This fumbling is just maddening. Too many political leaders extol the virtues of "markets" in healthcare, with little understanding of how those markets actually work.

If we need 3.5 - 4M tests per week (per @DrTomFrieden & @ashishkjha), it is a HUGE business opportunity. https://twitter.com/davidalim/status/1253073569799643148

Medicare is currently paying $100 per test. With that as a guide, we're talking about 15 - 17M tests per month and or $1.5 - 1.7 billion of monthly revenue.

That is enormous, in a commercial lab industry where the largest company does <$1 billion in monthly revenue.

Given that opportunity, and given that the testing technology is all available "off-the-shelf," it would be straightforward to finance the CapEx purchases to expand capacity...

...IF THAT REVENUE WERE ASSURED.

Also very possible to train up the staff. About 40,000 clinical lab techs and phlebotomists work in physicians' offices, many of which are short of patients right now.

But of course, the revenue is *not* assured.

Large labs (Quest, LabCorp, etc) which would make capacity investments normally collect most specimens from clinics or physicians' offices, many of which have shifted to remote care.

And, local testing criteria still often focus on rationing tests, not maximizing their reach.

Which is to say, we shut down one of the main distribution channels for diagnostic testing services, making it harder for large labs to put shiny new testing hardware to work, while public health leaders issue contradictory signals about the actual demand for tests.

That is why we are seeing this counterintuitive combination of:

- Plateau in completed tests

- Urgent calls to expand testing (though with 10x variations in the proposed target)

- Labs reporting idle capacity on existing equipment

Hence the need for clear federal coordination, in the form of official planning documents, standardized national testing criteria, RFPs for large-scale testing / specimen collection programs and funding commitments to/through states.

Those steps will convert uncertain, theoretical demand into actual specimen intake channels and assured revenue streams, which companies can then use to finance large capital investments and launch hiring programs to expand capacity.

Finally, with a bit of organization, test purchasing commitments can be national, even as private insurers bear much of the cost.

Most Americans carry health coverage, and the infrastructure to route claims among primary and secondary payers already exists.

National testing programs could commit to a certain test volume and payment rate, while leaving a fee-for-service incentive for labs to maximize testing within certain criteria, with all claims submitted to a new payer ID, using existing billing and claims routing infrastructure.

Claims paid on behalf of tested patients with private coverage can then be submitted to those insurers (using the same plumbing) to reimburse the taxpayers central fund. All of this can be done using systems that are already in place. /n