Thursday, August 27, 2009

Healthcare reform and infection prevention

From an excellent piece in the NEJM, by Dr. Nicole Lurie, that nicely links healthcare reform, infection prevention and the public health:
"Early detection of a new infectious disease—and potentially the survival of those who are infected—requires that sick people have access to the health care system and receive early treatment. Delays in seeking care can lead to delays in the recognition and control of an epidemic and in the treatment of patients. Indeed, experts have hypothesized that one reason the mortality associated with the current epidemic of swine-origin influenza A (H1N1) virus (S-OIV) was so high in Mexico is that many people delayed seeking care, in part because of its cost. In the United States, lack of health insurance is a key reason for delays in seeking care; health care reform that results in universal coverage would facilitate earlier detection of new diseases, enable disease-control efforts to be instituted, and alleviate the population’s vulnerability that is attributable to delayed care."
Read the whole thing here.

3 comments:

  1. No sane individual would argue against everyone having access to healthcare. The question is: Why do you think the government has the ability to resolve this issue? It is a body of corrupted, self serving lawyers beholden to lobbyist groups and industry with literally endless red tape and bureaucracy. Medicare: bankrupt, Medicaid: bankrupt, Social Security: bankrupt. The Mayo Clinic has denounced this bill stating:
    "the proposed legislation misses the opportunity to help create higher quality, more affordable health care for patients... In fact, it will do the opposite, because the proposals aren't patient-focused or results-oriented. The real losers will be the citizens of the United States."

    The recent death of Ted Kennedy has been cheaply exploited by those in favor of pushing this bill through. Ask yourself this question: If this bill passed, would a 76 year old man (with the government's insurance) diagnosed with a malignant glioma have access to surgery, chemotherapy, and radiation that could only extend his life by a matter of months with NO chance of cure? Ted Kennedy had every right to pursue that care, and regardless of my ethical beliefs, I shudder at the thought of living in a country where a body of individuals in Washington DC determine the value of another human being's life, and ration his treatment options - under the government option he would "get some pain pills," (to quote Obama).
    There are other ways to lower cost, and improve access without uprooting our entire system. This bill speaks nothing to tort reform, insurance company regulation to prevent pre-existing condition clauses, tax credits to help pay for private policies, and on and on...

    read Mayo article from The Washington Times here:
    http://www.washingtontimes.com/news/2009/jul/21/mayo-clinic-calls-house-plan-bad-medicine/

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  2. Assuming that you are sane (and therefore in favor of universal access), please provide your constructive suggestions for how to provided universal coverage.

    Remember also that Ted Kennedy, as a senator and as a senior, did have government healthcare.

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  3. Although you neglected to answer any of the questions I asked in my post, I will oblige you with a response.
    First off, Ted Kennedy was independently wealthy, and I dont think medicare footed the bill for his entire treatment. Even if it did, I'm not talking about our current system, I'm referring to the healthcare rationing proposed in this bill.
    The only thing truly wrong with our healthcare system is cost. Our innovation is unparalleled and our access is superb (if you have insurance). Access is atrocious in socialized systems. Everyone loves using the infant mortality/life expectancy statistics as an argument to support a socialized system, however, minimal investigation reveals these numbers have been contaminated by egregious reporting bias. http://www.ajph.org/cgi/reprint/84/5/850

    I included some suggestions at the end of my post, one of which was tort reform. Frivolous lawsuits and ambulance chasing lawyers have driven up the cost of malpractice insurance, forcing doctors to practice defensive medicine. That translates to physicians ordering an immeasurable amount of unnecessary diagnostic tests. Diagnostic testing takes up 1/5 of total healthcare expenditure in the United States. The politicians are not interested in addressing this because they are beholden to the trial lawyers that fund their campaigns - this is an utterly reprehensible conflict of interest that no one seems to care much about. Why would I trust these people to uphold some higher moral standard when they usurp the healthcare industry?
    Obama himself stated:
    "Let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.
    http://www.youtube.com/watch?v=SG56B2et4M8

    In reality, medicare riemburses 740-1140 dollars for a leg amputation (including follow up care). This is a dangerous distortion, and I am frankly dismayed that our president is making decisions about healthcare policy with this level carelessness. Furthermore, it makes physicians out to be greed-infested pigs - sorry, I disagree.

    The entire premise that there are 47 million people that cannot afford healthcare is a farce. In 2006, the Census Bureau reported this breakdown of the 46.6 million uninsured: 9.5 million are not US citizens (and Obama does not plan on covering them!), 17 million live in households with incomes exceeding 50,000 dollars that could presumably afford some type of health insurance, 18 million were age 18-34, most of whom chose not to have health insurance because they were in "good health," and 50% of the non-elderly population included in these statistics regained their health coverage within 4 months.
    Do not misunderstand, this is not an argument against driving down costs - its simply an example of statistics being manipulated to carry out an agenda.

    I dont have all the answers, but why should we acquiesce to the notion that a government run system is the only way? The unintended consequences of this are beyond the scope of this post, but suffice it to say, there has to be a better way.

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