Missouri State of Mind

Telemedicine was on  an upward growth curve before this current pandemic, only experiencing explosive growth since the beginning of mass stay at home orders.  What the future holds depends on a few things: how well telemedicine substitutes for the face to face encounter; how adaptable licensed health professionals, insurers, and self-funded employers are  in embracing Telemedicine in the long run; and how economically rational the transition to Telemedicine  may prove to be.

Telemedicine's growth, pre-pandemic, was overwhelmingly in the world of large employer-sponsored health insurance.  https://www.healthsystemtracker.org/brief/more-employers-are-paying-for-telemedicine-but-enrollee-take-up-has-been-relatively-low/ This means the urban-suburban-rural design of these systems will be quite different. This is complicated by the very high rate of uninsured individuals in rural counties.  Telemedicine or F2F encounter, providers are not equipped financially to take on a great many patients lacking insurance as out-of-pocket collection rates can be quite low, quite expensive, etc.  In addition, even in Medicaid expansion states (a group Missouri has very recently joined), Medicaid reimbursement rates are such that few providers can take more than a limited number of such individuals into their patient panels.  Many providers take none at all.  https://www.ky3.com/content/news/Missouri-Medicaid-reimbursement-low-and-slow-creates-boundaries-for-children-with-disabilities-566759491.html

Missouri Medicaid reimbursement low and slow, creates boundaries for children with disabilities http://www.ky3.com A new law in Missouri expands insurance coverage for disability therapies for children, but many won't benefit because of Missouri's "poor" Medicaid reimbursement rates.

More employers are paying for telemedicine, but enrollee take-up has been relatively low – Peterson-KFF Health System Tracker http://www.healthsystemtracker.org Telemedicine – the delivery of health services by providers at remote locations, such as through video conferencing or remote monitoring – has been seen as a way to possibly improve access to care while also lowering costs.  In our 2018 Employer Health Benefit Survey (EHBS), we find that the share of large employers offering health […]

Telemedicine has, in the U.S., been for the insured.  In other countries, telemedicine is available to a much broader swath of the population :  https://www.theguardian.com/australia-news/2020/may/13/the-genie-is-out-of-the-bottle-telehealth-points-way-for-australia-post-pandemic.

'The genie is out of the bottle': telehealth points way for Australia post pandemic | Health | The Guardian http://www.theguardian.com 'The genie is out of the bottle': telehealth points way for Australia post pandemic | Health | The Guardian

And this map tells you much about Missouri politics. The vote was close. Did it take the loss of employer sponsored health insurance on a mass scale as fall out from the pandemic to make it happen? If so, add this to the list of absolutely remarkable after shocks from this pandemic.

https://www.theatlantic.com/health/archive/2020/07/outdoor-schools-coronavirus/614680/?ncid=newsltushpmgnews

Even a few weeks of outdoor teaching, in particularly unforgiving climates, might benefit students. Sometimes it is better to be satisfied if the first step is a small victory and not necessarily insist upon swinging for the fences.

Well, since Herman Cain is reported to have gone without a mask right up until the day of his diagnosis with Coronavirus, we may never know. Cain’s representatives said in a statement after the diagnosis that “there is no way of knowing for sure how or where Mr. Cain contracted the coronavirus.” So, yes, once an infectious disease reaches the pandemic stage, it can be very difficult to attribute the time, place, and manner of infection.  A diagnosis nine days after the Trump Tulsa rally ought to make us all stop and think, though.

Herman Cain was a cancer survivor and has been quoted as feeling called to do something bigger, greater, more significant after his completion of cancer treatment.  If you contribute to a call to reason and decency about mask wearing, sir, you will have accomplished that goal.

Here's a good overview of what is going on for the July 2020 Missouri bar exam.  All the PPE discussion is here as part of the explanation that it is essential to have an in-person exam in a state trending toward uncontrolled Covid-19 status.  But why no discussion of the mandatory waiver of liability the Missouri bar examiners require? Oh, maybe that is covered by the last sentence's referral to mental health services available to bar applicants.

I am just loving the fake pharmacy set for the signing of a few executive orders today relevant to prescription drug pricing. So, were those real or fake pharmacists surrounding them?  Kind of interesting to think a real pharmacist would engage with such a crowd without a mask.  Asking for a friend.

And it is just as simple as that.

 
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I have, on multiple occasions, observed that we can learn something about who we are as a people by discerning what about social insurance programs collectively repel us. We have a hard time with public health concepts — our health is mutually interdependent, to a degree, on the health of others — because they contradict a rugged individualist health ethos. Now, some who missed the earlier program are appalled to discover that what applied to the ACA or, even more, various universal health care proposals also applies to Coronavirus social distancing and mask wearing protocols. We, are a people, who simply cannot get our minds around the idea that we are involuntarily  interdependent.

Doctor Anthony  Fauci noted, only a few days ago, that  “I think we need to emphasize the responsibility that we have both as individuals and as part of a societal effort.”

Smart move, that making this a matter of individual responsibility. May be the only way to sell it to Americans.

I, too, think the reopening of dentistry may be a bellwether for the reopening of much of America.  But, unlike the New York Times,  I don't see decreased consumer demand as only a study of higher unemployment producing lower numbers of individuals with dental coverage. 

Two thirds of all Medicare beneficiaries have no dental coverage.   AHRQ tells us (as of their 2010 survey): "[d"ental expenditures are distinguished from overall health care expenditures in the distribution by sources of payment. In 2010, a higher percentage of dental expenditures was paid out of pocket (47.5 percent for dental versus 14.2 percent overall) and a lower percentage was paid by Medicaid (5.8 percent versus 10.4 percent)."

Dental expenditures in the United States are a middle class luxury.  Let them be  a bellwether of that category of consumption.