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We Need a Centralized Medical System, Too
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The coronavirus pandemic has laid bare two fundamental flaws in the American health care system.

No. 1: There’s a reason that other rich countries treat health care as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford private health care.

The second inherent flaw in the U.S. approach is that it’s for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.

When your insurance company issues a denial, it doesn’t merely pocket that payment. It also adds to future profits. Even if you’re insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. “Visits to primary care providers made by adults under the age of 65 … dropped by nearly 25% from 2008 to 2016” due to routine denials by insurers, reports NPR.

Denials also create a societal effect: News stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.

There’s a third structural problem exposed by the pandemic, but it’s not receiving attention from public policy experts or the media. I’m talking about America’s lack of a centralized health care system.

A centralized health care system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for profit. In such a scheme, all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you’re on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.

The current system is primitive. Data is not transferable between doctors or medical systems without a patient’s directive, which is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that’s it’s not a weekend or a national holiday or a Wednesday, when some doctors like to golf.

Unless an unconscious patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether the person is allergic to a drug or has a chronic illness, or whether there’s a treatment regimen proven to be more effective. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter, one-size-fits-all treatment.

A few months ago, I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in Los Angeles. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. “We do not treat viral infections with antibiotics,” the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.

This would not have been an issue back home in New York, where both my general practitioner and my pulmonologist know my medical history. Either doctor would have prescribed a strong antibiotic and a codeine-based cough syrup.

Because I happened to be in LA, I left CVS empty-handed.

I declined.

It got to the point that I couldn’t walk 100 feet without pausing to catch my breath. I felt like I was going to die.

I called my doctor back in New York. She called in a prescription to the same CVS. It helped arrest my decline. But I wasn’t getting better.

I visited a different walk-in clinic, in West Hollywood. It was a better experience. They tested me for flu (negative), X-rayed me (diagnosis was early-stage pneumonia) and put me on a nebulizer. I began a slow recovery.

A centralized system would have been more efficient. The CVS nurse would have seen my history of non-response to treatment devoid of strong antibiotics. He also might have taken note of my pulmonologist’s effective use of a nebulizer to treat previous bouts of bronchitis and pneumonia. I might have been prescribed the proper medication and treatment as much as a week sooner.

COVID-19 almost certainly would have been detected in the United States sooner if we had a centralized medical system. “One example of a persistent challenge in the early detection of health security threats is the lack of national, web-based databases that link suspected cases of illness with laboratory confirmation. This leaves countries vulnerable, as they cannot accurately and quickly identify the presence of pathogens to minimize the spread of disease,” according to the U.S. Centers for Disease Control and Prevention. Algorithms can automatically scan massive volumes of information for signs of novel infectious diseases, help identify potential problems and focus responses where they are needed most.

How many people’s lives could have been saved if lockdown procedures had begun earlier? If public health officials had seen the coronavirus coming back in December — or November — they might have been able to protect vulnerable populations and avoid a devastating economic shutdown.


There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized health care system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.

We can’t pretend to be a First World country until we join the rest of the world by abolishing corporate for-profit health care and decouple insurance benefits from employment. But reform without centralization would be incomplete.

• Category: Ideology • Tags: Coronavirus, Health care 
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  1. As of today worldometers says the USA has 88000 coronavirus deaths => 268/million
    Japan, with half the population of the US in an area the size of California has 713 => 6/million
    The Japanese spend less than half per capita on medicine as the US.

    American medicine is a nest of cartels. The doctor part of the cartel is interesting

  2. anonymous[245] • Disclaimer says:

    Pick a topic, any topic, and Mr. Rall will tell you that “we need” more centralization and governance. ClimApocalypse, rent, health, whatever — someone in authority will wipe your nose, tuck you in, and slay those monsters in your life.

    There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized health care system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.

    I see his cartoon cover next to this. Did he really write a book about Snowden?

    • Agree: Ace
    • Replies: @Daniel H
    , @anonymous
  3. The medical industrial complex is already centralized. That’s what’s wrong with it.

    Consolidating the monopoly won’t improve it. It can only make it worse. Nothing the government does is done well, and can’t be.

    • Agree: g8way
    • Replies: @obwandiyag
  4. A Texan says:

    Ted Rall is a typical leftist idiot or do I repeat myself.

    The problem is the insurance companies with a lock on legislation preventing competition along with many laws passed at the federal and state level that has monopolized drug production and other aspects of the medical system.

    Even my family doctor is annoyed with the government edicts and the insurance companies.

    There is a hospital in Oklahoma with a price list for common procedures. Trump tried to make hospitals do this but it was shot down.

    And yeah, I’m going to trust my electronic medical records with the communist in government. &*(*& that!!!!

    • Agree: g8way
    • Replies: @obwandiyag
  5. Well, you were out of your native State, what did you expect? Suppose you were visiting Mexico. You would go through the same trouble, only worse. Would you write an article advocating the unification of the U.S and Mexico healthcare systems?

    • Replies: @Republic
  6. Daniel H says:

    Whatever your opinion of Rall, he is 100% correct on this matter.

    • LOL: schnellandine
    • Replies: @anonymous
  7. botazefa says:

    In such a scheme, all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care.

    Why stop there, Ted? You can add all sort of useful data to your database: sexual orientation, education, gun ownership, income level, marital status, political affiliation.

    What a great idea, Ted.

    • Replies: @Chris Mallory
  8. anonymous[245] • Disclaimer says:
    @Daniel H

    100%, huh?

    Why not retain – privately – all of your medical records? This could easily be done, would allow for individual choice, and would substantially reduce the risk of inappropriate access and abuse by third parties.

    • Replies: @animalogic
  9. anon[185] • Disclaimer says:

    Perhaps health-compromised people should not travel. Perhaps medical records should be the sole property of the patient, not institutions.

  10. @Rickhhhhhh

    NO. IT. ISN’T. You fucking dickhead mook. How dare you presume to even comment on something beyond your capacity to understand?

    • Agree: Ann Nonny Mouse
    • LOL: g8way
  11. @A Texan

    The logic of the free market is kill people to save insurance companies money. You fucking evil son of a bitch. You fucking people are going to be the death of the world–all this freemarket stuff proven utterly evil and wrong to your face and still you push it. Just go away and be the dog you are.

  12. onebornfree says: • Website

    “We Need a Centralized Medical System, Too”

    Translation: in other words Rall fantasizes that “we” “need” a system run by the exact same crooks/scumbags [Trump, Pelosi, Pence, Fauci, Schumer, Schiff, and others like them – and then subsequently by the crooks/scumbags who ultimately replace them], and who run almost everything else more or less centrally already.

    One has to be in complete denial of reality, and seriously retarded in order to seriously put forward this much bilge.

    Reality check: “The kind of man who wants the government to adopt and enforce his ideas is always the kind of man whose ideas are idiotic” H.L.Mencken

    “Because they are all ultimately funded via both direct and indirect theft [taxes], and counterfeiting [central bank monopolies], all governments are essentially, at their very cores, 100% corrupt criminal scams which cannot be “reformed”or “improved”,simply because of their innate criminal nature.” onebornfree

    “Everything government touches turns to crap” Ringo Starr

    “Government is a disease masquerading as its own cure” Robert LeFevere

    “Taking the State wherever found, striking into its history at any point, one sees no way to differentiate the activities of its founders, administrators and beneficiaries from those of a professional-criminal class.” Albert J. Nock

    “Why Government Doesn’t Work”:

    “Regards, onebornfree

    • Replies: @animalogic
  13. @botazefa

    You forgot “Stopped clapping before others during the Glorious Leader’s speech.”

  14. joe2.5 says:

    There are substantial privacy considerations … Keeping a centralized health care system secure would have to be a top priority.

    You don’t say! And to keep it secure, as you say, I appoint the best of the best, the NSACIAFBI… WXYZ: those who have been spying on every second of your travel, correspondence and conversations.

    There is a proper place for everything, and even suggesting data centralization in the American Single-Party dictatorship is more than a little criminal. You’re declining — try Biden’s doctor.

  15. It does not have to be centralised. That is just asking for monopoly rent to be extracted from the dumb sheeple, either as ‘profit’ by business, or ‘bureaucracy’ by the state, or both! This just offers loss to the individual citizen.

    What is necessary is a universal provision of health. This is best done a bit like the Swiss model. We know the population statistics for illness and disease, and can work out what the cost of those treatments is. So, flat tax income/profit a % necessary to cover illness, redistribute the money evenly to each citizen, and regulate the health/health insurance industry into perfect competition.

    It’s the last step that is difficult, because good regulation requires a good system of government, which our evolutionary autocracies are not.

  16. @anonymous

    “Why not retain – privately – all of your medical records? This could easily be done, would allow for individual choice, and would substantially reduce the risk of inappropriate access and abuse by third parties.”
    Absolutely correct. You can obtain the core advantages of centralisation while reducing it’s dangers by having the patient control their own medical record (on a card, memory stick etc)
    But frankly, I’m disappointed that Rall has linked the central record issue to the medicare for all issue. (the record issue is secondary if not tertiary in importance).
    Yes, the virus has helped to highlight what an expensive abortion US medicine is.
    Sad that there are still average persons who have swallowed the Elite lies about “socialism!” & “deficits, & OH! the money! We can’t afford it !” muck.
    US citizens deserve BETTER. The US CAN afford to supply basic medical care for ALL it’s citizens.
    It is more efficient, it’s cheaper & it’s fairer.
    (This subject shows just how ideological & committed to POWER US elites actually are.
    A medicare for all type of system would save Business 100’s of billions (trillions?) but still, they just can’t countenance it. Same thinking as, say Walton’s — better completely shut a huge shop down than accept even the existence of active Union representation.
    These guys WILL cut of their nose to spite your face….

    • Replies: @HallParvey
  17. @onebornfree

    Wow, taxes are theft, government is a criminal conspiracy etc, etc, etc.
    So let’s just chuck it all out…. & leave it to…. ?Well it gets a bit vague from the “chuck it” bit.
    Maybe it’s the old shrink –> drown in bathtub, formula?
    Thank God we have the Private Sector.
    A bit of totalitarian anarchy is what we really need…. May even be good for the environment — everything collapses, 100’s of millions, even billions die, will certainly help with Co2 & pollution etc.
    Hey! — silver lining.

  18. Republic says:
    @Brás Cubas

    He should have downloaded all his medical records to a flashdrive and take it with him on his travels.
    In Mexico almost all drugs can obtained without a prescription ,if not one can see a doctor for about \$10-20,or a specialist for around \$40.

  19. Ace says:

    Mr. Rall, the phrase “health care” cannot be found in Art. I, Sect. 8. I know you yearn for it to be there, but it isn’t. States can experiment all they want with various arrangements for health care; Fedzilla cannot. Please tell me what part of this you don’t understand.

    Your faith in efficient, effective, responsive government services is laughable.

  20. “We” need a “centralized” solution to the problem of dissatisfaction. There—all problems solved. All you need to do is step into a booth and pull a lever for whatever slime-cocooned ass promises to eliminate dissatisfaction. That’ll fix medicine, spouses, lawns, and the scarcity of excellent free beer. And everything else!

    I’m a genius. That Rall’s a piker. Health care—pffft!

  21. anonymous[245] • Disclaimer says:

    To further immunize yourself from this dim-bulbery, read Mr. Escobar’s “How Biosecurity Is Enabling Digital Neo-Feudalism,” just published here at Unz.

  22. Mr. Rall is right, we need centralized medical records. But we need to go one step further, all medical records should be public. Public medical records would allow medical service providers to target you to sell you better or cheaper medical services. If you are paying X dollars today for your maintenance drugs, with public medical records, a physician could invite you to become a patient because she believes, after reading your records, she could come up with a better treatment protocol which would make you healthier and let you save money. Back in the day when the surgeon was king of medicine, there was just not much in medical records. Now that medicine has taken the pharmacological turn, medical records are key. The idea of keeping your medical records “private” is the game paid by physicians so that they can keep you as a patient because others can’t look at your records and poach you away by offering better care. Remember today who sees your medical records: (1) your doctor; (2) the health care system your doctor works for; (3) your insurance company; (4) to some degree your credit card company because they know what drugs you buy and what types of specialist physicians you see; (5) your employer, because for most companies, insurance is self insurance; (6) Google, because they are signing contracts with health care systems to mine data from records. Half the planet already sees your “private” records–why not simply extend that to “competitors” to open up the market.

    • Disagree: schnellandine
  23. @animalogic

    Same thinking as, say Walton’s — better completely shut a huge shop down than accept even the existence of active Union representation.
    These guys WILL cut of their nose to spite your face….

    These people ARE Unions. The government Lawyers who make the rules, both elected and otherwise. The government licensed doctors and their AMA. The government regulated insurance industry. And the glue that holds the whole thing together, the University system that churns out plenty of Lawyers, Doctors and Insurance Executives. And then there are the Bankers who keep track of everything.

    The fact that they are not labeled members of some International Union of Self Interested Individuals in no way prevents them from being such. The problem with trying to change any of it is that any change, no matter how small, will cause disruption of the personal interest of many people. Change sounds like a good idea until it affects my paycheck, then it’s not so good. It’s the same with people who are Doctors, Lawyers and Executives.

    Remember B. Obama and his Hope and Change. After eight years the hope had evaporated and everything was pretty much the same. Nothing really important had changed.

    • Replies: @schnellandine
  24. @HallParvey

    Remember B. Obama and his Hope and Change.

    “Change” ranks among the most useless political aspirations. The current plandemic is change. Suicide is change. Anyone promising “change” is a charlatan, those demanding it, fools.

    • Replies: @Begemot
  25. Begemot says:

    Anyone promising “change” is a charlatan, those demanding it, fools.

    So those abolitionists who opposed slavery and worked for its’ eradication were fools and charlatans? Soviets dissidents who advocated for human rights were fools and charlatans? The Founders of the US who advocating American independence were fools and charlatans? Those who try to right a wrong are fools and charlatans? Those who promote wisdom as against ignorance are fools and charlatans?

    So the course you advocate is just meekly and quietly accept the status quo? Or have you engaged in excessive hyperbole here?

    • Replies: @schnellandine
  26. @Begemot

    Don’t know what to say, other than that you should have read and understood my comment before commenting.

    Mr. Unz should add a ‘Yikes’ button.

    • Replies: @Liberty Mike
  27. @schnellandine

    Color me a fool, but I demand a change of address for the following:

    Chocolate Jesus

    James Comey

    John “I voted for Gus Hall” Brenan

    James “Fibber-Flapper” Clapper

    Lisa “Horse Face” Page

    Susan “Blame it on the Video” Rice

    Eric Holder

    The Hildebeast

    Rod “Nobody Doubts I’m a” ((( Rosenstein )))

    Andrew Weissman

    Peter Strzok

    Adam “Piece of” Schiff

  28. Scott G says: • Website

    Dream on Mr. Rall….the nurse at the cheap drugstore clinic would have never taken the time to go though a voluminous electronic medical record TO CONFIRM WHAT YOU ACTUALLY TOLD HER ! Have you ever seen an EMR?? Really impossible to get to the meat of the issue.
    Good thing you’re not in line to be a politician or judge. Or getting married. That history of gonorrhea ( sarc ) and herpes you had in college would be all over the papers…and to your future ex-wife.

    As they say, for every problem there is a simple solution…and it is usually wrong .

  29. meamjojo says:

    We Do have a centralized medical dB. It was called “electronic records” by the 2010 ACA/Obamacare and most every hospital and MD was supposed to be on and using one by 2016..

    A big player in electronic records is Epic. I know that Stanford Health, UCSF and Sutter are all on the Epic system and can see/share patient records and info.

    Of course, like most everything in America, there are a variety of choices of these type of systems and my understanding is that they don’t easily talk to each other. Why would we expect anything better out of our fractured health system?

    Complete the story Ted. What system was your MD using in NY? And does it “talk” to whatever system CVS was using? If not, this could be your next article/rant.

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