Written by: David Levien, M.D., MBA, FACS
We Americans are smart people; we are practical and down to earth. We have a pretty good idea of the risks we take but it’s sometimes hard to resist fear engendered for political gain. Our brave warfighters know that they take a risk when they enter a battle zone. They do it anyway because they are loyal to our great country. The chattering class incessantly repeats the phrase “it’s the economy stupid” and, of course, if it were just about the economy President Trump would win in landslide. It turns out that there are many additional reasons why America needs President Trump to prevail.
Many people take on risk because of a sense of patriotism and not because it’s in their economic best interests. Our brave soldiers and law enforcement are such people, taking on a dangerous job for a sense of purpose. It’s risky riding a motorcycle but some of us do it for the feeling of freedom it imparts. We know we take on a risk when we maintain a sedentary lifestyle and under- and over-nutrition and lack of exercise are major risk factors. It is wrong to shame people for the lifestyle they choose.
With regard to public policy, we need to be very careful what we incentivize. Hospital administrators might be motivated to label cases coronavirus by huge sums of money paid by the government to do so, even without verification. Also, administrators are freed from costly privacy and quality and safety mandates by the 1135 waiver, which is a disclaimer that allows modification of certain Medicare, Medicaid and Children’s Health insurance Program (CHIP) requirements, but only if they have a given number of COVID-19 cases. This could provide a perverse incentive to overreport coronavirus cases. Are hospital administrators exploiting the President’s generosity by inflating their numbers?
It is intriguing when the overall death rate in an area stays constant but the number of deaths from heart disease goes down commensurate with the rise of so-called COVID-19 cases. There is a continuum between conspiracy theorists and failing to connect the dots. The massacre at the Boston marathon was enabled by a profound failure to connect the dots and listen to the intelligence. One of the many things honest Americans want is a simple actuary to look at the data and for the office of Inspector General to claw back money from hospitals that have inflated their COVID-19 numbers.
Dr. Levien is President and CEO of The American College of Healthcare Trustees. He was a Chairman of Surgery for 20 years and was Board Certified in General Surgery, Colorectal Surgery, and held the Certificate of Added Qualification in Surgical Critical Care. He practiced surgery and critical care for 33 years and was in the first group to become a Fellow of The College of Critical Care Medicine.