antibodies from the vaccine. I asked her if they have shown then that the vaccine has half the efficacy. Of course, this doesn't yield a response, but it does yield dirty looks. we talk to each other like edith and archie, except edith was much nicer. I've got archie nailed.

"I don't want to know how many antibodies I have, I want to know the chance that I'm going to get really sick!".

 

[D_W]

Having just spent some time talking with a friend in the US where the subject of healthcare there came up I can only conclude you have a very blinkered viewpoint; one might even say privileged.

It depends on the lens here. You can pay for healthcare, or you can become broke and get it for free. I choose to pay.

A pair of very liberal friends here lived in the UK for quite a while in the last decade. I asked them what they thought of the health care (in my view, I find some virtue in getting a discounted model with lesser access) and they said they didn't use it. I asked why, and they recounted an early experience with one of their children with suspected broken bone. She went to emergency services there and waited for a while to be seen, and then was told once she was seen that she'd have to go to another facility as they didn't have xray at that facility and it wasn't something provided as a standard at each location.

To us in the states, this is ludicrous. Our spend is also ludicrous, but to contrast that, my daughter fell down steps when she was very young. The nearest emergency center had a portable hand held xray device for kids. I have no clue what it was (think giant ipad). This wasn't a children's hospital.

They saw us within 15 minutes, got back to us that there were no observable issues and asked if we wanted to say in one of the patient rooms for a while - our choice, but it wasn't necessary.

Out of pocket cost - $50.

As a canadian company president said at my last employer (a benefits firm), "if you can pay, the US is the best in the world by far. The quality of care is as good as anywhere and the accessibility and responsiveness is better than anywhere. If you can't pay, you're better off in canada".

There are quite a few here who think they're going to cheat the system and go uninsured, though, and that's not great. There are also people who think they don't need to make the effort to seek public benefits if they are poor because they are too proud and will get past it and take the risk. Having assets and stepping into our health care system in an emergency uninsured is not a great idea. Even if you don't have much for assets.

(all that said, there's a strong notion among idiots here that the care level shouldn't go down, there should be no less access, but the price should be 1/3rd or some such thing - how would that be achieved? "make it the law and pay doctors less. They get paid too much".).

Doctors do get paid a lot here. Specialists probably far more than anywhere else in the world, and PCPs somewhere around $200k on average with those operating a practice with more than a few staff making a good bit more.

 

[D_W]

Sad only in a maximin way. I'm sure if you were here with good coverage, you vastly prefer the system here.

Personally, I'd like the option of a second tier system, but have heard the mental health care system there in terms of one on one therapy is poor. Therapists have been in demand here in the last year, but one on one therapy is standard coverage under parity laws. There's no shortage, either. That's a reality of paying a premium.

If you're looking for someone here who will complain about the cost, that's not hard to find. If you're looking for someone who has been overcharged for dental or medical work, that's not hard to find.

 

[Jelly]

I asked why, and they recounted an early experience with one of their children with suspected broken bone. She went to emergency services there and waited for a while to be seen, and then was told once she was seen that she'd have to go to another facility as they didn't have xray at that facility and it wasn't something provided as a standard at each location.

To us in the states, this is ludicrous. Our spend is also ludicrous, but to contrast that, my daughter fell down steps when she was very young. The nearest emergency center had a portable hand held xray device for kids. I have no clue what it was (think giant ipad). This wasn't a children's hospital.

To a Brit, that sounds like a case of confusion over names...

Nomenclature wise an "Urgent Care Center" in the states, which you'd expect to have X-Ray, triage based on severity etc, would be called a "Minor Injuries Unit" here.

But we do have "Urgent Care Centers" here... Which are effectively a doctor's office, with no special diagnostic equipment, but open 24-7 for the kind of illnesses which you'd normally go to a GP (PCP) for, which have now so unpleasant you can't wait until your GP is open to book an emergency appointment; these have no triage arrangements (and associated longish waiting times) because it's assumed that if you had something genuinely serious, you'd go to minors / A&E or dial 999.



The NHS definitely has a learning curve to use it effectively, if you don't pick the right service for the situation, there's likely going to be a miserable wait.

I've never waited more than 15 minutes for an x-ray in my local "Minors", who are rarely quiet, but really churn through patients at a rate of knots.

Compare that to going to A&E with a similar injury (suspected uncomplicated break) where on a busy day with no obvious signs of deformity, it can totally take several hours to get an x-ray, possibly with some pain meds whilst you wait for the radiographer to call you, if it's obvious you're in severe pain.

Yet the two times I have been to A&E with genuinely serious complaints (Infected Jaw Bone from a decayed wisdom tooth and Sciatic Pain with total numbness of both legs and lack of function in one leg) I've been treated very quickly...

 

[D_W]

True emergency rooms here can be clogged, but in my experience, only at the specialist places (as in, if you go to a children's hospital in the middle of flu season, they can be backed up). What used to be an issue here with ER (as in, the uninsured would go to the ER and elect to "not pay at the time of care" because they weren't going to pay at all) has been dealt with effectively.

Friends who went to the UK described where they went as an ER, but this is all, like you say, a matter of terminology. The lines are also blurred here as health systems fight over patients. AT first it was ER traffic, then urgent care private (low quality in my opinion) centers opened, and then they had trouble with insurers and started offering things like discount cash prescriptions, which moved the insured elsewhere (if you paid for script coverage, the copay is still going to be less than discounted cash cost - paying $50 for a pair of scripts at the urgent care is more like a convenience charge.

The large health systems battled back by opening urgent care centers in retail places (and the quality is much higher), and since then, now all PCPs offices with more than a couple of staff in my health system have opened to walk in patients 6 days a week. So you can go to your own doc's office no appointment, but you may need to see someone other than your doc if you don't have appt. Small price to pay).

Then the battle started to come over surgery location. As hospitals lost ER traffic and had negotiated rates with insurers (That were low) the health systems started making outpatient convenient surgical centers (back to smaller buildings) in my opinion so that they could work around insurer reimbursement rates (the new centers started at a higher price - the patient doesn't know the difference as it's all insured).

Then, to squeeze out community hospitals or inflict pain on a competitor's larger health care location, the battling health plans here have started building mini hospitals, which would've been normal hospitals eons ago, but like 40 beds and an ER. Who knows where it will all end.

So, you can go to big ER, little ER, PCP office normal hours, private independent urgent care, or now urgent care centers within the network. The PCP office may not have an xray, but likely there will be a private imaging company in the same building so you don't even have to go to your car.

Personally, out of laziness, I like this. If I had a chance to get a few grand back or added to my paycheck and take a lower level of service, I'd take it for everything other than mental health parity. That law has been especially good because it puts people in talk therapy instead of on pills right away. You have the option for one or the other or both, but if you're battling insomnia or something and want to talk about the root of it, you can generally be talking to someone the next day or two.

The extra capacity (in my view) is wasted money, though. Most of the plans around here are not for profit, which means if they have earnings, they have to retain them or spend them within the system. I wish they had to give most of them back to the employers and patients.

 

[Robbo60]

Looking good at the moment, maybe pressure will force the government to open faster, the vaccines seem to be working.

View attachment 104934

Government was fairly clear for each stage "no earlier than". TBH that was our expectation, so let's just stick to it. Got my snorkel Parka ready for my lunch outside on April 12th

 

[Rorschach]

Government was fairly clear for each stage "no earlier than". TBH that was our expectation, so let's just stick to it. Got my snorkel Parka ready for my lunch outside on April 12th

Yeah because the government has always stuck to their guns and never u-turned. Oh wait! lol.

Pressure has already started and it will increase over the coming days and weeks. They shot themselves in the foot, even though they said "no earlier than" they also said "data not dates" well data works both ways so dates can come forward as well as go back.
I've got my fingers crossed as I have a holiday booked before the May17th opening, the hotel hasn't cancelled it yet, they are quietly confident of a change.

 

[sploo]

"I don't want to know how many antibodies I have, I want to know the chance that I'm going to get really sick!".

Yea, but the first one is fairly easy to quantify; the second one is way, way, more complex

A pair of very liberal friends here lived in the UK for quite a while in the last decade. I asked them what they thought of the health care (in my view, I find some virtue in getting a discounted model with lesser access) and they said they didn't use it. I asked why, and they recounted an early experience with one of their children with suspected broken bone. She went to emergency services there and waited for a while to be seen, and then was told once she was seen that she'd have to go to another facility as they didn't have xray at that facility and it wasn't something provided as a standard at each location.

That sounds a little odd. Any large UK hospital (with an A&E - the equivalent of a US ER) will have those facilities; but there are many smaller walk in centers that are for more minor procedures. There are also a number of centers that specialise in one area (e.g. physio and rehabilitation type treatment) - so they're unlikely to have xray machines.

 

[D_W]

Agree on outcomes being measure. It could take a couple of months, but since older groups and front lines here are already vaccinated for a couple of months, that data is there.

Even though I got the *** from a large arranged private health system, I did see them whip out some kind of cdc card and app. Agree about your comment knowing where to go. Part of the overspend here in the US is having equipment everywhere when it could be in fewer places, but even the little urgent care centers have xrays They don't want to give up that business. I thought our friends overreacted with their response of "we just didn't use it after that", but that's their choice. I'd have just made note of where to go next time.

 

[Jelly]

So, you can go to big ER, little ER, PCP office normal hours, private independent urgent care, or now urgent care centers within the network. The PCP office may not have an xray, but likely there will be a private imaging company in the same building so you don't even have to go to your car.

Personally, out of laziness, I like this. If I had a chance to get a few grand back or added to my paycheck and take a lower level of service...

The extra capacity (in my view) is wasted money, though. Most of the plans around here are not for profit, which means if they have earnings, they have to retain them or spend them within the system. I wish they had to give most of them back to the employers and patients.

This speaks to the one thing the NHS does really really well...

It's extraordinarily cheap compared to other comparable systems in other parts of the world, and manages to achieve very good overall outcomes, and somewhere between adequate and outstanding for almost all patients on what is effectively a shoestring budget...

I'd take it for everything other than mental health parity. That law has been especially good because it puts people in talk therapy instead of on pills right away. You have the option for one or the other or both, but if you're battling insomnia or something and want to talk about the root of it, you can generally be talking to someone the next day or two.

I think I might have been one of the people that highlighted the failings with Mental Health care in the UK to you in other discussions, and yes it's much much patchier with a real postcode lottery in terms of quality of care.

This is compounded by the fact that significant elements of what would form an integrated mental health service was taken out of NHS hands, to be provided by private companies, with local councils providing the funding from their social services budget.

Unfortunately those budgets are set in stone years in advance, and have to compete with other priorities, whilst the private organisations have to bid so low to win patients, that even small changes in care or variable costs results in a situation where they're unable to make money...

It has created a zero sum game in which the patient's best interests (and often those of the staff caring for them too, who do genuinely care immensely), are squeezed by the incompatible interests of two competing large organisations where decision makers are only looking at the money 95% of the time.



You might think from that, that I'm arguing against the involvement of private companies in delivering healthcare; which I'm not wholly opposed to...

What I am opposed to is fixed-price contracting of these kinds of services with an opacity as to the actual cost of delivery, resulting in constant back and forth over money between the two organisations who should be focused on helping the patient.

I'd be much more comfortable with us using a "Pain-Share Gain-Share" model to contract for those services, where the company agrees a target price and a level of profitability with the funding body, and if they manage to bring down costs, both the funder and the company gets a cut of the extra profit, whilst if costs rise the funder covers some or all of the cost over-run, but no margin is chargeable on that cost.

More equitable distribution of business risk almost always helps to drive down cost, allowing either party to shoulder all of it on the other hand almost always drives it up.

 

[D_W]

I'm sure the mental health issue will be solved. It's too bad it couldn't be done easily (in my view). When something has worried me and caused me to lose sleep at night, I've felt worse than any bronchitis I've had in the past (that's just an individual account, I realize someone with problems on the physical side would feel different). It always resolves, but at one point getting CBT in the past decade was a life changer.

I'd appreciate a system here, though, where the base needs are covered more like the UK's at a reasonable cost, and the ancillaries, like this MH parity issues, are handled dynamically in a second layer (determined as per need). When a public part of a system goes private and people hide behind rules and disregard outcomes, nobody is served. I understand why it occurs (the private group would like the business, and the public side wants to offload it).

Our system is all second layer on steroids - trying to anticipate what everyone wants, offering it in spades and then competing with each other. And people here complain about the price, but show time and again that they'll go to the highest cost glitziest provider they can if they have a choice. Since the cost is split between various parties, most of us don't get a concept of just how much the convenience costs when we use it and the consideration of "would there be a better way to do the day to day stuff" and "do we really need to order all of these tests and follow up".

 

[Rorschach]

It's almost like they are shocked that people given a vaccine that would make them safe, would then go out and act accordingly. What is the point in being vaccinated if you can't go back to living a normal life?

 

[Spectric]

It's almost like they are shocked that people given a vaccine that would make them safe, would then go out and act accordingly. What is the point in being vaccinated if you can't go back to living a normal life?

Yes I agree people will act like this but we are getting carried away in the moment, assuming victory is ours now we are getting vacinated without thinking, it requires a majority to be vacinated before normality, there is still a lot of unknowns about the virus and the vacine and starting to run before you can walk will be a disaster. We all need to remain vigilant and not provide the virus with one giant petri dish in which to mutate and then turn on us vacinated or not. Until the majority are vacinated the virus still has food, it has opportunities to learn and change so if we take longer to unlock is this not worth the sacrifice so as to beat the virus and then they can modify the vacine to deal with the other strains and life can return to near normality and without going back into lockdown.

Vacine passports are needed, we already know it only takes one individual to enter a country to start the spread, so why can't they have a vacine stamp in a passport which makes the passport valid? I know of a few companies that are saying no vacine no job, so some form of domestic vacine passport is needed, could we all end up microchipped?

 

[Jelly]

could we all end up microchipped?

Bonus!

This is a major digression, but an acquaintance of mine who develops embedded systems for building automation, has an RFID microchip in his hand which controls lots of aspects of his home.

I asked him how he got it, and he explained that it was very expensive to get one implanted professionally by a doctor...

So he bought a sterile microchipping kit from an online veterinary supplier and DIY'ed it, then adjusted the RFID sensors to work with the chip he had. Apparently it took him three goes (and three kits over several weeks), because he wanted the chip in his right hand, but wasn't very good with his left, and he couldn't find anyone willing to do it for him. Absolutely Nuts!

But the way he forms his own key for the house, and can have things like light, heat and radio follow him round the house effortlessly does look mighty convenient. He's been working on trying to reverse engineer his contactless card to put that on an implantable chip too, which is again a little out there, but very... handy

 

[sploo]

It's almost like they are shocked that people given a vaccine that would make them safe, would then go out and act accordingly. What is the point in being vaccinated if you can't go back to living a normal life?
View attachment 105118

Because almost all of them will only have received a single dose so far; and the manufacturer's only tested the efficacy with two doses. I.e. they're not "vaccinated"... yet.

(yes, there is now data indicating that a single Pzifer dose looks to give promising results, but that's only recently become available)

 

[Mark Hancock]

Unless I am misunderstanding some of the recent posts, having the vaccine does not make one safe. The full course of vaccination reduces a person's chance of becoming seriously ill from Covid-19. The idea of it making a person safe is more than likely something decided on social media and passed on like Chinese whispers.