We all knew that our healthcare system was teetering but didn’t think it was in total shambles. One of the many things this pandemic has done is open up the reality of how utterly insecure our foundation is.

Many hospitals have closed over the past decade. They are expensive to run because the insurance is high. Delaying new equipment due to the cost including a deep back end supply of drugs has put many hospitals in the position of not keeping up with the latest and greatest. It has become an antiquated situation in many parts of the country where they can barely focus on saving sick people.

Is that how we want our hospitals to run? Don’t we want them to have state of the art equipment, be on top of the latest medical breakthroughs, give us comfort when we walk in the door that we are safe no matter where we are in this country?

The cost of insurance continues to sky-rocket. There is little competition that would force costs down. Nobody should have to decide between health insurance and rent? That is unacceptable. There needs to be a complete shakeup from bottom up in the healthcare industry starting with insurance and the cost of medicine.

We should all be able to afford to keep ourselves healthy with access to the system when need be such as state of the art hospitals that are constantly working on the latest and greatest and sharing that information with other hospitals across the country and globe.

Isn’t that what we all believe the United States should be? Certainly, now more than ever we should be asking ourselves how do we fix it because what we have now isn’t working for most and that is unacceptable.

Comments (Archived):

  1. carlsea

    While you are right that there needs to be a complete shake-up, I don’t see how to reconcile your statements that insurance costs are too high; that we aren’t investing enough in hospitals; and that you seem to think that the problem is costs of insurance. It’s largely true that the USA spends more per capita than most of the other developed countries without getting better results. To me that signifies that we aren’t spending it properly, not that we need to spend more. Maybe we can get rid of some middlemen like insurance companies but they do perform some useful functions including minimizing fraud (which has been a repeated problem) and some level of cost containment. But how much of the problem is that our doctors are paid much more than doctors in most other countries? Is that workforce prepared to take a pay cut? How about optional services especially in the last years of life? It gets to the third rail of rationing care, but one way or another, all single payer systems do that.It seems simplistic and naive to blame insurance. While our drug costs are high, they are only 10% of healthcare costs and generally when effective drugs are available, they are cheaper than more labor-intensive services. Yes we need a shake up, but it is going to require some sacrifices and foregone coverages and is going to involve some level of rationing or criteria for care. So far our politicians and organizations like AARP have made sure that the discussion cannot happen.

    1. Gotham Gal

      Many layers of problems. Insurance is just one issue. The unions, the layers, the cost on costs, no transparency, on and on.

    2. JLM

      .I manage a little program for buying drugs from Canada. The program pays on average about 22-23% of the US costs, even compared to places like Costco and Sams (which are quite good).There is a certified group of eCommerce pharmacies that are certified by both the USA and Canada.The actual drugs are manufactured by the exact same makers as the USA — Merck, et al. They are made in Canada, UK, New Zealand, and Australia — shipped to the USA.There are even greater discounts available for drugs made in India — which makes some 90% of generics. I do not access the Indian market.I have been doing this for more than a decade. You have to order your drugs at least 30 days before you need them. I get the doctors to prescribe for 90 days with an automatic 90 day refill.The Canadian companies are quite digital savvy and you send them “wet” prescriptions via snail mail, but digital copies of the prescriptions so they can proceed immediately with the order. You pay via direct bank transfer when they ship the drugs. The admin is very slick.You can track shipments and arrivals. You can get them to “match” prices and I always insist they match their own prior prices. Believe it or not, some of the drugs have come down substantially — thyroid medicines are dirt cheap, as little as $10/90-day supply for Synthroid/generic.If I can do this, anybody can. It isn’t rocket science. Here is a list of all the pharmacies who are part of the approved list: “Certified International Pharmacy Association”.https://themusingsofthebigr…You can do this today.JLMwww.themusingsofthebigredca…

      1. LE

        Other countries are cheaper because they negotiate based on the fact that we pay extra here to the pharma companies. So in the US our high prices are what is allowing them to pay the prices that they pay (from common sense and what I understand).This is really no different than what many businesses do you have customers you lose money on and the good customers or the people who pay premium prices (airlines last minute seats or business seats) are what is making that possible.

        1. PhilipSugar

          This happens is software and any other product where you have high fixed costs and very low marginal costs, and yes the U.S. subsidizes this.People are smart enough in the country to say we are also subsidizing the cost of the risk that comes with internationalized trade which makes the cost producing things in the U.S. not competitive.

          1. LE

            What’s good (if you want to call it ‘good’) is that when the situation is at ‘every man for himself’ territory many things that are not viewed as ideal can happen. For example there may very well have been a legit reason why we were allowing pharmas to subsidize and offer drugs to other countries at a cheaper price (diplomacy looking the other way) but when it hits the fan that is not as important.It’s like ‘mulch at the condo complex’. In normal times you want the place to look good so you mulch weed and do a good job of cleanup because it preserves values and just better all around. (As opposed to new roof which is needed for obvious reasons and you can’t generally get away with not doing). But if you fear not collecting condo fees (owners defaulting because they have no business or expenses) then maybe you can skip it for a year or longer. Ditto (using the same example) big parking lot they (to my dismay) lick every single inch clean (costs a fortune) even on days when there are not patients. But now needing to save money maybe we cut corners and take a chance. Or drop less salt most likely not only will nobody slip but if the slip they probably wont’ get injured enough to sue and even if they do they still have to get a lawyer to sue and so on (I fight this every year that battle).

  2. PhilipSugar

    I think the statement that “hospitals in the position of not keeping up with the latest and greatest”Is exactly why we have what we have.Would the latest and greatest save more lives or just more of blocking and tackling?When spending time in other countries the reason why our healthcare is what it is even though we spend the MOST, is because everybody wants the latest and greatest.Drugs, specialists, equipment, etc.When I stayed in Minneapolis people from around the world would come to the Mayo Clinic. They have one in Phoenix.If you have tons of money to spend we do in fact have the latest and greatest.Why are do drug advertisements dominate on TV? Why does Joe Namath pitch how much free shit can I get?Why do doctors not want to have nurses and pharmacists do some of the daily healthcare?Why do we do knee replacements for 90 year olds?Why if you don’t take care of your health we spend tons of money on heroic procedures and drugs? I’m not talking about checkups, I’m talking about diet, lifestyle, and vices.The list goes on, but trying to dumb it down to a twitter soundbite is why we have what we have. Nobody wants to have the hard discussions about the above and a ton more.And I’ll stop anybody right now that gives me: Why not do it the way this totally homogeneous country with a small single ethnic population does it? We aren’t.

    1. Gotham Gal


    2. JamesHRH

      One of us has lived in a universal healthcare country & the US.They are just as unprepared in Canada. Current Min of Health repeatedly stated – this week – there is no evidence of falsification of data out of China regarding Covid19. Flights from China still landing in Van/Tor/Mtl.And, in my first job, booking my boss into Scottsdale Mayo every two years was a task.Healthcare needs both for profit and universal aspects. It also needs best in class – thank god for crazy rich people going to the US to get the wildest shit done, otherwise innovation would barely happen- & basics for everybody.This response will get standardized. Flexible, fast, widespread testing will be at the front edge. Quarantine of vulnerable will be the meat of it.First go round is always the worst.

      1. Erin

        What? I thought our borders were closed.

        1. JamesHRH

          Snuck in w an LPR last year.And technically, I live in another country – Texas.

    3. LE

      Why are do drug advertisements dominate on TV?I study those drug ads (frame by frame almost) and marvel at them. They are a work of art. Music and images so you don’t hear the downsides and risks (only one example). Reason so many drug ads (I must watch the age group of shows they advertise on) is that drug companies segue to small batch after their patents ran out on the blockbuster drugs.Drug companies also tend to get them pulled from being shown on youtube or dedicated sites. This is counter intuitive and clearly shows they don’t want any attention going further. Think of the reasons behind that. I know this because of the difficulty I often have in pulling up a copy of an ad I have seen in the past the IP is never there.

  3. LE

    Much if not all of the problem in NYC Metro falls on politicians and individuals who are in NYC Metro.You have in NYC Metro a unique set of circumstances and I am sure that in any post mortem of the problem these things will come up:a) Build anywhere an everywhere in Manhattan without any consideration of traffic, the subways, people who work in Manhattan coming in from the outer boroughs and so on. That is now coming to roost. Traveling in means end of day the virus is elsewhere. More density means more spread. Compare NYC figures to LA Metro figures:NYC deaths (as of info I just pulled up): 1562 (Population 8.5 million)LA County death (as of info I just pulled up): 78 (Population 10 million)Philadelphia City: 14 deaths (Population 1.5 million)Buck County PA: 8 deaths (Population 630,000 ).(Go ahead and do the percentages..)LA is in parity almost with Philly. Subway is in Philly but nothing like NYC. Also middle class and wealthy people mostly and typically don’t take the subway in Philly (mostly millenials or working class, families don’t live where there is a subway or commute that way).b) Thinking that there is ever a situation where getting on a subway which is so packed that you can’t even move is a good thing. See ‘a’ above.c) Having a city where it’s obvious you are not going to have enough medical or other support to accommodate the amount of people that would need it in a crisis.Cuomo gets on TV everyday and talks a good game but where was he and his administration before this all happened? Who among all the smart people in NYC (vs. say West Virginia) stepped forward and said ‘hey our hospitals are operating at capacity and we could have an issue here). There are 50 States. And from what I can tell (by what I read) NYC has the big problem. That is not (separate from other fuck ups) the Federal Government’s problem to keep on top of. It’s the States issue. Sure Fed Government has issues of course. Yes it’s a clusterfuck. But the other blame goes to NYC and NY State Government with it’s ‘grow grow grow’ mentality w/o consideration of what having all those people would do to support services. If ever needed. But sure lots to do and plenty of restaurants.What’s also interesting is that the NYC hospital system apparently couldn’t even handle the health needs of tourists. So many people flock into NYC on a transient basis you’d have to wonder how they could be taken care of since they are not there now and there is a capacity issue. Where I am? No tourists doesn’t exist (as with most places).And we are paying for that now in other parts of the country (in the sense that the limited resources are being diverted to a place with a huge problem and a problem with so much media visibility because, as always, ‘it’s all about NYC’ (which in this case is actually true). Plus NYC cases have spread to North New Jersey (compare to Penna no comparison way less).You know where I am, where many people are, they have this thing called ‘open space’. Can’t even build more houses. Why? They don’t want to build more schools. So they have 55+ communities and so on. That’s planning saying ‘we don’t want to have a problem so don’t build more’.What is Manhattan? People packed on Subways. Really packed. That IS a big factor in how this spread and how people live IS why there is a problem. Make no mistake about that. (Also to be sure everything else is more packed as well stores, bodegas etc).How many people in NYC ride the subways and took them back to their communities in the boroughs? You see where I am not only is it not dense there are no subways. Only way to catch is at the supermarket and so on. Drastically less going on no question about it.

    1. JamesHRH

      This is fair – that NYC was specifically uncaring and unprepared.

      1. awaldstein

        NY is uncaring how?

        1. JamesHRH

          People acted completely selfishly. Young people going out, rich people flooding the Hamptons, city not managing social distancing on subway, DeBlasio being Lead Narcissistic and not doing anything. I could go on.NYC is the most self involved places on earth.

          1. awaldstein

            you have no idea what you are talking about.

          2. Tom Labus

            as usual

          3. JamesHRH

            As always, easy to type.Not an argument, btw.

          4. JamesHRH

            That’s not a counter argument.That’s denial.NYC is finance, real estate & media. All ego driven.Houston is transportation, energy engineering & cancer research. All science driven.I’m not saying that aren’t ego manicual a holes in Houston, those folks come with the species. And I’m not saying the average Houstonian is a better person.But the county is led by a young Stanford trained Judge & the mayor is local, up from his bootstraps, civic minded, always dreamed of being Mayor of his home town, put in his dues, smart guy.And we had Harvey in 2017. And people died from heat stroke when they did not listen to government officials & jammed the interstate during Ike. And this is the city that took half of NOLA’s Katrina escapees.The average person takes Acting Together to save each other more seriously because they have experience and technical minded politicians ( not so at the state level, those cats are ideologues ).DeBlasio used his 16yo biracial son in ads during his first election campaign. That’s all you need to know about him – he’s a user. He couldn’t give a shit about NYC or its inhabitants, beyond what it or they can do for him.Users are the worst, especially in a crisis because they only care about their feels & their image.But I have no clue.

          5. awaldstein

            no you do not.

          6. Miranda

            The person you reply to gave a list of reasons so why act as if you are above giving an actual counter, giving just a 4 word reply which says ‘you are not worth my time’. Are you really that important of a person? I am surprised quite frankly. Ditto for your other comment ‘you have no idea what you are talking about’.Do you deal with women the same way? Treat them like you treat this man? Like some old dude who just is so right he won’t even say anything.

          7. awaldstein

            Not at all important.I know this individual and his retort is not worthy of my reply, plain and simple.Where your remark comes from not really certain but not germane to the circumstance.

          8. JamesHRH

            Interestingly, I am not sure it’s a gender issue. Arnold deals in emotions – it’s not that he can’t think or is dumb, he is just far more comfortable sensing people’s emotional needs and filling them, in order to be liked.He loves NYC & likely voted for DeBlasio. He is emblematic ( as is Joanne I am afraid ) of a major problem in America – his political views are tied to his self esteem. When that happens, invalidating his political choices invalidates him as a person.There are studies that show that most liberal minded people can not argue conservative positions: it’s self negation. This theory is based on the idea that liberal views are based in self actualization or expression. The things you believe & support politically are an extension of your ego.Politics at every level is a duty, not a media category or an act of ego. Voting is not a form of self expression, it is a duty to pick the best candidate to deliver the greatest good for the greatest number.The same studies show that conservative views holders can argue liberal positions. The theory is that conservative view are based on sacrifice or discipline ( it’s why whacko religious folks are neo-cons: waaaaay overboard on the sacrifice / give yourself over to something else meter).So, Arnold can’t argue back because he voted DeBlasio & is too attached to the feelings & optics that DeBlasio works. DeBlasio, as you likely we’ll know, runs the $92B NYC budget like a personal fiefdom – he and his wife are ridiculously self serving, self dealing & in ethical conflict.FWIW, I am not anti-Dem or Pro-Rep, I am a CDN living in TX who is strongly pro-Competency. The easiest way to prove that would be to note that the folks outside of NYC that I mentioned ( Sylvester Turner – Mayor Houston, Lina Hidalgo – Judge Harris County & London Breed – Mayor SanFran ) are a nice mix of black, Latino & women, and all are Dems. What they have in common is doing a good job right now.Despite what Arnold or Tom may try to paint me as ( Trumper for example ) I’m a social liberal : fiscal conservative and I would describe myself as a Realist. So, I tend to not demonize or lionize politicians. There used to be a lot of us around.I’m not a big identity politics person but I have time for the power of seeing ‘people like you’ in power. It matters. It’s why what Joanne does in this blog matters a lot ( I don’t love how she does it as much I think it is valuable that she does it ).Good on you for chiming in.Also, please note that Mr. Waldstein is using ‘retort’ inappropriately. ??‍♂️?

          9. awaldstein

            deblasio?you think to highly of your knowledge of types or myself.

          10. JamesHRH

            Admittedly, given the civic minded citizens of NYC turned out to vote at that completely selfless 18% clip in 2017, the likely answer is that you didn’t vote.But if you expect me to believe that you took the time to vote & were part of the 25% of voters who supported Maliotakis, that seems…… unlikely.

          11. Gotham Gal

            Don’t believe everything you read

          12. JamesHRH

            I never do.But video 2 weeks ago of crammed subway cars, full bars & cafes is pretty valid.Houstonians started social distancing like it meant something 3 weeks ago.London Breed did the same thing in SFO.Now, NYC is a super busy INTL city & the most densely populated & the most reliant on public transit.So it’s the city that should have been most prepared – but it was the least. That falls on Bloomberg & DeBlasio.

  4. JLM

    .There are five things that can be done immediately to combat this problem:1. We desperately need tort reform wherein the unfortunate outcomes of something going wrong don’t turn into punitive Irish Sweepstakes. Talking to you, trial lawyers.States that have done this have seen both a decline in insurance claims, but also an increase in the amount of an award ending up in the hands of the victim, plus faster resolution.2. We need segmented health care wherein a senior nurse medical professional can prescribe green snot v white snot remedies. We need to turn this capability loose on site, via telehealth, and through visits.3. We need the American Medical Association to accredit more schools, increase class sizes, and to allow a class of doctors who are not going to become millionaires. If we had a better pipeline of doctors, we would have more available care.Today, in the US we only have 480,000 general practitioners and 525,000 specialists. We should have 2-3X that number.In NY those numbers are 41,000 GPs and 49,000 specialists with most of them concentrated in the NYC area.4. We need to explode telehealth wherein we broaden the audience per doctor, get rid of the physical plant, and provide economical imposition on both the doctors’ and patients’ time.5. We need to remove all barriers for a pharmacy, CVS/Walgreens, becoming a medical, doctor/nurse staffed clinic whereat the pharmacy load cna be offloaded directly to the store. This is where the docs who made “B’s” in college could practice.These five things alone would have a huge impact. They have all been discussed since the Geo W Bush admin, just like First Step.This is what the House of Reps should be legislating right now rather than another investigation of Pres Trump.JLMwww.themusingsofthebigredca…

    1. LE

      1. We desperately need tort reform wherein the unfortunate outcomes of something going wrong don’t turn into punitive Irish Sweepstakes. Talking to you, trial lawyers.Fwiw my wife just told me this morning that she was told in a memo or something like that that NJ and PA are passing a law that said you can’t sue for anything covid related. No time to pull up the story but of course that makes sense. (Same as the good samaritan laws). Tort bar was already preparing for sue all over.Not sure how this impacts things you can do federally. But since NY and PA are democratic I would think it would pass on a federal level if needed.

      1. JLM

        .The trial lawyers bar is a Dem stalwart source of contributions — think asbestos and guns.JLMwww.themusingsofthebigredca…

        1. LE

          Yeah but in a case like this ‘crisis go to waste’ lots of things can happen. Look at that tent city hospital in Central Park as an example. I am thinking someone (AOC I should tell her) should push for carving out a piece of Central Park for housing. It’s huge and can be smaller. Sure people will moan and the rich with views would block but honestly would be nice to tork them on a bit with what is a good idea the park can be much smaller than it is.

    2. LE

      3. We need the American Medical Association to accredit more schools, increase class sizes, and to allow a class of doctors who are not going to become millionaires. If we had a better pipeline of doctors, we would have more available care.This is in part a ‘where will they do a residency issue’ not just a ‘educate them’. There has to be hospitals and staff after graduation that system is typically at capacity (see ‘the match’ that med students do).In NY those numbers are 41,000 GPs and 49,000 specialists with most of them concentrated in the NYC area.You would be interested in knowing that my wife an Internist would make less money in NYC vs. where she is now. And the cost of living is obviously drastically higher. And we aren’t in the boondocks there you make much more than where we are big premium (they are always pimping trying to get doctors to serve those areas get postcards all the time usually stress the ‘Ozarks’ angle it’s cliche almost).One important thing to keep in mind though is more front line and diagnosis also means more people ‘turfed’ to tests, specialists and so on. Since many things are ‘nothing’ hard to say (I don’t know) if economically that works to a benefit or not). Many issues in healthcare are caused for sure by people who abuse themselves it’s not JLM in the hospital or even close. It’s all sorts of losers who do everything wrong you have no idea how many beds they take up.Look even my own father in law. Diabetic and I have seen how he cheats and eats things that he should be eating. And he is well educated and considered ‘smart’. The ‘losers’ literally have no governor their behavior.

    3. JamesHRH

      The most impactful single change that could occur in the USA is the adoption of Costs in legal proceedings.The USA, as it is with so many other things, is the only common law jurisdiction where frivolous lawsuits are encouraged. Every other major common law jurisdiction allows the judge to award legal costs to the defendant, payable by the plaintiff, for suits that are deemed frivolous.It would not affect the big, hairy, contingency cases that make lawyers billionaires. Or, the malpractice suits against negligent medics.It would just clear out the pipes of the legal system and reset the risk attitude of most small businesses.

      1. JLM

        .”Loser Pays” with a bond up front would sort things out a bit.JLMwww.themusingsofthebigredca…

    4. JamesHRH

      That last line is a doozy.The opportunity cost of NOT fixing broken American things with a President who has very limited ties to any mainstay of Republican policy (judges + tax cuts is about it) is astronomical.The Dems in congress are too busy being morally pure rather than doing good for the country.Trump isn’t a problem for Dems, he is actually an opportunity.

      1. JLM

        .The Dems — Speaker Pelosi, Minority Leader Schumer and their henchpersons — cannot get over the Nov 2016 election.They are stuck, unable to pivot, locked in, too angry, anger consumers all their energy.Right now, they could get Pres Trump to agree to an infrastructure bill of gargantuan proportions, but that would be a WIN for Trump and they cannot do that.They are traitors to the country, to our citizens, to all that is good and American.JLMwww.themusingsofthebigredca…

        1. JamesHRH

          Don’t know about traitors, but Lordy they are playing small ball.DACA, Healthcare, Infrastructure, Accountable Colleges : Student Loans – they sire lack vision.They have a Deal Addict in the WH & can’t get deals done.No vision.

  5. William Mougayar

    I think the US healthcare system is optimized for local/regional delivery. A crisis like the one we have now depends more on national/federal level coordination and this an adjustment that the US is making with some pains. That’s my take on the situation. Canada is not much different from a response approach. There is stuff that the federal gov can do and other stuff that the provinces control. They are all learning about working together.

    1. JLM

      .Epidemics are exactly why the state system of Health Departments was created. The state is where the “attic stock” is kept.Three years ago, the NY Department of Health asked for $$$ for 16,500 ventilators for their “attic stock” and was turned down by the Assembly. They asked every year for the last three years based on a study.The Berger Commission in NYC allowed the stock of beds to dip from 93K to 53K. NYC did this to themselves.The State of NY did this to themselves.To access the Federal Strategic National Stockpile, a state has to declare an emergency — which has huge financial implications — and only then can FEMA tap into the SNS.The State of NY did that on 7 March and the Trump admin immediately approved their application.The State of NY now has to pay 25% of all the costs associated with the Federal assistance — FEMA, SNS goods, Army Corps of Engineers, US Navy “Comfort” — of course they tried to get out of it and will try again to get out of it.The money going to the states in the CARES program is not supposed to be used for the 25% match in exactly the same way states cannot use transportation grants to pay for their 25% of required Federal matching funds — like the NJ-NY tunnel project which is now stalled.I promise you this is going to be a huge issue on the tail end of all of this.Only 29 US states have declared an emergency and only 10 have Federalized their National Guards.NYC-NJ-Conn is the hottest of the hot spots. Cut them out and the rest of the country is doing “OK” — not great, but OK. There are hospitals in Texas that have cancelled their elective surgery and have not one single COVID19 patient.JLMwww.themusingsofthebigredca…

      1. William Mougayar

        But you can’t totally blame the states. No one was well prepared for this pandemic. I’m reading the feds only had 10,000 ventilators in their emergency stockpile which turned out to be a very low number. Countries like S Korea, Singapore, HK already had a dress rehearsal with SARS and Mers a few years ago, so that’s why they are faring better than the rest.

        1. JLM

          .We are the United STATES of America, not the Federal Republic of America. Every Governor runs his state and all powers not specifically granted to the Feds in the Constitution are reserved solely to the states. The Constitution does NOT lay out a Federal role in healthcare.Even Federal elections in the several states are carried out by the Governors.I totally absolutely blame the states. As an example, NY State has had a bill to buy 16,500 ventilators for more than 4 years. Every year it gets put up, every year the Assembly decides to fund other things like solar power. They made this decision and they have to own it and all the repercussions.The USA had the same dress rehearsal with MERS, SARS, Swine Flu — the Feds used an enormous amount of the material in the Strategic National Stockpile in 2009 for Swine Flu and failed to replace it. They made this decision and they have to own it and all the repercussions.While that was the Obama admin, the Trump admin has to answer for it also as they should have picked it up. It falls under the Department of Homeland Security. I get it that DHS was focused on the Southern border, but tough stuff.From a legal perspective, the Feds are NOT the first line of defense on any epidemic or pandemic. By law the Feds cannot even provide any assistance unless and until the states declare an emergency.Once the states declare an emergency they are on the hook for 25% of the Federal cost of any support. That Corps of Engineers Javits Center 3000-bed hospital? The Corps will provide a bill.This is why states are slow to declare an emergency. Only 29 states have declared an emergency as of the last time I checked a couple of days ago. Only 10 states have mobilized their National Guard.Structurally, every state has a State Health Department which oversees county public health departments. One of the primary missions of these entities, their raison d’etre, is epidemic control.Interestingly enough, the State of Texas has a very robust number of ventilators in its “attic stock.” Nobody is able to account for why. They just do and have for a long time. From what I can tell, they have had a large number of ventilators for more than a decade, but nobody can explain who did it or why.I’d love the story to be that somebody in Texas was prescient, but there is no evidence of that being true.NYC commissioned something called the Berger Commission back in the early 2000s and the BC ended up recommending the reduction of hospital rooms in NYC from 93K to 53K. They did it.At the time, there was much intellectual grist for the mill: better treatment outcomes because of better drugs, shorter hospital stays because of better treatment, more out patient capacity, urgent care facilities, and a myriad of other reasons. What they did not anticipate was an epidemic.NYC is uniquely vulnerable to epidemics — huge marine port of entry, inbound/outbound shipping port, enormous airports and traffic, transportation hub for car/bus/train/airplane, huge mobile population, enormous tourism, huge illegal alien population, incredible density — based on the sheer traffic flow.No other city in the US has that witch’s brew of overlapping complex and compounding factors.It also suffers from being run by a moron.When we are on the other side of this, more attention will be given to “attic stock”.I do give American industry huge credit, American entrepreneurs rising to the challenge, except for 3M who is a bunch of jackasses.JLMwww.themusingsofthebigredca…

          1. William Mougayar

            North America and Western Europe have not had a real dress rehearsal to the extent that we are getting now. The population was not asked to quarantine, distance themselves or wear masks. This is all new for us, whereas many Asian countries have already been going through similar motions years ago.Second, how about these allegations that Trump fired the pandemic response team back in 2018. That seems to have been a big mistake in retrospect.…Finally, don’t get me started on baby Jared getting involved to justify his existence as a “senior advisor”.Thing is Trump is a master now at sugar coating everything and padding himself on the back every step of the way. The confinement order must be more broad and more forceful or the disease will continue to spread. It’s very simple. There’s a town in Spain that self-isolated itself and they have zero cases now.

          2. JLM

            .I think you make my point — who quarantined that small town in Spain? A MAYORWho should have quarantined NYC, its MAYOR? The GOVERNOR?The President has made it abundantly clear that he is not going to inject himself into the role of a state’s elected Governor or a city’s Mayor. In fact, he does not have the legal authority to do that. It is not good leadership, would stir up unnecessary political upheaval, and is not prudent as every state has a forceful leader elected by that state.The Snopes thing is just wrong. I find it to be a totally unreliable tool in searching for the truth.Let’s dig in, shall we?The guy who was the top guy at the NSC health section was a retired Admiral named Timothy Ziemer — plane driver, very traditional aviation and ship career. Taught at the Naval War College National Security Strategic Studies Group. Warrior type, not medical type. Flew gunships in Vietnam for Navy SEALs.Ziemer is 73 years old and has a history degree from Wheaton College. He is not a doctor, a public health professional, an epidemiogist. Ziemer’s only experience with disease was an appointment as the administrator for USAID in 2006 in President Bush’s Presidential Malaria African Initiative.[Dr Deborah Birx, the scarf woman, holding Ambassador rank at Dept of State and a leader of the AIDS/HIV project in Africa is a 29-year veteran, military doctor with expertise in epidemiology for 40+ years.]This — PMAI — was a collaborative initiative amongst US AID, HHS (actually the Center for Disease Control and Prevention), the Dept of State, and with the White House blessing all of it. Ziermer was the administrator of this group.CDC did the doctoring. State did the diplomacy. US AID provided the distribution and project management. The White House provided the authority and funding.The Obama admin blew up the NSC from a prior size of about 75 to more than 400. He did the same thing with the appointment of a shadow Cabinet with his Czars. Obama put on these positions we are talking about in response to the Swine Flu and Ebola epidemics with the understanding the people would be returned when those crises ran their course.He obtained this additional body count by “detailing” or “seconding” people from other departments of the government.When Pres Trump walked in the NSC was bloated and duplicative of other branches of government. The then National Security Adviser (and subsequent ones) began to assess duplication and began to cut things back.In every instance, the duplicative positions were eliminated and the individual was returned to his original department. [As an aside, the Whistleblower was detailed from the CIA to the NSC. He was returned to the CIA. He was not fired. His position as duplicated by from whence he had come in the CIA and in the State Dept.]The NSC section that focused on health fell under the same knife and Adm Ziemer was returned to the US AID where he is currently the Senior Deputy Assistant for the Bureau of Democracy, Conflict, and Humanitarian Assistance at US AID. This position is a 100% overlap with the role he had at the White House on the NSC. He was not fired.Similarly, two other persons were reassigned to other sections within the NSC that were duplicative of their prior positions.When Bolton came in as the National Security Advisor, he commissioned a study — actually an update of a study that was done before Pres Trump took office — which identified all the duplicative positions between departments and the NSC. One of his biggest beefs was that these positions were neither strategic nor rose to the level of national security.One can easily envision the desire of Pres Obama to “control” things by having his advisers close, but this was the deviation. other parts of the government already held these portfolios.This has been done with a number of the positions created by the Obama admin and is still ongoing. It will continue until the NSC is a clean, lean 75 persons.Be well, amigo.JLMwww.themusingsofthebigredca…

          3. Dan T

            I especially agree with the moron part. No accountability. No responsibility.

  6. jason wright

    On so many levels Corona is like the pebble falling in the pond. The smooth surface suddenly agitated, rippling, chaotic.All Western healthcare systems are fragile in the face of a pandemic. The question is how to remodel them to be antifragile?Why does it seem to some Americans to be an “un-American” thought to entertain the idea of a universal healthcare system? Cuomo talked of “anti-American” in his spat with Trump, but a virus is not a political agent. He seems to be playing politics (and grandstanding a little) with this crisis.

  7. Tom Labus

    From the trumpster manual spring edition 2020:1. Never say anything considered even remotely critical of FatBoy.2. Take whatever pathetic gibberish he’s babbling about and present it in some coherent fashion.3. Always, point to everyone else as the source of the problem at hand. Reminder: It’s never FatBoy4. Always attack anyone with knowledge, historical refence or a good idea on how to proceed.There’s a bunch more and the manual is floating around and you can take a peak if you salute properly

  8. LE

    Politicians? You have to be scared by this type of thing (link below) ie ‘rent forgiven’.Not that it would happen but the fact that someone (Sanders and Sen Gianaris NYS or AOC) would suggest it in a serious way (sponsoring legislation is somewhat ‘serious’) and that Sanders has so many followers:…According to the legislation, rent and mortgage payments would be forgiven rather than postponed.Note it says ‘forgiven’. Not delayed, suspended etc. Forgiven?What planet do they live on? Do they think all landlords are just big, rich and can take a hit? Everyone is Durst or LeFrak?You wonder why Trump was elected. And you curse the day that he was. This is exactly one of the reasons. This type of behavior and confiscation of everyone and anyone that has ‘more’ (which to be clear for sure includes you). I know you aren’t a Sanders supporter but can’t you see what is happening here? Also will note that the wealthy have a great deal less of an issue with confiscation than the ‘simply not poor living hand to mouth’ crowd. LIke with college the very poor do ok, the very rich do ok it’s everyone else that has to pay full freight tuition.Separately Cuomo has been NY State Governor for 9 years. That’s enough time to have a health department that might have given thought to the state of the hospital system in NYC. I hear he is now confiscating ventilators in upstate hospitals. Trivial to over order PPE’s at the very least.Last night on Anderson Cooper Cuomo said he didn’t even know what a ventilator was until a month or so ago. Amazing. Didn’t know what a ventilator was and very scary.

  9. Pointsandfigures… the data doesn’t support the hysteria. Especially if you are under the age of 60 and healthy