Just a few good ideas that I saw this morning:
Question: if there’s no medical reason for the quarantine tent in New Jersey, would the nurse’s insurance company fight the bill?
— Niels Lesniewski (@nielslesniewski) October 27, 2014
Really good question. Medical insurance tends to pay for “medically necessary” care and little else above and beyond that. If there is no good reason for a quarantine, the lawyers will have fun.
A good idea for the Sustainable Growth Rate/doc fix problem:
The solution to the SGR mess, then, may be simpler than convoluted formulas and political horse-trading. The Medicare Advantage program can serve as a “baseline” for physician reimbursements. For instance, traditional Medicare can take the second-cheapest MA plan in each county across the country, and base physician payments on that plan’s reimbursement schedule, plus any penalties/bonuses required under the program….it would make sense to test such an approach before implementing it across the board. Medicare could pick, at random, a set of counties where reimbursements would be based on private plans for a set period of time. Quality and cost data could then be analyzed to determine whether this method is worth it.
That is from Yvegeniy Feyman at Forbes, and this type of proposal is one that should, in a normal functional political environment be able to be debated, get through committee with a couple of tweaks and then piloted for a couple of years to see if it works. And if it works, or mostly works, a slightly tweaked out proposal would be rolled out nationally. Medical reimbursement, after the decision has been made that medical care for the elderly is a social obligation, should be a technocratic discussion under a functional political system. Unfortunately, I don’t think this idea is going anywhere.
srv
Christie should send her a bill for all the trouble she’s caused.
PurpleGirl
Governor Christie might not like it but I feel that the state should have to pay all the costs associated with that isolation tent. It’s the state’s decision to quarantine the person, they set up the tent and the care, they should pay for ALL of it. And if she was scheduled to work anytime during the quarantine period, guess what? The state can pay her salary, too.
ETA: And over the weekend Cuomo had time to think more about implications and consequences of quarantines in NYS. Guess what? If the volunteer’s employer won’t pay a salary during a quarantine period, the state now will. And if a person isn’t showing symptoms, it sounds like NYS will let the person stay at home for those 21 days. Ya didn’t plan very well did you, Andrew?
If the NJ hospital did not have the proper facilities, they should have arranged for care at Bellevue. No reason to create a facility in a tent. This whole thing doesn’t sound like they thought it out, it was done on the fly with no thought as to the implications and consequences of the state’s (Christie’s) actions.
Scott S.
Could she sue Christie and/or the state for wrongful imprisonment?
Amir Khalid
If there was no medical justification for the quarantine tent, methinks there should be no bill at all. The state of New Jersey, which ordered it for no good reason, should eat the cost.
Eric U.
I can’t imagine paying, wouldn’t sign a damn thing.
the guy in New Mexico that got the colonoscopy due to some police that wanted to punish him got a bill for all the procedures involved. I suspect he’s not going to end up paying those bills
chopper
i would assume the state, knowing that a quarantine is not medically called for, would understand that they have to foot the bill for all that shit.
chopper
@PurpleGirl:
it’s tragically hilarious. i understand cuomo and christie both have eyes on higher office and want to come off as the ‘keep the people safe!’ types, but it isn’t that difficult to craft a ‘quarantine’ policy that looks like it’s doing the job but doesn’t involve throwing docs and nurses in the hoosegow. something that puts off more light than heat, if you will.
this is one of those situations where i really wish the feds had gotten in front of the situation earlier, rather than letting dudes like chris christie write medical policy. yeesh.
Belafon
@chopper: See Eric U.. How fiscally responsible would Christie be if he had the state pay for her care?
// high levels of sarcasm.
Eric U.
apparently she’s being released and going to Maine. It has been cold, I doubt that tent was very pleasant.
Southern Beale
Wait … Christie was going to make the nurse’s insurance company pay for her quarantine??? Seriously? I’d think that would be the state health dept’s responsibility.
PurpleGirl
@Scott S.: IANAL so I don’t know what she can sue for, but an attorney has already been signed on.
The Dangerman
Nurse going home; Christie was 2016 leader going into the first turn (he could have had it sewn up if he had burned her at the stake and blamed Obama for the need to do so)…
…but Christie reversed course to follow Obama Administration wishes. That should just about finish him off for 2016.
Amir Khalid
@chopper:
Wasn’t Christie confidently predicting, just last week, that all the other states would soon see that he and Cuomo were right, and start imposing similar quarantine restrictions? I wonder if he still stands by that prediction.
PurpleGirl
@PurpleGirl: Two attorneys have been quoted as being hired by Hickox. One of the attorneys is Normal Siegel, a noted civil and human rights attorney, especially when involving the government.
The lawyers will have a field day.
beth
@The Dangerman: Can she sue that fuck for going on tv and saying “she’s obviously sick”? Who is he to talk about her medical condition and spread false rumors about it?
chopper
@Amir Khalid:
yes he was. then again, christie thinks that every turd he shits out is pure gold.
‘hell yes i punched that teacher in the face. i think pretty soon everybody else is going to be doing it too!’
chopper
@beth:
i dunno, but i’m sure that statement is going to be a big part of any lawsuit. kind of makes his policy look stupid and unnecessary when he makes it seem like it’s wholesale based on a complete lie.
JPL
@The Dangerman: Yup!
scav
Oh, look, grandstanding politicos not thinking things through and making stupid big gestures! This part of the circus is always fun, if a bit predictable. The jumping and inserting both feet into one’s own mouth is always amazing, in a sort of Circque-de-Soleil kind of dexterity sense.
Gin & Tonic
@beth: If she didn’t consent to release anything about her condition, then it’s pretty clearly a HIPAA violation (clear to me, anyway.)
Ruckus
@scav:
You’d think they’d run out of room, even considering the size of most of their mouths, or that they’d contract hoof and mouth disease. But they keep doing this, day in, day out. I believe it’s lost it’s appeal as a carnival side show type event.
MomSense
I remember laughing at the witch and bring out your dead scenes in Monty Python’s Holy Grail but never imagined the Governors of two of our more modern states would regress such that they would fit right in as characters in those skits.
Jumping Jesus on a unicycle, Ebola has brought out the ignorance.
Shakezula
I’m not sure how this is a good idea for the patient. Typically when insurance refuses to pay, the patient gets stuck with the bill and has to appeal.
@chopper: The state decided to put its need to act like a bunch of hysterical diaper wetters ahead of her civil rights, I doubt it thought this far ahead.
Punchy
Where is she quarantined? In her house or in a hospital?
Belafon
@Punchy: In her apartment since she’s not showing any symptoms. She’s also been tested negative for having Ebola.
Another Holocene Human
@PurpleGirl: It was done on the fly with no thought by a couple of corrupt wannabe tough guy authoritarian pricks–?
You don’t say–?
It’s like shutting down a bridge to show some uppity town councillors who’s boss. Sure it SOUNDS like a brilliant political smackdown at 11:15pm after a hard night of campaign shindigs when that rotty supermarket wine has started to wear off and give you a headache and you aren’t home to start hitting the scotch yet.
scav
@Shakezula: It’s exactly not the state deciding, it’s a single politico using the mechanisms of the state to grab some news cycles and airtime for campaign purposes.
Another Holocene Human
@chopper: Fuck it, the Feds had already issued some science-based regulations.
The usual core of screaming idiots in NYC area, the same people who keep electing Peter King to office and the rest of their dead wood and self-seekers and wife-beaters and real estate speculators, were screaming at the top of their lungs as usual for Mommy because a little germ was going to teleport into their lungs and kill them dead.
The best answer for that is to come in calm and in control and hand it over to the experts. After all, this is New York, and most people have faith in the process, even if they are vile bottom-feeding scum like Pam Gellar seeking to exploit it.
Says a lot that Cuomo pulled a Giuliani move and played right into the hysteria*. Christie is just a fucking jerk so it’s not really surprising at all.
*-this is not to say I am trying to be fair to Cuomo. I do not like him or trust him. Just that the evidence of his perfidy takes a bit more investigation than Christie’s
Elie
@chopper:
They TRIED. CDC had just announced guidelines around potentially exposed personnel taking their temps twice a day at home and how they would be monitored. Indeed, they now have backed down and both agreed that a person without symptoms can be quarantined at home.
Again as I argued with you and John endlessly a few days ago. No matter how real and strong the politics, your policy can’t wander too far from science or it cannot be sustained. We see that very plainly with the outrage and scathing politics that assailed Christie. They can’t run the science from just a political perspective and this made both of them look stupid.
Yes, the administration did get in front of it THIS time, though I acknowledge that being pro-active has not always been a strength of the administration. The CDC had just announced the new policy when the two dudebros stepped on the announcement with their “great idea”. There will be plenty written and analyzed about all of this when (hopefully) the Ebola threat is under control.
Jay C
@chopper:
Unless I’m badly misremembering quite-recent history, the “Feds” HAVE been out in front of the Ebola situation – for quite a while. It’s just that official (Federal) government policy has been low-key, non-hysterical and medical/scientific serious. Which, sadly, for an American public which prefers to get its ideas about epidemics from overheated “viral-apolcalypse/zombie-plague/everybody dies” movies and TV, doesn’t make for hot news ratings and media exposure. Whereas sowing panic and stoking fear most certainly does.
CONGRATULATIONS!
The state will pay all costs. Period. There will be the usual mouth-breathing scum who will insist that since you decided to go contaminate yourself with icky Negro fluids, you should bear the costs (no one’s done it yet but you know it’s coming!) but the courts have established precedent on this a long time ago and the state will pay for their involuntary incarceration/quarantine. Missed salary is sadly probably not going to be on that list of reimbursable costs, but hey, fuck the poor.
The bigger point’s been made, though. Christie is a guy who, like Reagan, has no qualms about doing blatantly illegal shit and then explaining it away with a regret-tinged smile as being for the good of his victim(s). The mouth-breathers have noticed and are now talking about his “leadership” and “willingness to take an unpopular stand”.
Wingnut gold, my friends, wingnut gold.
Jeb’s going to have a fight on his hands.
@chopper: As I explain above, that sort of sane policy defeats the whole point of what Christie and Cuomo decided to actually do, which in the end has nothing to do with keeping people safe at all.
Elie
@Another Holocene Human:
Amen!
Another Holocene Human
@beth: How do you prosecute anyone for practicing medicine without a license these days when anybody can claim to be a practitioner of “Oriental Medicine” and claim they were talking about her chi flow or something and recommend a $300/month supplement regimen?
feebog
@Punchy:
Apparently, neither. She was set up in a tent OUTSIDE a hospital. No running water, no shower, not much of anything but a bed, a table, and a chair. The newspaper reports make it quite clear that she was not running a fever when she arrived at the hospital, nor was she exhibiting any other symptoms.
I sure wish someone would ask Christie why he isn’t calling for a quarantine of health care workers who are treating Dr. Spencer at Bellevue. Don’t they carry the same risk of spreading the disease as someone who has been exposed in West Africa?
Elie
@feebog:
Some may argue reasonably that people treating folks there in Africa, may have a much more risky situation as the poverty and poor economic status allows for more exposure to infected dead bodies, pools of excrement, etc. In terms of their PPE and other isolation management, they are probably equal. This is all highly speculative on my part, but I am thinking a lot more will be analyzed afterwards…
PurpleGirl
@feebog: Also Ms. Hickox comes from MAINE. If/when they let her leave the tent, she has to get home somehow and the medical establishment in Maine has to work out how to handle the situation. And she has no TV in that tent. (I doubt anyone has volunteered to bring her books/magazines/whatever to occupy her mind and time.)
Elie
Apparently we have soldiers quarantined in Italy who will be flown back to US where they will be in 21 day monitoring on their return. Since we are going to have a few thousand soldiers there, this will be a real effort ongoing – as long as this outbreak is flaming. Underscores the need to stomp it out… its just going to get more complex with more moving parts over time…
Jay C
@scav: @scav:
Well, it’s actually TWO politics trying to grab airtime/pixels/ink – even if one realizes the bi-state nature (and authority) of the NY/NJ ports-of-entry wrt quarantine measures, I’m not sure it will turn to be all that swell of an idea to turn what was probably conceived as a serious attempt to put across their new policy into “The Andy and Chris Show” * – especially after they both have had to backtrack on their BFD quarantine hoop-te-do really quickly. You’d think this would embarrass them, but I won’t hold my breath….
* which, I realize, makes them sound like a team of morning-radio “shock jocks” than serious State Executives, but then, I think the simile is pretty apt…
“Goooood Morning, Tri-State!! You’re on WTF-FM!! With our morning crew of Andy and Chris! Coming to you live this morning straight from Newark! You guys find your tent, yet???!!“
chopper
@Jay C:
if the feds had an overarching and controlling policy for returning health care workers, they sure didn’t push it very hard in places like NY and NJ.
chopper
@Elie:
this sounds much more conciliatory than your actual posts a few days back, which came off as decrying any departure at all from ‘the science’.
obviously policy can’t wander that far away. that’s what christie has plainly done and it’s garbage.
Elie
@Jay C:
That kind of sloppiness might work for a while, but it signals some basic flaws in both men that will not result in good things for their political careers. Recklessness eventually does not work for you. The stakes just get higher and higher. You see much more cautious politicians like Obama have “watch-out!” careless moments that cost them. People with strong proclivity for recklessness will just multiply that, (and the consequences) exponentially. I think this is worse for Christie. I think he will be a formidable opponent for Jeb, but I wouldn’t underestimate the Bush ruthlessness by any means. They will use Christie’s weakness — his over aggression and impulsiveness very much to their advantage..
chopper
@Jay C:
clearly, if NY and NJ decided to up and make up and institute their own policy. that’s kind of what i mean by ‘the feds getting in front of the issue’.
scav
@Jay C: So, same page essentially — just slight uncertainty about the exact number of grand-standarders playing with the buttons for personal gain.
Elie
@chopper:
I am more conciliatory only in tone. My belief stands: while politics are important, the further you wander away from science based policy, the more dangerous the situation. Once your policy loses factual mooring, it is absolutely alarming to think where policy can go. You guys were arguing that there was some way to “get in front” of the science with a “touch” of common sense politics. I argue, “maybe”, but its pretty dangerous.
scav
@chopper: that’s in part why I was being a bore earlier repeatedly asking about the CDC and their exact legal parameters about imposing a quarantine. The system seemed to be an unclear combination of state and national authority. CDC definitely covered international travel contagion and between state stuff, but states seemed to retain a fair bit of autonomy. I don’t know if the feds / CDC have much “control” of within state stuff (in hospitals) let alone what individual games states play with at their borders. (If there were more legislative buy-in with debate, I would consider it less personally motivated grandstanding, even if they made shit-stupid decisions. States are always managing that.)
chopper
@Elie:
well, that’s policy-making for you.
chopper
@scav:
i’m not too sure either regarding the CDC, but the executive branch as a whole has a bit of weight to throw around.
i understand that public opposition to cuomo’s policy had some effect in him reversing parts of it, but i’m sure that the call from the white house telling him to knock it the fuck off did the job.
Elie
@chopper:
Chopper — these are Governors. They have staff informing them of what is up. It was all over the media about the new cdc guidelines. This was NOT because the administration was too low key. It was two anxious, politically insecure men trying to alternately handle their risk and promote their own agendas and their apprearance as “leaders”. They both did some damage to themselves and to the appearance of sophisticated management — particularly Cuomo after doing this big shindig presser on the first day, and having comparisons made to how Texas looked so bad in comparison – then throwing that all out, dissing his public health people, the Mayor AND the CDC and the administration.These folks will remember this and it was not a smart move at all… it wasnt at all due to the new policy being “low key”
Ruckus
@chopper:
As covered the other day, there is much history/case law with quarantines and who is responsible, state or fed. Don’t remember who pointed out the law but the fed really does not have jurisdiction, the state and local governments do. The fed is out in front of this as far as they can be. Another reason to elect competent managers as governors, not some political hack, like in NJ/NY(FL, KS,etc, etc).
chopper
@Elie:
guidelines being the operative term here. they’re recommendations. obviously they themselves don’t carry much weight if guys like christie can just chuck em out the window and say ‘whateva, i’ll do what i want’.
the fact that the WH called cuomo after he implemented this garbage to tell him to knock it off is pretty reactive rather than proactive, innit?
i dunno, maybe the WH didn’t expect guys like cuomo and christie to pull this sort of shit. given the freakout over ebola, it really wasn’t too hard to predict. shit, john pretty much called it.
Mandalay
@Elie:
Heh. I notice you yell and scream your poutrage when Christie quarantines. But when the US military does it ….not so much.
chopper
@Ruckus:
i didn’t read too much of that thread. i did notice that, according to the CDC’s web site, they have some pretty broad powers under title 42 when it comes to detaining/quarantining people coming into the US. the surgeon general is also authorized to create regulations for that purpose, but hell, it’s not like we have an actual surgeon general, right?
Elie
@Mandalay:
From Hufington post, they are not actually “quarantined”. the lede, as is typical for Huffington, is more inflammatory. The are isolated, meaning they are being kept together and will not be able to mix with the Italians or other soldiers at the base.
Once they return to the US they will be monitored per the new CDC guidelines which means that they will take their temps twice a day in their own homes for 21 days.
The “quarantine” that Christie and Cuomo announced were poorly specified and ad hoc, committing an asymptomatic nurse to a plastic tent with no discussion of when she would be released.
Even YOU should be able to see the difference. But then again, maybe not.
Elie
@chopper:
Most Governors have better sense. I don’t think that this or any other administration figures that they are going to have to scold Governor’s or that their staff don’t keep them up with current policy in an emergency like this. Did you see Perry (certainly not the sharpest bulb), flapping his lips trying to make up public health policy on his own. They hurt themselves. Self inflicted damage (though people will forget pretty quickly – some of the NY locals (Mayor and Dept of Public Health), the CDC and NIH mullahs, will remember)
Mandalay
@Elie:
I certainly see the similarity: the US military, Christie and Cuomo all see the need to quarantine people who have potentially been exposed to the Ebola virus – a wise policy that you have been ridiculing as unnecessary.
chopper
@Elie:
yeah, perry was being a buffoon. then ny, nj and now il started trying to invent idiotic medical policy.
personally i wouldn’t doubt it if we saw something soon out of HHS dictating exactly how returning health care workers are and are not to be treated when they arrive.
Elie
@Mandalay:
sigh
Actually, this is an example of what chopper is talking about… “getting in front” of the issue. We are more aware of these things and know it could be a problem having them wandering around the base without any restriction. Are they dangerous? No. They are not symptomatic as reported.
Its not a quarantine. They are being kept (the army) away (isolated) from others to minimize risk while they are in transit to the US. There is more than one person so it makes sense to keep them together. They are at a busy base in a foreign country, thought Italy is an ally. The army was not providing direct care to Ebola patients, but they were building the hospitals/care facilities in remote areas of Liberia where the environment is poverty stricken and with many environmental risks with dead bodies, etc.. None of them were reported as high risk for acquiring the disease and none were reported as having any symptoms.
Elie
@chopper:
Chopper, I referenced these above, already. CDC IS part of HHS. So is NIH
Elie
@chopper:
Perry was actually quiet. He was not the buffoon. The NY and NJ Governors were.
Mandalay
@Elie:
Of course it is quarantine:
– The Army has decided that troops returning from deployments to Liberia should be quarantined…
– U.S. Army troops are under an Ebola quarantine in Italy…
– Soldiers coming back from serving in Ebola-hit Liberia will be kept in quarantine for 21 days…
Now stop posting your irresponsible drivel that there is no need to quarantine people who may have been exposed to Ebola.
Elie
@Mandalay:
You are incorrectly interpreting a poorly worded article.
Thats ok.
I take nothing back. Read. I know you have trouble with comprehension. They are in isolation while in transit.
Hey you support Christie and Cuomo’s policy for quarantine? Fine. Their “policy” has been modified to pretty much match the CDCs. But its ok if you don’t get that. Its ok… I know its hard for you…
Have a nice day!
Larv
@Mandalay:
It is entirely possible to have a quarantine even when there is no need for one. The military is isolating them from others because it avoids a potential morale issue, and because there’s no real reason not to. Military personnel don’t have the same rights to freedom of movement that civilians have. That’s the problem – you can’t quarantine civilians who are entirely asymptomatic, because there’s no compelling public interest in doing so. It doesn’t matter how scared of Ebola you personally are. And it’s pretty rich for you to be accusing others of irresponsible drivel – that’s your schtick.
Mandalay
@Larv:
You just made that up. It’s meaningless nonsense.
The military is quarantining them because it knows very well that however low the risk of soldiers having the Ebola virus may be, it is possible. Therefore it would be irresponsible and reckless not to do quarantine them. The military is even choosing to exceed CDC guidelines.
The probability may be very low, but the risks are enormous, and that is why the soldiers are being quarantined. The reasons you offer are absurd.
chopper
@Elie:
perry is always a buffoon.
Mandalay
@Elie:
Say what? You asserted that the soldiers are not being quarantined and I posted three articles that explicitly stated that they were being quarantined. I could have posted a dozen more.
You need to rethink some of the absurd claims you have been making about the Ebola virus.
chopper
@Elie:
clearly the bit about ‘how health care workers are not to be treated’ hasn’t been addressed yet.
chopper
@Larv:
that doesn’t sound scientifically based.
chopper
@chopper:
besides which, he started bleating about a travel ban, even one that would include american health care workers, two weeks back. he’s a dim bulb.
Larv
@Mandalay:
Okay, so what’s your source for this? I mean, if you’re going to accuse others of making things up, then obviously you have one. Right? Otherwise, it’s just your opinion, same as mine.
As for absurd, the absurd thing is to think that these soldiers are any risk whatsoever. They didn’t even have contact with Ebola patients. It’s far more likely that the Army is afraid they will freak out their fellow soldiers or the local populace.
More to the point, what the Army does is irrelevant – they can control the movements of their soldiers for any or no reason whatsoever. The same is not true of US civilians who have been exposed to Ebola.
Larv
@chopper:
First, I think you’re confusing my arguments with Elie’s. Second, as someone who spent much of my childhood on military bases, I don’t expect the military to make decisions based on science. The military is concerned with troop morale and host nation relations, and if they think a little irrational isolation will further those goals they’re going to do that. If you think I’m being inconsistent please explain how.
chopper
@Larv:
eh, i’m just funnin’.
Larv
@chopper:
Gotcha. Sorry, my sense of humor has been seriously impaired by these Ebola threads.
scav
@Larv: Mandaley is playing the Cheney favorite 1% risk game with Ebola, she’s warped around to her supposed personal worst nightmare behavior, logic, rules of argumentation and risk-management. Most amusing to watch her kowtow to the US military as the source of benevolent all-knowing authority to bow down before.
chopper
@Larv:
that’s one of the first symptoms, friend.
Larv
@chopper:
Does that mean I should stay home from work for the next three weeks and monitor myself for other symptoms while playing Civilization: Beyond Earth? Hmmmm.