The Covid hospital bill

My brief encounter with emergency surgery [1 hour] and a night in the hospital was about $50,000.

The typical Covid patient is in the hospital for 5-29 days. Some people end up on a respirator for as much as 30 days, which requires very close observation. And yesterday we had over 83,000 people in hospitals with Covid with many more to come.

Does anyone care to estimate the bill?

 

Data related to hospitalizations
https://www.tfah.org/wp-content/uploads/2020/04/COVIDunderlyingconditions040320.pdf

Here is a rough first pass:
About 20% of Covid cases end up in the hospital
Assume an average length of stay as 15 days at $20,000 a day
Assume 5 days on a ventilator at $50,000 a day
Assume the total cases [before this is over] is 3 times the current 12 million as we are currently seeing exponential growth

So we have 20% of 36 million cases = 7.2 million hospitalizations
Each cases goes as $20,000/day X 15 days = $300,000
Average 5 days at $50,000 per day = $250,000
Average of $550,000 per case X 7.2 million hospitalizations = $3.96 trillion in hospital bills

One problems with this is that I doubt hospitals have that much capacity. So many would-be hospital bills will never be because the patients will die first. They won't be able to get help in time. As one doctor commented, we will soon be seeing vidoes of people dying from Covid in hospital waiting rooms.

So perhaps the real number will be determined by the maximum capacity of US hospitals. The difference will be a head count of the additional dead.

 

I have been terrified to even bring up this problem. Its huge Nobody could pay these kinds of hospital bills when they had a 40 hour job pre-covid and Trump is trying to throw everyone under his I-hate-everything-the-black-muslim- Pres -did bus using the courts. .

 

So that comes out to what, $12,000 for every US citizen.

 

What is tragic, is that for some republicans these numbers directly above will get them encouraging masks and social distancing when the death toll did not.

 

Maybe some, like the lieutenant governor of Texas, will volunteer to stay home and die for the sake of their grandchildren.

 

Maybe they shouldn't be in the hospital for days.

They should rent an oxygen tank from a private medical supply, and cordon off in a room inside their house.

Even as hospitals and governors raise the alarm about a shortage of ventilators, some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support.​

Ventilators are overused for Covid-19 patients, doctors say - STAT (statnews.com)

They say BiPAPs (bilevel positive airway pressure ventilators) are a substantially cheaper less invasive option, with likely better patient outcomes in the vast majority of situations.

The fact is, doctors overreacted to this situation. Staying in the hospital only makes sense when money is not an issue. For the financial situations of the majority of people, doctors are not giving them the most appropriate advice.

These people should not have stayed in the hospital for weeks. Just because your life is potentially in danger doesn't automatically mean that staying in a hospital is necessarily greatly going to help very much with that.

 

Did these people have any financial common sense?

Were they shown the bill before they completed their hospital stay?

Did they even ask to see what the bill would be??

 

Sorry, too expensive. Some people are going to have to die.

 

Remember, that is $12,000 paid by every person (including children), and we would be talking about saving the lives of only a very small fractional percentage of the population, and of that small fractional percentage, the majority of them would be old people with likely only a couple more years left to live anyway, and often really not in good shape and reduced physical capacity.
Let's not forget that the National Debt per person is $82,000, and that doesn't even include state debt. In California, it's an additional $37,000 per person.

You're going to have to pay for that National Debt in BLOOD. Sorry, your fault. We tried to warn you in the past, but your kind didn't care.

 

I'll tell you all quite honestly and plainly right now. I'm high risk and if I get COVID I'll likely be one of these people in the hospital. Should I be graced to leave it I absolutely will not pay any bill of any amount for any reason. I know most of the COVID required treatment is cover *if* you're uninsured but I wont so much as pay for a cup of jello. I will tell the hospital, my insurer, whatever debt collector(s) they send after me to seek reimbursement from my anti-masker anti-lockdown anti-science anti-common sense city council, from the Florida Governor's office, and from Trump For America, Inc. I wont pay one damn penny!

 

This brings up an interesting point. Can the Blue States sue the red states that ignorantly and arrogantly helped to drive this disaster. When they are done counting the dead, there is going to be hell to pay.

 

Oh my there have been and still are so many lawsuits because of COVID. Lawsuits over tenancy, lawsuits over fake/harmful products, lawsuits over price gouging, lawsuits over voting, lawsuits both for & against mitigation efforts like mandates and orders, lawsuits over distance learning and tuition reimbursement, lawsuits work safety related matters, lawsuits over refunds like for sports season ticket and whatnot, I'm sure tons of other things too. State vs state lawsuits, hmm, I think we might have a good chance of seeing something like that if PE Biden gets Congress to wield the Commerce Clause in a way that would force mandates on states that refuse to do it on their own.

 

Don't worry too much.

As long as the resources are available for the duration of the pandemic, the Federal government - the sole ISSUER of the $US dollar - can pay off the bill by simply creating the funds 'ex nihilo', via its treasury and reserve bank.

Money is NOT a real or scarce commodity. It is a concept, a tool of governance. (link below)

MMT: overcoming the political divide. | PoliticalForum.com - Forum for US and Intl Politics

Orthodox economists don't want you to know, because they are paid by vested interests who want to ensure their own greater share of the nation's output.

 

Here we go again, back to you imaginary MMT theory.

For anyone who does not know, this theory of his basically goes something like "If we only had more money, it would help our economy operate more efficiently and increase output".
He thinks government can print more money and that can somehow create wealth without just causing inflation.

 

For anyone who does not know, Kazenatsu is merely spouting the outdated, evil, neoliberal monetarst orthodoxy which claims money is a real scarce commodity.

It is not. Money is merely a concept, a promise to supply resources (goods or services), and a tool of sovereign governance.

[Note: there was no money in Boudicea's pre-literate Britain (even though Britain had entered the iron age c.1000BC). Money only appeared in Britain after Augustus ordered the Roman invasion in 43AD].

Interestingly this pandemic proves the sovereign currency-issuing governement can and should create money 'ex nihilo' (just as private banks do when they write loans/create deposits); it is so utterly obvious in the present circumstances in which there is forced under-utilization of the economy's available resources and productive capacity, that the requirement for the public sector to tax or borrow money from the private sector to pay for covid related hospital 'costs' is utterly insane, the result of blindly following evil neoliberal monetarist orthodoxy.

 

We can continue this debate about economics here:
more debate about MMT

 

Read this treatment protocol and see if you realize how complex the care of someone with severe, hospital-grade Covid-19 is:

https://www.evms.edu/media/evms_pub...cine/EVMS_Critical_Care_COVID-19_Protocol.pdf

Sorry, I don't want to appear nasty, fut frankly, I've rarely seen such a misguided post. You don't seem to have a clear idea of how complicated pulmonary critical care is. Rent an oxygen tank???

Look, pretty much every patient who gets the serious kind of Covid-19 (approximately 20% of patients) would die if not treated in a hospital, according to the above protocol.
Moderate cases? Sure, one might survive with residential treatment IF the person has access to the treatment outlined on page 9 of the above protocol - you'll see that some parts of it are not that easy and not that available for home care. Serious cases? Either you go to a hospital and hope that they do implement at least something similar to the above protocol (starting on page 10), or you die.

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About BiPAP: there is some use for these devices (especially for Covid-19 patients who also have COPD), but be careful. If the settings are not right, they may result in the patient getting too much tidal volume with subsequent baro and volutrauma. I would definitely not recommend BiPAP use at home by non-trained individuals. Not to forget, BiPAP use increases aerosol formation and would increase the likelihood that household contacts would get infected.

Yes, we are trying to delay invasive ventilation as much as possible or avoid it completely (the above protocol describes extensively what to do instead) but rather than BiPAP, what we've been doing is High Flow Nasal Cannula with a flow of 60 to 80 L/min (and you won't get that from a rented oxygen tank).

Invasive ventilation is indeed a problem and can do more harm than good, especially when not done right. If it can't be avoided, use a tidal volume of approximately 6cc/kg, and set the machine for the lowest driving pressure (lower than 15cmH2O) and PEEP.

If the patient is poorly treated and allowed to develop AFOP (acute fibrinous organizing pneumonia) the battle has been pretty much lost. You can keep the patient alive with ventilation for a few days but the patient will ultimately die. Prematurely used ventilation especially with the wrong settings may actually increase the odds of developing AFOP, due to what is called VILI or Ventilation-Induced Lung Injury.

The bottom line is, the treatment of a severe case of Covid-19 is not for amateurs. It is a VERY complicated treatment, and absolutely, it must be done in a well-equipped hospital, by a Pulmonary Medicine and Critical Care specialist, if possible. Many of the life-saving drugs included in the protocol are IV (intravenous) drugs. In addition to this, you have to maintain magnesium within a certain range (2.0 to 2.4mmol/L). You have to monitor QTc with frequent EKG and monitor for arrhythmias with telemetry. You have to monitor the pulse ox. You need to watch the D-dimmer and implement full anticoagulation. You have to watch Ferritin and CRP to watch for Macrophage Activation Syndrome. That is, you need frequent lab tests. You need hemodynamic monitoring (maintaining euvolemia is essential). And so on and so forth. The MATH+ protocol details what else is needed.

Pray tell, how do you do all the above at home??? Do you think that just an oxygen tank is sufficient treatment for a severe case of Covid-19???

 

I thank you for going to so much trouble to thoughtfully respond to my post.
I recognize that trying to dispel BS takes 10 times more effort than it does to make it in the first place.

Although you have some valid points, I still believe my argument still has at least some moderate level of validity.

I think it depends somewhat on exactly where you draw the line for "severe cases", and exactly how common those actually are.

 

Oh no, we do know the approximate frequency of these. About 20% of confirmed cases get to be serious cases that warrant hospital treatment. About 5% become critical, up to 10% depending on underlying conditions. We tend to use pulse ox to guide the need for hospitalization. If it drops below 94, do head to the ER (see page 7 of the protocol I linked to). And sorry, I don't just have "some" valid points. ALL the points I made above are the result of sound medical practice of Pulmonary Medicine and Critical Care. They are the state-of-the-art treatment for Covid-19.

We only recommend that people stay at home - hopefully doing ALL that is recommended on page 7 - if the person's oxygen saturation is at or above 94%.

It is a good idea to purchase a pulse ox monitor, easily available and cheap from any major online vendor. It is a good idea to have over-the-counter medications listed on pages 6 and 7 at home, including quercetin, vitamin C, vitamin D, B complex, melatonin, aspirin, famotidine, omega 3 fatty acids, and zinc. Ivermectin is an excellent idea but is a prescription medicine. Do not in ANY circumstance use ivermectin intended for veterinary use. The human formulation is available in pharmacies but of the treatments recommended for mild cases recovering at home, it is the only one that requires a prescription, but if you have a well-informed PCP, he/she should be able to give it to you.

So, an asymptomatic or mild case, absolutely, should stay home doing the above (page 7). But if your pulse ox drops, don't worry about costs... your life is more important. You'll sort out the costs later. You can recover from an economic crisis but you can't recover from being dead.

PS - I edited the post above after you replied, so I'm adding here what I edited there: another downside of BiPAP at home is that it greatly enhances the production of virus-laden aerosol. If a person with Covid-19 is at home on a BiPAP machine, the odds that other household members will also catch Covid-19 are increased. In this case it is important to open the windows, use fans, air purifiers with HEPA filters, and get the household contacts to wear N95 respirators.

 

We disagree on what percent of those cases that they say warrant hospital treatment actually do warrant hospital treatment.

 

"Sound"? I wonder if these medical experts might start having a little bit of a different opinion if the government wasn't giving them special funding to pay for it.

I know that's cynical.

But we believe the medical expert community couldn't possibly be self-serving, right?

I mean, think about it, the government banned all those elective surgeries, so the hospitals started being pressured to make up the difference in revenue.
If the government's going to give you extra money, why not give some people some extra care that might help them?

 

I'm a medical doctor. No, you don't have this situation perceived the right way. No, we don't make money because of Covid-19. We are actually in big trouble because of it. And no, we don't keep people longer, unnecessarily, and we MOST CERTAINLY DON'T ADMIT PEOPLE TO THE HOSPITAL who don't need to be admitted; we send them home if they are not serious enough, with the recommendations I detailed above, because we want to preserve the beds for those who do need them. We try to rotate the beds as fast as possible due to the demand. For a while things were calm but now they are dire again. We are overworked, exhausted, doing our best, catching the disease ourselves, and many of our hospital systems are in trouble, including, downsizing and laying off people. Even some doctors took pay cuts (I say even some doctors not because we are superior or anything, but we are so essential to hospital systems that we tend to be the last ones to be fired if a hospital needs to downsize).

This may be a shock to you, but actually, we do mean well and we do want to save people's lives. The vast majority of doctors want to do honest work, be paid for it of course, but they are actually ethical, and not greedy bastards.

Your accusation that we are self-serving is distasteful. We are working hard for YOUR sake, in difficult conditions, short-staffed, and in many cases with inadequate PPE (although this part has been better, lately).

After our ranks having lost to Covid-19 a number of doctors, nurses, and respiratory therapists, this accusation that we are self-serving is hard to stomach.

Look at me, for example. Due to very hard work for many decades in a two-income household (my wife is also a doctor) and due to some assets that my father left for me when he died, I could PERFECTLY retire tomorrow if I wanted to. I can afford it. I'd stay home, not exposed to this virus. Well, I didn't do that. I don't want to short-staff even more my hospital, so, I soldier on. It's my mission. No, I'm not self-serving.

 

Okay, but that doesn't automatically make you right here, as you should well know.

From what I heard, hospitals were getting three times as much payment from Medicare if they put their patient on a ventilator versus the alternative course of treatment.

(Sorry if we are having a discussion based on something that is happening outside of the US. I am aware this is a world forum)

Not necessarily you, but the hospitals. They are under financial pressures, have to run things like business. Any administrators or experts with a special more administrative position (that is higher paying promotion) they employ could also be under some pressure.

But I know even the noblest of doctors can be self-serving in some ways, by convincing themselves that it's in the best interest of their patients.

The reality is the type of treatment you would choose for yourself would be different if you were earning ten times less money.

 

You heard wrong. Nobody makes a ventilation decision thinking of reimbursement. It doesn't even cross our mind. We started by using ventilators a lot in the early days because we THOUGHT that we were facing a situation like the SARS and MERS, of typical ARDS (which does respond positively to invasive ventilation), before we understood that SARS-CoV-2 is a very different animal, with its predilection for endothelial lesions. Then, we realized that we should try to avoid invasive ventilation as much as possible. So, OF COURSE we won't put someone on ventilation, risking VILI, and possibly killing the patient, to make more money. That is PREPOSTEROUS.

Evidently you don't know much about how doctors think.

And what makes me right, is that I practice state-of-the-art care, based on the latest medical literature. The protocol I linked you to, which is practiced in my hospital with a few differences, is based on 338 scientific papers.