Thanks, as always. Lying liars who tell lies are so unattractive, and we have a lot of them, in high places. You continue to voice sane things. Hang in there.
Meant to say thank you so many times! I love your acronym (the "you" in "your" makes it feel so personal! I am a retired (tired) physician looking for as much (real) information as possible - your site is so much appreciated!
Some additional details regarding EMTALA (Emergency Medical Transfer and Active Labor Act).
It is my understanding the EMTALA only pertains to hospital-based emergency departments (EDs). In that context, it does not pertain to physicians' offices, clinics nor to "free standing" ERs that are not a department of a licensed hospital.
EMTALA allows hospital-based EDs to screen for the presence or absence of an emergency medical condition, as that term is defined in federal law. The screening has to be done before any insurance coverage / payment information is obtained. Naturally, patients who present with "obvious" emergency medical conditions are treated directly without going through screening, per se. Because the option to screen applies to everyone else, most hospital-based ERs do not screen at all, but instead see all comers.
Once the patient is "admitted" to the ED, the hospital is required to evaluate, stabilize and treat to the best of their capability and capacity. The hospital can only transfer when a higher level of care is needed.
A stunning stat… 41% of all births today are by women receiving medicaid benefits. Think about this… 41% of women have no other avenue for health insurance other than public health insurance. This means that less than 60% of Americans have access to health care apart from government programs. Toss in the 70+ million Americans with medicare coverage and you are well over 50% of Americans receiving their healthcare via a government program.
So why in the f*** don't we just go ahead and phase in single payer medicare for all.
Silly me… then UHC et al won't be mega–billion $$$$ profit black holes. Sick country.
In my conspicuously large red state, over 50% of the births occur to moms on Medicaid.
Here is an optimistic thought: disabled persons (defined in federal law), low income pregnant women and children are "required" populations in Medicaid - in other words, a state Medicaid program must include those folks or they don't qualify as having a Medicaid program. For that reason, I think it is very unlikely that the feds will cut funding to those populations. Rather, I believe the current administration is targeting those states that "expanded" their Medicaid programs, i.e., added optional populations.
As we know, healthcare is a zero-sum financial universe: thanks to the EMTALA law mentioned in this YLE post, everyone gets treated once their condition reaches emergency status. If the patient is uninsured (basically, can't pay), the hospital has to cover the costs somehow and the "somehow" is making up the loss through patients that do have sources of payment. Clearly, this is inefficient and costly.
But alas, IMHO, we Americans really can't untie the Gordian Knot of healthcare financing that we have created over the past decades. While many of us are dissatisfied, many others are doing just fine, thank you.
It seems the ultimate goal (in an earlier time it was called the final solution) is death by a thousand cuts to anyone who intentionally or unintentionally needs help staying healthy and alive.
I live in a bright red district. My congressman sends out emails weekly about the deficit and how it will kill our nation. In the same emails he struts and preens about how he is voting for things like the "big beautiful bill" because it will save the handful of families in our district who pay federal taxes $1200 per year.
This sort of mixed messaging disconnect is indicative of how f'ed up this all is.
Had it not been for John McCain in 2017 and his thumbs down the Mitch McConnell led republican senate would have dumped any sort of federal public programs and left all but medicare people to fend for themselves. The next 3+ years are not going to end well. You might get better medical care in the Trump family farm in El Salvador.
I got to visit Taiwan a few years back. They have a "universal" healthcare system (covers 99.7% of the population), have similar population health statistics as us (people still drink, age, get sick, etc.) but they spend only one third as much of their GDP on healthcare as we do.
They do it by not only having comprehensive benefits / services (hospital, medication, home health, DME, mental health - everything) but by having comprehensive and centralized data and data analysis. If your liver function tests take a jump, the will reach out and find out why. You will have a hard time refusing their multiple invitations.
But Taiwan is, more or less, a mono-culture of Han Chinese descent. There is a level of trust (shall we call it acquiescence) for this sort of government involvement that would simply not happen is the USA.
I am not saying I prefer Taiwan to the US, just saying there are deep cultural and historical factors that have produced the systems that exist around the world.
I do not see the US coalescing around a consensus revision any time soon. Just IMHO.
I can reconcile some of our US high health care cost to two factors. First, many meds are invented in the US. Someone has to pay for this. The pharma companies are not going to fund this out of the goodness of their hearts.
Second, the pharma companies spend more on lobbying than they do on r&d. This is "confirmed" via google AI. Again, someone has to pay for all the conferences, sales presentations, lunch at Old Ebbitt Grill, etc.
A country such as Taiwan likely piggybacks on the work done in the US when it comes to medical treatments, drugs, surgical machines, etc.
Finally I wonder just how accurate the stats on the cost of medical care in the US are. For example, I had an emergency appendectomy on March 9 this year. I just received my EoB from the surgery and two day hospital stay. Using round numbers the hospital billed $100K. Insurance paid about $9K. I had to pay $200. So which of these numbers is used when calculating the US pays more for med care than the next 19 countries combined?
As Saint Reagan said, statistics can be funny things (or something similar).
Agree with all your comments: I didn't know about the advertising vs R&D costs. Figures, given that Pharma seems to pay for every network newscast and then some.
As for as your hospital bill (hope you are fully recovered), you point out yet another odd tic in our system. As I understand it, hospitals have to publish a "price list" that is the price that you or I would pay if we paid out of pocket.
That stated price is the price that the hospitals can discount off of when they contract with payors. Same goes for Pharma. That benchmark price can be set sky-high because almost nobody ever actually has to pay it.
The system is complex, convoluted and opaque.
At root, I am convinced that at least some of the most breathtaking healthcare costs (prices) are due to the fact that "the healthcare dollar" is not a real dollar - as it is essentially taken out of the marketplace that - via supply and demand - sets the price of everything else.
When you pay your health insurance premium - or you pay your taxes or contribution to a government health program - your money goes into a one-way valve. The only value that healthcare dollar has once it is captured in the system comes in the form of whatever "benefit" you qualify for.
Moreover, for the most part, the world of healthcare is not really a market at all since it is characterized by inelastic demand, especially for the priciest services. When you need a stent to preserve your myocardium, there is no time for shopping around.
I do think there is some (limited) hope in the concept of Health Savings Accounts. These would be private, pretax accounts that individuals could use to pay for various healthcare goods and services. They would remain "real dollars" in that they remain under the control of the individual. This might inject some "price rationality" in certain mid-range and/or discretionary services, e.g., you could shop around for the least expensive CPAP machine.
Progress in reforming healthcare financing will require a level of societal insight, wisdom and consensus that I believe we are not yet capable of achieving.
Most of the "cuts" to Medicaid affect people who shouldn't be on medicaid like illegal aliens and able bodied working age people. Major cuts also impact states like California who are ripping off the federal government by imposing "provider taxes" to juice their federal reimbursement and eliminating people registered in two or more states.
Per the US government, 78 million people are on Medicaid and the US population is 342 million. That makes 23% of the population on Medicaid (numbers rounded for clarity).
Statistically, poor people are more likely to have multiple children (and younger adults are more likely to be poor than older ones). That leads to a surprisingly high rate of children on Medicaid.
Thanks for this info. About 20% of the US population receive medicare benefits. So about 43% of the US population have some sort of US gov't paid healthcare.
I suspect there's some number of Americans who go without for whatever reasons. Assume say 7% so 50% of Americans do NOT get healthcare paid for by the US gov't.
And those with private healthcare such as employer paid or semi–paid or people buying medical insurance via the marketplace make up the other 50%.
I guess my question would be is this the best we can do? Can we as a collection of individuals called a country do better taking care of ourselves and our fellow citizens health?
Interestingly, this report from 2023 gives a dramatically smaller number of people on Medicaid (62 million). It also gives 65% as the percentage of insured people who are on private insurance versus public.
I’m not sure how to reconcile the differences in the numbers. Isn’t it great when the federal government can’t agree with itself on statistics?
Maybe the states are not so good at record keeping hence the reason the numbers on medicaid have such a wide variance. I remember in the days covid was a little less threatening it was discovered that California had made more covid relief payments than was proper. Billions more. With nearly 40 million people to keep track of California may not have such good record keeping. I can image other states being just as inaccurate.
Doing a search now google AI reports this number to be 71.2 million as of January 2025.
Regarding the uncertainty and chaos caused by the government's radically opaque messaging on COVID vaccines, another shoe has dropped. If you're looking for clarification from CDC's ACIP meeting at the end of the month, know that four of the advisors just got fired. Also, without a CDC Director in place to consider the now-diminished committee's recommendations, it's looking more like Kennedy will make the decisions on the fall vaccines (https://covidandvaccineupdate.substack.com/p/waiting-for-acip).
Do we even know which strain we will see in the vaccines in the US? I presume the US rec’s, and not the current one that the committee suggested? I can no longer recall the WHO rec’s, the chaos is catching up…
VRBPAC recommended sticking with the offshoots of JN.1, but hesitated on picking the current dominant virus, LP.8.1, as the one. FDA then also told manufacturers to stay with the JN.1s, but went further with the preference for LP.8.1 - same as WHO, and the Europeans have already picked LP.8.1 as the next target.
Yep, according to Kennedy in his opinion piece in the Wall Street Journal, it was "needed to re-establish public confidence in vaccine science."
The ACIP meeting at the end of the month will be more interesting than usual. Where's Kennedy going to find the replacement members in time for them to go over the ton of data to be discussed? It's a 3-day meeting to go over not just the COVID vaccines but also many other shots.
Thanks for tracking all the things and for bringing clarity.
Regarding wildfire smoke and particulate pollution, I think it's wise for everyone to limit their exposure, the exposure of children, and the exposure of pets during orange and yellow alerts. Exposure to particulates becomes a risk factor for other things, so it makes sense to adopt the precautionary principle when possible.
Hmm, would slapping a tariff on it keep out the new NB.1.8.1 subvariant that's started early summer surges abroad? It's already coming in with increasing numbers of infected international passengers monitored by the Traveler-based Genomic Surveillance Program at 8 major airports here (https://covidandvaccineupdate.substack.com/p/waiting-for-acip).
Add to the mix the 25-year highs in measles at popular summer destinations such as Europe and the summer surge/wave is more than likely - surf's up!
Distressed to read that RFK Jr has just fired all members of ACIP and will replace them with those who "will prioritize public health and evidence-based medicine. The Committee will no longer function as a rubber stamp for industry profit-taking agendas." Dear God. While I am sure Big Pharma has more influence than we would like, this is definitely throwing out the baby with the bath water. If ACIP completely changes the vaccine recommendations, does insurance coverage follow??
"But the law itself didn’t change. A memo doesn’t override a federal statute, like EMTALA." That would be pretty relevant if the nation weren't in the control of a gang of outlaws.
as an update, there are now 12 Colorado cases, with the latest being a vaccinated person. (and I have a possibly wrong recollection that an earlier one in the cluster was also vaccinated.)
Really really appreciate all the effort you and your team put into these newsletters. In my part of CA currently I know 4 people with Covid so I wonder if there is an uptick not detected yet here. Thank you for all you do!
Where in CA are you. Bay Area here. I am hearing rumors but know no sick people (or at least nobody who knows they are sick). I have been luxuriating in going mask-free to uncrowded grocery stores. It feels too early for that to be over. Boo.
I hate masking in the summer. I wear sunscreen every day, all year, but stronger stuff now. Squishing the stronger stuff with a mask during hot weather gives me peri-oral dermatitis. Also it means more re-application.
Ugh. When is this stupid virus going to be more akin to a cold? I have friends with cancer or tiny babies, and family who are high-risk elderly. I am careful.
Re: Novovax. The LA County Health Department told our non profit they will not have it this fall, and the pharmacies have no clue as to whether they will have it. What do you think?
This is really disappointing. As someone who doesn’t tolerate mRNA vaccines well, I hate seeing people’s options continue to shrink. It will hurt uptake, and thus more preventable hospitalizations and deaths. I’m still hoping Novavax remains available in places like Costco. We’ll see how it plays out...
Our experience in LA is that some of the non-chain pharmacies will quite happily order a 10 dose vial of novavax if we organize a group of people who want it so that there will be no waste.
Thanks for the clarification on EMTALA and abortion care. As a House Supervisor, I have ED Doctors asking for clarification on this and I'm starting to think that confusion is the goal.
Thanks, as always. Lying liars who tell lies are so unattractive, and we have a lot of them, in high places. You continue to voice sane things. Hang in there.
You do a great job!! Thank you!
Meant to say thank you so many times! I love your acronym (the "you" in "your" makes it feel so personal! I am a retired (tired) physician looking for as much (real) information as possible - your site is so much appreciated!
Howdy!
Some additional details regarding EMTALA (Emergency Medical Transfer and Active Labor Act).
It is my understanding the EMTALA only pertains to hospital-based emergency departments (EDs). In that context, it does not pertain to physicians' offices, clinics nor to "free standing" ERs that are not a department of a licensed hospital.
EMTALA allows hospital-based EDs to screen for the presence or absence of an emergency medical condition, as that term is defined in federal law. The screening has to be done before any insurance coverage / payment information is obtained. Naturally, patients who present with "obvious" emergency medical conditions are treated directly without going through screening, per se. Because the option to screen applies to everyone else, most hospital-based ERs do not screen at all, but instead see all comers.
Once the patient is "admitted" to the ED, the hospital is required to evaluate, stabilize and treat to the best of their capability and capacity. The hospital can only transfer when a higher level of care is needed.
A stunning stat… 41% of all births today are by women receiving medicaid benefits. Think about this… 41% of women have no other avenue for health insurance other than public health insurance. This means that less than 60% of Americans have access to health care apart from government programs. Toss in the 70+ million Americans with medicare coverage and you are well over 50% of Americans receiving their healthcare via a government program.
So why in the f*** don't we just go ahead and phase in single payer medicare for all.
Silly me… then UHC et al won't be mega–billion $$$$ profit black holes. Sick country.
In my conspicuously large red state, over 50% of the births occur to moms on Medicaid.
Here is an optimistic thought: disabled persons (defined in federal law), low income pregnant women and children are "required" populations in Medicaid - in other words, a state Medicaid program must include those folks or they don't qualify as having a Medicaid program. For that reason, I think it is very unlikely that the feds will cut funding to those populations. Rather, I believe the current administration is targeting those states that "expanded" their Medicaid programs, i.e., added optional populations.
As we know, healthcare is a zero-sum financial universe: thanks to the EMTALA law mentioned in this YLE post, everyone gets treated once their condition reaches emergency status. If the patient is uninsured (basically, can't pay), the hospital has to cover the costs somehow and the "somehow" is making up the loss through patients that do have sources of payment. Clearly, this is inefficient and costly.
But alas, IMHO, we Americans really can't untie the Gordian Knot of healthcare financing that we have created over the past decades. While many of us are dissatisfied, many others are doing just fine, thank you.
I honestly don't know the answer.
It seems the ultimate goal (in an earlier time it was called the final solution) is death by a thousand cuts to anyone who intentionally or unintentionally needs help staying healthy and alive.
I live in a bright red district. My congressman sends out emails weekly about the deficit and how it will kill our nation. In the same emails he struts and preens about how he is voting for things like the "big beautiful bill" because it will save the handful of families in our district who pay federal taxes $1200 per year.
This sort of mixed messaging disconnect is indicative of how f'ed up this all is.
Had it not been for John McCain in 2017 and his thumbs down the Mitch McConnell led republican senate would have dumped any sort of federal public programs and left all but medicare people to fend for themselves. The next 3+ years are not going to end well. You might get better medical care in the Trump family farm in El Salvador.
I got to visit Taiwan a few years back. They have a "universal" healthcare system (covers 99.7% of the population), have similar population health statistics as us (people still drink, age, get sick, etc.) but they spend only one third as much of their GDP on healthcare as we do.
They do it by not only having comprehensive benefits / services (hospital, medication, home health, DME, mental health - everything) but by having comprehensive and centralized data and data analysis. If your liver function tests take a jump, the will reach out and find out why. You will have a hard time refusing their multiple invitations.
But Taiwan is, more or less, a mono-culture of Han Chinese descent. There is a level of trust (shall we call it acquiescence) for this sort of government involvement that would simply not happen is the USA.
I am not saying I prefer Taiwan to the US, just saying there are deep cultural and historical factors that have produced the systems that exist around the world.
I do not see the US coalescing around a consensus revision any time soon. Just IMHO.
I can reconcile some of our US high health care cost to two factors. First, many meds are invented in the US. Someone has to pay for this. The pharma companies are not going to fund this out of the goodness of their hearts.
Second, the pharma companies spend more on lobbying than they do on r&d. This is "confirmed" via google AI. Again, someone has to pay for all the conferences, sales presentations, lunch at Old Ebbitt Grill, etc.
A country such as Taiwan likely piggybacks on the work done in the US when it comes to medical treatments, drugs, surgical machines, etc.
Finally I wonder just how accurate the stats on the cost of medical care in the US are. For example, I had an emergency appendectomy on March 9 this year. I just received my EoB from the surgery and two day hospital stay. Using round numbers the hospital billed $100K. Insurance paid about $9K. I had to pay $200. So which of these numbers is used when calculating the US pays more for med care than the next 19 countries combined?
As Saint Reagan said, statistics can be funny things (or something similar).
Agree with all your comments: I didn't know about the advertising vs R&D costs. Figures, given that Pharma seems to pay for every network newscast and then some.
As for as your hospital bill (hope you are fully recovered), you point out yet another odd tic in our system. As I understand it, hospitals have to publish a "price list" that is the price that you or I would pay if we paid out of pocket.
That stated price is the price that the hospitals can discount off of when they contract with payors. Same goes for Pharma. That benchmark price can be set sky-high because almost nobody ever actually has to pay it.
The system is complex, convoluted and opaque.
At root, I am convinced that at least some of the most breathtaking healthcare costs (prices) are due to the fact that "the healthcare dollar" is not a real dollar - as it is essentially taken out of the marketplace that - via supply and demand - sets the price of everything else.
When you pay your health insurance premium - or you pay your taxes or contribution to a government health program - your money goes into a one-way valve. The only value that healthcare dollar has once it is captured in the system comes in the form of whatever "benefit" you qualify for.
Moreover, for the most part, the world of healthcare is not really a market at all since it is characterized by inelastic demand, especially for the priciest services. When you need a stent to preserve your myocardium, there is no time for shopping around.
I do think there is some (limited) hope in the concept of Health Savings Accounts. These would be private, pretax accounts that individuals could use to pay for various healthcare goods and services. They would remain "real dollars" in that they remain under the control of the individual. This might inject some "price rationality" in certain mid-range and/or discretionary services, e.g., you could shop around for the least expensive CPAP machine.
Progress in reforming healthcare financing will require a level of societal insight, wisdom and consensus that I believe we are not yet capable of achieving.
Stay well my friend!
Most of the "cuts" to Medicaid affect people who shouldn't be on medicaid like illegal aliens and able bodied working age people. Major cuts also impact states like California who are ripping off the federal government by imposing "provider taxes" to juice their federal reimbursement and eliminating people registered in two or more states.
Per the US government, 78 million people are on Medicaid and the US population is 342 million. That makes 23% of the population on Medicaid (numbers rounded for clarity).
Statistically, poor people are more likely to have multiple children (and younger adults are more likely to be poor than older ones). That leads to a surprisingly high rate of children on Medicaid.
Sources:
https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights
https://www.census.gov/popclock/
Thanks for this info. About 20% of the US population receive medicare benefits. So about 43% of the US population have some sort of US gov't paid healthcare.
I suspect there's some number of Americans who go without for whatever reasons. Assume say 7% so 50% of Americans do NOT get healthcare paid for by the US gov't.
And those with private healthcare such as employer paid or semi–paid or people buying medical insurance via the marketplace make up the other 50%.
I guess my question would be is this the best we can do? Can we as a collection of individuals called a country do better taking care of ourselves and our fellow citizens health?
https://www.census.gov/library/publications/2024/demo/p60-284.html
Interestingly, this report from 2023 gives a dramatically smaller number of people on Medicaid (62 million). It also gives 65% as the percentage of insured people who are on private insurance versus public.
I’m not sure how to reconcile the differences in the numbers. Isn’t it great when the federal government can’t agree with itself on statistics?
Maybe the states are not so good at record keeping hence the reason the numbers on medicaid have such a wide variance. I remember in the days covid was a little less threatening it was discovered that California had made more covid relief payments than was proper. Billions more. With nearly 40 million people to keep track of California may not have such good record keeping. I can image other states being just as inaccurate.
Doing a search now google AI reports this number to be 71.2 million as of January 2025.
Regarding the uncertainty and chaos caused by the government's radically opaque messaging on COVID vaccines, another shoe has dropped. If you're looking for clarification from CDC's ACIP meeting at the end of the month, know that four of the advisors just got fired. Also, without a CDC Director in place to consider the now-diminished committee's recommendations, it's looking more like Kennedy will make the decisions on the fall vaccines (https://covidandvaccineupdate.substack.com/p/waiting-for-acip).
Do we even know which strain we will see in the vaccines in the US? I presume the US rec’s, and not the current one that the committee suggested? I can no longer recall the WHO rec’s, the chaos is catching up…
VRBPAC recommended sticking with the offshoots of JN.1, but hesitated on picking the current dominant virus, LP.8.1, as the one. FDA then also told manufacturers to stay with the JN.1s, but went further with the preference for LP.8.1 - same as WHO, and the Europeans have already picked LP.8.1 as the next target.
Now all of them: https://www.msn.com/en-us/health/other/rfk-jr-removes-all-members-of-cdc-panel-advising-us-on-vaccines/ar-AA1GnZJA?ocid=BingNewsVerp
Yep, according to Kennedy in his opinion piece in the Wall Street Journal, it was "needed to re-establish public confidence in vaccine science."
The ACIP meeting at the end of the month will be more interesting than usual. Where's Kennedy going to find the replacement members in time for them to go over the ton of data to be discussed? It's a 3-day meeting to go over not just the COVID vaccines but also many other shots.
Thanks for tracking all the things and for bringing clarity.
Regarding wildfire smoke and particulate pollution, I think it's wise for everyone to limit their exposure, the exposure of children, and the exposure of pets during orange and yellow alerts. Exposure to particulates becomes a risk factor for other things, so it makes sense to adopt the precautionary principle when possible.
Hmm, would slapping a tariff on it keep out the new NB.1.8.1 subvariant that's started early summer surges abroad? It's already coming in with increasing numbers of infected international passengers monitored by the Traveler-based Genomic Surveillance Program at 8 major airports here (https://covidandvaccineupdate.substack.com/p/waiting-for-acip).
Add to the mix the 25-year highs in measles at popular summer destinations such as Europe and the summer surge/wave is more than likely - surf's up!
Tongue-in-cheek tariff suggestion....check!
Distressed to read that RFK Jr has just fired all members of ACIP and will replace them with those who "will prioritize public health and evidence-based medicine. The Committee will no longer function as a rubber stamp for industry profit-taking agendas." Dear God. While I am sure Big Pharma has more influence than we would like, this is definitely throwing out the baby with the bath water. If ACIP completely changes the vaccine recommendations, does insurance coverage follow??
I just read that, too. We are SO scr3wed. 😵💫
"But the law itself didn’t change. A memo doesn’t override a federal statute, like EMTALA." That would be pretty relevant if the nation weren't in the control of a gang of outlaws.
can you send the source of the study about uti treatment with the new drug. 40% cure rate for the standard drug seems wrong to me.
as an update, there are now 12 Colorado cases, with the latest being a vaccinated person. (and I have a possibly wrong recollection that an earlier one in the cluster was also vaccinated.)
https://www.cbsnews.com/colorado/news/12th-colorado-measles-case-confirmed-out-state-traveler-connection/
Really really appreciate all the effort you and your team put into these newsletters. In my part of CA currently I know 4 people with Covid so I wonder if there is an uptick not detected yet here. Thank you for all you do!
Where in CA are you. Bay Area here. I am hearing rumors but know no sick people (or at least nobody who knows they are sick). I have been luxuriating in going mask-free to uncrowded grocery stores. It feels too early for that to be over. Boo.
I hate masking in the summer. I wear sunscreen every day, all year, but stronger stuff now. Squishing the stronger stuff with a mask during hot weather gives me peri-oral dermatitis. Also it means more re-application.
Ugh. When is this stupid virus going to be more akin to a cold? I have friends with cancer or tiny babies, and family who are high-risk elderly. I am careful.
Thank you!
Re: Novovax. The LA County Health Department told our non profit they will not have it this fall, and the pharmacies have no clue as to whether they will have it. What do you think?
This is really disappointing. As someone who doesn’t tolerate mRNA vaccines well, I hate seeing people’s options continue to shrink. It will hurt uptake, and thus more preventable hospitalizations and deaths. I’m still hoping Novavax remains available in places like Costco. We’ll see how it plays out...
Our experience in LA is that some of the non-chain pharmacies will quite happily order a 10 dose vial of novavax if we organize a group of people who want it so that there will be no waste.
Hopefully that continues.
Thanks for the clarification on EMTALA and abortion care. As a House Supervisor, I have ED Doctors asking for clarification on this and I'm starting to think that confusion is the goal.