Administrative burden is all of the little frictions of filling out paperwork, cross-referencing qualifying criteria and putting the right stamp on the right part of the envelope in the right direction and then signing your name in the correct color ink. Administrative burden is often used as a means of reducing public program take-up without actually “cutting” people out. Instead of cutting people, eligibility criteria is rechecked every week/month/quarter so if someone has a good month at work, they lose the benefit even if they would be eligible over the course of the entire year. The voting wars are effectively wars on administrative burden. Is it easy to vote or hard to vote? If it is hard to vote, some people will explicitly decide to not pay the price to vote and other people will attempt to navigate the needless complex bureaucracy and fail somewhere along the way.
The current proposal to require insurers to pay for COVID testing on a reimbursement basis is heavily laden with administrative sludge. The people who can navigate that burden are likely able to already have resources and motivation to get tested. It is likely mostly a transfer without too much clinical impact. We need routine, regular, reliable testing to create externalities. An individual who is testing is testing to gain information that will change their behavior after they are pre-symptomatically infected. An individual who is getting tested won’t change their disease course (all that much, some of the anti-virals have a narrow window of efficacy) but they can change their behavior to minimize the probability that they are infecting other people.
Jen Psaki somewhat mockingly asks reporter at the White House Daily Press Briefing if the US should be sending out rapid #COVID19 tests to every household.
In the UK you can order 1 pack (containing 7 tests) everyday. https://t.co/ErnSsiLxxl pic.twitter.com/L7ruKWdy5n
— Matt Karolian (@mkarolian) December 6, 2021
So yeah, everyone should be getting test kits for free, every week in the mail. And sure, there will be waste, there will be abuse, there will be an active secondary market of kits being sold and an Etsy market using these kits to make anti-vax art, but the kits are cheap enough that even partial efficacy in breaking chains of transmission is still massively cost-effective. We’re relying on testing to generate externalities so we need to make the cost of testing as low as possible in both cash and hassle.
Betty Cracker
I agree 100%. I like Psaki, but she was wrong to treat Mara Liasson like a common Doocy because Liasson’s question was legit. The other day I heard a brief clip of Biden saying insurers would reimburse for the tests and that free tests would be available to those without insurance. It was breathtakingly tone deaf.
Betty
@Betty Cracker: Too many people who need to understand the mess our health care system is in do not. And so it continues as a burden on the American people that is inconceivable to other developed countries.
NeenerNeener
And I’m paying 40 bucks each for them at Walgreens and Amazon….
Betty Cracker
@Betty: Yep. We have to put up with shitloads of administrative burden to get regular healthcare in this country, which is regrettable to say the least. But like DA says, we can’t let that friction mess up our pandemic response.
RepubAnon
Waiting for reimbursement puts testing out of reach for the paycheck to paycheck folks.
bluefoot
The US should absolutely be mailing test kits to every household every week. And making test kits available for those w no address. It’s a necessary tool in the toolkit to end the pandemic and especially to protect at-risk people.
Don’t know if the Republicans in Congress would approve the budget necessary but it’s what we should be doing.
Anecdote: I got exposed at work a couple of weeks ago and had a hard time finding kits. Thankfully I could pay the $80 out of pocket for a PCR test. I have immunocompromised friends and family and I do not want to be giving them Covid.
Another Scott
We have bought 3 boxes of Binaxnow tests because we were tired of waiting for the cost to us to drop. Yeah, they should be free and everywhere and FDA approved. Friction is far too high and has been for far too long. STATNews – Home test results don’t get reported to public health departments – so we’re in the dark unless people see doctors and get reported that way…
Similarly for covid genetic sequencing. STATNews – It routinely takes 2 weeks to get Covid sequencing results because of system friction.
We’ve still got lots of work to do to get timely, meaningful, high quality data.
Thanks.
Cheers,
Scott.
Salt Creek
@Betty Cracker: I’m afraid that we’re going to have to agree to disagree on Mara Liasson, at times she can be a right wing hack. She has demonstrated this during Bush II’s tenure on numerous occasions.
NPR=National Patricians Radio. IMHO.
NYCMT
I’m going to gently push back on the assumption that ubiquitous free saturation home rapid testing is going to do anything for the pandemic.
The only value these tests have is the private action they recruit. If these tests are not acted upon by the individuals using them they are worthless. We have seen two years of a bifurcated response to the pandemic with regards to individual private action. The people who undertake private action already took the npis that protected them from the infection by and large and these are the people who purchase the tests out of pocket as an additional pacifier or security blanket. The people who ignored precautions and restrictions promiscuously spread the virus and did not quarantine or do anything else to prevent the spread and a test would not prevent those people from continuing to do the same even if it was 10 cents a day and you could do 30 of them.
The tests are just too inaccurate. The type 2 error rate on the binax now lateral flow immunoassay pushes close to 10%. This is an error rate which makes it more likely than not that a random gathering of 10 people who use these tests to assure themselves that they are not transmitting virus that at least one person has false negatives. In fact this is what happened to me and my family at Thanksgiving dinner 10 days ago. We had a gathering of 12 persons we used 10 tests we had 10 negatives and one of the adults who had been vaccinated but not boosted became positive the next morning and symptomatic.
The failure to push out ubiquitous testing is a failure of the supply chain. I looked into these various scarcities of precursor products and chemicals and there are scarcity of these products going back to last winter and the collapse of the grid in Texas. There is only so much fixed capacity for manufacturing pharmaceutical grade equipment. When I did the math on how many binax now tests have been produced since last year I get a number of around 750 million to a billion tests, which is short by at least an order of magnitude for the kind of saturation that we would need to snuff out the pandemic using twice confirmed tests.
The Great American productive engine is not going to spend the money for that when more than half the population won’t listen to the results of a rapid test and stay home from work or keep their kids home from school.
gvg
@NeenerNeener: Walmart has Binax(?) 2 for $14. all the other sources were higher and often out of stock. I got two 2 packs to have on hand for the holidays. It is still too much, but it is better than before.
Another Scott
@NYCMT: Good points, but…
Humans don’t like change. A substantial fraction won’t do anything different unless there are consequences for not changing. Mandates about masking and vaccination and testing work. If people have to show negative test results to go back to work, or go to a show, or get on an airplane or an Uber, then people will get tested and it will become the new routine. Even if the quick tests aren’t as accurate as the need to be – and they aren’t – they will help end the pandemic in the belt-and-suspenders way (everything that drops community spread helps).
95+% of federal employees are vaccinated (or on the path to being) as a result of the mandate. We can get the rest of the country there, too, but it will take time and determination.
Thanks.
Cheers,
Scott.
Whereaway
Colorado makes the Binax test available by mail at no cost. There is the burden of having to sign up on a government website, but other than that no issue.
I retired recently and have far less Amazon orders coming to my door. It was a surprise the day after ordering the tests to have an Amazon package arrive. As it turns out, Colorado is fulfilling the test orders via Amazon, and deliver was within 24 hours.
We test twice, 48 hours apart, to mitigate the risk of false negatives.
Percysowner
Ohio has Binex free at the libraries. One per family member. They have run out a few times, but they keep stocking them.
Another Scott
@Percysowner: Made me look.
Washingtonian:
Good, good. It needs to be universal everywhere, and people need to know about it.
Thanks.
Cheers,
Scott.
Xavier
I feel like they should line up all the school kids daily and test every third* one, and test the kid’s whole class daily for the rest of the week*, also the kid’s family. It’s my belief that school kids are causing the increase in covid but who knows because we’re not testing.
*I don’t know if these numbers are appropriate but someone who is good at statistics could figure it out.
NYCMT
In order to force people to test before they access the public interface, you have to have the power to force people to test, which means there has to be enforceable consequences for *not* testing.
We don’t live in a country with institutions powerful enough to do that. I live in a city that went through concentrated, obvious public hell last year, and we barely have the power to begin forcing health care and public safety workers to begin vaccinating.
We used our power and resources to get people vaccinated, a one time thing, and still only got 71% of people vaccinated after a whole year. The consent for anything more obtrusive is now absent.
The dubious silver lining in all of this is you get to realize that you live in a country that is okay with killing off a Denver’s worth of people every year for personal convenience.
We blame the Fox and the leadership of the Republic party and TFG and all of the media, but the truth is – the nihilism is in the people. They want to believe nonsense and do nothing in a dreamworld.