I’ve been writing about this for years, but our healthcare debate isn’t about healthcare per se, it’s about healthcare insurance. That is, the money is the easy part (even though the U.S. political system and actors within it go out of its way to make it as difficult as they can for obvious reasons). Providing healthcare is difficult because we don’t have a healthcare system, healthcare systems, plural. Lots and lots of plural.

Which brings us to this Bloomberg story about the U.S.’s inability to count things (boldface mine):

The U.S. government has over-counted the number of Americans who are at least partly vaccinated against the coronavirus, state officials warn, meaning millions more people are unprotected as the pandemic’s winter surge gathers steam…

The move acknowledged a dynamic state officials have discovered: in collating reams of data on vaccinations, the U.S. has counted too many shots as first doses when they are instead second doses or booster shots.

CDC data show 240 million people with at least one shot, or about 72.5% of the population. But the agency says only 203 million are fully vaccinated, or 61.3%, an 11-percentage-point difference that is far larger than in other developed countries.

State and local officials say it’s improbable that 37 million Americans got one shot without completing their inoculations. Instead, they say, the government has regularly and incorrectly counted booster shots and second doses as first doses.

That means both the fully vaccinated and completely unvaccinated are officially undercounted. The precise number miscounted is unknown, but revisions in data from three states — Illinois, Pennsylvania and West Virginia — found enough over-counting of first shots to indicate millions of unvaccinated people nationally who’ve mistakenly been counted as having received a dose.

Changes to national data on the scale of Pennsylvania’s revisions, for example, would mean increasing the number of Americans who are unvaccinated by more than 10 million…

State officials say the explanation isn’t that Americans are uniquely unlikely to get a second shot but instead that the country’s health system, unlike its G-7 peers, is exceptionally fragmented. Each state maintains its own set of data, some have several, and all blend their information with data from health providers such as pharmacies and federal programs.

The system struggles to accurately record people who get shots in different places or from different providers. For example, someone who got a shot in one county and a second shot in another might be recorded as two first doses, instead of fully vaccinated.

Another example: a patient vaccinated in the Department of Veterans Affairs system who then gets a booster shot at a private pharmacy might also be inaccurately recorded as two first doses.

Based on what’s in myirdc.com, I’m pretty sure D.C. either has me at one dose in total, or they’re counting me twice, because I received my first two doses at a federal facility in Maryland, and my third dose in D.C.

I realize this is a minor thing, but, as someone who spends a considerable amount of time fighting antibiotic resistance, I’ve known about this–and had to deal with this–for a long time. Gathering information isn’t a therapy, but it does help us understand the scope of the problem and make better choices.

The U.S. healthcare system(s) circa 2021, Year of Our Gritty, doesn’t help us make better choices.