The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 11 · 1 year ago

A Return to Normal in 2021 & America’s Healthcare Ranking


John Dalton & Ed Eichhorn, Editors of The Three Minute Read™ review articles about the projections for when a return to normal could be expected amid widespread vaccinations. They also discuss nurse burnout as a result of the pandemic and the US’s healthcare spending and general health statistics compare to other countries.

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Welcome to the three minute read podcast. I'm John Dalton, editor of the twice monthly newsletter of the healing American health care coalition. Joining me once again is Ed Ichorn, the coalition's cofounder and Co author of healing American healthcare, a plan to provide quality care to all while saving a trillion dollars a year. By John. It's nice to be back again this week. Together, ed and I have nearly a century of healthcare experience and we're still trying to figure it out. You can find our background and contact information at the end of the podcast. We launched the three minute read last March to summarize some of the critical issues that are affecting busy clinicians and physicians as they continue to struggle through this band amic today's issue launches our second year of publishing what we hope you found to be timely information on these issues for America. February was a month of horror and of hope. Horror when the covid nineteen death toll past half a million. Hope with the approval of J and j's safe and effective single ghost vaccine. The horror continues. As we record today's podcast. America's Covid nineteen death toll will reach more than five hundred and twenty one thousand. That's the same as the total number of combat deaths in World War One and World War II combined. But hope is on the horizon, with more than eighty million doses of vaccine having been administered. The first article in our issue outlines its timeline for a return to normal. So let's dig into the latest three minute read, published March fourth, one year after New Jersey's first confirmed covid nineteen case. That was one in Metro New York Join Milan and Madrid as epicenters of the global pandemic. So our first article appeared in the Atlantic, written by Joe Pinsker, and it's called the most likely timeline for life to return to normal. And, as you can see from the icon, the new normal still includes masking. The author expects an uncertain Spring and amazing summer, a cautious fall and winter and finally relief in two thousand and twenty one. For the next few months, daily life will continuer be far from normal. The wildcard the equations, we're all aware, is the potential emergent of a virulent vaccine resistant variant of the stars Kov to fires. There are a couple of them more already raging in Britain, the bee seven and Brazil the P one variant. Fortunately, most of the scientific research seems to indicate that the vaccines that are being produced do prevent serious illness and death from...

...those variants. By Spring, small gatherings of vaccinity to people should be possible, so we can start to tune up the barbecues. Warmer weather late spring and summer will make many activities even safer. We can start thinking about taking public transit, being in an office, going back to the workplace, dining inside and restaurants and traveling domestically. But we won't see indoor concerts, we won't see full stadiums and we won't see international travel. Travel bands will still be in place. The summer full with colder weather, we may see a resurgence of the virus, but the new vaccines should be able to tame them relatively quickly. So beyond next winter the experts do expect a return to what we will see as a post pandemic normal. The next article is the first one who've actually excerpted from the American Journal of Infection Prevention Inter ourting, as you can see from the icon. We've all seen these for the last seven years. Protect Yourself, get the FLUCIA, get that seasonal flucia. It's a study that looked at the impact of the influenza vaccine on covid nineteen infection rates and severity and it was written by several co authors. What they looked at was a retrospective cohort at twenty seven thousand two hundred and one patients who have been tested for Covid nineteen between February twenty seven and June fifteen two thousand and twenty in the Michigan Medicine Healthcare System. What they found was interesting. People who had received the influenza vact scene, the seasonal flu vaccine, were less likely to test positive for covid nineteen. If they did get infected with the virus, they were less likely to need hospitalization, mechanical ventilation or a longer hospital stay. The research suggested a possible association between getting your seasonal flu vaccine and decreased risk of Covid nineteen and even if you contract the covid nineteen, better clinical outcomes. So this fall we managed to avoid the dreaded twin demmic through the spring and summer there were a lot of concerned expressed that with seasonal flu on top of covid nineteen, are hospitals and the healthcare system would be overwhelmed. This winter we had some early indications from the Southern Hemisphere, because our summer was there winter, that the seasonal flu in the southern hemisphere this past summer was nowhere near what it had been in prior years. So we did kind of expect a mild seasonal flu season. However, mild is an understatement. As of February, early February, there are only one thousand three or sixty three confirmed cases reported to the CDC, and that compares with an average of four hund one thousand at the same time during five prior flucy reasons, as at a hospital board wing at the end of January and asked the obvious question, what's what's happening with the seasonal flu? Are we overwhelmed?...

And the answer from the our chief medical officer was no, we haven't seen hardly any at all. That's what left us with capacity to deal effectively with the COVID nineteen pandemic. We're still only in a horse race between the vaccinations and variance, but today I think we're in a little bit better place and an Econmis I think this is important information and we should keep it in mind because, even though we are all focused on the pandemic, when the flu seven rolls around the next year, we should all get flu shots once again. So I think this is important just to remind us of where we need to be. I'm going to discuss two articles that we featured in our current issue that deal with nursing concerns that have been raised. The first article is by Teresa Brown and it appeared in the New York Times on February twenty eight. It's entitled American nursing is having a crisis. Teresa Brown is an American clinical nurse and a frequent contributor to the New York Times. She is also the author of two books about nursing, called the shift and critical care, that share accounts of the complicated challenges that nurses deal with every day in normal times. In this article, she interviewed takes vector nurses throughout the US, with evidence of the growing shortage of nurses as caregivers. The Bureau of Labor Statistics Projects that one hundred and seventy six thousand new nurses will be needed every year through two thousand and twenty nine nursing schools don't have enough faculty to expand the nursing workforce as is needed to meet these future demands. Beyond burnout, research suggests that Covid I see you, nurses are now suffering from moral injury, which is also known as PTSD, a term more typically applied to combat soldiers, Brown quoted and L Passo. I see you, nurse. That said, it's a moral injury when I leave a hospital bursting at the seams and all the bars and stores are full of people. To take just a brief digression here, leadership and public health intersect when we have to work our way through a crisis like the pandemic we all face every day. It's not easy. Are elected officials need to make decisions in in times like these that affect the economy, the business community and consider public health issues. This I see you, nurse, lives in Texas and this Tuesday her governor, Governor Abbott, announced that he is ending the statewide mask requirement and is allowing businesses is to fully open it's certainly true that everyone in America would like to return to life as early as a life was before the pandemic. Times of...

...great crisis to me in the best of our elected leaders. The pandemic really demands that they think carefully about the decisions they make, and they should try to be careful about following the science. Not Following the science doesn't make it go away. In this decision, the governor is ignoring science in the data that his state will use to make the jobs of Icee you nurses in Texas even more challenging. Today, the infection rate in Texas is more than seven thousand patients per day and it's higher than it was last summer during the second peak in his State. The death rates climb from eight point three per hundred thousand at the end of last June to more than a hundred and fifty thou at the end of February. That's an increase of more than seventeen hundred percent. The vaccination rate as a percentage, when compared with other states, is forty eight. It's only higher than Utah and Georgia. The injection rate for Texas is only thirteen percent. Texas is not anywhere near herd immunity. His decision will likely cause an increase in cases over the next three to four weeks. That will add to the burden of nurses who work in Texas. To return to the article, there are some additional quotes that Teresa Brown included that are worth repeating. Another icee you veteran, is studying to become a nurse practitioner. She said, I am going into primary care to keep people out of the hospital. We never had enough nurses. A second nurse, a veteran from Pittsburgh, said going into the pandemic we were not prepared. We never had enough nurses and support staff. We never increased the nurses in two thousand and twenty and Hfma report shows that having enough nurses in hospitals can actually save money. However, thirty six of America's sixty largest hospital chains have laid off, furloughed or cut the pay of staff members to save money during the pandemic. Teresa Brown calls for changes in the profession that include creative ways to bring more nurses into the workforce, adding faculty at Nursing Schools and making them more affordable. The next article that appeared in three minute read. This week is about nursing homes. The title is average Nursing Home Nursing staff turnover exceeds one hundred percent. This article appeared in modern healthcare and was written by Ginger Christ. She was commenting on a health affairs article that was released this week that reported at the average rate of nursing home staff turnover exceeds one hundred percent per year. The turnover for registered nurses in this market segment was one hundred...

...and forty point seven percent. The rate for license practical nurses and certified nursing assistants was one hundred and fourteen point one percent. This was a very comprehensive study because it covered more than Fifteenzero nursing homes with a combined census of more than a million patients. The study found that nursing homes with higher levels of Medicaid recipients had higher turnover, largely because of the pay to work in these facilities was lower. A STUDY CO author, Dr Ashen Gandy, who is an associate professor at UCLA's Anderson School of Management, said that we see fairly clear evidence that higher turnover rates tend to be associated with lots of factors that are associated with worse quality of care. The authors recommended nursing staff tone over rates should be included on the CMS nursing home compare quality rating system so that prospective patients and potential employees can better evaluate facilities. interpressing that that's an article for me March first issue in Martin Healthcare. The prior issue of Martin Healthcare also looked at staffing stress and its effect on nurses. They quote in some of the studies being done by the American Nurses Association, which is the Professional Organization for nurses. They point to one of our local hospitals, St Peter's University Hospital in New Brunswick, as an example of maintaining adequates staffing levels having mandated ratios as those California, for example the nurse the patient ratio. St Peter's is a former seventy eight bed teaching hospital and part of a project from not for profit organization of Nurse Leaders of New Jersey that organizations focused on establishing the councils at hospitals throughout the state. The councils include frontline nurses and leaders who work together to address staff and concerns at their facility. So St Peter's maintained that council even during its surge of covid patients in the spring when we were part of the global epicenter of the pandemic and their chief nursing over stray indicates that some nurses did take leaves of absent student childcare responsibilities because of close our school shut there, but no nurses left Saint Peter's due to or unsafe working. Additions and stamping ratios haven't been impacted. They maintain strong snapping throughout covid nineteen because they regularly engaged with staff and implement the suggested solutions. And the quote Linda Carrol, who's the cheap nursing lovat sir, our stand is our biggest voice. They know what is needed at the bedside. So there is a glimmer of hope in the whole issue of staffing and curent at, so long as you have participated management that empowers nursing staff to speak. With...

...that. Let's turn to my blog. This is my first blog and I it came about last Sunday as watching some of the snippets from the sea pack meeting where we kept hearing about America first, because on Health America is really worse. For those of you who read my two thousand and sixteen series of articles that appear to my professional organization magazine, they were entitled American Healthcare and pose the question worst value in the developed world. Using data from folks like a Commonwealth Fund, the World Health Organization the OECD, I demonstrated that when it comes to healthcare, America is not getting the Bank of the book. We are the worst value in the developed world. Surprising at that time, when we looked at all of the data and all of the research critain's National Health Service was first in the world in terms of being able to deliver quality healthcare at affordable costs. So last week there were two sets of data release, one from the Common Fund and, by the way, for anyone that monitoring health policy in the US, the Commonwealth Fund and the Kist of family found nation of both very credible sources of current data worldwide. It's more World Health Organization and the Organization for Economic Cooperation Develop that monitor this data. So today we'll be talking about data from the Commonwealth Fund and report that was released by Lancet, which is the British equivalent of the New England general of medicine. But let's go back to the Commonwealth Fund. They have four years seven monitored the eleven height income industrialized nations for a part of the thirty seven member OECD organization for Economic Cooperation Development. Each year they update performance for Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the United States. So those who have been following three minute read know that we've covered health issues in several of those countries over the past year. America is the only member of the Organization of Economic Cooperation and Development that does not recognize access to healthcare as a fundamental human right and we do not provide universal health care for all. The only member of the OECD that does not. So let's examine the down the data isn't have multinational comparisons of health systems data two thousand and twenty and it was put together by Russa Tikeenen and Catherine fields of the Commonwealth Fund. In the first chart of the Commonwealth Fund, resented is healthcare spending as a percentage of gross domestic product from one nineteen eighty through to two thousand and nineteen. So here at the left hand side of your back, in one thousand nine hundred and eighty, healthcare spending as a percentage of GDP range from about five percent to eight percent...

...of GDP, with the US at the top of one, with Germany and Norway. Over time, you can see that we have managed to outpace the rest of these countries by your wide margin, winding up in two thousand and nineteen at seventeen percent of gross domestic product. At the other extreme, we have for Australia and New Zealand spending a little more of the handful of what we spend as a percentage of the Gross Domestic Product, Germany at eleven point seven percent, in Switzerland at twelve point one percent. Of the two that follow us, those closed next year. I look at for capital spending by source of funding and can see New Zealand is the lowest at four thousand two five per kampus spending on healthcare. The average for the entire thirty seven number OECD is fourth and two twenty four dollars are here. And then for the US again is at the high end at ten thousand six very seven dollars. So that means for a typical family of for in the US, you're spending about forty two thousand dollars a year on healthcare. Part of it's out of pocket, eleven fifty per capita, part of his private spending, part of its public spending. So Joland is the highest on the out of pocket. Course, the typical Swiss spends two zero dollars out of pocket annually. Switzerland is one of the last of the OAC countries to move to universal healthcare and as we followed their course trends, they tend to be the second highest after the US. The next jar is life expectancy. At Burn in one thousand nine hundred and eighty. We have the US at about seventy three and a half years, the UK and Germany at have had seventy four years, and then over time we see where we've gotten to in terms of life expectancy. But currently the UK is at eighty one point three years and Germany at any one years, the best in the world of the Swiss at any three point eight years old. I think Japan is also up in that breee. So we have Switzerland eating two point eight, Norway at a two point eight. I think switzonthing in mountains country. That may have something to do with the health of their citizens, because I have to climb mountains every day. But the US has not been able to keep pace with the other countries in terms of increase in life expectancy, and this data is only through two thousand and seventeen. We do know that for the first six months in the pandemic the US lost a full year off life expectancy and for box and Hispanics was closer to three years. So what's the difference? The UK? We were pretty much on far with him through nineteen ninety from nineteen seventy nine through nineteen ninety seven, Margaret Thatcher and then John Major were in power as prime ministers and the Conservative Party was in power during that period of time. The investment in the National Health Service was pretty much flat line. Tony Blair to evolve is... nineteen ninety seven and then he and Gordon Brown from the Labor Party were in power as prime minister to two thousand and ten. Nineteen Ninety seven through two thousand and ten, UK's life expectancy continued to parallel the rest of the OECD. From two thousand and ten on where they started. The fallter a little bit. Basically, once David Cameron and S Rica May took office as prime minister, there was a disinvestment in the National Health Service. So much of the day that we looked at during this time period, from about two thousand and Sixtrough two thousand and fifteen, the National Health Service was delivering top quality care at an affordable course, the quality has slipped and the UK has had significant difficulty coping with the pandemic. So disinvestment in the National Health Service has come at a cost, of course, to British life. Look at suicide rates again. US is worst among the eleven nations. The average suicide rate the OECD is eleven point two four hundred thousand for some res. The UK is at the low end, follow by Germany. Look at adults with multiple chronic conditions. What are the count as chronic conditions? That's adults age eighteen years or older who have two or more the following chronic conditions joan painter, routhritis, asthma, of chronic one disease, diabetes, heart disease, including heart attack, hypertension or pipelood pressure. The US, twenty nine percent of adults so greteen and the US have multiple chronic conditions. France, Neviland Switzerland. You know, the eleven country average of seventeen point seven percent. So the US again is worst among the eleven countries. OBCD rate US highest in the OCD at forty percent a piece. That's a body mass index greater than thirty. At the low end, Switzerland, Swiss of Norway are both matters countries that may help account for the their low obes. Theory, within the US, Colorado has the lowest OBC. Theory that twenty three point nine percent. Again a mountain states that they have something to do with the rate. New Jersey is is at the lower end with twenty six point nine percent of piece. Mississippi is at the highest at forty one percent. And we unfortunately, we do know that the World Health Organization has found eighty eight percent of covid nineteen deaths are in countries where more than half the population are overweight, and that includes the US. After age, OB CD is the second highest risk factor with covid. So not good news for US health. The one area where the US is at the top of the chart is in breast cancer survival rates and unfortune, these dat are only from two thousand and ten through two thousand and fourteen. You don't have data subsement to that. So they always see the average for five years survival rates with eighty five percent.

US is at ninety percent and that's been a major focus of research here in us, thank God. However, the second part of the chart, cervical cancer. The US is at the bottom of the barrel again with the lowest five years survival. So the Commonwealth Fund data is not good news for help in the US. Moving on to the Lancet. That's the British journalis see, pretty much considered the equivalent to our Union Journal of Medicine. So in late February and early February rather, they released the report of their Lancet Commission public policy and help in the trump era, and it's not good news for us. Why did they form it? They felt that the trump administration policies close the uniquely urgent threat to help. So the Christians established in two thousand and seventeen with thirty three commissioners with a wide variety of education of professional backgrounds, equally from Canada, the UK and the US. The aim of the commission included identifying major health related policy actions from the trump era. That's two thousand and seventeen through two thousand and twenty, evaluating emerging data on their effects and it finally recommending alternative and more salutary policies to the next US administration. I went through the entire report. It's very lengthy, as stirs well research and it's wide range. It's highly critical of the trump administration on many fronts, including the environment, white supremacy and racism, immigration, the opioid academic and food nutrition and public health. A limit of my remarks to public health. So let's see what they found. They're very critical of actually taken by the trump administration required to the pandemic, including when trumps of Goofus. They imposed the hiring increase on the CDCAT. It left seven hundred positions bacon, mostly scientists and physicians. They also hold that Ash's Asha is the occupational safety and Hazard Administration part of the Department of Labor. That Cabinet department a should was finalizing regulations on airborne infection control standards for workplaces. They halted all development the finalization of those regulations and I think we will remember back last spring when there was more massive outbreaks in many of the meat packing plants and think most of the major networks spent a full week in Super Fall South Dakota of reporting on the outbreaks and of ovid nineteen in those meat packing plants. In fact, at some point we saw neet prices going up because it was a shortage. They also eliminated the National Security Council's Global Health and Bio Defense Directorate in two thousand and eighteen. It's a fancy title, but the key, the core component of that director was the group that wrote the pandemic playbook coming out...

...of the Ebola atpidemic. I remember when Obama took Golfer since two thousand and nine who were hit with the h one n one flu, and then a few years later in two thousand and fourteen, the Abola epidemic emerged in Africa. Obama insisted that we've come out of that EBO epidemic that was confined to Africa because of massive intervention early on. We did a lot of the right things. So out of that we created a pandemic playbook which a lot of the rest of the world used during the covid crisis. But we eliminated the departments that did that. So we were left weaponless. So what does the report state? Quote, trump's mismanagement of the covid nineteen pandemic, compounded by his efforts dismantle the USA is already weak in public health infrastructure and the affordable care acts coverage expansions has caused tens of thousands of unnecessary deaths. And now we routinely monitor the OECD and the fatality rate throughout of the OCD. As of February, Twenty Eight, two thousand and twenty one. We looked at excess debts in the US versus the OECD's average. So we had just performed at the average for the Organization of Economic Corporation developments thirty seven countries. A hundred and fifty thousand more Americans would be alive today. If we looked at Germany, Canada or the for nordered countries, those numbers would be much, much higher. So I've got to believe that somewhere in this country there's a group of the defense attorneys looking to put together a class action lawsuit against trump and the trump administration for wrong of them. All the ovens they have is in the Woodward interviews. Over all, they have in say. He was in the Woodward interviews. So where do we go from here? The lasting commission report came to the following conclusion with respect to help quoth the suffering in this location and flickted by covid nineteen has exposed the frailty of the US Social and medical order and the interconnectedness of society. Remember, the first case diagnosed in the US was in Washington state and was a travel who returned to Mohan sharing. On the other hand, why hit us in Metro New York, or travels returning from Europe with the fires that they picked up in places like Milan and material? The report continues. A new politics is needed who's appeal rests on a vision of share prosperity and a kind society. Healthcare workers have much to contribute and fun letting and advancing that vision, and our patients, communities and planet have much to gain from it. So one such reason was described in detail in the book that Ed Co ordered, giving American healthcare a plan to provide quality care for all while saving a trillion dollars a year.

The icon and Hutchinson all care plan depicted therein provides a practical path to universal healthcare for all Americans. Like biding here. It builds on the strengths of the affordable care act without the imposing the economic destructions that would take us through a medicare for all kind of coverage or single pair system, mentally run similar to the National Health Service. So where are we in my judgment, assigned for all Americans to unite behind moving America's healthcare system from worst to first, and frankly, there is some hope on the horizon. That's happening. It's beginning to happen. When I wrote this blog last Sunday, a couple of things that have happened since then that are good news for all of us. Work has agreed to manufactured Ja and Jay's Backstin, and with that happening, there will be sufficient supply so that all Americans can be vaccinated by the end of May. That's adding to gating plus more and dose is already ministered. And Sixty four million of those that happened in the six weeks since in Biden was INAUDERA. The car vaccination rate now is running higher than two million a day. Two weeks into open enrollment, more than two hundred thousand Americans have signed up for private healthcare insurance, healthcare dotcom, and more signing up every day. So we're expanding coverage and it appears that the American rescue plan, the Covid nineteen rescue plan, will finally pass the stubborn Senate sometime next week. So hope is on the way. And any concluding comments? Yeah, thanks, John, for that insightful analysis. You know, in addition to the two million a day that you reference that we are at now, there's still another vaccine in the United States that should be approved probably some time in April, and that's the one from the company called Nova VACs, and they are taking the risk of producing the vaccine now and they expect to have one point six a hundred six million doses available by the beginning of June also, and I think that would help the United States and its place in the world, because if we will have enough doses for Americans, that means we will be ready to provide those to other countries that need to have vaccines in order to control infection in their countries and in the poorer nations of the world. Less than two percent of their citizens. In seventy two of the poorest countries have actually been vaccinated as park. So I think in addition to the great news that we can provide innoculations to everyone in America who wants one, our country will be in a position to provide support for the increased need for vaccinations around the world. I also wanted to thank you for talking about the Korn Hutchinson all care plan in your analysis of how we might move forward and in response to that, we're going to do our next podcast on our plan and compared to Medicare for all and the current congressional effort to improve Obama care.

That will follow up the bill that you mentioned for the one point nine trillion dollars build to help and the coronavirus, pandemics economic issues in our country. So I hopefully the podcast that we can do next week will provide a clear and concise comparison to these approaches to universal healthcare so that our listeners can decide what plan might work best for them that they could support. Once again, I want to thank you for listening to our podcast today. Please take our brief survey at our website, www dot American healthcare dot org. We look forward to providing our next podcast on universal healthcare in the United States over the next week. Thanks and be well. Thank you. Will see you next time.

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