Nurses bag a swab at a drive-through testing center at the University of Washington Medical campus on March 13, 2020 in Seattle, Washington. John Moore/Getty Images

The international response to the novel coronavirus has laid this bare: America was less prepared for a pandemic than countries with universal health systems.

There is a real concern that Americans, with a high uninsured rate and high out-of-pocket costs compared to the rest of the world, won’t seek care because of the costs. Before the crisis even began, the United States had fewer doctors and fewer hospital beds per capita than most other developed countries. The rollout of Covid-19 testing has been patchy, reliant on a mix of government and private labs to scale up the capacity to perform the tens of thousands of tests that will be necessary.

“Everyone working in this space would agree that no matter how you measure it, the US is far behind on this,” says Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation.

People need to go to the doctor and get checked if they have Covid-19 symptoms, yet Americans may avoid medical care, even for serious conditions, because of the costs. Hospitals will need rooms for the people who require close monitoring in a clinical setting, and ICU beds and ventilators for patients who take a turn for the worse and require mechanical support to keep their bodies functioning.

Kaiser Permanente medical workers take swabs from people for the coronavirus at a drive-through testing facility in San Francisco, California on March 12, 2020. Josh Edelson/AFP via Getty Images

But none of those units are sitting empty right now — they already have non-coronavirus patients who need them and will continue to need them through the crisis. New York Gov. Andrew Cuomo said Sunday that nearly 80 percent of New York City’s intensive care units were already filled, even with the Covid-19 outbreak still expanding.

By any of these metrics on pandemic preparedness, America trails most of the rest of the developed world.

“The U.S. performs worse than average among similarly large and wealthy countries across nearly all measures of preparedness for a pandemic,” Cynthia Cox, director of the Peterson-Kaiser Health System Tracker, told me. “The coronavirus outbreak is already exposing inefficiencies and inequities in our health system, and it is likely to put much more strain on the system in the coming weeks.”

And the slow start to testing in the US is only going to exacerbate those problems.

Testing is important not only because it gets people diagnosed and on an appropriate treatment if they do have an infection. It also establishes how widespread a virus actually is. Experts know the size of the problem, they know the rate at which people are being hospitalized or dying, and they can follow its movements. That leads to a more informed response.

But the United States has faltered in rolling out coronavirus tests, putting us far behind our economic peers in tracing the outbreak. A manufacturing problem with the test kits that were initially sent out in the field, and a delay in approving commercial tests, set the nation back in stopping or slowing down Covid-19.

“The testing failure is putting additional strain on our already challenged health system,” Cox said. “The combination of all of these factors will make the U.S. worse off than similar countries.”

Universal health care is not a perfect treatment for emergencies like this. Italy has a universal health care system, a federalized national health insurance program similar to Canada’s, but an uncontained outbreak has still forced the country to lock itself down as cases and deaths continue to pile up.

Nevertheless, other countries are still generally better prepared for a pandemic than the US is, and we are seeing right now the consequences of that gap.

For the time being, US politicians are proposing to make American health care more like these other nations: making care free or cheap at the point of service, either by having the government cover more of the cost or by mandating private insurers cover services related to the outbreak.

They are, however, only a temporary patch on these structural problems.

Why America is less prepared for a pandemic than other countries

On many measures, the United States has one of the worst health systems among developed economies. A bigger share of the population lacks health insurance. We carry more medical debt. We die more often from preventable causes. The weaknesses in this system, which already puts the US behind its peers on many health outcomes, are exposed in an outbreak.

And the biggest single problem, the one most unique to the American system, is costs.

Americans face higher out-of-pocket costs for their medical care than citizens of almost any other country, and research shows people forgo care they need, including for serious conditions, because of the cost barriers. Patients here are much more likely than those in most other countries to say they had a cost-related barrier to getting medical care: 33 percent in America vs. between 7 percent (Germany) and 22 percent (Switzerland) in other developed economies. Americans are more likely to say they struggled to afford or couldn’t afford medical bills and that their insurance plan had refused to cover some of their medical claims.

Peterson-Kaiser Health System Tracker

We know Americans delay care as a result of these cost barriers: in 2019, 33 percent of Americans said they put off treatment for a medical condition because of the cost; 25 percent said they postponed care for a serious condition. A 2018 study found that even women with breast cancer — a life-threatening diagnosis — would delay care because of the high deductibles on their insurance plan, even for basic services like imaging.

Those cost barriers hit patients at several points in a pandemic situation. First, they might be wary about going to the doctor at all because they are afraid they can’t afford the check-up or any testing. But then if they do get a Covid-19 diagnosis and require hospitalization, they have the bills from the hospital, the doctors they see, and any treatment they receive to worry about.

In America, and only in America among developed countries, do patients risk thousands of dollars in medical bills by seeking help in a crisis. Some Americans have already been billed nearly $4,000 over a government-imposed quarantine, as the New York Times reported.

Making matters worse is our system’s health care infrastructure, built on top of this fractured payer system. There are capacity shortages that put us at further disadvantage in a time of pandemic, when they are most needed.

Hospital beds, for example, will be necessary for Covid-19 patients with more serious symptoms. America has fewer hospital beds per capita than most other countries in the developed world.

Peterson-Kaiser Health System Tracker

A potential shortage of hospital beds is compounded by the fact that the US has higher rates of hospitalizations for chronic conditions that, with proper management, shouldn’t require the patient to go to the hospital. Those conditions include congestive heart failure, diabetes, and asthma. Researchers think a lack of access to primary care, and the high costs of seeking even this routine care compared to other countries, drive potentially preventable hospitalizations in the US.

That means our hospitals are already taking in patients they wouldn’t have to if the system functioned better, and now they will have to accommodate an influx of Covid-19 patients.

We have fewer doctors per capita too: 2.6 per 1,000 people, well below the comparable country average of 3.5 and lower than every country tracked by Peterson-Kaiser except for Japan. Experts blame the high cost of a medical education in the US, inextricably linked to America’s world-leading health care prices, for much of that shortfall.

And, likely as a result, Americans struggle more than people in most other places to get a same-day or next-day appointment with their doctor.

Peterson-Kaiser Health System Tracker

Take these structural problems together with America’s slow start to testing for coronavirus, and we are far behind where we should be.

“A failure to widely test and slow the spread means that we could have large spikes in the number of people who need medical care all at once, putting exceptional strain on our health system,” Cox told me. “By not acting quickly enough to prevent spread, our health system will be under greater, more concentrated strain.”

Many countries with universal health care are doing better than the US, but some have problems too

Countries with universal health care are testing more people and seem to be faring better with Covid-19 death rates than the United States. More centralized planning is an asset in a crisis.

Taiwan has seen a remarkably low level of coronavirus cases despite high traffic with the Chinese mainland. As Vox’s Kelsey Piper reported:

As of March 10, Taiwan has just 45 coronavirus disease (Covid-19) cases, and only one death. Health experts do not expect that Taiwan is overlooking many cases, either. That’s many fewer than its neighbors like Japan and South Korea and one of the best containment track records in the world so far. The Netherlands, with a comparable population, has five times as many cases despite having much less frequent direct travel with China.

In Taiwan, with its single-payer health program, every citizen has their digital medical records loaded into the same system. In the coronavirus outbreak, the country has added travel records to that online medical file, so every doctor can check whether their patients have visited an area affected by the outbreak.

And by getting jumpstarted on their response, those countries are able to lower the burden on their health systems. The primary goal with the coronavirus outbreak at this point is to slow the spread so health care providers aren’t overrun: to flatten the curve in this chart so patient needs don’t exceed the system’s capacity.

Christina Animashaun/Vox

So even though, as you may have noticed above, countries like Canada and United Kingdom have about the same number of hospital beds as the United States does, they should be better positioned to mitigate the outbreak. They are already testing a lot more people. More testing allows them to take smarter protective measures, because they have a better idea of the scope of the pandemic, which helps to reduce the burden on their health system during the worst peak of the outbreak.

But even universal health care cannot fully prepare a country for the unpredictable movements of a pandemic virus. Italy, with a national health service that provides care to each of its citizens, has seen its coronavirus situation spin quickly out of control. On Monday, the country decided to close its borders in a desperate attempt to stem the crisis.

As Vox’s Julia Belluz reported, there are competing theories for the problem. Perhaps the aggressive testing had just made the scale of the problem clear earlier than in other places. It’s hard to say for sure. Or:

Another is that intense spread of the virus in the hospital system, before doctors realized there was a problem, may have amplified the outbreak. Some 10 percent of medical workers in Lombardy have been infected, according to a March 3 Washington Post report, and health workers account for 5 percent of those infected in the country. (Bolstering this explanation: The WHO-ECDC joint mission report suggests Italy should work on its infection prevention and control measures in hospitals.)

There’s also speculation about whether Italy’s burden is particularly severe because of the country’s aging population. Covid-19 is known to hit the elderly particularly hard. That, along with the fast rise in confirmed cases, has tested the limits of the health system.

And yet, Italy still has more hospital beds per capita and doctors per capita than the United States, according to OECD and World Bank estimates. As experts worry whether Italy shows a glimpse of what’s to come in America, it’s worth remembering their health system still had a bigger capacity to handle a surge in patients than the US system currently does.

But the point is, pandemics are unpredictable. Their spread and containment depends a lot on human factors that even the most well-designed health system, or pandemic response plan, can’t fully anticipate.

And if the pandemic does overcome a country’s best preparedness efforts, some other countries could conceivably be at a deeper disadvantage than the US.

Patients who develop pneumonia because of Covid-19 may require mechanical ventilators. The Johns Hopkins Center for Health Security reported in 2018 that Canada, Australia, and New Zealand (each with their own version of national health insurance) had fewer ICU beds with mechanical ventilation capability per capita than America does, though we too are not equipped to handle a crisis on the scale of the Spanish flu.

Nevertheless, “these numbers suggest that the capacity of other countries to provide ventilation therapy might be significantly lower than our own,” the Johns Hopkins experts wrote.

For now, US officials want to temporarily make our health care more like other places

America’s fractured health system has made it more vulnerable to coronavirus. And in response, members of Congress and state governors keep proposing to make our health care more like other countries’ systems — at least during this emergency.

Some states are doing what they can to lower those burdens. New York Gov. Andrew Cuomo announced last week he would require insurers and Medicaid in New York to cover treatment and testing cost-free with an emergency declaration. States have some discretion with what their Medicaid programs cover, and more states are taking their own actions: California Gov. Gavin Newsom issued a similar order in the last few days.

Members of the National Guard attend the opening of a drive-through coronavirus mobile testing center in New Rochelle, New York, on March 13, 2020. Spencer Platt/Getty Images

States are limited in what they can do, though ERISA, the federal law regulating the large employer health insurance plans that cover about 100 million Americans, is a barrier to state officials who want to do more. Cuomo’s order, for example, noted it applied to private health plans regulated by the state — the plans available to small businesses or individuals — but not the self-funded employer plans covered by ERISA. It’s another way a more decentralized health system complicates the response to an outbreak.

Rep. Ruben Gallego (D-AZ) announced last week he would introduce a bill that would make Medicaid cover testing for and treatment of Covid-19 for every American, no matter how they get their insurance. This would be an important change to US health care: The federal government would assume responsibility for medical care for every American under these particular circumstances.

And the Trump administration appears to see a need to do something drastic, too, even if experts don’t think some of their proposed actions will have a significant effect.

Vice President Mike Pence, for example, said Covid-19 testing and treatment would be treated as an “essential health benefit” (a standard established by the Affordable Care Act) to cover everyone’s care. But that change would actually not apply to the self-funded plans, nor to Medicare, as Nicholas Bagley, a law professor at the University of Michigan, wrote for The Incidental Economist:

Even if they did, insurers can (and do!) impose cost-sharing for EHBs, and could do so for a COVID-19 test. It’s a completely meaningless statement.

Though that may be, Pence’s statement still reflected a real need to put at least a temporary patch on our health system. Everybody seems to agree on that.

But these problems don’t go away when the coronavirus disappears. They are still there, if treated less urgently than in a crisis, affecting the lives of millions of Americans every day.

Tom Stachler is a licensed realtor, broker working and selling real estate or homes in the Ann Arbor, Saline, Dexter, Ypsilanti Michigan and surrounding areas.  

Bored Yet?  So take a break from Binge watching on the streaming sources and check out these Links. 

Going into a self-quarantine can have many complex issues and complications beyond having enough food and supplies for two weeks. In terms of entertainment, it also probably means you’re in for a lot of boredom, a lot of Netflix, and a lot of browsing the internet.

But there is a way to get a little culture and education while you’re confined to your Home. According to Fast Company, Google Arts & Culture teamed up with over 500 museums and galleries around the world to bring anyone and everyone virtual tours and online exhibits of some of the most famous museums around the world..

Now, you get “go to the museum” and never have to leave your couch.

Google Arts & Culture’s collection includes the British Museum in London, the Van Gogh Museum in Amsterdam, the Guggenheim in New York City, and literally hundreds of more places where you can gain knowledge about art, history, and science. This collection is especially good for students who are looking for ways to stay on top of their studies while schools are closed.

Take a look at just some of Google’s top museums that are offering online tours and exhibits.

British Museum, London

This iconic museum located in the heart of London allows virtual visitors to tour the Great Court and discover the ancient Rosetta Stone and Egyptian mummies. You can also find hundreds of artifacts on the museum’s virtual tour.

Guggenheim Museum, New York

Google’s Street View feature lets visitors tour the Guggenheim’s famous spiral staircase without ever leaving home. From there, you can discover incredible works of art from the Impressionist, Post-Impressionist, Modern and Contemporary eras.

National Gallery of Art, Washington, D.C.

This famous American art museum features two online exhibits through Google. The first is an exhibit of American fashion from 1740 to 1895, including many renderings of clothes from the colonial and Revolutionary eras. The second is a collection of works from Dutch Baroque painter Johannes Vermeer.

Musée d’Orsay, Paris

You can virtually walk through this popular gallery that houses dozens of famous works from French artists who worked and lived between 1848 and 1914. Get a peek at artworks from Monet, Cézanne, and Gauguin, among others.

National Museum of Modern and Contemporary Art, Seoul

One of Korea’s popular museums can be accessed from anywhere around the world. Google’s virtual tour takes you through six floors of Contemporary art from Korea and all over the globe.

Pergamon Museum, Berlin

As one of Germany’s largest museums, Pergamon has a lot to offer – even if you can’t physically be there. This historical museum is home to plenty of ancient artifacts including the Ishtar Gate of Babylon and, of course, the Pergamon Altar.

Rijksmuseum, Amsterdam

Explore the masterworks from the Dutch Golden Age, including works from Vermeer and Rembrandt. Google offers a Street View tour of this iconic museum, so you can feel as if you’re actually wandering its halls.

Van Gogh Museum, Amsterdam

Anyone who is a fan of this tragic, ingenious painter can see his works up close (or, almost up close) by virtually visiting this museum – the largest collection of artworks by Vincent van Gogh, including over 200 paintings, 500 drawings, and over 750 personal letters.

The J. Paul Getty Museum, Los Angeles

European artworks from as far back as the 8th Century can be found in this California art museum. Take a Street View tour to discover a huge collection of paintings, drawings, sculptures, manuscripts, and photographs.

Uffizi Gallery, Florence

This less well-known gallery houses the art collection of one of Florence, Italy’s most famous families, the de'Medicis. The building was designed by Giorgio Vasari in 1560 specifically for Cosimo I de'Medici, but anyone can wander its halls from anywhere in the world.

MASP, São Paulo

The Museu de Arte de São Paulo is a non-profit and Brazil’s first modern museum. Artworks placed on clear perspex frames make it seem like the artwork is hovering in midair. Take a virtual tour to experience the wondrous display for yourself.

National Museum of Anthropology, Mexico City

Built in 1964, this museum is dedicated to the archaeology and history of Mexico’s pre-Hispanic heritage. There are 23 exhibit rooms filled with ancient artifacts, including some from the Mayan civilization.

Sadly, not all popular art museums and galleries could be included on Google Arts & Culture’s collection, but some museums are taking it upon themselves to offer online visits. According to Fast Company, the Louvre also offers virtual tours on its website.

To see more of Google Arts & Culture’s collection of museums, visit the collection’s website. There are thousands of museum Street Views on Google as well. Google Arts & Culture also has an online experience for exploring famous historic and cultural heritage sites.

 

Tom Stachler is a local realtor and broker marketing homes, investment properties and condos in the Saline, Ann Arbor, Dexter, Ypsilanti and surrounding communities.  

Advisory: Information Regarding Executive Order Prohibiting Large Gatherings 

Local Police, Sheriff Support Executive Order Prohibiting Large Gatherings

The Washtenaw County Sheriff’s Office and our law enforcement partners are asking residents to do their part in helping slow the spread of the Coronavirus by following the executive order recently announced by Governor Gretchen Whitmer. The order prohibits gatherings of 250 people or more and recommends that you cancel events with more than 100 people in a shared space. It also recommends that you cancel gatherings of more than 10 people where individuals at higher risk of severe illness are involved.
 
“For some, the threat of the virus may seem insignificant,” says Sheriff Jerry Clayton. “However, we’re asking for your help in slowing the spread. The sooner the virus is subdued, the sooner we can get back to our normal way of life. One way to do so is to keep your distance and follow the direction of our health experts.”
 
We are not looking for social isolation, but we are asking for social distancing. Those who disregard the order could be subject to a misdemeanor that includes up to 90 days in jail and/or a fine of up to $200. More importantly, violation of the order puts us all at significant risk. If needed, the Washtenaw County Health Officer can issue additional, local orders prohibiting gatherings where necessary.
 
“Now is the time for us to cooperate fully to protect everyone’s health,” says Jimena Loveluck, MSW, health officer with Washtenaw County Health Department. “Our individual and collective actions are incredibly important for slowing the potential spread of illness in our community. Keep washing, covering, and distancing. Together, we will get through this.”
 
The large gatherings ban is one of several statewide efforts to help stop the spread of coronavirus disease 2019 (COVID-19). The ban went into effect at 5 p.m. on Friday, March 13 and remains in place until Sunday, April 5 at 5 p.m.
 
The executive order applies to all gatherings of more than 250 people in a single shared space and includes both private businesses and public locations. A single shared space includes, but is not limited to, a room, hall, cafeteria, auditorium, theater, or gallery. People gathering for the purposes of industrial or manufacturing work; mass transit; or the purchase of groceries or consumer goods are currently exempt from the state ban.
 
Health experts are still learning about how this new coronavirus spreads. The virus is thought to spread mainly from person-to-person, between people who are in close contact (within about six feet) of an ill person, through respiratory droplets produced when an infected person coughs or sneezes. Therefore, keeping your distance is important.
 
Prevention
There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. Information from Centers for Disease Control and Prevention (CDC) is available in English, Chinese, and Spanish.

• Clean your hands often. Scrub with soap for at least 20 seconds. Use hand sanitizer if you cannot wash.
• Avoid close contact with people who are sick.
• Stay Home when you are sick, except to get medical care. Call ahead before going to your healthcare provider. Learn what to do if you are sick. 
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash. Immediately wash your hands.

• Clean and disinfect frequently-touched surfaces. 

Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. View additional prevention steps from CDC for people at higher risk. Consult with your health care provider for more steps you may be able to take to protect yourself.

REMEMBER: Discrimination harms public health. People of Asian descent, including Chinese Americans, are not more likely to get coronavirus than anyone else.
 
Please continue to rely on official sources of information for local (www.washtenaw.org/covid19), state (www.michigan.gov/coronavirus), and national (http://www.cdc.gov/COVID19) updates.

Tom Stachler is a local real estate broker, realtor selling residential, income and investment property in the Ann Arbor, Saline, Milan, Ypsilanti, Dexter and surrounding areas and communities.  

Novel Coronavirus Update

When does Spring Daylight Savings Time Start in Michigan?  

Mar 8, 2020 - Daylight Saving Time Starts

When local standard time is about to reach
Sunday, March 8, 2020, 2:00:00 am clocks are turned forward 1 hour to
Sunday, March 8, 2020, 3:00:00 am local daylight time instead.

Sunrise and sunset will be about 1 hour later on Mar 8, 2020 than the day before. There will be more light in the evening.

Also called Spring Forward, Summer Time, and Daylight Savings Time.

More info:
DST Starts in the US & Canada

Looking like the right time for sell or Purchase a Home?  Check out our Links and resources above and let us know what we can to to help or setup an automatic new listing email update service for you.  Tom Stachler is a licensed real estate broker serving the Ann Arbor, Saline, Dexter, Milan, Ypsilanti, Chelsea and surrounding markets.  Call us today to chat.  

SALINE SCHOOL DISTRICT - COMING SOON

Commuters First Choice because its only 5 minutes from the US-23 & I-94 Expressway exchange.  Low York Township taxes, Highly desirable Timber Ridge Subdivision and in the top rated Saline School district.   This wonderful Home has new hardwood flooring and carpeting, New Granite, New Roof, updated flooring, 1.5 acre lot and professional landscaping. More Photos and Video Here

This York township area is very popular for those wanting to be close to Ann Arbor but wish to avoid the traffic backups at State St and Plymouth Roads.  15 minutes to downtown AA or UM Hospital and 25 minutes to Toledo or Detroit Metro Airport.  Larger homes and lots with small tax bills.... what more could you ask for? 

• 3000 Sq. Ft.
• Award Winning Saline Schools
• 4 Large Bedrooms
• 3 Full Baths / 1 Half Bath
• In-Ground Sprinklers
• Updated Stainless Appliances
• Low York Township Taxes
• New Granite Counters
• New Hardwood Flooring
• New Carpet
• Driveway Resealed 2019
• New Roof 2019
• Partially Finished Basement
• Sunroom With Scenic Views Off Kitchen Area
• Gracious Master Suite With Sitting Room
• Marvelous Wrap Around Porch...and SO MUCH MORE!!!

​​MORE PHOTOS AND WALK THROUGH VIDEO COMING SOON, SO STOP BACK OFTEN OR CALL THE NUMBER BELOW. 

CALL 734-996-0000 TO BE PUT ON OUR FIRST TO VIEW LIST!!!

Investment Properties 101: How to Get Started

There are many different kinds of investments that can make your money work for you. One lucrative option: rental real estate. Ann Arbor is a desirable city with plenty of locals and tourists looking for space. If you can capitalize on that energy and make your mark in the local rental scene, you may be able to dramatically increase your monthly income.

Investment Property Options

Real estate investment comes in many different shapes and sizes.

Single-Family Investment Property

Starting a Vacation Rental Business: An Investor's Guide           

Commercial Real Estate Investing Guide - How to Get Started

9 Ways to Invest in Real Estate Without Buying Property in 2019

Expenses and Income

You can’t make a profit if you’re not paying attention to your cash flow.

How to Get Financing for Rental Properties

How to Set the Perfect Rent Price for Your Rental Properties

How to Price Your Vacation Rental to Maximize Your Income

25 Rental Property Expenses Investors Can't Afford to Forget

Getting to Work

Although some sources call Rentals “passive income,” you can up your profits by taking an active role in your property.

What It Takes to Be a Landlord

How to Market Your Vacation Rental on Social Media

When Should a Landlord Hire a Property Management Company?

Fixing Up Your Investment Property for Rental Income: Where to Splurge, What to Skip

Property Management Supply List

Self-Storage for Rental Property Upkeep Equipment (Avg. Price $84)

Are you ready to become a landlord? If so, these resources will guide you through the process of getting started with your own investment property. With hard work and the right knowledge, you can take the Ann Arbor rental real estate market by storm.

Tom Stachler is a commercial and residential real estate broker working in the Saline, Ann Arbor, Ypsilanti, Dexter and surrounding communities.  He has also been a income property manager for and advisor for over 30 years.  Contact him today for more information, listings and advice.  

Disagree with your local Assessor - Paying to much for Property Taxes?

It is that time of the year again when property owners get their assessments for the local assessor.  If you feel the amount is too high, check out the video below and let us know if you have any questions.  

If you do not wish to appeal yourself (it's an easy process) then there are attorneys I can recommend who will do this for you.  The initial process with the local tax board of review is free and they will give you 10 minutes to make your case then get back to you two weeks later.  If you disagree with their determination, then the appeal application to the state is free for your Home or $75 for investment property at this state level. 

Check out the suggestions in the video and keep in touch.