COVID Booster Shot Meets Health Care Monopoly

This post is part of an occasional series on health care. Here’s the prologue to the series, which originally preceded the post below.

Here’s a fairly straightforward story from The New York Times from a few days back, reminding us of the fact that immunity from some of the COVID vaccinations is limited in time, and may well require a booster shot.

 WASHINGTON — Biden administration health officials increasingly think that vulnerable populations will need booster shots even as research continues into how long the coronavirus vaccines remain effective.

Senior officials now say they expect that people who are 65 and older or who have  compromised immune systems will most likely need a third shot from Pfizer-BioNTech or Moderna, two vaccines based on the same technology that have been used to inoculate the vast majority of Americans thus far. That is a sharp shift from just a few weeks ago, when the administration said it thought there was not enough evidence to back boosters yet.

On Thursday, a key official at the Centers for Disease Control and Prevention said  the agency is exploring options to give patients with compromised immune   systems third doses even before regulators broaden the emergency use authorization for coronavirus vaccines, a step that could come soon for the Pfizer    vaccine.

Skipping a bit:

Pfizer’s continuing global study of its clinical trial participants shows that four to six months after the second dose, the vaccine’s effectiveness against symptomatic infection drops from a high of 95 percent to 84 percent, according to the company.

As a (then) full-time hospital worker actively exposed to high concentrations of COVID, I got my second dose of the Pfizer-BioNTech shot on January 6. If the vaccine’s effectiveness definitely drops from 95% to 84% in four to six months, then I’m well past my due date for a booster. Though I’m no longer a full-time hospital worker, I’ve been waiting for twelve weeks now for the paperwork to go through on my bid to work per diem for Hunterdon Medical Center’s OR. Assuming it goes through, I’ll be back in the COVID-intensive environment I previously inhabited. And if it doesn’t go through, I intend to apply to do the same work at a different hospital. So one way or another, I intend to make my way back to hospital work, and (by implication) to re-immerse myself in COVID.

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Health Care: A Series

This was originally a post on COVID booster shots, but I’ve now broken it into two separate posts, the first a prologue offering a very general summary of my approach to issues in health care, and the second, a post expressing skepticism about the need to wait any longer before we roll out a COVID booster, as well as skepticism about monopolistic institutional arrangements (distributive and/or regulatory) in health care.

I work in health care, but have no worked-out view on the political economy of health care. In fact, part of the reason I accepted the (full time) job I currently have, in hospital revenue cycle management, is to clarify my thoughts on that very subject. So I’m open to being schooled on issues in health care by anyone willing and able to do so–a category that probably includes a very large number of people. For the time being, I’m willing to remain at least temporarily in a state of curmudgeonly skepticism, willing to take pot shots at almost everyone, but unwilling to pledge allegiance to much of anything. You might regard that as a frivolous position to take, considering the stakes involved. But I don’t.

Since I’m going to be writing here at PoT about health care a fair bit in the near future (I’ve done some already), take what I say in the preceding skeptical (or dialectical) spirit. My aim is, through discussion and experience, to work my way from skepticism to something more definite.

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Hospitals Are Not Safe: Infection, PR, and EVS

I get the need (I suppose) to see the bright side of things as expressed in this article on LinkedIn, especially after the misery of the COVID-19 pandemic. Hospital workers did great things during the pandemic, and can be justifiably proud about the good they did. But I wish I had thirty minutes with a hospital executive at the level of Mikelle Moore below, to give them a small dose of some realities with which they seem oddly unacquainted.

Adapting to Uncertainty, Learning on the Front Lines and Creating a Purposeful New Normal | AHA News

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Paul Krugman on Masks and Public Urination

I agree with Paul Krugman about masking, but he’s wrong about public urination, and wrong to use the laws against it as an analogue of the laws requiring masking in the COVID-19 pandemic:

Relieving yourself in public is illegal in every state. I assume that few readers are surprised to hear this; I also assume that many readers wonder why I feel the need to bring up this distasteful subject. But bear with me: There’s a moral here, and it’s one that has disturbing implications for our nation’s future.

Although we take these restrictions for granted, they can sometimes be inconvenient, as anyone out and about after having had too many cups of coffee can attest. But the inconvenience is trivial, and the case for such rules is compelling, both in terms of protecting public health and as a way to avoid causing public offense. And as far as I know there aren’t angry political activists, let alone armed protesters, demanding the right to do their business wherever they want.

Laws against public urination do not impose a merely trivial inconvenience. If someone has a medical condition that involves urinary frequency or urgency, and there are no public bathrooms available (as often there aren’t), discreet “public” urination becomes unavoidable. Likewise if someone is homeless. Continue reading

Vox Populi: Arguments Against In-Person Schooling

People sometimes like to brag on social media that they “don’t read the comments.” I like to brag that I do. In this post, I’ve posted nearly a dozen screenshots of comments by ordinary commenters at The New York Times website, demolishing David Brooks’s ignorant, self-righteous, shaming defense of in-person teaching in K-12 public schools.

I’ll refrain from extensive commentary on these comments, but I will say this: I stand in awe at the pathetic quality of the parenting in our country, largely populated by middle class people. Such is the job that American parents have done that they’re falling apart over the dire prospect of leaving their kids home alone in their well-stocked, heated, accoutrement-centered homes. And the kids themselves are so not all right, that faced with the supposedly overwhelming prospect of not learning what they supposedly learn in school, they can’t bring themselves to get off their asses and do some learning on their own steam–not even with the beneficent resources of the Internet, Khan Academy, and the entire paraphernalia of high-tech learning at their finger-tips, so loudly valorized by ideologues until people actually had to rely on the much-hyped technologies to get anything done. Continue reading

Wal-Mart and Mask Mandates: The Empirical Issues

This gallery is meant to illustrate the issues raised in my discussion with Michael Young over Wal Mart in the post on the Great Barrington Declaration. See the combox of that post for further details. Click the thumbnails of each photo for important empirical findings.

“The Useful Libertarian Idiocy of the Great Barrington Declaration”

Will Wilkinson is the most talented, insightful, and (incidentally) successful writer of the cohort of libertarians to which I once half-belonged back in the 1990s, when I was (sporadically) associated with David Kelley’s Institute for Objectivist Studies and the Institute for Humane Studies at George Mason University. His apostasizing critiques of libertarianism are among the best of their kind. He’s been derided as a mere “centrist,” but that often seems, in libertarian circles, a convenient way of attacking someone whose political views accommodate the actual constraints that arise in political life.

His criticisms in this piece of the so-called Great Barrington Declaration strike me as spot on. And the acid tone he takes is perfectly appropriate to the subject matter. Libertarians will undoubtedly attack him, and try their best to drag some red herrings across the ground, but once the dust clears, I think they’ll be left with a sober reckoning—one they should have made last March, but have yet to make. 

I started a conversation on Will’s piece on my Facebook page, but thought I’d put it here to encourage wider participation (including, perhaps, Will’s). The piece was actually published in late October; I just happened to encounter it a few days ago.

The Great Barrington Declaration itself.

The Pfizer-Biontech Vaccine: Firstcomers and Latecomers

In a paper I’ve mentioned here before, Pierre LeMorvan and Barbara Stock discuss a moral dilemma that arises from the ubiquity, in health care, of what they call “the medical learning curve.” The idea is that neophyte health care workers face a learning curve that puts patients at risk: the earlier I am in my career as a health care worker, the less skilled and knowledgeable I’m apt to be, and the more prone to error. The more error-prone I am, the more likely to impose medically dangerous risks on patients. Since health care workers need to practice their knowledge and skills on patients in order to achieve proficiency, this situation is ineliminable, even with the best supervision by more experienced practitioners. Continue reading

Hi, and Welcome to Your Den of Thieves Experience!

The New York Times article linked below exemplifies a general pattern that’s played out since the beginning of the COVID pandemic. The pandemic began, and started taking a terrible toll on many people rendered helpless by circumstances beyond their control. Calls for leniency were reasonably enough made to prevent such people from being swallowed alive by those circumstances–eviction halts, rent freezes, mortgage forbearance, changes to grading policies, diminished scrutiny on unemployment and insurance claims, and so on. But that leniency has brought with it huge amounts of moral hazard and other sorts of imprudence and dishonesty, incentivizing almost unimaginable levels of fraud, near fraud, and quasi-fraudulent but morally dubious claims. Until you look, or are personally affected, you’d be amazed by how many people are trying their hardest to exploit the chaos of the moment, or to exploit the noble intentions of this or that benefactor–always easiest when the benefactor has deep pockets, or appears to.

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Atlas Mugged

Here’s an idea: let’s take two of the most crucial, stressful jobs out there, teaching and nursing, push their practitioners past their limits, then complain when they fail to deliver the impossible. By all means, let’s clap for them, call them “heroes,” give them gold stars for their performance, and then push the burden of their difficulties onto another overtaxed profession, mental health counseling. But let’s not question our sense of entitlement to make idle, arbitrary demands of them in the name of our “freedoms,” our “needs,” and our “rights” to their satisfaction. Continue reading