International United Healthcare Form: Fill & Download for Free

Well, hypothetically speaking…0 hour. A member of a terrorist group, say, Aum Shinrikyo (a Japanese doomsday cult that orchestrated two similar biological attacks, but with sarin, more than a decade ago in Japan) or……a Chechen Islamist separatist group like the Caucasus Emirate (who, let us pretend, managed to gain access to smallpox stockpiles from Zagorsk before they moved it all to Koltsovo)……surreptitiously drops a vial containing smallpox on the floor of a busy international airport in Japan.↓0 hour. The vial hits the ground and shatters. The virus dissipates into the air.↓0 hour + 1 min. The virus diffuses 5 feet off the airport floor to head height (most people in an airport are adults) and enters the nasal and oral passages of everyone in the vicinity. They are now infected. The virus is called variola. The disease it causes occurs in two variants: variola major and variola minor. The latter is a far safer disease, but happens only 1% of the time.99% of the people who breathe in the virus will contract variola major.↓0 hour + 2 min. Life will go on for all these people as usual. They will board their flights, or collect their luggage and leave the airport, or finish their shift and check out of their airport job for the day. These people will infect nearly no one. Variola is only contagious once the symptoms appear. That hasn’t happened yet.↓0 hour + 3 min. The virus invades the mucosa of the respiratory and oral tract of the infected.The first victims reach their destinations and disembark, or reach their homes and families relatively close to the airport.↓o hour + 1 day. The virus reaches the regional lymph nodes near the infected tissues and begins to multiply there as well.The infected are still asymptomatic and non-contagious. They hug, kiss, fist-bump and high-five other people, infecting none of them.↓0 hour + 4 days. The virus bursts out of the cells it infected, destroying them in the process. It breaks out of the respiratory and oral tissues it first infected, resulting in a cold and a sore throat respectively. It breaks out of the lymph nodes into the bloodstream, causing a fever.The infected come down with fevers, sniffles and a cough. Some of them take to bed. Some of them shrug it off and go to work. Some of them go the the hospital and get themselves looked at by doctors trained in scientific medicine. Some of them, depending on how badly their schooling failed to actually educate them, will go to a practitioner of Ayurveda, Homeopathy, Unani, Chiropractic, Acupuncture, Siddhi, Reiki or might decide it is time for a colon cleanse.The people the infected exchange fluids with get infected.The supportive boyfriend who owes more of his neural processes to a steady diet of Paulo Coelho than high school biology, and thus believes love trumps everything, who then kisses his girlfriend (who has what appears to be some variant of generic flu) on the lips… gets infected.The young and harassed medical intern who took a mouth swab of one of the infected without putting on a pair of gloves first (so the tip of his thumb just brushed the patient’s upper lip) and got the patient’s saliva on his thumb, and was about to wash it off but got yelled at by a harassed medical resident for being such a hypochondriac, and so delayed washing it off, and then ten minutes later forgot about it and rubbed his eyes… gets infected.↓0 hour + 10-12 days. The first rashes appear in the mouth, tongue and throat. The rashes are the most contagious. From here on, each infected person with a rash is a walking smallpox dispersal machine.More of the infected realize their illness is serious and get checked out at hospitals.The variola claims its first victims. Somewhere, someone suffers an accelerated version of the disease and dies from heart failure or fluid in the lungs. The body of the victim is brought to the mortuary.↓0 hour + 14 days. The rashes appear on the skin. They start at the forehead and work their way down over the face and across the trunk to the limbs. This spread takes less than two days. No more new rashes appear on the same person after this.Even more of the infected go to the hospitals. Most trained medical interns will be stumped by the disease (not having been trained to recognize a disease they successfully eradicated a long time ago). A few of them might confuse it with chickenpox (failing to notice the rash has involved the palms and soles, which is something chickenpox does not do). But the others, being professionals, will call in a resident, who will call in a professor or an infectious diseases specialist. One of them will figure it out.Someone in the medical community will realize what he or she is looking at.↓0 hour + 14 days + 30 seconds. The CDC will be immediately called. Quarantine measures will be taken immediately. The patient will be isolated and skin samples will be sent for microscopy, ELISA and culture.Worried relatives and other people on the quick-dial list of the infected will conglomerate at the infectious ward entrances, demanding to know what the problem is. The medical staff will keep them at bay with the infuriating but rational, “We suspect so-and-so might have a potentially infectious disease. Protocol dictated we isolate him/her until we can receive confirmation. Please be patient.” This only serves to make them more impatient.↓0 hour + 14 days + 1 hour. Microscopy returns. Guarnieri bodies are positive in some of the skin samples. The CDC is notified.Guarnieri bodies are negative in some of the skin samples. The CDC is notified.↓0 hour + 14 days + 4 hours. The ELISA test results begin to come in. Variola major positive. The CDC is notified.Hospital security is called to the containment area in force. Local law enforcement is briefed on the situation. The news is broken to the huddled clumps of anxious relatives outside the isolation wards. Some of them break down. Some go into shock. Then they turn and notice that hospital security hasn’t formed a barrier between them and the doctors, but around them. They are informed that they are all potentially infected and will have to be placed in quarantine. Some of them, usually the ones who read a lot of Ayn Rand in their twenties, start shouting about civil rights and have to be restrained. Some of them panic and try to run and have to be tackled. Most of them comply in shock.↓0 hours + 14 days + 15 hours. The CDC declares a smallpox emergency. It sends out alerts to all hospitals, clinics and healthcare centers. Trained medical staff hit Wikipedia (no time for the textbooks) and instantly go on the alert for the symptoms of smallpox. The CDC alerts all airports. Flights are instantly quarantined. The CDC alerts the media. The media promptly starts broadcasting the alert.While local and state agencies mobilize resources to cure the infected, federal agencies mobilize resources to prevent further infection. Each country mobilizes its Strategic National Stockpile, that has been formed precisely for this purpose. The SNS, if they’re lucky, will contain stocks of smallpox vaccine. If they’re really smart, they will already have these vaccines in “push packs” ready to go. The federal government simultaneously orders mass production of these vaccines.Patients exhibiting symptoms are quarantined in negative air pressure rooms wherever possible.Local and state authorities start tracking down everyone exposed to the patient and informing them of the crisis, requesting them to come in, even finding and escorting them into quarantine units.Mortuary assistants who handled any bodies with similar signs are brought in and screened.Where negative air pressure rooms are unavailable, airtight rooms are quickly equipped with HEPA filters and converted into quarantine units.Healthcare personnel wearing N95 masks and protective clothing attend to the infected patients in these units.A bunch of smartasses will take advantage of the omnipresent image of doctors in these masks tending to smallpox patients and will hawk these masks (below) at wildly inflated prices, falsely claiming these masks will protect the person from smallpox (not really, and everyone will probably wear them wrong).↓0 hours + 15 days. The rash in the first infected progresses to form papules; raised lesions that feel solid to the touch.Air force personnel that have already received the vaccine will fly push packs out to collection points for hospitals. Armed military units will pick up the packs and transport them to hospitals.Schools, TV channels and internet websites quickly form educational modules to modulate the response to the smallpox alert. The outpatient departments of hospitals and local clinics are inundated with anxious people worried their acne could be smallpox. Google will change its homepage doodle to reflect the emergency.Stampeding ensues. Law enforcement, if it wasn’t prepared already in anticipation of this, steps in now. The unruly crowds are quickly disciplined and streamlined into a semblance of order. Some people die in riots.↓0 hours + 17 days. The smallpox nodules form hollow lesions called vesicles that are filled with tissue debris.Over the course of the next 12 days, these pustules individually leak and deflate to form a crust and scab. The scabs are still infectious. The patient remains infectious until the last scab disappears.Now, if they are not treated in time, the variola will kill 30–35% of these patients. Some of them might develop a lung infection or a brain infection (encephalitis) and die faster. Which is why…↓0 hour + 17 days and any time soon. The push packs arrive at health centers. Priority levels are instituted. The healthcare personnel coming in direct contact with potential infected (friends and relatives of the infected, who have already been quarantined) are the first to be vaccinated. Any soldiers assisting in transport who were not vaccinated are also vaccinated. Then all people with a history of exposure to the disease are vaccinated. Older people who were vaccinated back in the day when smallpox wasn’t eradicated wouldn’t need the vaccine because duh.Those also in advanced stages of the rash are treated mostly with supportive therapy. They are treated using protocols similar to patients with first-degree burns: fluid resuscitation, ventilator assistance and wound care.But everyone who was vaccinated within 2–4 days of infection stands a very high chance of survival. Even people vaccinated within 4–7 days of infections stand a very good chance.Not everyone who was infected can be saved. Those who lived in isolated areas might die. Those who already had other diseases might die. Those who consciously choose to rely exclusively on Ayurveda, Homeopathy, acupuncture and other similar forms of non-scientific psychological reassurance might die, (but not before infecting far more people than the former two groups, like the a**eholes they are). The smarter among the quacks who treat this group will rush to healthcare centers begging for the very medicines they criticize. The dumber among them who actually “trust” their “science” won’t. Many of them might die.In the end, without assistance, 30% of all those infected would die. With modern medicine, that number can be dropped to the single digits.So no, it wouldn’t be the end of civilization as we know it. Put away your Mad Max cosplay costume.But even the number of the people infected would be relatively small. Smallpox was the first disease we managed to eradicate because, you see, smallpox was easy to eradicate.Diseases that become contagious before the first symptoms appear (like AIDS and the common cold) are hard to eradicate. But smallpox advertises itself all over the body right before it starts spreading its love.Diseases that linger in the host’s body for long after the symptoms subside are hard to eradicate. But smallpox leaves the person right around the time the last scab clears up.Diseases that change their identification signatures (like AIDS and influenza) from time to time are hard to develop a vaccine against. But smallpox never bothered (and never will bother) to procure more than two or three fake IDs.Of all the diseases in the world that we can beat, smallpox was one of the easiest. I say “was” because we beat it once, at the peak of its strength. We can beat it all over again.Really, diseases like smallpox are easy to beat if we have a coordinated force of technically trained operators armed with plastic and steel delivery systems that can fire lethal doses of the right stuff.Diseases of belief, however, that can cause a person to try to infect his/her own kind with smallpox, are slightly harder to beat. But then again, if we have a coordinated force of technically trained operators armed with plastic and steel delivery systems that can fire lethal doses of the right stuff, nothing is impossible.So this story isn’t over until I elaborate on what this force’s treatment protocol would be for the person who purposely dropped the vial in the first place, but that’s a better story for another time, and my expertise ends here.

We tolerate the status quo (to varying degrees) for 4 reasons:The totally fabricated myth that alternatives are MORE expensive than the status quo.The insane complexity of 4-party billing (employer, employee, provider and payer) which is designed to:Mask the real economics behind selective health coverage (as opposed to universal health coverage)maximize revenue and profits — not safety, quality or equalityAs citizens, U.S. Americans are up against a heavily entrenched and well funded industry that benefits enormously from the status quo. Those same entrenched economic interests stand to lose billions in revenue and profits with major healthcare reform.A strong aversion to “socialism” at a time when our government is visibly dysfunctional.Working backwards.Reagan’s now famous quote summarized #4 well. “Government isn’t part of the problem, government IS the problem.” Large swaths of America believes this and so we elect candidates that represent the “molotov cocktail” option. Our national electoral process is complicit here because it’s rigged in a way that makes it relatively easy to manipulate — both internally (with money) and externally (by foreign powers with “alternative facts” at scale).Lawrence Lessig had a great quote for #3 — the heavily entrenched and well funded healthcare industry: “You know, when Bernie was talking about single-payer healthcare people rolled their eyes. Not because it was a bad idea, but because there’s no chance to get single-payer healthcare in a world where money dominates the influence of how politicians think about these issues.”The insane complexity of 4-party billing is an accident of history (WW II) and how almost 1/2 of U.S. Americans (~150 million) receive their health insurance benefit — through employment. But the United States is also the only industrialized country that uses employment as a way to tier health insurance. The only purpose behind tiered coverage is to support tiered pricing — which is how to maximize revenue and profits.The overriding myth — that alternatives to the status quo would be MORE expensive — is a key objective in the battle ahead, but easy to argue against. This one chart dramatically highlights the cost of our ignorance — and how our healthcare system has been hijacked for revenue and profits — not safety, quality or equality.All of this combines to form an almost impenetrable fog around major — and sustainable — healthcare reform — and so what we get is healthcare reform around the edges — not at the core.

Let’s start with the basic numbers. The US spends 17.1% of GDP on healthcare, that’s a cool three trillion dollars a year. (For comparison, the global mobile advertising market - that’s the market that gives companies Facebook and Google pretty much all their valuation - is $100 billion per year, the global handset market is $400 billion per year.) In other words, a mind-bogglingly large number.But, well, it’s our health, so it might be worth spending that amount of money. However, Germany spends 11.3% of GDP on its healthcare system (and everyone is insured throughout his or her whole life), Switzerland spends 11.7% of GDP, France 11.5%, Japan 10.2%. In fact, you won’t find another developed country that spends more than 11-12% of GDP on healthcare. If you plot this against life expectancy, people in the US die earlier than in all those countries I just listed, and we somehow manage to spend 50-100% more on healthcare per GDP than any other rich country in the world. (And we leave 10% of our population uninsured, while we’re at it.)Right then and there, you see the absolutely incredible inefficiencies of our healthcare system. There might not be another economic system on the planet that is as dysfunctional with regards to what is “normal” operations, as the US healthcare system is vs. the rest of the rich world. By the way, that translates into about a trillion dollars per year in over-allocation of dollars. As you know (and it’s an issue in this election, at least indirectly), real wages haven’t grown very much in the US since the early 2000s or so, and it’s at least partly because some of the real wage growth that could have existed has been eaten up by rising healthcare costs. So it is an incredible issue. One that has often been shielded from you and I - because your employer picks up the tab of rising healthcare premiums before you even know it; but the average person sees it, among other ways, in the fact that incomes have been depressed because so much of our national income generation goes to healthcare. In the 1960s, I think 5% of GDP went to healthcare.So why is that the case? There aren’t any extremely simple answers, but we know of a few that are very clearly big drivers. I like to break down our internal calculations around healthcare costs into three components: (risk / member) x (utilization / risk) x (unit cost / utilization) (let’s call it R x U x C). (“Risk” in health insurance terms is a codeword for the set of medical conditions that a member has.) What this translates into: for someone with a certain medical condition (R), how much does this person utilize healthcare (U = go to the doctor, go to the emergency room, get surgery, get drugs etc.), and then per each unit of utilization, what does it cost (C, that’s unit cost).If you compare those three components across countries, then you see that the US is slightly less healthy than other rich countries (we have more of an obesity problem, we like to shoot each other more with guns, we don’t eat as healthy as the French), so that’s a slight problem in R. You actually wouldn’t see much of a difference in utilization - we go to the doctor similar amounts of time and have a similar number of colonoscopies as people in Europe, for example. And you would see a massive difference in unit cost, which is almost where you can entirely isolate the problem: we have a huge issue with unit costs. Some of those stories you’re probably very familiar with, e.g., the insanity of drug pricing (see the Epipen example). In New York, the same procedure can cost 2-3x more, depending on which hospital you go to - with, and this is extremely important, no difference in quality! In fact, healthcare might be the only one of our big “markets” in which there is no correlation between price and quality.So what is happening with unit costs? I think there are several things at work: 1) Unlike in other countries across the globe, the US government doesn’t set reimbursement levels for healthcare procedures. (That’s what Germany does, for example.) So everyone is free to set their own price. 2) There is no transparency on unit costs across providers: even though a doctor or a hospital might charge “you” (we’ll get to why I put that in quotes in a second) a factor of 3x for what the doctor next door would charge you, you have no idea that that is the case, because you can’t really ask doctors and hospitals for what they will charge you. 3) There really isn’t any competition between providers of medical services. Insurers build “networks” of doctors and hospitals largely by going to everyone in a city and asking them what their price is, then negotiate that down a bit. Because everyone will be in that network, and because largely every actual cost will be replaced by the insurer by a flat co-pay towards you, you actually have no idea whether you’re getting good value for money, because you have no idea what the “system” as a whole ended up paying for that transaction that you just did. Providers therefore essentially have gotten used to a world in which everyone can raise prices by 5-10% every year, and in which insurers largely mark up those rising unit costs by a constant 15% administrative margin, and in which this then all gets passed on to us. 4) But who is “us” in this sentence? That’s where the final issue comes in: it’s usually your employer. Most of us have no idea how much the cost of healthcare has gone up, because the bill has been footed by the employer, and then passed on to us over time in the form of rising premiums. That the rising premiums are coming down to a constant creep of unit costs is not something we can ourselves discover in any of the day-to-day transactions we experience ourselves in the healthcare system.There are many other issues, but they tend to be similar across other nations: for example, that there isn’t often any centralized “orchestration point” in the system (nobody watches you and checks if you’re staying on the right path that will keep you healthy, even if you just had a surgery); providers tend to get paid not for outcomes, but simply for services that they put on a bill (so the actual incentive is to get you back into the office more, not make you healthy - which conflicts with the vast majority of providers’ fundamental drive towards getting you healthy, not just charging you money); data flow is very poor across the system, etc.