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The global health-care collapse
- simmerup 4y agoAnother article stuck behind a paywall…
- PaulDavisThe1st 4y agoAnd yet 10 minutes before you, someone posted an archive.org link so that you could read it without obstruction. The archive.org link is invariably the #1 or #2 comment for any post that links to the economist.
- noobermin 4y agoIt probably helps that generally, someone posts an archive link that helps show the full article. Just wait a few minutes if you are early to a story or otherwise search for the archive link.
- monero-xmr 4y ago[flagged]
- agent281 4y agoIt's not quite obese people. It's women who weigh 220+ lbs and men who weigh 260+ lbs. Interesting that it's absolute weights. You could be 5'0" man who weighs 230 lbs and qualify. It also seems to exclude anyone who has ever used tobacco products daily for longer than 3 months. So if you have quit, you're out. https://www.joincrowdhealth.com/faq https://www.joincrowdhealth.com/faq
- monero-xmr 4y agoI have no idea if they used hard cutoffs for legal reasons or what their algorithm is. I'm just happy there is some innovation at all.
- Jcowell 4y agoIsn’t the word “innovation” doing a shit ton of heavy lifting here. It’s different for sure.
- jonahx 4y agoThat model sounds horrific. Pay $175/mo, the first $500 of every incident, and then when you do need money you have to beg the others members for it, and they'll decide if they want to "fund" you based on your own "generosity score" of funding other people.
- monero-xmr 4y agoI'm not sure you have any idea how unbelievably expensive healthcare in the US is. I have pretty good insurance, but for my family I pay $7500 per year in premiums, the company kicks in another $22k. A lot of other models look more attractive when faced with this insanity.
- adamredwoods 4y agoI am very familiar with hc costs in the US, and I feel a empathy-based crowdfunding model is disastrous. I believe there was a Black Mirror episode related to their model: from the website: >> If he has been a good community member and has given often, then he will have a high score and a high likelihood others will give to him. If he has a low score then he will most likely not get funded.
- notahacker 4y agoPaying $2k per family member per year for the right to start a crowdfunding campaign if they get sick looks like an even worse deal than paying $30k for actual health insurance for a family though...
- luckylion 4y agoHow large is your family? I'm single and have private health insurance in Germany. I Pay around 5.5k Euros / year. The public option would be around 10k Euros a year (though this would include insurance for family members, the private option does not; private insurance is much better, covers more, and gets you better treatment).
- paganel 4y agoIt is horrific, it practically institutionalises begging, with some good old paternalistic undertones for good measure.
- hotpotamus 4y agoIt would probably be even more cost effective if they didn't allow the mentally ill or people with congenital bone deformities or diabetes or long covid or high blood pressure.
- pjc50 4y agoHealth care systems turn out to be really easy if you exclude unhealthy people, yes.
- 88913527 4y agoThere's a long tail of expensive health care events that have little to do with lifestyle. As a model, it's intriguing, but I wonder how financially feasible this is. If everyone ate their kale, and did their squats, what would health care spending look like? Certainly better, but we all succumb to the ravages of time and most health care spending is back-loaded in life.
- klipt 4y agoIn fact don't smokers actually consume less healthcare in total because lung cancer kills faster and more cheaply than old age does? But maybe lung cancer means they end up paying less in taxes, so could still be worse for society overall...
- carabiner 4y ago> the company pays the bill for you What? It says other members can choose to donate to you. There's no guarantee that they will. What's the ratio of paid in amount vs. paid out? Can they actually show that this is better than just stuffing money under a mattress? Oh god and they're crypto affiliates. Most of their adcopy reads likes sovereign citizen hysterics. This will not end well.
- jprd 4y agohttps://archive.md/sHicw https://archive.md/sHicw
- GalenErso 4y agoWhile I am aware of the extent of the morale and exhaustion problems in health care, and largely sympathetic, I must push back against the overuse of the word "collapse" for everything these days. I must have seen hundreds of headlines since the beginning of the pandemic about how this country's health care system is collapsing or that country's health care system. Here's what an actual collapse of a health care system would look like to me: - 95% of a country's health care personnel disappearing - Hospitals have to close because they no longer have any health personnel. All hospitals, not just rural hospitals. And the closures must be permanent. Since HN's crowd heavily tilts toward the US West Coast and the Bay Area in particular, I googled a list of all hospitals in San Francisco.[1] - California Pacific Medical Center - Davies Medical Center - Kaiser San Francisco Medical Center - Friends of Laguna Honda Hospital - Langley Porter Psychiatric Institute - Letterman Army Hospital - Pacific Dispensary for Women and Children - Public Health Service Hospital (San Francisco) - Saint Francis Memorial Hospital - St. Joseph's Hospital (San Francisco) - St. Luke's Hospital (San Francisco, California) - St. Mary's Medical Center (San Francisco) - San Francisco Chinese Hospital - San Francisco General Hospital - San Francisco VA Medical Center - And the UCSF system A proper collapse of the Bay Area's health care system, to me, would entail the permanent closure of every one of the above. All of them. A "every man for himself" scenario. A scenario where there are no more nurses; no more doctors; no more surgeons. A scenario where health care requiring any kind of advanced equipment is no longer possible, where MRIs become impossible, where cancer treatments become impossible, for rich and poor people alike. A scenario where pregnant women have no choice but to give birth at home. A scenario where no one but the wealthiest billionaires can access any kind of health care that's not a Tylenol or an Advil. That's a collapse. 25% of nurses leaving within a year (and being replaced), or anecdotes of personnel calling out sick, while deeply concerning (as I wrote above, I am very sympathetic), just aren't bad enough to warrant the use of the word "collapse". [1] https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Francisco https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Fran...
- PaulDavisThe1st 4y agoSpeaking for myself, I think that's an overly strong requirement for the use of "collapse". I'm not sure I agree that it's the right phrase for the situation(s) described in TFA, but I don't feel it would be wrong to use it for a scenario where, say, 25% of people with previously treatable conditions in fact die.
- nubinetwork 4y ago> The problems facing health-care systems are not therefore caused by a lack of cash. Much of the increased spending has gone on programmes to combat covid Maybe in your country, but not in mine... Our government is sitting on a surplus and won't spend it, and what little we do get goes to executives and all the laptops we had to give out so they could work from home, while all the serfs toil and burnout.
- newaccount2021 4y ago[dead]
- nradov 4y agoCalling the situation a collapse is a bit alarmist. However, the cold realities of demographics make continued service level declines inevitable. Demand is accelerating because populations are sicker on average, due to both aging and chronic diseases caused by overeating and sedentary lifestyles. We can't really afford to spend higher percentages of GDP on healthcare and there don't appear to be any revolutionary productivity improvements on the horizon, so unfortunately those who lack the means to pay out of pocket for high-quality care can expect to wait in longer queues.
- deleted 4y ago[deleted]
- bryanlarsen 4y agoAs Keynes said, "Anything we can do, we can afford". We can afford to spend more on health care, we just choose not to because we'd rather spend on something else.
- rossdavidh 4y agoIn the U.S., at least, our spending as a % of GDP is at an all-time high.
- nradov 4y agoWhile technically correct, that saying is meaningless in the real world. Healthcare spending increases are only affordable as long as the rest of the economy is growing. At some level, healthcare spending would act as a drag on the rest of the economy. But even within theoretical affordability limits there are tighter limits imposed by political reality. Voters are already strapped by inflation in the cost of daily living. They're going to balk at paying more in taxes or insurance premiums just to maintain healthcare service levels. We might be able to reach a political consensus for a moderate tax increase on high-income people but that would only delay the worst effects by a few years and won't resolve the root problem. In the meantime there are marginal gains to be made in software to improve productivity. That won't solve the problem either, but it will slow down the decline so that's what I'll continue working on.
- mise_en_place 4y agoPerhaps the institution of hospitals is outdated. With concierge medicine, a doctor can make house calls with a nurse and solve most medical issues. The ideal should be like Star Trek (hyperbolic, I know). A tricorder should be able to scan me and care should be in the form of a hypo spray. Hospitals are a single point of failure as an institution and we should be moving away from centralized medical care in the 21st century. As an aside, I’ve noticed a lot of people are in hospital waiting rooms whereas they could be served with a doctor making a house call. Just my 2c
- noobermin 4y agoConcierge medicine is expensive and likely doesn't scale. Centralized medicine helps for a few conditions where you can't fit an MRI, CT-scan, and various medicines into a van you bring to house calls. In some situations, you need access to all of those in order to save one's life.
- engineer_22 4y agoDoctors don't have enough time to spend with their patients under current arrangement and the patients are all lined up in one hallway. Would not house calls be inefficient because a significant fraction of a medical team's time is spend in transit?
- raggi 4y agoWhen every house has a teleporter, perhaps your model might work.
- dragontamer 4y agoHospitals exist because CAT scan machines are expensive, and it makes sense for patients to drive to the CAT scanner, rather than the CAT scanner drive to the patients. Lather, rinse, repeat for every medical device. Sleep analysis tools, XRays, surgical tools and instruments, etc etc. ----- Furthermore, doctor time is expensive. It makes more sense for patients (who probably make less money than doctors) to spend their time driving. Not for doctors to be driving around making house calls like a maid or milkman.
- doubleg72 4y ago
- noobermin 4y agoRelated post from a very harsh doctor who really has lost hope in American healthcare. In the comments he mentions essentially collapse as the only way out he sees. https://news.ycombinator.com/item?id=34347962 https://news.ycombinator.com/item?id=34347962
- rr808 4y agoLike the article says, US is probably the best of the Western healthcare systems right now.
- soperj 4y agoOnly if you're loaded.
- doubleg72 4y agoIdk, I have had many jobs with great health care and never been loaded. Two kids now and out of pocket expenses never exceeded $500 for either of them. You're clearly very ignorant regarding this topic and should work on that before making such incorrect assumptions.
- hotpotamus 4y ago[flagged]
- adamredwoods 4y agoSeems sus. I don't think donations from the street will pay for bills as efficiently as getting a job-- not that finding a job is an easy feat. Additionally, many hospitals have financial assistance programs (for example) : https://www.texaschildrens.org/patients-and-visitors/insurance-financial-billing-matters/financial-arrangements-and-assistance https://www.texaschildrens.org/patients-and-visitors/insuran... The Ronald McDonald house also helps families with a lot of other expenses: https://rmhc.org/ https://rmhc.org/
- daxfohl 4y agoSummary of causes per the article: treatments delayed due to covid coming back to haunt, out-of-practice immune systems, provider burnout, all of which should normalize in time. The tone of the article doesn't match that of the title.
- aquafox 4y agoThere is no such thing as an out of practice immune system.
- ciconia 4y agoIANAD, but I believe there are some reasons why immune systems might be out is practice in large parts of the population: - Under-exposure to pathogens due to living in an overly sterile (i.e. artificial) environment. - Over-reliance on medication for the slightest physical discomfort. - Physically inactive life style. - Bad nutrition. - High prevalence of chronic conditions such as obesity, diabetes, circulatory disease, cancer etc.
- redrove 4y ago> - Under-exposure to pathogens due to living in an overly sterile (i.e. artificial) environment. This has no scientific basis, it has been disproven time and time again.
- PeterisP 4y agoI think the global problem is that medicine has improved so much that, unlike a hundred years ago, it's impossible to provide the full extent of modern medicine (which is huge!) to everyone, so some form of rationing/filtering is inevitable and necessary. You can do the rationing through market forces, where people who can't afford it get less care; you can do the rationing through some other allocation system (e.g. priority systems, or long queues, or lottery, or committee allocation) which in effect still mean that not all people get everything. If you want to say "In our society, everyone gets healthcare" then you have do define "healthcare" narrowly, which includes some services but not everything technically possible - I mean, if we have services that take more than a man-month of labor for each month of prolonged life (and there are some) then that's not possible to provide for everyone always even from a purely mathematical standpoint. On the other hand, if you want to attempt to provide (nearly) everything to (nearly) everyone and avoid planned rationing of the available healthcare resources (which still comes up to more care for more people than it was 50 or 100 years ago) then the overload catches up to you as described in this article, and you get a collapse of the system.
- maxerickson 4y agoIn the US, it's arguable that medicine barely existed in 1900, so I think you make a good point. The thing is, we aren't even doing the simple thing of making sure that the medical care that is delivered is done so somewhere close to the best possible cost. We heavily regulate supply and then pretend that we have a market. Or like we have laws like EMTALA, which requires stabilizing care, which is expensive, that leads to hospital systems making walk in clinics that aren't subject to the law, and then encouraging their patients to figure what level of treatment the need. Like my PCP has little placards in their rooms explaining the difference. There's no law that the ER can't triage down to a lower level of care, but it would cost them revenue. It's fucked.
- shigawire 4y agoFrom working in and around EDs, I highly doubt any ED is purposefully taking up beds with low acuity cases for revenue. Most EDs are swamped constantly and will tell you to go to Urgent Care because their halls are already filled with boarders waiting for inpatient beds.
- deleted 4y ago[deleted]
- Animats 4y agoThis is partly a UK view. The UK is in serious trouble. GDP is down 10% since Brexit. The combination of Brexit, COVID, and several incompetent government in a row has just been too much.
- nivenkos 4y agoIt's the same in Sweden at least though. The whole of Europe is on the verge of collapse.
- ChuckNorris89 4y agoSame in Germany. Too many people who need care, too little doctors and nurses in the public healthcare system even though spending on healthcare has never been higher.
- luckylion 4y agoIf I understand correctly, there's also a lot more people who rush to the ER for everything instead of seeing their regular local doctor, especially for children. It's understandable individually, they're afraid, even more so when it's about their children, but it's also putting additional strain on the system.
- ChuckNorris89 4y agoProbably because the local doctors are also swamped.
- Shoue 4y agoIt's not quite as bad in Sweden, look at the graph at the bottom of this article by John Burn-Murdoch[0] for a glimpse into we're faring compared to other European countries, and also how other European countries don't necessarily have it as bad as the UK or even Sweden. [0] https://archive.is/t6tSb https://archive.is/t6tSb
- mikrotikker 4y ago
- DoreenMichele 4y agoI imagine I will very much regret commenting here. When the pandemic began, I left a few comments with home healthcare tips, like how to do lung clearance. People attacked me and accused me of practicing medicine without a license. At some point, I went looking for an officially recommended list of OTC drugs for covid. I couldn't find any such thing online. Healthcare shouldn't really be used to mean medical care. I think it's a mistake to treat those as synonyms. Diet, exercise and lifestyle choices are all part of caring for your health. We could include grocery stores, restaurants and gyms as part of the "Healthcare Industry" though they certainly aren't part of the medical industry. I think it was a huge missed opportunity that no official health organizations, like the CDC, put together tips of a sort I naively tried to share as someone with a serious condition who therefore has no choice but to do a lot of medical-like healthcare things at home. I was shocked at how hostile people were to that. Because of that, I've mostly opted to say little about this topic. People are scared, etc and I didn't want to become a target. But the mistake we made here was relying too heavily on the medical industry and not leveraging the internet as the perfect first line of defense for sharing good info without sharing germs.
- s1artibartfast 4y agoI largely agree. Healthcare in the general sense isn't something that you can Outsource efficiently. While this is true in the obvious sense of diet exercise and behavior, it is also true in terms of medical care. Doctors and medical databases are not a complete alternative to taking ownership and responsibility or understanding your medical needs and history. You wouldn't expect a home contractor to know everything after visiting a 50-year-old house for 30 minutes. As a homeowner, it is your job too collect information over time and synthesize the advice of experts
- spfzero 4y agoTotally agree with you.
- LarsDu88 4y agoThe internet as a source of home remedies wrought gross misinformation like ivermectin, chloroquine, and a host of other bad advice that got people killed. There's a reason lots of medical professionals dissuade people from relying on the internet for medical advice, and it's not some vast corporate conspiracy.
- ciconia 4y agoA few years ago we were visiting friends in northern Netherlands. Our friend's father in law was feeling unwell and asked to be taken to the hospital. Apparently in the Netherlands you can't just go to the hospital (unless it's an emergency I guess), so you need to call them first. You'll be interviewed by a doctor, who'll schedule an appointment. The doctor told the father in law to continue taking his medication and come to the hospital the next morning. I got to accompany him to the hospital and go with him through the whole process. It was like nothing I've ever seen - the hospital was quiet, very few people, the guy for a while room for himself, and the treatment was efficient and on schedule. I thought the whole pre-screening on the phone thing was brilliant.
- stefanfisk 4y agoAs a swede I’m confused, how does it work where you are from?
- zinekeller 4y agoYou'll call 911, gets transported to the hectic emergency room by ambulance and then you'll be triaged and whatever things that needs to be done will be done. Few weeks later, you'll receive a financially-crippling bill in the mailbox because the insurers refuse to reimburse your treatment/you were sent out to a out-of-network hospital/because you don't have health insurance in the first place. Oh, don't forget to pay for the ambulance!
- madaxe_again 4y agoOoh, you get ambulances? Fancy. In the U.K., you dial 999, and then you die on the kitchen floor. Seriously. Excess deaths due to failure to treat are off the charts.
- myspy 4y agoIsn't that a problem of Brexit? As I read here https://eand.co/britains-finally-figuring-out-brexit-really-was-the-biggest-mistake-in-modern-history-8419a8b940c6 https://eand.co/britains-finally-figuring-out-brexit-really-...
- looseyesterday 4y agoI think regulatory thinking has failed to keep up with health issues. We need to treat excess sugar consumption like we do smoking. Its amazing to me how you can walk into a supermarket and be consistently advertised things that are bad for you, a 'sharing' pack of M&Ms 2-for-1. Want to buy a single ice cream? Too bad its actually cheaper to buy a pack of 4, and most singles are out of stock .... Another issue not widely discussed is that 20% of patents are responsible for 80% of the cost. If you look at said 20% more often than not you'll find consistent failure to intervene early enough while the illness is easy to treat.
- cies 4y agoDeep frying, processed meat, air pollution and lack of supersize. But then I believe everyone it entitled to their vice. So please no "forbidding" (as with recreational drugs) but some heavy taxes. The forbidding lead to smth else becoming very dangerous for public health: US police.
- looseyesterday 4y agoYes I agree. I love a good deep-fried chicken and chips as much as anyone. But it should be an occasional treat rather than the cheapest / easiest option to get. Eating healthy is expensive, so its not surprising that most people dont. Tax could help a lot but so could choice architecture, putting fatty / sugary foods out of reach and healthy alternatives at eye level could help alot
- cies 4y ago> Tax could help a lot but so could choice architecture, putting fatty / sugary foods out of reach and healthy alternatives at eye level could help alot I dont like too much govt intervention. Taxing something into oblivion, and forbidding ads seems to me the most acceptable things a govt should be able to implement. Bit like smoking (as OP said).
- looseyesterday 4y ago
- unity1001 4y ago40 years of slow and creeping privatization of healthcare, and this is what happens. The worst impacted were the countries that privatized their healthcare totally and maximized profits instead of any concern for the society. Now that a pandemic hit, its not surprising that they don't have the personnel, medical facility capacity and enough beds to handle the impact. Not to mention that in these countries, the entire vaccination process has been one that was run to suck out the maximum money from the healthcare system as much as possible while delivering the minimum possible. Classic profit maximization.
- pedro2 4y agoPaywalled; didn't read.
- Traubenfuchs 4y agoPublic healthcare in Austria has declined shockingly fast over the covid times. Many doctors and nurses from hospitals filed official Gefährdungsanzeigen ("endangerment reports") because their overwork and lack of personnel has been starting to endanger human life. Politicians do NOTHING. The only thing we hear from our minister of health is blips about Covid. Waiting for appointments with publicly funded doctors can now take several months, some doctors refuse adding further people to their wait lists. Many publicly funded positions for doctors stay vacant. Doctors are fleeing into private practices, where they earn significantly more money, have a more pleasant set of patients and less regulations. I had to wait 2 months for a heart MR at the only institute that does heart MRs in Vienna. Paying privately, I would have gotten it at the day and time of my choice. We are still getting our brain, heart and lung surgery or organ transplants for free as in 0€, but anything not absolutely necessary is declining, slowing down or starting to cost real money.
- m000 4y agoEconomist articles are usually well-founded and fairly objective, but not this one. With cherry-picked quotes from several reports but no citations, this read like it was written to serve some agenda/narrative. E.g. a study "found only one example where there were more covid patients than intensive-care beds". For real? Was it perhaps because of the triage process used during covid? What about the non-covid patients that were left without an IC bed because of IC bed segregation? It is also reprehensible that everything is pinned down to "productivity" of health workers. Are those the same people hailed as "heroes" a year or so ago?
- paganel 4y agoI guess this Economist article can be read in relation to this very recent quote made by Keir Starmer, the leader of the Labour Party in the UK: "The NHS must reform to survive" [1], where "reform" of course that means more privatisation. If you look at it through that prism you can better understand how come some people have started talking about "productivity" when it comes to the health system. The peace dividend dying off also doesn't help, you've got to get the a lot more money for the military from somewhere, so it's either from education or healthcare (or from both). [1] https://www.bbc.com/news/uk-64279654 https://www.bbc.com/news/uk-64279654
- philjohn 4y agoExcept some of the reforms being discussed by Labour are things like finally doing away with GP's being employed by private practices and instead employed by the NHS. The last reforms, after the Con/Lib coalition came to power, which split the NHS up into clinical commissioning groups is where a lot of blame has to be put (along with not keeping funding to the level required). From centralised purchasing giving economies of scale, to each CCG doing their own purchasing, and lots of duplication of roles across the whole country.
- Semaphor 4y agoI remember the news articles of patients being airlifted from neighboring countries to Germany because we still had capacity, while they did not. So yeah, I agree with you.
- LatteLazy 4y agoOver the last 50 years or so, the west has become much more individualistic and less social. This has lead to all sorts of problems (good things too, I am sure). And it just so happens that medicine is where people turn to fix many of those issues. We don't properly regulate food, and people are free to get obese and malnourished, then after a few decades of that their body starts to fail and they need complex, expensive, flawed medical intervention for instance. The same applies to exercise and stress. We've also become hyper-competitive, busy and isolated, and that's leading to an epidemic of mental health issues. No one wants to make the decision to let people with serious neurological conditions like dementure die. So again, we spend enormous sums and cause great suffering because no one wants to make a hard decision. So spending has ballooned and it's done it in the most inefficient and ineffective areas. This is the price of "freedom".
- jeffybefffy519 4y agoThe most exciting thing about ChatGPT is the potential for an AI which can perform same functions as a General Practitioner. Its such a good use case for AI and feels so close. The biggest road block will be lawyers dumbing down its capabilities.
- edhelas 4y agoNo. Seriously ?
- jeffybefffy519 4y agoAn AI based General Practitioner could offer health care to large parts of the world population that are currently under served because the cost is too high for them. Thats huge even if its not 100% perfect.
- ciphol 4y agoActually, the biggest roadblock is ChatGPT's hallucinations which mean that any answer it gives to a complex question is highly likely to be completely wrong.
- candiddevmike 4y agoI can't wait to be diagnosed with a fake disease that ChatGPT hallucinated
- jeffybefffy519 4y agoPeople think Doctors are perfect, the fact is they make mistakes just like an AI would. Its just about getting to acceptable levels which seems within reach over the coming decade.
- doubleg 4y agohttps://archive.ph/z4BOq https://archive.ph/z4BOq
- retube 4y agohow does this work? how do the archive.ph bots get around the paywall?
- qwerty456127 4y agoBecoming and keeping being a licensed medical practitioner is artificially made extremely hard. It doesn't have to be.
- nine_zeros 4y ago> Becoming and keeping being a licensed medical practitioner is artificially made extremely hard. It doesn't have to be. This is the main problem in America, at least. Our government loves capitalists but hates people.
- qwerty456127 4y agoAFAIK this takes place more or less everywhere, although America probably takes this to the extreme. I dunno about distant, hot and poor 3rd world countries but in Europe the more developed a country is the harder it is to get to a doctor (incl. a dentist). Some (reasonably competent) doctors travel to the west to invite patients from there to their licensed practice in non-EU Balkan countries because just getting a license in the west is too hard.
- krhinkson 4y agoI think a lot of this has to do with older, more experienced staff retiring as soon as they can. That was brought forward by COVID. So of course productivity drops off a cliff. As more boomers retire we will continue to see this compound many issues, including healthcare.
- dxbydt 4y agoWe are at ~300 comments. If these same set of 300 comments had been posted in 2020, over 50% would have been greyed out, users shadowbanned, and within an hour the entire discussion would be flagged and demoted from the front page. And all for what ? Because you can’t use the C word. So in that sense, we’ve come a long way. But realize that we are the same people we were 3 years ago. We haven’t changed. So what has ?
- lamontcg 4y ago> Everyone you know has—or has recently had—the flu. Nobody I know has caught the flu... but they all had their flu shot.