America Doesn't Have Enough Hospital Beds To Fight the Coronavirus. Protectionist Health Care Regulations Are One Reason Why.

Federal bureaucracy slowed America's response to the new coronavirus outbreak. Now state-level red tape is now poised to cause more problems.


By now, it's fairly obvious that federal bureaucrats slowed America's response to the new coronavirus outbreak. As university researchers and private-sector labs tried to develop tests that might have given health care providers a jump start on containing the virus, they were repeatedly stymied by the Centers for Disease Control and Food and Drug Administration.

As the focus shifts from testing to treating, yet more red tape is poised to cause yet more problems.

The most acute of those problems: America simply doesn't have enough hospital beds to handle the expected influx of patients suffering from COVID-19. In many places, that shortage of beds is the result of state-level regulations—known as "certificate of need" laws, or CON laws—that artificially limit the supply of medical equipment. Those laws help politically powerful hospital chains limit regional competition and inflate health care costs, but they also create shortages of medical equipment that could prove disastrous during a pandemic.

Certificate of need laws are on the books in 35 states, but they differ from place to place. Their stated purpose is to keep hospitals from overspending, and thus from having to charge higher prices to make up for unnecessary outlays of capital costs. But in practice, they mean hospitals must get a state agency's permission before offering new services or installing a new medical technology. Depending on the state, everything from the number of hospital beds to the installation of a new MRI machine could be subject to CON review.

"There have been artificially imposed restrictions on the number of beds, ventilators, and facilities in general that can exist. Some states might find themselves having a real problem," says Jeffrey Singer, a medical doctor and a senior fellow at the Cato Institute, a libertarian think tank. (Singer is also a contributor to Reason Foundation, which publishes this website.)

In 28 states, hospitals must get state regulators' permission before adding beds, according to data collected by researchers at the Mercatus Center, a think tank at George Mason University. Bed space in nursing homes and long-term care facilities are subject to CON regulations in 34 states. CON laws limit long-term acute care services—the sort of thing that many coronavirus victims may need as they recover—in 30 states. Specific medical equipment, such as ventilators, could be subject to CON laws covering the purchases of new devices.

Those laws are one reason why America has fewer hospital beds than most other developed countries.

The United States has only 2.8 hospital beds per 1,000 people, according to data from the Organization for Economic Cooperation and Development. That's even less than the 3.2 hospital beds per 1,000 people in Italy, where the COVID-19 outbreak has been particularly devastating. In China, the figure is 4.3 beds per thousand people, and South Korea (whose response to the virus seems to have been the most effective so far) has a whopping 12.3 beds for every thousand people.

After the coronavirus outbreak in Wuhan, China, a new hospital with 1,000 beds was built in less than two weeks. It would be nearly impossible to duplicate that feat in America, says Singer—not because America lacks China's top-down authoritarian structure, but because regulations (including CON laws) routinely prioritize protectionism over health. In recent years, a CON board in Virginia has blocked a hospital from building a needed neonatal intensive care unit because a nearby hospital complained about unwanted competition. A similar board in Michigan tried to restrict cancer treatments for reasons that had nothing to do with medical efficacy or patient safety.

Even when there isn't a dangerous virus on the loose, CON laws are bad for patients. In 2016, researchers at the Mercatus Center found that hospitals in states with CON laws have higher mortality rates than hospitals in non-CON states. The average 30-day mortality rate for patients with pneumonia, heart failure, and heart attacks in states with CON laws is 2.5 to 5 percent higher even after demographic factors are taken out of the equation.

Singer says governors and state lawmakers should suspend any CON laws that might limit hospitals' ability to respond to the COVID-19 outbreak. It's likely too late to quickly expand the number of hospital beds available in the United States, but removing these impediments to expanding medical facilities should be a no-brainer.

After the coronavirus crisis has passed, those suspensions should be made permanent, so the market can adequately prepare for future pandemics without running up against protectionist rules.

"Let's learn from this," Singer says, "and not make this mistake again."

NEXT: China Bans Pandemic Video Game From App Store and Steam

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  1. America simply doesn’t have enough hospital beds to handle the expected influx of patients suffering from COVID-19

    I sure am glad I have a bed at home right now.

    1. Does Italy have one of those single-payer healthcare things?

      1. No. It’s a mix of public/private. In fact, it’s often considered – the extent you can believe or trust various studies and rankings – one of the best in Europe if not the world.

        1. Remove ‘no’.

        2. Italy has a universal, government-run healthcare system. Yes, you can buy private insurance if you can afford it, as is true in Spain, but everyone is covered. It is a universal healthcare nation. The “we need universal healthcare because…covid-19” is just not an argument that makes any sense. We’ve seen that demographics are far more relevant to how hard a nation is hit than is the type of healthcare system they have.

  2. The laws are one reason but the market is another and more important reason. It makes no economic sense from a hospital’s perspective to maintain a surplus of beds and equipment that will only be used in the unlikely event of a pandemic or disaster. Even if the eventuality arises, it is unlikely the hospital will make back the money it spent maintaining the unused capacity. So, you can’t blame them for not doing it.

    1. Same problem with the Vaccine stockpile people. It makes no sense to stockpile vaccines.

      1. The market doesn’t solve every problem. That is not to say that the alternatives won’t create worse problems than the ones the market can’t solve. In some cases they will. The problem Libertarians have is they refuse to admit there is a problem the market wouldn’t solve if left alone. That is just not true. Instead of admitting that and having a productive conversation about whether the problem can be solved at all, they just deny the obvious and construct elaborate explanation for why reality is something other than what it is.

        1. I don’t speak for all libertarians but I’ve never made that argument. I’ve only argued that some problems simply can’t be solved.

          I’m not saying that the market can plan the economy; I’m saying the economy can’t be planned.

          1. This. The market is only failing at “solving” for coronavirus if you think the coronavirus is a problem that some level of central planning can “solve”.

          2. Exactly. “The Market” doesn’t do anything. “Markets” are simply the sum total of individual actions. “Free Markets” means not interfering with the ability of individuals to act.

            Asserting that is not the same as asserting “The Market will solve All Problems.”

        2. Libertarians unlike the Anarchists are fine with government providing certain services, like stockpiling vaccines for national emergencies.

          Under this example, the market could not be able to recreate enough vaccines if the USA is attacked.

          1. As a libertarian, I always prefer that the free market address our problems rather than government. The exception of course, is the legal and legitimate use of force to deal with people who harm others (say foreign invaders, murderers, rapists, thieves, etc.). While some societies over history have provided certain people or organizations the power to use force against others to one degree or another (e.g., the power of store owners to hold a shoplifter until the police arrive, or security personnel to do the same say with an intruder), nations mostly don’t allow anyone but the government to do so.

            I’ll further agree that some problems can’t be solved. You can’t convince most alcoholics or smokers to quit, because it’s up to them. And with limited resources, there just aren’t enough kidney’s to go around – on the other hand, government restrictions on selling kidneys also makes the problem worse (which brings up the objection of people complaining that other people are selling their kidneys and they don’t like it – which is another problem).

            1. What I object to on organ transplants is that the donor is the only one in the process who doesn’t profit from it.

            2. Let’s not forget that smokers and alcoholics were enticed into addiction by social pressure AND the belief that they wouldn’t come to harm by sucking hot, carcinogenic particles into the only lungs and/or solvent into the only bloodstream they have. People who are part of societies which don’t reward self-destructive behavior have significantly fewer people who indulge in it. This is the free market on both sides — the people who profit from the addicts, and the people who choose to not become addicted.

          2. Socialist.

    2. I don’t know much about the medical field, but the idea that hospitals make “market based” decisions sounds fundamentally wrong. My recent $40 dollar nasal spray is testament to that belief. Maybe they make decisions based on some uber-distorted market, but that’s kind of the point of the article though. The distortions to the market are the problem.

      1. In what ideal market does it make sense for a hospital to carry extra capacity that it is unlikely to ever use and there isn’t an economic justification for doing so? None as far as I know. So the old “but the market is distorted” really doesn’t answer the mail here.

        1. and as some else stated earlier on another article how does one prepare for the next emergency when one doesn’t know what it will be

          1. You’d be amazed at how good markets and market mechanisms are in dealing with uncertainty and unpredictable events!

            1. Yeah. I’m amazed all right. I’m amazed how fucked we are because The Market fastened our economy to a country run by the Chinese Communists. After we imported a serious disease from China, I am amazed to learn that China, (you know, the place run by the Chinese Communists), makes almost all of the precursor chemicals for pharmaceutical production and most of our finished medicines.

              I am procreatingly amazed at The Market, I am.

              1. I wonder what would happen in a free market if supplies from China came to be restricted but there were still a demand for them?

              2. Yeah. I’m amazed all right. I’m amazed how fucked we are because The Market fastened our economy to a country run by the Chinese Communists.

                That wasn’t the market, that was the US government. Specifically, the US imposed high labor costs and high taxes on Americans and American businesses while eliminating tariffs on imports from China and giving China favored nation status.

          2. The same way early education teaches skills which will be needed whatever field one enters later, most disaster preparedness is useful for many kinds of disaster.

            It’s not the “preppers” who are having fistfights over toilet paper and bottled water.

          3. The basic idea is “don’t live from paycheck to paycheck”, and extend that to everything.

            So keep more food/water/medicine/etc. in stock, so you can (if needed) go two weeks without going to the grocery store.

            Keep enough supplies in the warehouse that you can keep going for a while if supply chains are disrupted.

            And so-on.

            Of course, this kind of preparation is inherently costly. To some degree you’ll be stockpiling things you never use because the “just in case” stuff keeps longer but is less desirable then the day-to-day stuff. There’s also the matter of storage… if you have a warehouse of “just in case”, that’s space/land that’s not actively being used in production.

            Throw in that businesses have been trying to get “leaner” and more “efficient”, maximizing their use of “just in time” deliveries and such to minimize on the afore-mentioned efficiency loss of storage…

            It’s not hard to prepare for next emergency without knowing what exactly it is. You might not be perfectly prepared, but you can be generally prepared.

            But that kind of preparation is inherently at odds with emergencies.

            1. Last line should have read “But that kind of preparation is inherently at odd with efficiency.” Emergencies on the brain, yo.

        2. The market is very good at solving problems of allocation of scarce resources. As you note John, no hospital is going to create beds that sit empty in a free market. And that’s a good thing, since it would be a waste of resources.

          What a lot of people don’t realize is that when markets solve problems, it may not be in the way we expect. The demand isn’t for hospital beds. The demand is for treatment of patients, and in a free market we may see that solved in many ways (in home care, pop-up medical facilities, repurposing of existing facilities to accept spikes in demand) and the point is that a less free society will also restrict that dynamism.

          The important point of this article is actually kind of in agreement with you. The government, trying to keep prices down, created these rules to restrict the number of hospitals in an area. So even though there is demand enough to warrant additional hospital beds, regulation is preventing them from being added.

          1. That does not even make sense.

            How does restricting the number of hospitals keep prices down.

            Is this some sort of Bizzaro-world economics?

            1. How does restricting the number of hospitals keep prices down.

              Because it’s not a free market. Hospitals charge to cover their costs, and since they have a government granted monopoly, if their costs go up due to overcapacity, they can and will raise their prices to cover their costs. In a free market, competition would keep that in check, but in healthcare, the government is restricting competition.

            2. You have to remember that the market is not remotely free to begin with, and the payer is quite often not the consumer, or even the person who controls the decision to consume.

              In such cases there is no real elasticity of demand, so the cost of all that capacity gets loaded into whatever good or service that does get provided.

              No, I’m not arguing in favor of any of it, but that is how we end up with such bizzaro world economics actually existing.

      2. And maybe you pay $40 for nasal spray because the demand for such will command such a price? Who ever told you that the price of something must always equal its cost and a reasonable return on investment? It doesn’t.

        Further, you are clearly getting a good deal buying it or else you wouldn’t do it. That you think you are entitled to a better deal doesn’t make the deal you have any less advantageous for you. If you think the price of it is too high, don’t buy it. If you do buy it, don’t complain about the drug company’s willingness to charge as high of a price as you will pay.

        1. We pay $40 for nasal spray because people are not price sensitive. When they go in for medical care, they consume these products without judging the price versus the value they expect to get. It is an all you can eat buffet.

          1. There should be price controls.

            1. Said “price controls” being “competition in a free market”.

              1. No, as in if “you charge more than $3.00 for a nasal spray, you will be executed following conviction by a military commission”.

                1. Yeah, that about sums up the kind of society Obama, Sanders, and Biden want to create. I didn’t immigrate to the US to live in just another socialist shithole.

            2. Or, instead of price controls, we could go back to having health insurance as insurance instead of a payment system…

            3. Or consumers would have to be able to see prices of goods well in advance, be able to purchase those goods on their own outside the hospital, and purchase whatever kind of health insurance they see fit. The only one of which that is even close to possible currently is the 1st, and that only because Trump attempted to change it from the previous system.

          2. Plus, your $40 nasal spray is partially subsidizing all those Medicare and ER patients that the medical field never quite recovers all their costs on.

            Not to mention other countries like Canada take our medical inventions and allow generics forcing lower prices where the Pharm company has to factor those losses into drugs that Americans pay for.

          3. We pay $40 for nasal spray because people are not price sensitive.

            When it comes to medicare care, we’re often not given the option.

            I go to the doctor, he gives me a prescription. Even if he talks about multiple options, price isn’t often mentioned. Heck, even if you asked, the doc will rarely know anything about the price. And given how hard it is to get in to see the doc in the first place, taking a prescription, doing independent research (without the aid of your hired expert, the doc), and then going back to the doctor to ask why they didn’t go with a cheaper option? Often means putting off treatment for minimum days, if not a week or more.

            And it’s not like, when you’re at the pharmacy, you can dicker over price either. You either take what they slap on the counter, or you do without.

            For bigger things like surgeries? Even if it’s an elective surgery you can put off for a year or more, “price-shopping” means setting up appointments with different surgeons, going through the whole process, and then seeing if you like the final number they give you (which will be like pulling teeth all on it’s own). And if the anesthesiologist is different on the day of surgery then the one they expected, that number is meaningless and you’re still on the hook for thousands more that you didn’t plan for.

            The current American health care system makes being price sensitive stupidly difficult. Even if you believe in the power of the “free market”, our system needs radical change for that to be possible.

      3. your nose spray “costs” forty bucks BECAUSE of market meddling… laws and regs add costs, boondoggle the marketing and distriution of that bottle, add good ol’ boy anti-competition costs, and generally muck things up.
        Case in point: i Canada I had a nasty bout of hayfever, by doc listened to my plight on the phone, told me to head to the local discount drug store, look for THIS product, and take as directed on the box. I did so, for four bucks I got 30 caps They worked. Over some time I used them all. I went to the allergy section at the local grocery, did not have it. I asked at their pharmacy counter, OOH that’s prescription You have to go see your doctor to get that one. So I paid $130 for an office visit, he asked if I’d tried anything that worked, I named the one I’d bought in Canada, he wrote the scrip. Back to the discount pharmacy, TEN caps cost me THIRTY BUCKS. For the cost of one and one third caps, I had bought THIRTY caps in Vancounver. Next time up that way I bought about five boxes…….

        THAT is not a free market here, but is there. WHY are we so stupid/tolerant here?

        1. It’s not a free market in Canada either and they pay for their lower costs in other ways such as longer waits via a triage system and high taxes. Why are they so stupid/tolerant there? I agree on the prescription drug thing here we need to free up the market for it stop the crazy middle man price obfuscation scams going on but Canada has a lot of issues in its healthcare system “there” as well.

    3. Thanks for bringing this up, because it’s a joke that a free market would handle contagion any better than central governments.

      In fact, the irony in this case is that a central government is actually better at it and the entire reason why is because they can just shoot anyone that has symptoms or shut down all travel everywhere.

      It’s inhumane as hell, and immoral, but disease doesn’t give a fuck about your human rights either.

      1. In fact, the irony in this case is that a central government is actually better at it and the entire reason why is because they can just shoot anyone that has symptoms or shut down all travel everywhere.

        True. We talk about how well South Korea is doing, but they’re doing terrible compared to North Korea!

        1. Fair enough, North Korea probably couldn’t find it’s ass with both hands. They also really don’t care if everyone dies from disease. I probably should have thought about them instead of some other hellholes.

          1. It does occur to me that North Korea might be doing ok in this case, although the reason why would be because no one really leaves or wants to go there. Either way, they’ll never tell us.

      2. “As university researchers and private-sector labs tried to develop tests that might have given health care providers a jump start on containing the virus, they were repeatedly stymied by the Centers for Disease Control and Food and Drug Administration.”

        Free markets allow any organization to develop and sell tests. The FDA and CDC disallowed it. Trump changed the rule/law, and blamed the Obama administration (which didn’t create the rule, but didn’t eliminate it either), but it was Bush’s administration that created the rule. Boehm should have mentioned it, so Trump gets some credit for his libertarian free market action. Heck, Trump could use some support from Congress to free up the market, but they’d rather not. And Reason isn’t helping either by not supporting Trump’s libertarian actions by ignoring then.

        If this keeps up, I’ll have to reconsider the money I left Reason in my will, to give it to an organization that celebrates, publicizes, promotes and supports libertarian actions by our government.

      3. Thanks for bringing this up, because it’s a joke that a free market would handle contagion any better than central governments. In fact, the irony in this case is that a central government is actually better at it and the entire reason why is because they can just shoot anyone that has symptoms or shut down all travel everywhere.

        The US seems to have been pretty good at containing it so far, and no violence or even government force was involved. In fact, pretty much all the containment measures in the US have been voluntary so far.

        You know what those authoritarian regimes have done? They haven’t managed to contain the spread, they just contain the spread of negative information. That’s far worse.

      4. If central government was good at it, the Wu Flu would never have gone past Patient 1000.

    4. A hospital having an oversupply of beds would be as stupid as having two hospitals right next to each other.

      Which is why you would never see a Kroger and a Safeway and a Publix and an Ingles all right near each other or an Exxon, a BP, a Sunoco and a Marathon on the same block. 4 businesses all selling basically the same thing right next to each other is an obvious oversupply of the product and an utterly wasteful duplication of services. Who needs 23 kinds of deodorant?

      1. Seems pretty stupid to compare food and gasoline stores directly to healthcare, but hey what do I know. I need surgery just as often as I eat or drive to work, after all, right?

      2. The clusters of supermarkets we have next to each other generally stay in business, which suggests that there is a demand.

        Believe it or not, a single supermarket can only serve a limited number of customers per hour. That’s because people and stuff take up space. Imagine that.

      3. The point isn’t whether the supply is way too little, way too much, just right or close to it, but whether we as individuals and companies are free to provide it.

        People who invest in providing goods/service do so because they believe other people want it and are willing to pay you a profit to do it. People in government getting in the way with CON laws are involved because that’s how they get business owners to donate to their campaigns, and a way they control commerce to the benefit of who they choose instead of free people deciding through the free market.

      4. Where I work, you can literally see two different McDonald’s from my parking lot. Opposite directions, but still…

      5. A hospital having an oversupply of beds would be as stupid as having two hospitals right next to each other.

        And yet – most every city’s hospitals are concentrated on pill hills. And an even larger % of ‘new construction capacity’ that go through CON stuff is – to increase the density of facilities on those pill hills.

        For reasons that are completely rational when you understand actual markets instead of hypothetical markets. And that phenomenon is exactly why the CON’s were put in place.

        Whether they work or not is – entirely irrelevant right now to this epidemic.

        This is just simply a hoary old trope that has been the subject of countless CON articles here – dusted off so that ‘Coronavirus’ can be attached/tagged to the subject. As if it is a solution to this rather than simply a repetition of the usual. Never let a crisis go to waste applies to ‘libertarians’ too.

        I look forward to the upcoming articles about how Ex-Im bank, privatized post office, and coronavirus are directly linked.

    5. It’s only anecdotal, but I used to work for a mental health company that wanted to expand, because the company thought there was a market for more beds. Their CON was denied.

      I don’t believe that the market would have all the beds needed for this, but I’d bet there would be more beds than there is now.

    6. That’s true to a point. But without CON laws, hospitals could already have been purchasing and preparing more beds for the last month or two.

    7. No, the market is not a ‘more important reason’. If it were, there would be no “need” or effect of CON laws in the first place.

    8. You are right John. Spare medical capacity for an emergency is similar to arsenals for a militia. You don’t let ‘price signals’ for muskets/gunpowder determine a town’s ability to respond to an immediate threat. You put some extra capacity in an arsenal so the militia will respond to a signaled threat by coming to the arsenal rather than sit at home waiting for their hoard of muskets/powder to arrive from some online source at ‘now – panic prices’

      Too bad you conservatives can’t see that that sort of capacity – based on a legitimate and accountable assessment by that community of the threats it might face – or the means via ‘the militia’ – for anything other than guns/military.

    9. The lack of beds in hospitals is not the reason why the
      Corona virus is spreading so rapidly or why it is so dangerous. One of things Trump did was to drastically gut federal health agencies, among others regulatory agencies he gutted. Then he put Pence, who know nothing about health care let alone the virus, in charge. There are not enough staff and facilities to mount a quick and adequate response to the spread of the virus and they are led by an incompetent (Pence). Hence the lack of test kits and the lack of testing people when they came from Italy, a super hot zone.

      The Corona virus is a man made, weaponized virus. It may have originated in China, however, it is a byproduct of the bio weapons facilities here in the US and of other countries. Bio weapons development should be banned and criminalized. It serves no purpose, except indiscriminately killing innocent people, millions of them with the potential of worldwide pandemic.
      Mad lunatics usually run these labs, and you will find the same lunatics in the Pentagon. Some will reason the food supply cannot support a large population (not true), and therefore thinning out the herd is a good thing.
      To describe the lunacy of those in the Pentagon, former Air Force General Curtis Lemay proposed a preepmtive nuclear strike on the former Soviet Union. He reasoned the response from the soviets would have only killed 15 million Americans, but we would have won the war. In contrast the US lost about 450,000 soldiers in the second world war. He fails to acknowledge the hundreds of millions of Russian civilians that would have been incinerated alive within seconds.

      1. “…One of things Trump did was to drastically gut federal health agencies, among others regulatory agencies he gutted…”
        Your cite was eaten by your TDS.

        “The Corona virus is a man made, weaponized virus.”
        And you’re a conspiracist:

    10. “It makes no economic sense from a hospital’s perspective to maintain a surplus of beds and equipment that will only be used in the unlikely event of a pandemic or disaster.”

      Funny how you try to spout that theory as a free-market fault at the same time people are buy up so much free-market junk the storage rental unit business is booming…

      Can we also say there won’t be enough Televisions to supply emergency information unless we subsidize them?

  3. >>America Doesn’t Have Enough Hospital Beds To Fight the Coronavirus

    virus impervious to the little wheels.

  4. One typical argument for government control of anything is that profit-minded private enterprise won’t make the investments for emergencies, that they will pinch pennies and provide the absolute minimum they can get away with.

    Yet when private enterprise actually does propose spending their own money on some facility, the State steps in and says “Not so fast!”.

    And the Statists never see the hypocrisy.

    1. ^EXACTLY +1000

  5. This leads to the question how does the US compare to Canada or the nations in Europe that have socialized medical care to the availability of hospital beds per population? I know that it will not be the total number of that matters but the ratio of beds to the population in each nation?
    Does any one know the answer.

    1. Yes. And socialized medicine doesn’t fair well

      Italy lags other large European countries in provision of acute-care hospital beds, furnishing 2.62 of them per 1,000 residents as of 2016, according to the Organization for Economic Cooperation and Development. In Germany it’s 6.06 and in France and the Netherlands it’s 3.15 and 3 respectively. That year, Italy devoted around $913 per capita to inpatient acute and rehabilitative care, compared with $1,338 in France, $1,506 in Germany, and $1,732 in the U.S.

      U.K. policy makers understand what such analyses portend—because underinvestment in Britain’s creaking health-care system is even worse. The U.K. spent the princely sum of $901.70 per capita on acute care in 2016, according to the OECD. British data don’t distinguish acute-care beds, but a comparison of available beds overall isn’t any more favorable to the U.K. (or to Italy). In 2017, when Germany provided 8 beds per 1,000 residents and France offered 5.98, Italy managed 3.18 and the U.K. only 2.54.

      The problem with the government running everything is all decisions become political and planning for a disaster that may never come doesn’t gain many political points compared to things like paying for sex change operations for transvestites or free healthcare for refugees.

      The best of a bad set of answers is something in between where you have a private system but with some government regulation to require excess capacity for emergencies and disasters.

      1. “. . . [S]ocialized medicine doesn’t fair well[.]”

        That’s only because the rich hoard all the wealth and deprive the healthcare system of needed funds. When will you realize that the state must own and control all the means of production? If that were the case, everyone would have what they need and nothing more – a veritable utopia.

        1. This feels like sarcasm and I’ll take it as such, but amusingly the cited story John posted includes the idea that the NHS is ‘under invested’.

          Yeah, well, that’s because it’s not possible to actually fund decent universal health care but nevermind that. LOL.

          It’s the oldest argument they have, and it still has traction even though it’s ludicrous. The NHS type systems are always ‘under invested’ and that’s the argument to invest more, even though more can never solve the problem. You could spent every dollar in the world and not have decent universal care, but you can pretend to do it even while people drop dead from lack of actual providers.

          1. Definitely sarcasm, and the “underinvestment” quoted in the article was the reason for my post; socialists will always blame the government for not taxing and redistributing wealth as the reason why centrally-owned and -controlled systems under perform more distributed, market-based systems.

            1. Sarcasm is hard to detect around here when you have actual socialists like DOL and Tony gaslighting in the comments.

              1. Go ahead and link any single comment of mine where I endorse an “actual socialist” idea.

                1. Haha loser.

                  1. Shh, no one is talking to you. But if you can do it, go for it.

                    No? Well then. What do you call a sincere belief that is held in the absence of evidence?

                    1. Nobody cares Jeff.

                    2. R Mac can’t respond with an intelligent response, ’cause he’s forgotten to take his-her-its daily dose of “smart pills” from underneath the rabbit hutch. If-when he-she-it comes up with an intelligent response, I will BET that he-she-it will let us all know!

          2. “The NHS type systems are always ‘under invested’ ”

            As are our schools. And our Aircraft tracking infrastructure. And our social security. And our medicare. Gosh, it is like the government underinvests on EVERYTHING. Maybe the government should spend more- I’d be willing to run a modest deficit if it would properly fund all our services.

            1. The problem with other people’s money is that there’s never enough of it, I suppose.

              1. Those cheap bastards need to get out there and work harder.

        2. Health lines are good because in other countries the rich get all the health and the poor sick to death.

          1. It feels better to die in line than it does to die knowing that you couldn’t afford the service, I suppose.

            Maybe there should be a health lottery or something for surgery or cancer.

            It would be about as effective as centralized healthcare. Probably even more effective, since there’s at least a chance the homeless guy would get treatment. In centralized healthcare, they’d just die exactly like they would in a capitalist system.

      2. An anonymous person posting on a message board on Instapundit citing a WSJ op-ed is not a fucking source for hospital beds/peeps John

        Try again. Yes it is very easy to find this info online – from the ACTUAL sources that collect this info.

  6. Now that the number of new people infected with the coronavirus in China is slowing down, the country’s Communist Party is ratcheting up threats against the West, with a particularly nasty warning about access to life-saving drugs aimed at the United States.

    In an article in Xinhua, the state-run media agency that’s largely considered the mouthpiece of the party, Beijing bragged about its handling of COVID-19, a virus that originated in the city of Wuhan and has spread quickly around the world, killing nearly 5,000 people and infecting thousands more. The article also claimed that China could impose pharmaceutical export controls which would plunge America into “the mighty sea of coronavirus.”

    1. China needs the US far, far more then the US needs China. Methinks they are getting a bit full of themselves and may regret pushing these buttons now unless they can get one of they paid-lackeys in the DNC elected president.

    2. When this is over, I would ask Congress to pass an act of war. It’s time to put an end to shithole China which literally threatens the entire world.

    3. Killing off a bunch of American consumers would not be good for the Chinese economy. They need us fat and happy.

    4. “The article also claimed that China could impose pharmaceutical export controls which would plunge America into “the mighty sea of coronavirus.”

      Coupled with their Foreign Ministry twit who yammered on about the US Army giving this to Wuhan during some military get together last year, and I’m guessing their trying to whip up some foreign Goodstein to distract from their incompetence. Not that they won’t have a gazillion useful idiots here who’ll repeat it.

      It will have grave consequences if the Chinese decide to play fuck-fuck games with limiting pharmaceuticals or their ingredients to be shipped to the US.

      1. Goldstein, you ignorant fucking autocorrect.

  7. Do we know approximately what percentage of infected persons needs a hospital bed rather than home recovery?

    1. The number I’ve seen was around 6% of infected persons need hospitalization. But this was based on known infections and doesn’t include the number of not-tested, non-symptomatic infected people.

      And also, with all the political uproar over testing, we’ve lost clarity to the accuracy and reliability of the testing results. I’ve seen a number of reports that the false-negatives and false-positives are way too high to allow good statistical analysis at this point. It’s also unclear how much the testing picks up just normal coronaviruses raising the levels of false-positives

      1. Surface antigen testing just tells you it’s corona. That’s why they are doing PCR (DNA analysis) to confirm it’s COVID 19.

        1. Thanks

          It is difficult to find accurate information at this point with sensitivity and specificity for what is available.

          I found this which is a communication from someone at Johns Hopkins.

          Please feel free to share what you can find.

        2. Since you seem to have expertise.

          I found this article. Just a preliminary case series about radiology chest CT findings.

          The pattern seems to be most at first negative or scattered ground glass opacities. No lymphadenopathy. May have bronchiectasis. Progresses to consolidation with peripheral predominance.

          1. Yeah IIRC that ground glass finding was one of the things that clued the early identification in China that this was a thing.

            But it’s also not entirely specific to Coronavirus much less this unique version.

            1. Ddx groundglass opacities is very broad. In proven cases imaging can help in prognosis and treatment.

              The findings need to be correlated to clinical suspicion and related signs and symptoms.

              At this point all one can do is maintain a high degree of vigilance. Sharing information is very helpful.

      2. I’ve tried to find this info and it’s starkly absent. It’s impossible to declare values, rates, or trends without understanding the absolute accuracy of the test used.

      3. Yea, but testing is the only thing they can ding Orange Man for, so it’s all the rage

  8. Declarations of emergency by State governments make your arguments moot as the red tape and protectionist laws will be replaced by the centralized bureaucracy. joy

    But on a specific note, the comment on number of hospital beds is just a lame and silly way to make your point. That has nothing to do with protectionism, but is rather directly driven by insurance and financial considerations. In the hospital care market, time in a bed is expensive….and the US healthcare industry actively pushes people out when they do not need to be in beds. This is a good thing. And relative to coronavirus treatment, the number of total beds is meaningless. The number of ICU beds is all that matters, because if you can’t provide intubation and respiratory aid, having patients laying around in a hospital is far far worse then laying around at home.
    I can’t find a number link, but the US typically leads the world in access to higher-end care….like ICU.

    1. Italy’s issues isn’t a lack of total hospital beds… is a lack of ICU beds and the trained doctors/nurses to provide significant respiratory support. And this stems directly from the socialized medical system prevalent in Europe. It is likely that when all this is over, the real mortality rates in the US will be far better then anywhere else.

      1. Exactly this. This will hopefully make people look long and hard at state-rationed medicine.

  9. I think the real reason behind CON laws (besides the cronyism, which I think is indisputable*) is that many states do not want to be on the hook for additional Medicaid spending caused by reimbursement applications from additional health care facilities such as nursing homes and for psychiatric care. Not sure about ICUs – you would think Medicare or private insurance would cover those, and you would think increased competition among providers would lower private insurance rates (and feds would continue to deficit-spend on Medicare reimbursement without corresponding pressure on state budgets).

    *For example, New Jersey requires letters of support of CON application from competitors.

    1. More often than not it’s cronyism & rent seeking by politicians and the physicians in charge.

      1. People love to point at the government, never noticing that many of those complaining are doing so from within that very briar patch.

        1. Agree with you on that, for sure. It’s fairly common knowledge that physician associations like to keep their own wages up, and market protection helps them do just that.

          1. Which they could not do without the power of gov’t coercion,

        2. “People love to point at the government, never noticing that many of those complaining are doing so from within that very briar patch.”

          And some people love to suggest that it could be accomplished without the gov’t, right ThomasD?
          IOWs, it IS a function of the gov’t; even lefties have to admit that.

        3. Just so it’s clear, ThomasD is full or shit.

          1. No, sevo, you miss my point entirely. I’m not arguing for any dog in that fight. I’m saying the fight is rigged.

            1. rigged by the, “power of gov’t coercion”… Which I assumed you meant all along by the very first response, “cronyism & rent seeking by politicians”

              1. Thank you


    A homeless patient checked into what used to be an EconoLodge motel in Kent on Thursday, that was recently purchased by King County to use as a quarantine site. The patient entered the facility as a voluntary response to an offer for services while he awaited coronavirus test results.

    Shortly after, he reportedly “disregarded the instructions of an onsite guard and left the motel.” He then entered a convenience store, “where he allegedly shoplifted items,” before getting on a northbound Route 153 King County Metro bus.

    Metro reports that the bus has been immediately taken out of service for cleaning and sanitization.

    Sea-Tac outlines new steps for healthy travel

    Because of this incident, King County’s isolation sites will only be used to house those “who not need supportive social services or additional supports.” It will also look to identify and staff separate sites for those with behavioral health needs in the days ahead.

    1. What are unintended consequences of giving away ‘free shit’ for $500, Alex.

    2. And Seattle’s homeless problem is nothing compared to the Bay area’s.

      Tacoma (just south of Seattle) got pretty smart about the homeless issue and simply made tents illegal on any public property. They corralled the homeless into a single park (which is now totally ruined and they are going to be removing soil for probable Hep) for a while, and then gave them the boot from there too. They opened one additional shelter consisting of “tiny homes”, as well.

      Homelessness has practically disappeared in Tacoma. Conversely, Portland and Seattle have made it legal to camp on any public land, resulting in the Mad Max scenery sections of those cities have turned into.

      1. I like how the local media has suddenly gotten concerned about a group of people living in tents under the overpass, wallowing in human waste, used needles and meth residue might be a vector for disease.

    3. “where he allegedly shoplifted items,”
      to spare the cashier from infection, how thoughtful!

  11. “Let’s learn from this,” Singer says, “and not make this mistake again.”

    He must be new here…

  12. While I consider CON laws detestable, Mr. Boehm is overlooking another important trend in healthcare. Hospitals are decreasing beds because approaches to treatment are changing; doctors attempt to discharge as soon as possible for multiple reasons, one of them being hospitals are dangerous places. Beds have partially decreased because of the standard of care practices have changed.

    1. “Hospitals are decreasing beds because approaches to treatment are changing; doctors attempt to discharge as soon as possible for multiple reasons, one of them being hospitals are dangerous places. Beds have partially decreased because of the standard of care practices have changed.”

      Wanna get sick? Check into a hospital; there are all sorts of sick people there who can infect you.

      1. +2
        I worked in billing and practice management for a while. The biggest win was always if a physician or facility could figure out a way to deliver acceptable outcomes while moving a treatment from inpatient to outpatient. Or even to a single overnight. The payors would have cases lined up for you,

        Being first to market with that would make a career.

  13. No, the reason America has so few hospital beds is because hospitals are run by “for profit” companies or “for profit” non-profits; that is, technical non-profits that run for all intents and purposes as for-profit entities.

    Excess capacity costs money and does not bring in revenue. The sole goal of executives is to limit expenses and maximize revenue. When was the last time you flew? How many empty seats did you see? When was the last time you were at a restaurant at a peak meal time? How many empty tables did you see? The idea that a hospital would create and maintain empty beds and excess capacity defies every economic law and reality.

    The reason why the U.S. healthcare system runs so “lean” is not because of certificates of need, but rather that it exists solely to generate a profit.

    So Mr. Boehm do you really want to explain to a hospital board, “I want us to spend $15M on creating an extra 50 beds, 10 step-down and 10 ICU beds, with associated equipment. Now we have absolutely no plans to use them, and they won’t generate any revenue, but it would be nice to have it in a pandemic.” You would be thrown out of the window. The ONLY place that pitch works is with a government entity that is concerned about the big picture and not for organizations driven by profits.

    1. Vandalia
      March.13.2020 at 10:20 pm
      “The reason why the U.S. healthcare system runs so “lean” is not because of certificates of need, but rather that it exists solely to generate a profit.”

      Your inferred claim means
      “In October 2007, the Fraser Institute, a Canada-based libertarian think tank, reported that Canadians waited an average of 18.3 weeks between seeing a general practitioner and getting surgery or treatment.”
      Wanna bet it hasn’t gotten better, shitbag? That’s 12 years ago, and no one is bragging about improvement.

      1. Oh, and that wonderful UK system (which anyone who can afford it dodges; it’s Non Healthcare System for those who would rather be cheap than healthy):
        “NHS brings in three month minimum waiting times despite warnings patients will suffer ”
        “NHS officials have introduced new limits which mean patients in some parts of the country will be made to wait at least three months for routine surgery, such as hip operations and cardiac procedures.
        Note that the wait time is the government-claimed chance for your mom (who should have aborted you) to die, thereby reducing their case-load:
        “…will be made to wait *AT LEAST* three months…”

        1. Finally:
          “Patient wait times in America: 9 things to know”
          “1. It takes an average of 24 days to schedule a first-time appointment with a physician — a 30 percent increase since 2014, when the average wait time was 18.5 days, according to The 2017 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.”

          Given your obvious IQ level, let’s just assume you’re a fucking lefty ignoramus to whom your idiocy is far more valuable than facts.

          1. A year ago last October, I had a physical. The doctor referred me for an echocardiogram, which I had two weeks later. The results were sent to a cardiologist who scheduled an appointment three weeks after that. At that appointment, I was told I needed to have heart valve replacement surgery and was scheduled to see the surgeon two weeks later. At that appointment, the surgeon scheduled me for surgery in one month. From initial physical exam to open heart surgery- about three months.


            1. Good on ya and your choices for medical care; there’s a good chance that they’d have buried you in England, Canada or several other ‘free medical care’ places before you got the procedure.
              We have a family friend who is an MD from Cda, here on a ‘rare skills’ card. Swears she wants to go back to Cda, but can’t seem to find her way to the airport.
              Sometime back, wife, in a philanthropic dinner effort, ended up with a shoe full of boiling water; rushed home. We cooled and dressed it, decided to wait until the morning and then ended up going to ‘urgent care’.
              On relating this to the “MD from Cda”, she said ‘you’d never do that in Cda; you’d lose your place in line!’. IOWs, the gov’t-imposed scarcity supplies the incentive to over-use the under-provided facilities!
              BTW, her mother needed some pretty important care not long afterward; she was not at all shy about her using connections to move the woman to the front of the line; what a demonstration of the ‘fairness’ of gov’t-supplied medical care!

              1. You don’t even realize she is from one of those countries and was disproving your point, do you? Healthcare in Canada and England is far more rapid than in the United States. There, most providers offer “same day” appointments and actual surgeries and procedures far faster than in the US. Here it takes at least a year to get through the insurance pre-authorization process. In Indiana, it takes 4 weeks to get an appointment with a primary care doc. Same day versus four weeks. Hint: Same day is better.

                You didn’t even realize that “I’m Not Sure” was slamming your ignorance, did you?

                1. “…Healthcare in Canada and England is far more rapid than in the United States…”

                  Didn’t read the links, or the rely, did you?
                  Are you here to prove how stooopid lefty ignoramuses can be?
                  You’re doing a good job, lefty ignoramus.

                2. Vandalia, citations required.

                  1. No chance; lefty claims.

                3. I wasn’t slamming Sevo.

                  BTW- my family is Canadian and they routinely come to the US for medical services. I’m sure there must be a reason.

        2. Well, six months is not bad at all. In the United States there is currently a wait of over six months for a new replacement to do the pre-authorizations, the peer-review, and the appeal once the pre-authorization has been denied.

          Three months is far better than six months.

          1. Vandalia
            March.13.2020 at 11:47 pm
            “Well, six months is not bad at all.”

            You’re right, so long as fucking lefty ignoramuses like you die before that.

      2. Since you are not able to actually read and comprehend, I suggest you stop writing. What exactly does available bed space have to do with outpatient wait times? Absolutely nothing.

        However, since you brought it up, in all of the countries you mentioned, patients receive far higher quality care – look at child mortality and life expectancy – at a fraction of the cost and a fraction of the wait. In Indiana right now there is a six month wait to see a neurologist.

        1. Vandalia
          March.13.2020 at 11:46 pm
          “Since you are not able to actually read and comprehend, I suggest you stop writing. What exactly does available bed space have to do with outpatient wait times?”

          Other than everything, not much at all.

        2. Vandalia, citations required.

    2. Not so much profit Vandalia. There is not profit the way Disney or Amazon declare profit.

      More just maintaining operations and expanding services.

      Hospitals need to generate enough revenue to meet payroll and other ongoing expenses. They also need to think about the new PET-CT or other investments they need to make. Sure it is a business. The only product they sell comes from the providers, doctors, nurses, other folks who are mostly blinded about the business aspect.

      The consumer is the patient. The demand and supply curves are inelastic.

      Not a box of cornflakes.

    3. “The ONLY place that pitch works is with a government entity that is concerned about the big picture and not for organizations driven by profits.” — Freak-en hilarious….

      If you’ve never seen “profit” motives grow a city in under a month you must live in outer-space. If you’ve never seen “profit” motives grow industrial output overnight you must be down right blatantly ignorant.

      If you’ve never seen “government entities” STALL production and growth you must live under a rock.

      Actually; I’m thinking your statement has absolutely NO (downright a negative/opposite) evidence in reality.

  14. Oh,,,God, sorry to hear this.

  15. So leading up to the 2016 election and until, oh, a couple of weeks ago, we just couldn’t get enough articles on TRUMP!!!!!
    Now, for reasons which I find suspicious, we just can’t get enough articles on COVID-19!!!!
    Knocking back the (as yet not appropriate) panic level to, oh, 15 on a 10-scale might mean a bit of cred for this site.
    SCREAMING ABOUT EVERY POSSIBLE NEGATIVE EFFECT!!!!!!! leaves you looking like Hihn, wide-spread.

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  17. Clearly, the shortage of hospital beds is Trump’s fault too. ????

    1. If you’re going to do a serious analysis, it probably lands on Truman.
      FDR was criminally negligent in preparing Truman for the presidency as regards many issues in spite of knowing full well he was ‘circling the drain’. Regardless, the wanna-be dictator can’t be blamed here; he was no more knowledgeable of the underlying economic laws than Truman.
      Truman, hoping he knew more than the market regarding what things should sell for, kept wage and price controls in place in the booming post war labor market.
      Hoping to attract the best people, companies offered ‘free’ medical care, since that was not considered part of wages.
      Sadly, we live with the result.

  18. Why does the west pats Korea on the back when they’re the second most infected Asian nation? They’re still letting in people from China (minus certain provinces) even though they’re much closer and right below a Chinese puppet state. Masks are being rationed and their medical staff is exhausted thanks to round the clock testing.

    Tawian had the best response, although Asians are using surveillance technology to track individuals.

    America had an ok response because most of the people limited their panic to hoarding toilet papers. The “more tests bro” folks should go to a local CA hospitals where trying to see a doctor is 2 hour wait minimum. You add in 50 more people who tested positive and those places are in trouble.

    1. Was there a point other than whining in that word salad?
      Try to keep it logical, please

      1. Korea is the second most infected Asian nation. The west thinks Korea did some bang up job of a response, when they failed to restrict movement in time.

        What’s so hard to understand? They’re testing lots of people (relying on surveillance tech) after letting the virus spread in this country. If you locked down an entire city because you messed up, you have no choice but to ramp up testing. No other Asian nation near China is in such dire condition. Maybe NK.

        The people who praise Korea are the same people who want to use this crisis to score points for socialized medicine. The Koreans are not happy about their situation, and masks and hospital beds are being rationed.

        1. edit “spread in their country”

    2. XM

      One solution is telemedicine. If you have a doc often no visit is needed. Just call in. If not there are telemedicine services you can find online.

      Here the major centers have started up the drive through service if you have a doctors order for testing. That is helpful.



  20. Not enough hospital beds to handle unusual events? And presumably not enough of all other medical resources, including people?

    In the US we are approaching 20% of GDP for spending on healthcare. So just doubling normal capacity (which would still be insufficient during a crisis peak) would take us to 40%. Hell, we could allocate all our time, effort, and resources to health care and still fall short under some circumstances.

    1. Agree with that. The bed and other equipment are just stuff. Not so difficult to add capacity. An ICU is a unit. Not only composed of physical capacity but Human Resources. Those are much more difficult to replace and add redundancy to. There are only so many people with those skill sets. It goes beyond the unit itself in support services, laboratory, radiology, IT, respiratory therapy, administration, pharmacy, supply, and on down the line.

      Think of a military unit. How many more people does it take to support one combat soldier? The military can afford to maintain excess capacity. It is designed for that. The hospital has to pay its bills.

      It is not uncommon for a tertiary care hospital to be at capacity and go to “bypass” sending EMS somewhere else. I have been there.

      So everyone from your local community hospital, EMS, to the university center in the city by now is likely as ready as they can be should there be a surge of cases.

      The most important factor is us taking precautions and doing what we can. This is a time to come together as a community and put aside political differences.

      1. … and somehow the free-market mattress companies always has extra mattresses stocked for sale and doesn’t consist of 20% of the GDP.

        1. Thank you for that helpful input.

  21. 6 rolls left…. I’ll keep y’all updated.

    1. Yeah, we all hoped you’d died.

  22. Day three without sports.

    Found this lady on my couch.

    Apparently she is my wife.

    She seems nice.


  23. Lets wait to see if “america doesn’t have enough hospital beds” before we write inflammatory articles. The US is not (outside of overcrowded cities) heavily densely populated urban upon urban areas such as… well… everywhere in Europe, especially where this started in China… and S. Korea. It could be the spread is very well matched with the bed to patient ratio over the vast span of the US.

    Also, in the worst season flu epidemic in US history… that long long time ago in the year of our Lord 2018, that period of history no one currently in the media seems to recall… up to 1.4 million Americans were hospitalized due to the seasonal flu, with 60-120,000 deaths that year from the worst seasonal flu ever to hit our shores.

    Even during that epidemic in the Midwest (specifically Omaha to Des Moines) there were stories upon stories in same said media of hospitals closing because the region is “over-bedded” aka no one was filling these rooms. Large university research Hospitals (Creighton) to small regional Hospitals did close due to lack of patients among many other things I am sure. But the “over-bedded” cry is still going on strong in the Omaha health region and I am sure other places in the country.

    This reminds me of a vein diagram I once did using two “research” stories, one with the estimated percentage of US children either starving, underfed, or malnourished in one circle, the other with the percentage of children overweight or obese… wouldn’t you know they overlapped?! That is both impossible and reported often, obviously not in the same research. This smells the same.

  24. I sure am glad I have a bed at home right now.

    visit : Open Trip

  25. Better file this article under Fake News:

    “In reality, according to the most recent information from The National Center for Biotechnology Information, The Journal of Critical Care Medicine and The Journal of Intensive Care Medicine, the US has (per 100K population) almost 3 times the critical care beds (34.7) that Italy has (12.5), more than three times Korea (10.6), 5 times Great Britian (6.6), almost 10 time China (3.6) and more than France, Spain and Japan combined (27.6). See the table at


    As Roseanne Roseannadanna would put it: “Never mind”

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  28. One of the most annoying and uneducated criticisms of the US healthcare system is, “The US doesn’t have enough hospital beds for a pandemic because hospitals are GREEDY.” Completely unfounded. Many, many states (35) require hospitals to apply for a Certificate of Need to build new beds. This is burdensome, takes a long time, and often hospitals likely say screw it, not worth the headache. Why does the government do this? Well, it’s actually BECAUSE of the existence of government healthcare, namely Medicare and Medicaid. Many years ago, the government, including state and local governments, realized that when hospitals have a lot of beds, they tend to find ways to fill them. The problem for governments is that some of those beds will be filled by Medicare and Medicaid patients, whom the State is paying to take care of. They don’t want too many hospital beds because some of those will cost the State/state/city money, they don’t want unnecessary hospitalizations, so they limit the hospital beds. As Reason points out, big healthcare companies sometimes like these rules too, since it artificially prohibits competition, but the reason the government instituted these rules was to protect themselves, not hospitals. They should be repealed, but it’s simply not true that we don’t have enough beds because hospitals won’t build them.

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