Monday, November 08, 2004

In Sickness and In Health...

A lively new article says that the United States is "woefully unprepared" for bioterrorism, and adds that "long-tolerated weaknesses in the U.S. health care system have become serious national security vulnerabilities."

Subsitute "long-tolerated" with "hard-won," and you're onto something I've been saying since Reagan took office. A huge amount of these "weaknesses" are the result of conscious decisions made by people in government, people to whom the words of Grover Norquist are thunder-loud and honey-sweet. Most of these weaknesses were never viewed as problems, but as the ecstatic realization of a dream too long denied.

Most people know that the big pharmaceutical companies are simply unwilling to manufacture stockpiles of drugs against epidemics and bioterror attacks. As this article puts it,

Big firms are accustomed to huge profits on their drugs for arthritis, ulcers, impotence and the like, and foresee returns a fraction of that size for biodefense work.

That's so patently unpatriotic, vicious, and stupid that it doesn't bear going into here. What I'd rather discuss is "the challenge of redirecting cash-starved hospitals and local health agencies into the unfamiliar field of mass casualty response." For example:
Local and state health officials say their underfunded agencies, which focus mostly on caring for the poor, have received inadequate federal funds and guidance on what the states should address in their bioterrorism master plans.

[snip]

Most U.S. hospitals also lack the "surge capacity" to respond to a bioattack -- the ability to rapidly bring in hundreds of trained medical professionals to care for a huge influx of very sick people. Expanding staffs runs counter to the decades-long trend of hospitals reducing staff sizes because of budget pressures.

The reasons for this are all pretty simple, but here's one of the simplest: Without national healthcare, the poor are compelled to go to emergency rooms for routine problems. Emergency room treatment is much, much more expensive than a visit to a doctor, and the poor can't pay for it. Thus, general hospitals cost states and municipalities a great deal of money. Staffing is cut; doctors and nurses are overworked and highly stressed. They make mistakes, in triage or treatment. There are investigations, and perhaps lawsuits. That costs more money. Staffing is cut, and so are supplies. More hospitals close, and thus the burden on nearby hospitals increases, exacerbating the same problems.

It would be irrational to expect a public-health system in this condition to be able to respond to an epidemic. The surprise is not that it can't, but that anyone would believe it could.

As I've said before, national healthcare and homeland security are quite simply synonymous. But we're expected to believe that in making our willfully broken healthcare system safe and sane, we'd succumb to that primal evil known as "collectivism." I'm not impressed with that line of argument, not least because if a country is anything at all, it's a collective. In our case, the word "united" - whether it's used in our country's name, or intoned piously by some political hack - is supposed to denote a particularly high-minded adherence to the concept of shared destiny. Well, there are few more "collective" experiences than being caught in the middle of a smallpox or influenza epidemic. In our vulnerability to anthrax spores, at least, our nation is admirably indivisible.

That said, let's lighten up a bit, and take a look at the punchline of this article:
Some believe that Bush should publicly declare the seriousness of the government's bioterrorism concerns, name a bioterrorism "czar" to focus public attention, and initiate vastly expanded research into new drugs. Administration officials said that such steps are unnecessary and that the current arrangement works fine.

6 comments:

Thersites said...

Ah hell, just trust in Jesus & he'll turn the spores into Oreos.

Pastabagel said...

While I have nothing against Oreos or Jesus, I do find a problem here:
Without national healthcare, the poor are compelled to go to emergency rooms for routine problems.The problem is precisely not this. Medicaid and state medical welfare provides for routine visits (the poor on average don't take advantage). It is that the poor never see anyone for routine problems, which then fester, but show up to the emergency room for very serious problems that routine checkups would have caught early, eliminating the need for the emergency room visit. You have to require regular checkups for national healthcare to have a cost impact here, and while that may work, you have a situation in which the government is telling people when to see the doctor, which may be a little too nanny-state for most people. And even this is samll peanuts compared to the big problem.

The big problem is poor people who show up in the emergency room with drug overdoses, alcohol poisoning, gunshot wounds, stabbing wounds, injuries after being beaten up by husbands/boyfriends/parents whatever.

National healthcare won't eliminate these costs because they have nothing to do with medical prevention, but rather have socioeconomic roots. You simply shift the cost from the hospitals (who pass it on to insurance companies as higher prices for insured patients)) to the government, where all taxpayers absorb it.

And for the umpteen millionth time, investors in drug companies don't have to be in the drug business. Drug companies aren't going to stockpile drugs that in all likelihood will not be used and will have to be discarded and replaced periodically. If you impose too much regulation, too many mandates, and too much cost on these companies, their investors will take their money elsewhere. And before you dismiss this idea out of hand, note that a similar thing has already happened in the aviation industry.

THEY CALL ME PASTABAGEL

Phila said...

Hey Pastabagel,

The problem is precisely not this. Medicaid and state medical welfare provides for routine visits (the poor on average don't take advantage).That's a very optimistic overgeneralization. State medical welfare benefits vary widely, and most of 'em are trending resolutely downwards and have been for many years. What I find amusing about comments like yours is that I know people in the situation I'm describing. I'm not arguing merely from statistics, but also from experience! Years and years and years of experience. There are older people in my family, for instance, who have no coverage for routine visits...not from the state, not from Medicaid. None whatsoever. For them, it's ER or nothing.

It is that the poor never see anyone for routine problems, which then fester, but show up to the emergency room for very serious problems that routine checkups would have caught early, eliminating the need for the emergency room visit.That's quite true. And something really ought to be done about it.

You have to require regular checkups for national healthcare to have a cost impact here, and while that may work, you have a situation in which the government is telling people when to see the doctor, which may be a little too nanny-state for most people.Here we have an amazing notion. On one side of the balance, we have a host of actual social evils that affect everybody. On the other, we have a hypothetical objection to the alleged moral implications of a dishonest phrase invented by Social Darwinist zealots. And for a certain percentage of society, the false perception created by that phrase outweighs the reality of the dangers that all of us face together. An admirable accomplishment, if you happen to be a nihilist or a sociopath.

Insurance companies currently require physicals and other tests. So does the military. And teachers are required to take TB tests, and to provide proof of immunization to employers. Is that too "nanny-state" for you? Of course, the government wouldn't be "telling people when to see the doctor" in any case. It'd be offering a service, under certain terms. You don't want to meet those terms, you can opt-out of coverage. Or perhaps your deductible would go up if you refused to get a check-up. Really, this "nanny-state" argument is so logically inane that it must have a very deep psychological appeal to some folks...otherwise, they'd laugh it right out of existence, like the rest of the civilized world does.

The big problem is poor people who show up in the emergency room with drug overdoses, alcohol poisoning, gunshot wounds, stabbing wounds, injuries after being beaten up by husbands/boyfriends/parents whatever.Yep. Those "poor people" and their sordid little lives, and all those woes they bring on themselves. Obviously, this sounds better from your standpoint than talking about a mother bringing a child into the ER with strep throat would, but that says more about your own preoccupations than it does about the actual statistics of ER admissions. Again, I do happen to know something about this, which is why I feel confident enough to make the arguments I'm making.

National healthcare won't eliminate these costs because they have nothing to do with medical prevention, but rather have socioeconomic roots. You simply shift the cost from the hospitals (who pass it on to insurance companies as higher prices for insured patients)) to the government, where all taxpayers absorb it.No, it won't eliminate those costs. But by solving the problems you listed above (i.e., treating problems in dr's offices BEFORE they get out of hand), you reduce the costs and the burdens on the system, which makes the unavoidable problems more tractable. Pretty basic economics, really: Reduce the costs over which you have control, and you're in a better position to deal with the ones you can't control. Right?

Of course, there's also the fact that right now, taxpayers are footing the bill for all of these costs. That's not going to change, either. Sorry to disappoint you, but we are simply not going to start letting people without money die in ERs. And it would be perverse - to say the least - to argue that unless all costs can be controlled, none should be.

Drug companies aren't going to stockpile drugs that in all likelihood will not be used and will have to be discarded and replaced periodically. If you impose too much regulation, too many mandates, and too much cost on these companies, their investors will take their money elsewhere.This remark just goes to show the invincible obduracy with which people confuse a flawed and transient economic arrangement with God's Own Truth. The whole point of my post was that public health can't be left to the Free Market, because the Free Market penalizes long-term planning. Just like military defense, public health is not a free-market issue, but a homeland security issue. If the government can use taxpayer money to protect us from Al-Qaeda, it should also use taxpayer money to stockpile vaccines and so forth to protect us from epidemics and bioterrorism....either by making them itself at the NIH (my preference), or by paying private firms to do it. Sheesh. It's really not that goddamn complicated.

Pastabagel said...

I am sorry to hear about your family. Why won't medicare pay?

No, insurance companies providing insurance through the policyholder's job do not require physicals. I've had more jobs than I can remember and I've never been required to do anything.

Look you can argue rhetoric all you want, but that doesn't count as arguing the point. There is a serious liberty and civil rights problem with the state ordering people to visit a doctor. Should it also dictate where you live in the interests of managing traffic congestion and sprawl, and protecting the environment?

I think what we're seeing here is the issue boiling down to collective interest vs. individual interest. I completely agree that if you force people to do things in the interest of the greater good, you will probably accomplish that goal in the short term. You will also create a host of unforseen problems that may be worse in the long run than the original problem.

If the state can require regular checkups, can the state order you to give up drinking, and cut you off benefits if you don't? Can the state then force you to take the medication prescribed to you during your routine checkup? Did proponents of this idea even think this stuff through? This is why trying to centrally manage things like healthcare always fail, because you can never perceive all the ripple effects.

Should people who can't afford healthcare be subject to greater control by the state simply because they are poor?

And you comment about my characterization of the poor coming to the ER with trauma's is silly. Visit a downtown ER sometime on a Friday or saturday night and ask yourself how much of what you see would be preventable with routine checkups.

THEY CALL ME PASTABAGEL

Phila said...

Yes, Pastabagel...I'm familiar with all forms of the "slippery slope" argument. However, every first-world country on earth offers national healthcare, and none of them have devolved into communist tyrannies as yet. Further, I find insulting the notion that America can't do better than they can. The conservative movement in this country has crippled science, crippled American ingenuity, and punished visionary thinking for far too long now. You honestly believe that your irrational fears of what might happen with national healthcare have more moral urgency than the situation we're in right now, and you honestly believe that because neither you nor whatever "authorities" you accept can posit a solution, none can exist. I find that argument unpatriotic, counterproductive, superstitious, and willfully ignorant.

You want to argue individual versus collective? Then explain to me, dearie, the conceptual difference between protecting the collective from al-Qaeda, and protecting the collective from mutant influenza strains. (Hint: There isn't one.) Look, I'm really not particularly afraid of being killed by Muslim terrorists. I think that one's odds of dying in a terrorist attack are far less than one's chances of being killed in a car wreck. So why should my tax dollars subsidize homeland security? Why should I worry about the fears of the collective? Hell, I can look after myself...I don't need Bush's "nanny-state" programs to protect me from terrorism, right? Let's scrap the whole thing, and leave it to survival of the fittest.

Christ almighty, Pastabagel. If you read history...really read it, instead of relying on this month's fashionable neocon gloss of it...you'd know that we already tried all of this, and it didn't work. Lord knows I admire Dickens, but that doesn't mean I want to live in the real-world equivalent of Coketown.

Phila said...

Oh, and I should really let this go...but re: your last paragraph about visiting ERs on a Friday or Saturday night (and wasn't it carefully worded?), this is the problem in a nutshell: You assume a) that I haven't done that; b) that I have no other source of knowledge for what I'm talking about. Fact is, I've prepared papers for major hospital chains on the allocation of funds and the specific problems with emergency rooms. To do so, I had to look at data...not opinions, not stuff I wanted to believe 'cause it made me feel good, but actual raw data relating to ERs, insurance and profitability. And that's what I'm basing my argument on. Even the recent studies that show that 85% of ER users have insurance, which the Right has derived some obscure satisfaction from, concedes that ERs are seeing lots and lots of poor children who don't have primary doctors...hence my argument about strep throat. On top of which, not getting reimbursed for, say, 10% of one's services is a pretty hard burden to bear. Don't take my word for it, PB; look it up. Medicaid and state programs have been lowering the type of services and the percentage of costs they'll cover for quite some time; that's simply a fact.See, that's what bugs me about people like you. You're probably a fine fellow in the flesh...I'm pretty easygoing, and I get along just fine with people who's opinions are even more ignorant than yours. But the central flaw with your brand of conservatism is that it relies on maintaining ignorance. It believes that all knowledge is predicated on belief systems, and that there's no such thing as objective truth...just political interpretation. Personally, I can't live that way. The political conclusions I draw from a set of facts might be dead wrong, 'cause I'm as fallible as anyone else, but I'm still going to get the facts themselves down as carefully and objectively as I can. There's nothing to be gained by doing otherwise.