Thursday, February 03, 2005

More About a National Health Plan

A while ago, I wrote about an episode of O'Reilly Factor on Fox, during which Mr. O'Reilly discussed the idea of a national health plan with Dr. Stephanie Woolhandler.  Now, the Physicians for a National Health Plan have the video up on their site.  It is recommended viewing for all medical students.  Not because they need to learn about universal coverage, but because it may be their only opportunity to see an actual case of rabies in a human. 

Mr. O'Reilly practically starts frothing at the mouth in this interview.  He objects to the notion of himself having to bear part of the cost of someone else's illness, particularly when that illness was crated or exacerbated by personal choices, such as overeating, or lack of exercise. 

The flaw in this argument is that it is not just an argument against universal health coverage, it is an argument against all risk-sharing arrangements.  Carry that to its conclusion, and it reduces to the absurd fairly quickly: no health insurance, auto insurance, homeowners insurance, shipping insurance, etc.  The absence of insurance would set our economy back to the eighteenth century.  Most often, you cannot drive a car, own a home, or erect a building without insurance. 

Yesterday, I pointed out the fact that the lack of universal health coverage poses a threat to everyone's health, because of the problems posed by emerging and reemerging infectious diseases.  Improving the health of the entire population is the best way to protect your own health.

Mr. Bush, meanwhile, goes around insinuating that a National Health Plan would mean that "the government" would control your health care.  That is nonsense, of course.  It probably does not sink to the level of a damn lie, but it certainly is propaganda.  We can design any plan we want; if we don't want the governement to control it, then we don't design a plan with governmental control.

By the way, I know a lot of MD's who favor a national health plan; I don't know any who favor a plan run entirely by the governement.  In fact, I don't think anyone is seriously proposing that.  So it is ridiculous for Mr. Bush to imply that.  It is not a valid form of argument, to mislabel the opposition, then criticize the incorrect label.  I'm sure there's a Latin term for that kind of argument, but I don't know what it is.

Others who object to a national health plan point to the long lines that some Canadians experience while waiting for health care, and imply that the same thing would happen here.  That is just plain dumb.  The length of the lines would be up to us.  If we want a cheap system, we can design one, and have long lines.  If our priorities are such that we want to get rid of the lines, we could do that, too.  It just depends on how much we want to spend, and what other priorities we have.

The war in Iraq is estimated to cost five billion dollars a month.  We could improve health care quite a bit if we would just keep our priorities straight.

Enough ranting for tonight.  I'm just going to make one more point.  This is from an article I encountered somewhere, while browsing through various medical journals.  I can't recall where I found it first, but the article of interest is up on the PNHP site, which is what got me going on this topic in the first place.
Bankruptcy Study Highlights Need For National Health Insurance
Most Bankrupted by Illness Had Insurance
Physicians’ Group Decries Fake Reforms and “Counterfeit Coverage”

A new Harvard study of medical bankruptcies highlights the growing number of Americans with dangerously skimpy health insurance coverage and the need to address the problems of the insured as well as the uninsured, according to Physicians for a National Health Program (PNHP). The study, published today as a Web Exclusive by the journal Health Affairs found that half of U.S. bankruptcies, affecting 2 million people annually, were attributable to illness or medical bills. (Copies of the article can be accessed at: www.pnhp.org/bankruptcy/uninsured.html)

The physicians’ group pointed out that three-quarters of those bankrupted by illness were insured when they first got sick. While politicians acknowledge the need to cover the uninsured, they have ignored the worsening plight of those with coverage. Rising health care costs, skimpier policies and the cancellation of coverage when illness causes job loss have augmented the financial risk for those with insurance. This heightened risk is reflected in the 2200% increase in medical bankruptcies since 1981 found in the Harvard study. [...]
Bankruptcy, like infectious disease, is a problem that affects us all.   When a member of your community goes bankrupt, the entire economy of the community is affected.  It's a huge problem, and it is getting worse.  The economic impact of two million bankruptcies per year is staggering.  Eliminating that would partly offset the cost of the program.

In his State of the Union Address, Mr. Bush proclaimed his support for a "pro-life" society.  He is pro-life alright, unless saving that life happens to cost money, in which case, well, it's a tough world out there.

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Wednesday, February 02, 2005

Framing the Social Security Debate;
White House Strategy

Although the debate about reformation of social security is a matter of moderate interest for me, being at the tail end of the baby boom generation, so far I have not commented on the matter here.  The reason: debates should begin with observations, or at least with information of some sort.  Until there are facts to talk about, there is no point in having a debate.

When Bush is asked about the details of his plan, he always says that it is too early to talk about the details. 

OK, fine.  Then shut up.  If you are not ready to talk about facts, then we have nothing to talk about.

The peculiar thing about this is that the Bush Administration does have facts to discuss.  They have been working on social security privatization since 2001.  The Administration has worked up at least three proposals, and has prepared financial analyses of the proposals.  Yet for some reason, the White House has not been trotting these out for the press. 

Perhaps the reason for the reticence is that their own data do not show any benefit for their proposals.  The illustration above is from the Economic Policy Institute.  It is an analysis of one of the proposals that the Administration came up with in 2001.  That was before we got sidetracked by the wars in Afghanistan and Iraq. 

For those who are really interested in old data, Paul Suskind has put up scans of some early Administration documents pertaining to their plans for Social Security. 

Of course, I have no way of knowing what their current plan is.  Perhaps it is better than the ones they had in 2001.  Brad DeLong, Josh Marshall, and other well-informed professionals  in the Blogosphere have been tracking the issue closely, and they appear to have not learned any specifics.

Mr. DeLong, in particular, has done a nice job of dissecting what little is known so far.  But is doing so, he reveals to the Administration the kinds of arguments that they will have to address, once they finally get around to unveiling the details of their plan. 

Despite the lack of hard data, there is plenty of debate going on: a Blogpulse search shows 38,625 hits for the search string, Social Security.  It has been a topic in numerous newspaper editorials, such as this one, by Paul Krugman. 

So what are people debating about? Vague ideas, catchy slogans, and cherished ideals, that's what. 

Why would the Administration proceed in this manner?  Because that is how they are most likely to succeed.  They won the election based, not upon facts, but catchy slogans, etc.  The strategy worked before; they are hopeful that it might work again. 

By conducting the debate in this manner, they are basically "preparing the battlefield."  Get people to agree with certain basic ideas, then cast the specifics in terms of the vague ideas that people have come to accept.  Once people have already thought about, and accepted, the vague ideas, they do not pay any attention to the details when they come out.

Clever.  Except if people realize that their minds are being played with, they might get upset. 

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Monday, January 31, 2005

Dangers Old and New;
Pertussis and H5N1

Another Rationale for Universal Health Care

More than just a pesky cough
By Shari Roan
[LA] Times Staff Writer
January 31, 2005

The chronic, spastic cough started with what appeared to be a cold. A few months later, it was ruining Zachary Graham's life. The 16-year-old Sunapee, N.H., resident was often left gasping for air, gagging and unable to sleep. During one particularly ghastly coughing spell, Betty May Graham, Zachary's mom, feared her son was about to stop breathing.

That incident led the family to a lung specialist who delivered a diagnosis that stunned the Grahams: Zachary had pertussis, also known as whooping cough, a disease far better known in the 1930s than today.

"When the doctor said whooping cough, it kind of blew my mind," the teenager says. [...]

A vaccine introduced in the 1940s sent pertussis cases in this country plummeting to a low of 1,010 in 1976. But the disease roared back in the 1990s. According to the national Centers for Disease Control and Prevention, about 10,000 cases were reported in 2003. 
About ten thousand cases of pertussis were diagnosed in the USA in 2003.  That probably is a subset of the true number of cases, since the disease often is mild in adults, and may not be diagnosed.  The disease used to cause almost 10,000 deaths per year in the USA.  We have made a lot of progress since then. 

Of course, we now face new threats.  Bird flu has been reported in 31 areas of Viet Nam, as well as in other Asian countries.  Recently, the first reported cases of human-to-human transmission were reported.  The current strain of bird flu usually passes from animal to human, so it can be contained by killing all suspect animals.  With the emergence of human-to-human transmission, the threat of a pandemic is much greater.  A specialist at the University of Michigan School of Public Health has written an editorial about this in the New England Journal of Medicine.  Dr. Arnold Monto states the threat more directly. 
The report by Ungchusak et al. in this issue of the Journal (pages 333–340), however, clearly suggests the occurrence of person-to-person transmission through close contact with an infected child, leading to both clinical illness and death.
So it is not absolutely certain that human-to-human transmission occurred, but that is by far the most likely explanation.  He goes on to say:
But what if recognized transmission does begin to occur in a limited geographic area? Isolation and quarantine, which have proved effective against the severe acute respiratory syndrome (SARS), will probably not be sufficient to stop the spread of such an infection. Vaccine specific for the new strain will not be available for months after its appearance in humans, although studies of the necessary characteristics of such vaccines are ongoing, mainly under the sponsorship of the National Institutes of Health, and will provide essential information on their use should a pandemic begin. [...]

The logistic hurdles are formidable. A mobile stockpile of the drug would have to exist and be made available in the affected country. Oseltamivir is now being stockpiled by a number of developed countries for use once a pandemic virus becomes established and begins to spread rapidly around the globe. Developing a stockpile in an attempt to restrict the spread of the new virus at its source might mean diverting drugs from other national stockpiles. However, this diversion must happen. [...]

The avian origin of previous pandemic viruses was recognized only after the fact; this time, we have been given a warning. We really are not sure when, or whether, the type A (H5N1) virus will start to spread among humans, but we must be ready to stop it if we can — and, if we cannot, at least to mitigate its effects through the use of stockpiled antiviral drugs and, eventually, strain-specific vaccine.
A faction of neoconservatives argue against universal health care.  They voice various objections, but what it boils down to is this: they don't think they should have to pay for somebody else's health care. 

Guess what?  Health care is everybody's business.  If other people in your community are not vaccinated, it puts you and your family at risk. If other people are not adequately nourished, housed, and otherwise able to attend to their basic health, it puts all of us at risk. 

And if there is a pandemic of bird flu, or if pertussis makes more of a comeback, or if any one of many other illnesses starts to spread, there is not only a risk to your health, there is a risk to your pocketbook.  A pandemic of bird flu would devastate the world economy.  The demand for oil would plummet.  Halliburton may have to lay off some employees.  Dick Cheney might not get his yearly payment from them.  We might not be able to afford to invade Iran.  Boy, wouldn't that be awful?

Seriously, even if one is an unabashed card-carrying capitalist pig who doesn't give a damn about anyone else, and is unashamedly more pro-dollar than pro-life, universal health care -- as distasteful as it may seem -- does more than save lives: it protects the health of our economy. 

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