> This is the opposite of most western countries, where the incentives are to over-report.

Ahem.

https://www.cnn.com/2020/06/22/politics/donald-trump-testing...

https://floridaphoenix.com/2022/01/06/desantis-admits-roughl...

https://www.washingtonpost.com/nation/2021/01/19/rebekah-jon...

Yes, that's news about Florida and Donald Trump. Now do New York and California. The most populous states were likely over-reporting deaths.

By the way, despite the rhetoric, states were getting money from the federal government for reporting a COVID death. There was literally a per-death payment. If that is not an incentive to over-report (despite the usual bloviating from Republicans), I don't know what is.

[citation needed]

Here you go, straight from the primary source (the center for medicare and medicaid services):

https://www.cms.gov/files/document/se20015.pdf

> Inpatient Prospective Payment System (IPPS) Hospitals - Section 3710 of the CARES Act directs the Secretary to increase the weighting factor of the assigned Diagnosis-Related Group (DRG) by 20 percent for an individual diagnosed with COVID-19 discharged during the COVID-19 Public Health Emergency (PHE) period.

Hospitals get to charge Medicare/Medicaid a 20% surcharge for COVID patients and COVID deaths.

Note that this is deaths and patients who test positive for COVID while at the hospital, not deaths/patients whose reason for being in the hospital is COVID. At one point, those were all counted as "COVID hospitalizations/deaths" respectively by the CDC.

Given that COVID tests are tuned to have high sensitivity and (comparatively) low specificity, all a hospital needs to do to get their hands on that money is just give out a lot of COVID tests, and avoid re-testing the false positives. COVID tests are cheap, and to patients, it looks like the hospital being extra careful about keeping them safe from COVID.

That doesn't pay hospitals 20% more, the MS-DRG weighting factor is used to calculate the resources needed to care for the patient. This document is simply acknowledging the complexity and cost of COVID-19 care.

I don't expect anyone who has swallowed the pandemic conspiracy theories to change their mind. Perhaps someone who is reading along will gain insights into how misinformation starts and is spread.

And that MS-DRG premium means that they get $0 extra? Maybe it's less than 20% extra, and maybe it's more, but I certainly doubt that it's $0.

It sounds a lot like you were presented with evidence that people, particularly hospital administrators, were incentivized to pump the numbers of COVID cases in the US, and dismissed it as a "conspiracy theory."

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The fact of the matter is that people respond to incentives. Whether consciously or not. When you pay people to hand out COVID diagnoses, you are going to get a lot of COVID diagnoses. Particularly, you are going to get people who accept false positives as true positives.

Note that this doesn't mean that they over-counted cases in total: the US likely still under-counted cases due to all the people who never took a test when they were sick. They just under-counted a lot less than many other countries, thanks in part to the incentives being in favor of producing positive test results. Past epidemics have had reporting rates well under 10% in countries with good surveillance.

In China, the incentives are different. Chinese administrators are heavily incentivized to have fewer COVID diagnoses. This means much more draconian lockdown policies (which reduce the number of true positives for COVID), but it also means that they will accept negative test results (true and false negatives) without much question and try very hard to eliminate false positives.

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IMO the most likely story ("conspiracy theory") is:

1. The US and Western Europe, which had similar disease management policies and similar levels of contact between people, likely had very similar true positive rates of cases.

2. China probably had a lower true positive rate due to using more serious procedures to reduce R.

3. Due to co-morbidities (Americans being fat), cases in the US were on average more serious than cases in the EU, meaning more infected people going to the hospital and more people taking tests. On its own, this raised the reporting rate in the US.

4. Hospital systems and doctors in the US followed their incentives and over-reported cases (still under-counting the actual number of total cases by a factor of at least 2). What could have been "you have a mild cold, go home and get some rest" turned into "better take a COVID test just to be safe," and if that test was positive, it was reported as a case.

5. Hospital systems and doctors in China followed their incentives and under-reported cases (under-counting total cases by a factor of 50+). Things that could be COVID cases, but were unlikely, would get swept under the rug without a test.

6. Hospital systems in the EU ended up somewhere in between the US and China in terms of their surveillance rate.

This logically explains the variance in the reported case numbers between countries that did the same things, and also explains why a rational person could be skeptical of official numbers in certain countries. But sure, offering a narrative that lines up better with reality than the official narrative is a "conspiracy theory." As we all know, the official narrative is always correct, even when it is "there are WMDs in Iraq" or "smoking has no adverse heath effects."

Making the statement "The most populous states were likely over-reporting deaths" is alarmist to say the least.

Upon challenge, dialed back to "over-reported cases" or even "under-counted a lot less than many other countries" or "[didn't] try very hard to eliminate false positives" (which is a very strange accusation for different reasons?), still sounds like you have an ideological axe to grind here.

If I remember rightly we even know and have evidence of some of the specific ways in which China did this, such as not counting deaths of people in high-risk groups immediately after being infected with and hospitalized due to Covid as Covid deaths and instead blaming their deaths on some existing health conditions. Whereas the UK for example counted everyone who died reasonably soon after catching Covid as a Covid death.

we don't need to rely on the numbers coming from the CCP to get an estimate of how bad it is in china. what we can do is to rely on the covid count of passengers coming in from China, reported by non-Chinese disease authorities. we have several: south korea, singapore, and taiwan who were taking in chinese travelers at various points of the pandemic. china is a minor contributor to imported cases in these three countries.