Trump has great health care. His supporters? Not so much…

As I’m sure you know, President Trump returned from the hospital on Monday. Of course, no competent doctor would have allowed him to leave the hospital so quickly after having been given oxygen, as well as an experimental treatment so far reserved for Covid patients in serious danger. However, competence is not only not a precondition for being White House physician nowadays – it’s a complete disqualification.

Of course, Trump didn’t just paint his return as a triumph for him personally in beating Covid-19 (a highly dubious assertion to make at this point), but as a triumph for the American people. An important part of his message was that Americans have nothing to fear because we have the best healthcare system in the world – and he’s right, as long as you overlook the fact that we’re in the middle among developed countries in terms of life expectancy and close to the worst in terms of infant mortality. But we are the runaway champion in one area: the amount we spend on healthcare vs. the return we get from it in terms of patient outcomes. Nobody comes close to us in this metric, by a long shot!

One of the big problems is that health care is so unevenly available in the US, which is a big contributor to differences in life expectancies. One differentiator is wealth: Residents of the wealthy Streeterville neighborhood in Chicago have a life expectancy of 90 years, while those in the poor and overwhelmingly Black Englewood neighborhood (about ten miles away) can expect to live 60 years.

But another differentiator is urban vs. rural. Residents of large metropolitan areas can expect to live 79.1 years, while rural residents on average live 76.7 years. A story on NPR this morning pointed out that the biggest reason for this was the unavailability of quality health care to many rural residents due to:

1.      The fact that many of them don’t have health insurance. This is going to get much worse if the Supreme Court overturns Obamacare in December, which seems likely to happen. Some of the worst-impacted states from this will include West Virginia and Kentucky, where there are large numbers of Obamacare users.

2.      Closing of many rural hospitals in recent years, due in part to the lack of enough insured patients to pay the bills.

3.      Low availability of broadband internet access, which is becoming a crucial part of healthcare nowadays.

4.      Lack of free testing sites for Covid-19.

All of these problems have been aggravated under President Trump, and they will continue to be aggravated if he is re-elected. Yet – at least until very recently – he has had the overwhelming support of rural residents. You would think that Trump, after emerging from his gilded, 100% taxpayer-financed hospital stay, wouldn’t brag about the great healthcare he got, but might perhaps think about doing more to help his erstwhile fervent supporters who have anything but that.

Yes, you would certainly think that…

 

The numbers

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into the projected numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 2.4%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen in the near term if there are no significant intervening changes.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Deaths as percentage of previous month’s
March 7	18	3
March 14	38	5
March 21	244	35
March 28	1,928	275
Month of March	4,058	131
April 4	6,225	889
April 11	12,126	1,732
April 18	18,434	2,633
April 25	15,251	2,179
Month of April	59,812	1,994	1,474%
May 2	13,183	1,883
May 9	12,592	1,799
May 16	10,073	1,439
May 23	8,570	1,224
May 30	6,874	982
Month of May	42,327	1,365	71%
June 6	6,544	935
June 13	5,427	775
June 20	4,457	637
June 27	6,167	881
Month of June	23,925	798	57%
July 4	4,166	595
July 11	5,087	727
July 18	5,476	782
July 25	6,971	996
Month of July	26,649	860	111%
August 1	8,069	1,153
August 8	7,153	1,022
August 15	7,556	1,079
August 22	7,552	1,079
August 29	6,675	954
Month of August	30,970	999	116%
September 5	5,961	852
September 12	5,310	759
September 19	5,696	814
September 26	5,353	765
Month of Sept.	22,809	760	75%
October 3	5,102	729
October 10	5,120	731
October 17	5,243	749
October 24	5,368	767
October 31	5,496	785
Month of Oct.	23,212	749	102%
	233,762

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 215,822

Deaths reported yesterday: 790  

Percent increase in total deaths in the last seven days: 2.4% (This number is used to project deaths in the table above. There is a 7-day cycle in the reported deaths numbers, caused by lack of reporting over the weekends from closed state offices. So this is the only reliable indicator of a trend in deaths, not the three-day percent increase I used to focus on, and certainly not the one-day percent increase, which mainly reflects where we are in the 7-day cycle).

II. Total reported cases

Total US reported cases: 7,722,746

Increase in reported cases since previous day: 43,660

Percent increase in reported cases in the last seven days: 4.7%  

III. Deaths as a percentage of closed cases so far in the US:

Total Recoveries in US as of yesterday: 4,936,501

Total Deaths as of yesterday: 215,822

Deaths so far as percentage of closed cases (=deaths + recoveries): 4.2%

For a discussion of what this number means – and why it’s so important – see this post. Short answer: If this percentage declines, that’s good. It’s been steadily declining since a high of 41% at the end of March. But a good number would be 2%, like South Korea’s. An OK number would be 4%, like China’s.

IV. 7-day average of test positive rate for US: 4.7%

For comparison, the recent peak for this rate was 27% in late July, although the peak in late March was 75%. This is published by Johns Hopkins. As of 10/2, rate for New York state: 1.2%. For Texas: 6.0%. For Florida: 10.9%.  For Arizona: 6.2%. For California: 2.8%).

I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com