3 ms·

The US health system is not well positioned for command-and-control from a centralized source. This has various advantages and disadvantages, but is a severe hi

The US health system is not well positioned for command-and-control from a centralized source. This has various advantages and disadvantages, but is a severe hindrance in a pandemic. There wasn't even a unified diagnosis code for COVID until April 1, and that required a herculean effort and a shirking of normal coding update processes. There were various guidances for coding, but identifying diagnosis in structured data for fast analysis was a difficult ask. (I know this to be true, I've done it across the health records of millions of patients.) I'm sure some fault lies in the administration, but my belief is that our health system is systemically unable to properly deal with widespread pandemic, especially from a newly discovered illness. That's one of those trade-offs that have to be considered when looking at how health care in the US should be handled in the future.

Retric 6y ago
As long as the US has free movement of people across state borders, it needs a nationwide response to infections disease. Historically, the US had the ability to coordinate a nationwide response to pandemics. Starting in 1947 the National Malaria Eradication Program was one very successful example of this process which succeeded in eradicating malaria in the United States by 1951. https://en.wikipedia.org/wiki/National_Malaria_Eradication_Program https://en.wikipedia.org/wiki/National_Malaria_Eradication_P... Similar efforts for widespread vaccinations etc have also worked just fine. This pandemic is exactly what the CDC was designed to handle, it’s simply been horrifically mishandled. PS: The blame goes beyond this administration, but great leadership early on could have made a massive difference.
nradov 6y ago
Are you referring to ICD-10 code U07.01? I thought the US had to wait for the WHO to add the code, so I'm not clear on how our health system was worse than other countries in that respect. https://www.who.int/classifications/icd/icd10updates/en/ https://www.who.int/classifications/icd/icd10updates/en/
- cabaalis 6y ago
  Yes, U07.1. I was not aware of the WHO aspect (only that it had to be accelerated.) Prior to April 1 there were several CDC guidances for covid that unfortunately were complicated by existing code re-use.
jonahbenton 6y ago
Thanks for reply. No disagreement about the US health system from a command and control perspective. There actually isn't even a US health system, in the sense of other countries having a (public) health system. The US has a ton of private health systems, plus some large public ones for the elderly, poor, and veterans who are unable to buy into a private system. It is a mess. Issues with this mishmash of public and private systems aside, the primary failing I would argue is political- as a coordinated response to a pandemic involves education, housing, supply chain- lots of systems that have nothing directly to do with health. I would be curious if points you raise from a health system perspective were to some extent covered in the pandemic playbook that had been created and was handed over to the new political leadership following the election- then abandoned by them, as is well documented. If they were, it points even more strongly to political failure, as an aggressive political approach, building on prior planning work, could have greased so many administrative wheels- instead of, as is clearly happening now, simply and shamelessly lining the pockets of political allies. Cheers.

Retric 6y ago

As long as the US has free movement of people across state borders, it needs a nationwide response to infections disease. Historically, the US had the ability to coordinate a nationwide response to pandemics. Starting in 1947 the National Malaria Eradication Program was one very successful example of this process which succeeded in eradicating malaria in the United States by 1951. https://en.wikipedia.org/wiki/National_Malaria_Eradication_Program https://en.wikipedia.org/wiki/National_Malaria_Eradication_P... Similar efforts for widespread vaccinations etc have also worked just fine. This pandemic is exactly what the CDC was designed to handle, it’s simply been horrifically mishandled. PS: The blame goes beyond this administration, but great leadership early on could have made a massive difference.

nradov 6y ago

Are you referring to ICD-10 code U07.01? I thought the US had to wait for the WHO to add the code, so I'm not clear on how our health system was worse than other countries in that respect. https://www.who.int/classifications/icd/icd10updates/en/ https://www.who.int/classifications/icd/icd10updates/en/

cabaalis 6y ago
Yes, U07.1. I was not aware of the WHO aspect (only that it had to be accelerated.) Prior to April 1 there were several CDC guidances for covid that unfortunately were complicated by existing code re-use.

jonahbenton 6y ago

Thanks for reply. No disagreement about the US health system from a command and control perspective. There actually isn't even a US health system, in the sense of other countries having a (public) health system. The US has a ton of private health systems, plus some large public ones for the elderly, poor, and veterans who are unable to buy into a private system. It is a mess. Issues with this mishmash of public and private systems aside, the primary failing I would argue is political- as a coordinated response to a pandemic involves education, housing, supply chain- lots of systems that have nothing directly to do with health. I would be curious if points you raise from a health system perspective were to some extent covered in the pandemic playbook that had been created and was handed over to the new political leadership following the election- then abandoned by them, as is well documented. If they were, it points even more strongly to political failure, as an aggressive political approach, building on prior planning work, could have greased so many administrative wheels- instead of, as is clearly happening now, simply and shamelessly lining the pockets of political allies. Cheers.