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October 25, 2005
The Kinky Appeal of Avian Flu
The Avian Flu is coming. Are you scared yet? You should be. Various newspapers and helpful outlets like The History Channel are doing their best to scare the bejeesus out of us. But why would we allow ourselves to be scared? Physician Abigail Zuger shares her experience in a terrific essay in today's New York Times. Some of her patients prefer to worry about unlikely health threats rather than actual health threats. (Don't miss the emphysema sufferer who prefers worrying about avian flu to quitting cigarettes.) Once again, denial trumps reality. And why not? Reality is a bitch.
"Of four patients I saw in a single hour last week, three announced how scared they were of the avian flu. I reassured them, but there was quite a bit I did not say, and here it is.
"I did not say: If you want to be scared, then how about that drug habit of yours you think I don't know about? How about the fact that you are 100 pounds overweight and eat nothing but junk? How about the fact that in a few short months Medicaid is going to stop paying for your very expensive medications and no one knows how just high that Medicare Part D deductible and co-payment are going to be? I did not say: If you want something to be scared of, how about the drug-resistant Klebsiella that is all over this very hospital, an ordinary run-of-the-mill bacterial strain that has become so resistant to so many antibiotics that we've had to resurrect a few we stopped using 30 years ago because they were so toxic.
"That Klebsiella is one scary germ. It's in hospitals all over the country, and by now it's probably killed a thousandfold more people than the avian flu.
"But you don't hear much about our Klebsiella. Like our bad habits and our dismally insoluble health insurance tangles, our antibiotic-resistant bacteria are with us, right here, right now."
Speaking of dismally insoluble health insurance tangles, it's nice to see Wal-Mart's charm offensive include more affordable health insurance for its employees. Although that won't solve all their problems. If they get seriously ill the first year, they're screwed thanks to a $25K cap on benefits. And if Barbara McNees has her way, the naughty ones won't get coverage because they won't deserve it. McNees is president and CEO of the Greater Pittsburgh Chamber of Commerce and as a representative of small businesses, she's understandably concerned about the employer cost of health insurance.
"We must deal with the 600-pound gorilla sitting in the national living room -- health care spending that is approaching one-sixth of U.S. gross domestic product. This will require nothing less than wrenching changes in health care delivery, health care financing (e.g., no payments for preventable patient injuries such as hospital-acquired infections) and individual accountability for behavioral choices."
Individual accountability for behavioral choices: Does that mean smokers would no longer be entitled to health insurance? That only wealthy people would be able to afford character defects, at least when it came to medical treatment? Isn't getting lung cancer, say, accountability enough? Do we have to thumb our noses at people who may have made some poor choices and deny them insurance coverage as well? That is one scary concept. Scarier, even, than avian flu. McNees may spring from upstanding, Puritan stock that never exhibited human weakness or fraility in any way. Most Americans can't make that claim. We're flawed; so are the people we love. But not as flawed as McNees' idea or a health system that leaves millions without coverage.
Posted by Deborah Branscum at October 25, 2005 04:02 PM
Comments
Arguments about who deserves what usually miss the point. We don't allow conjugal prison visits for the benefit of the prisoner. We merely accept that the prisoner will benefit as a side effect of the benefit which accrues to the prisoner's spouse. Likewise, we don't offer medical care to smokers because we want to make it easier for people to poison themselves; we offer it because smokers are earners and have dependents and we think it's worse to deprive those people of loved ones.
Posted by: Pete at October 27, 2005 07:08 PM