Covid Models Get It Wrong


I admit I’m jealous. In my profession as an orthopedic surgeon, I’m not allowed to make mistakes. If I do, someone is sure to file a medical malpractice case against me. But in the world of meteorologists – and Covid models – mistakes are ignored with no loss of credibility. When are we going to learn?

Case in point is the University of Washington Institute for Health Metrics and Evaluation (UW), which has been consistently wrong about predicting Covid future experience but is still quoted by the media. It’s about time we stopped talking about their models.

The Wall Street Journal has also had enough. Their editorial board has called out their mistakes. Here’s some of their predictions from the recent past:

  • UW forecast New York would need 49,000 regular beds and 8,000 ICU beds at the peak of the pandemic.
  • N. Y. Governor Andrew Cuomo’s experts projected 140,000 regular beds and 40,000 ICU beds needed.
  • Actual regular beds needed was 18,825 and 5,225 ICU beds at the peak
  • Actual regular beds needed were only 38% and ICU beds 65% of the UW model predictions – even though New York was the epicenter of the pandemic.
  • Actual regular beds and ICU beds needed were only 13% of Governor Cuomo’s experts’ predictions


Governor Cuomo now admits their mistakes. “All the early national experts, ‘Here’s my projection model.’. . . They were all wrong. They were all wrong. . . There are a lot of variables. I understand that. We didn’t know what the social distancing would actually amount to. I get it, but we were all wrong.”

Despite the media’s attempts to overhype the resurgence of cases, the actual numbers are tell a different story. In Texas, hospitalizations have been climbing, but weekly fatalities are down 40% from a month ago. Covid patients occupy fewer than 55 of all hospital beds, and more than a quarter are available. Even in Houston, where the largest increases in hospitalizations have occurred, Covid patients occupy only 6% of hospital beds. More than 20% are unused.

Covid-19 patients take up a small share of ICU beds in most states that have reopened including California (16%), Texas (11%), Georgia (10%), Utah (9%), Wisconsin (8%) and Florida (7%). Nearly all states have plenty of hospital beds and ICU capacity.

Yet the UW models are once again predicting dire expectations and the media is promoting their claims despite their earlier mistakes. UW now projects that reopening will cause deaths to triple in California and increase six-fold in Florida and Arizona through September. I live in Florida – and I’m not worried.

Stanford epidemiologist John Ioannidis discusses models and why their predictions are often wrong in a new paper. He says models overshot by making faulty assumptions about virus reproduction rates and homogenous susceptibility. A Massachusetts General Hospital model predicted more than 23,000 deaths within a month of Georgia reopening but the state had only 896.

Ioannidis writes, “In the presence of strong groupthink and bandwagon effects, modelers may consciously fit their predictions to what is the dominant thinking and expectations – or they may be forced to do so. Forecasts may be more likely to be published or disseminated, if they are more extreme.”

In other words, the worse the prediction, the more the media will accept and promote it. No wonder the media – and the models -have lost all credibility.

Trump Improving Medicaid


I’m no fan of Medicaid. It’s a second-class healthcare system that offers free healthcare at government expense but reduces access to doctors and hospitals. What good is free healthcare if you can’t get it?

President Obama’s Affordable Care Act (ObamaCare) greatly expanded the eligibility for Medicaid from its originally intended categories of poor children, pregnant women, the disabled and seniors to include able-bodied adults who earn less than 138% of the Federal Poverty Level (FPL). This may benefit those who get free healthcare coverage, but it is bankrupting the federal government and those states who accepted the expanded Medicaid coverage. Unfortunately, like many government efforts, the people they intended to help aren’t getting the benefits they need.

President Trump is trying to do something to improve this situation created by the Obama Administration. Naturally, Democrats are claiming this is an attack on healthcare for the most needy, when in fact it will benefit those people the most.

The Wall Street Journal editorial board says the biggest beneficiaries of this Trump plan will be Democratic states and low-income Americans. The Centers for Medicare and Medicaid Services (CMS) in a recent letter invited state Medicaid directors to apply for block grants under Section 1115 of the Social Security Act. That law allows the Secretary of Health and Human Services to approve state “demonstration projects” to experiment with plan designs, payment models and delivery.

This is nothing unusual in itself. The Obama Administration enticed several Republican states into expanding eligibility under the ACA by giving them waivers to require cost-sharing by beneficiaries and provide premium assistance for private plans, among other things.

The Trump Administration is taking this one step further by allowing states more flexibility to manage their ObamaCare expansion populations in return for a cap on federal funds in the form of a per-capita limit or lump-sum payment. If the states manage to spend less than the cap, they could keep a share of the federal government’s savings. The goal is to give states an incentive to control skyrocketing costs, especially for able-bodied adults who gained coverage under the ACA.

Under the old Medicaid rules, the federal government pays between 50% and 76% of the cost for the disabled, children, pregnant women and the elderly. Under the ObamaCare expansion rules, the feds pick up 90% of the tab for able-bodied adults earning up to 138% of FPL. In other words, states can spend $1 and get $9 free. (Taxpayers get to spend $9 and get nothing free.)

These incentives have led to more liberal spending on these newly eligible Medicaid enrollees. According to CMS, these enrollees cost the government $16 more per person than other eligible adults. This is resulting in exploding expenses for state governments that accept the ACA Medicaid expansion. Since states must balance their budgets, the net result is less money for all Medicaid enrollees and for education expenses.

The Trump plan of block-grant waivers would allow states more flexibility to control these costs with innovative ideas such as requiring cost-sharing by ObamaCare beneficiaries as long as the co-pays and premiums combined don’t exceed 5% of income. Benefit plans could also be changed as long as they align with ObamaCare guidelines.

Other cost-saving measures might include “closed formularies” that limit which drugs are covered in the plan. Since states currently must pay for all medically necessary drugs, the waiver would give them more leverage to negotiate discounts with drug makers. Democratic governors who complain about out-of-control drug prices will like that.

These Trump plan changes would only apply to able-bodied adults, the demographic previously excluded from Medicaid eligibility entirely. Presidential candidate Pete Buttigieg says these reforms “breaks America’s promise to those in need.” This is clearly untrue.

Similar block-grant waiver programs have been done in the past with good results. President Bush granted such waivers to Rhode Island and Vermont and a 2011 follow-up audit by the economic consulting firm Lewin Group concluded it was “highly effective in controlling Medicaid costs” and “improved access to physician services” for Medicaid patients with asthma, diabetes, heart problems and mental disorders. This latter conclusion is critical. Anything that actually improves access to healthcare is a good thing – and saving money while doing that is government at its finest.

The WSJ editorial ends with an important question: “Block grants would help realign ObamaCare’s perverse incentives that encourage states to spend more on healthy folks and less on those who need care. Do Democrats loathe President Trump more than they want to help their citizens?”

Corona Virus: Is This Really a Second Wave?

The media wants you to panic. No surprise there; that’s how they sell television time and newspapers. More importantly in this age of liberal media bias, they want you to distrust everything the Trump administration is doing to revive our economy.

It’s no secret and no surprise that the number of corona virus infections is rising. As testing becomes widespread, more cases of infection will naturally be identified. The real question is whether or not the number of infections is leading to more hospitalizations that may overwhelm the healthcare system. That was the initial concern that led to the shutdown.

But the response to this threat has successfully met the challenge of providing additional personal protective equipment (PPE) and sufficient ventilators to meet the demand. There is no reason any longer to believe the pandemic will overwhelm our system. Therefore, reopening our economy is vital to the interests of our nation and the welfare of all its citizens.

A strong case can be made that more infections means more development of “herd immunity”, which protects the most vulnerable from the virus. As more and more healthier Americans become infected and experience mild or no symptoms, they develop antibodies that protect them from future infections. This is the next best thing to vaccines and lowers the risk for others.

How accurate are the media accounts of a “second wave?”

Vice President Mike Spence is chairman of the White House Corona Virus Task Force and his Op-ed in The Wall Street Journal gives important perspective. Here are statistics he provides:

  • More than half of states are seeing cases decline or remain stable
  • Every state, territory and major metropolitan area, (with 3 exceptions) have positive test rates below 10%.
  • Less than 6% of Americans tested each week are positive
  • Daily average case rates nationwide have fallen from 30,000 in April, to 25,000 in May to 20,000 in June.
  • Daily deaths down to less than 750, dramatically down from 2,500 a few weeks ago
  • Daily testing is now 500,000 per day; more than 23 million in total.
  • Strategic National Stockpile now has 30,000 ventilators; no one in America has ever been denied a ventilator who needed one.
  • PPE has increased by billions since March when there were fears of shortages


Pence explains the situation: “The media has tried to scare the American people every step of the way, and these grim predictions of a second wave are no different. The truth is, whatever the media say, our whole-of-America approach has been a success. We’ve slowed the spread, we’ve cared for the most vulnerable, we’ve saved lives, and we’ve created a solid foundation for whatever challenges we may face in the future. That’s a cause for celebration, not the media’s fear mongering.”

The costs of the shutdown have been profound, as I have written earlier (Corona Virus: The High Cost of the Shutdown.) This is no time to be pushing for a return to the shutdown that decimated our economy. The risks of the virus are still with us, but the healthcare system is well-prepared now to handle the challenge and the American people are more than ready for the reopening.