Health Reform and Epidemic Disease
The CDC’s “Swine Flu and You” page offers the following under the heading of “what should I do if I get sick”:
If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.
Of course as Igor Volsky points out:
But for the millions of Americans who can’t afford to purchase health insurance, a visit to a “health care provider” is an expensive proposition. We know that the 45.7 million Americans without insurance are less likely to visit a doctor and receive needed care, but the the economic crisis, the erosion of employer-based benefits and the skyrocketing costs of health insurance are now causing an increasing number of insured Americans to avoid their “health care provider.” According to the latest Kaiser Poll, 60 percent of Americans say that “they or a member of their household have delayed or skipped health care in the past year” and many are “substituting home remedies or over the counter drugs for doctors visits.”
Obviously, it’s not as if epidemics wouldn’t take place if we had comprehensive health care reform. But people being unable to go see their doctor for economic reasons doesn’t help; nor does the lack of sick days faced by many workers.
More broadly, the epidemic serves a reminder that the health care system is in many ways a public function. Free markets work very well for ordinary consumption goods, but Tamiflu is not an ordinary consumption good. It’s important to be able to direct the health care delivery system’s resources toward public purposes and not have the resources allocated purely by market demand.
31 Responses to “Health Reform and Epidemic Disease”
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April 30th, 2009 at 3:20 pm
It’s not just whether people can afford to see a health care practitioner, but whether they’re able to access one at all. If you’re uninsured, you can’t get a primary health care provider, and no regular doctor’s office you can is going to be willing to see you. So your options are either to go to the emergency room or to a quick stop clinic, such as in WalMart or CVS. If you go to the emergency room, you’ll be waiting there a very, very long time while they treat people with more immediately life threatening conditions–possibly you’ll wait until your own condition deteriorates to life threatening (and the advice that’s been put out on this so far says how rapidly you get medical attention can make the difference between life and death). The Nurse Practitioners at WalMart and CVS are terrific, but have they been given the training/support/resources to respond to people coming in with this new illness? I don’t know.
April 30th, 2009 at 3:34 pm
p.s. facemasks are useless
April 30th, 2009 at 3:40 pm
Yes, we need government to mandate sick-days because there’s no way that people can save money for these days and no way that chuckleheads will take advantage of sick-days. Plus, if an employee consistently performs well, there’s no way an employer will be willing to let an occasional sick-day slide. Why do we even let employers make any decisions? The fact that it’s their money and their place of business should have little effect on what happens there. And there’s no chance that employees can go to different employers.
April 30th, 2009 at 3:40 pm
In a pandemic where death is a significant risk (and let us hope that this isn’t the case here), no country of any size is going to come even close to having enough doctors, if that is the standard of care needed to prevent such outcomes. Insurance, or lack thereof, or having the government act as a single payer, won’t make a damned bit of difference.
April 30th, 2009 at 3:48 pm
MattY signs on to this Igor Volsky claim that there are “45.7 million Americans without insurance”. That claims is false. If MattY and Igor Volsky are willing to mislead you about that, can you trust the other things they say?
April 30th, 2009 at 3:49 pm
Why don’t we orchestrate a mass ER check-in by non-insured Americans, to see if they’re infected.
We could call it “Going Salk.”
April 30th, 2009 at 3:50 pm
Gotta be false. It was 46.6 million in 2005.
April 30th, 2009 at 3:54 pm
As Ezra Klein pointed out, the main factor in how big an epidemic grows is how many people, on average, each sick person infects. So there is a direct link between the defects Matt points out – people going to work sick because they can’t afford to stay home, or putting off medical care – and the size of the pandemic.
April 30th, 2009 at 3:57 pm
X happens and therefore a Yglesias’ favorite program should be funded. How convenient.
How many times have we gone from X to government bullet trains, bank bailouts, auto bailouts, and medical industry bailouts.
April 30th, 2009 at 3:59 pm
The CDC web site author clearly comes from the Yglesias school of sentence construction. The brief excerpt raises several questions: (1) what if I live in only one area? (2) Whose health care provider, precisely, should I be contacting, and why not my own? and (3) Why is a government agency telling me what I may want to do? I know what I want to do. I consulted the government to find out what I should do.
April 30th, 2009 at 4:00 pm
Even with health insurance, Tamiflu is expensive. I have pretty good coverage and we had to pay $70 out of pocket for a week’s course for my son who had the “regular” flu a couple of weeks ago.
April 30th, 2009 at 4:01 pm
@9 – yeah, how dare Matt use things that happen in the world to argue for policy changes that he thinks would make the world work better? Geez.
April 30th, 2009 at 4:04 pm
Indeed. Why shouldn’t employers be allowed to require 16 hr. workdays, 7 days a week without paying overtime? Why should we restrict them from using children to perform dangerous tasks? Etc.
April 30th, 2009 at 4:25 pm
To 24hournutjob:
Must be embarrassing to be wrong all the time.
April 30th, 2009 at 4:31 pm
JM says: Gotta be false. It was 46.6 million in 2005.
Actually, that’s false too. Let me spoil the surprise: millions of that number and the 45.7 million from MattY/Igor Volsky are actually citizens of other countries. They aren’t “Americans” as MattY/Igor Volsky falsely claim. Now, the Dems are certainly welcome to promote their plans as being open to anyone no matter their status, but they should at least be open about that. The fact that they’re willing to lie to your face is not a good sign for those who want to believe them.
April 30th, 2009 at 4:38 pm
Indeed. Why shouldn’t employers be allowed to require 16 hr. workdays, 7 days a week without paying overtime? Why should we restrict them from using children to perform dangerous tasks? Etc.
Nobody would work there because some other employer would offer better conditions. Etc.
April 30th, 2009 at 4:42 pm
Healthy Markup is a good example of how idiots pollute the discourse. It’s as if this dimwit knew nothing of history.
Hey Will, someone is trolling to take away your title as the dumbest poster on Matt’s blog. Better bring back McGovern’s “full throated support” of the Khmer Rouge, otherwise people are going to think you are losing your touch.
April 30th, 2009 at 4:52 pm
Nobody would work there because some other employer would offer better conditions. Etc.
Yeah, that’s exactly how it played out in the late 19th and early 20th centuries in the US. And the Invisible Hand gave all the workers a massage, too!
April 30th, 2009 at 5:14 pm
Yeah, that’s exactly how it played out in the late 19th and early 20th centuries in the US. And the Invisible Hand gave all the workers a massage, too!
Well, there are some people who work those hours, but they tend to work in odd situations like fisheries in Alaska. Of course, they can make $30,000 in three months, so it’s not as if they’re not getting paid. Then, there are the doctors or the investment bankers. I’m not sure where you’d put them in your pity-parties.
April 30th, 2009 at 5:25 pm
I knew that the Randroid idiots would be on this post. TSG, you have to remember that according to these guys, the employer should be able to demand whatever conditions they want, because it’s their business and their money that they made through their hard work – and not through the hard work of the employees, you know, the people who actually do the work. And of course any problems will be solved by the special magical powers of the free market.
April 30th, 2009 at 5:38 pm
… the employer should be able to demand whatever conditions they want, because it’s their business and their money that they made through their hard work – and not through the hard work of the employees, you know, the people who actually do the work. And of course any problems will be solved by the special magical powers of the free market.
If there were few employers, then magic might be required, but no one is chaining you to the desk and you can leave when you want. If an employer gets a record for mistreatment, it can become hard for him to find good employees and he’ll fail. When the labor market becomes especially tight, employers have to keep bidding up wages just to attract new employees. Maybe you should offer employers in a tight labor market tax breaks to offset their increased costs due to employees scorning them when the unemployment rate falls too low.
Not a Randite. She believed in things like objectively beautiful art. Crazy.
April 30th, 2009 at 5:44 pm
@Healthy Markup,
Objectively beautiful art is crazy. The nonsense you’re talking is batshit insane and woefully ignorant of history and the real world.
Teh wikipedia might help you with this. Try searching it on “labor law.”
April 30th, 2009 at 6:00 pm
I just got back from the E.R. not because I assumed i had the dreaded Swine Flu, but because I was generally feeling under the weather and the lousy plan provided by my school only listed doctors who were not accepting new patients. Upon being seen by the doctor, I was told that I was not covered in this hospital, but since I had flu-like symptoms they were required to swab my throat for cultures to test for Swine Flu…which would cost me 200+ dollars. I refused, as I dont have the funds for that sort of thing. What I found most interesting/discouraging is the fact that all I’ve heard of this Swine Flu outbreak is that ‘we have to keep it contained’ and yet, the way they propose we protect the larger population from an epidemic (which is largely their responsibility) is at incredibly high cost to the poorly insured/uninsured? Not to add to the echo chamber, but it’s certainly time that we asses the matrix by which we provide health care in this country as it has become glaringly obvious in the last couple of weeks that our bad health care policy no longer affect JUST the poorly insured. Who knows, if I indeed have this flu, I was right there, to be dealt with and advised as to how to keep contamination to a minimum. But instead, I am left confused and with little desire to trust another health care institution.
April 30th, 2009 at 7:53 pm
Healthy Markup is right. Slavery is the only answer. A Slave State is Capitalism in its most efficient form. We are all good Capitalists. It is time to be true to our system and call out with love and joy, slavery now! Slavery forever!
April 30th, 2009 at 8:09 pm
Well, the trolls here today are a pretty disgusting form of vermin. But it’s easy to see why they have nothing better to do than blab on the computer, in spite of the fact of having nothing to say.
April 30th, 2009 at 8:13 pm
Healthy Markup, under normal conditions I would agree with you–there is no need for government regulation of the labor market because the free market will tend to produce optimal conditions. In a pandemic, though, both employee and employer get all the benefit from a sick person coming in to work, while society as a whole suffers the cost through increased rates of transmission. Under these conditions there will always be a greater than optimal proportion of disease-carriers working, so government action is warranted to increase incentive for the sick to stay home–and conditional mandatory increase in sick days for the duration could be net beneficial.
April 30th, 2009 at 9:30 pm
In a pandemic, though, both employee and employer get all the benefit from a sick person coming in to work, while society as a whole suffers the cost through increased rates of transmission. Under these conditions there will always be a greater than optimal proportion of disease-carriers working, so government action is warranted to increase incentive for the sick to stay home–and conditional mandatory increase in sick days for the duration could be net beneficial.
This is reasonable and if this hits us, even I think the gov should do things like quarantine, etc. But to mandate sick days outside of emergencies is not. Beyond that, if there is a chance that this could become big and bad, people should have enough food and water to hole up for a couple weeks. This, of course, would be too useful an idea and too obviously self-relianty for MY to mention it. But I’m serious. Being forced to leave the house for lack of water or food because you were too shortsighted to store them at home is worse than being too shortsighted to save money so you could afford to not work.
April 30th, 2009 at 10:07 pm
Of course, it’s important to quarantine yourself when you’re sick, and anything that can make that more likely and easier is going to contribute to containment. But it’s a mistake to think that only sick people pose a risk. Healthy people can transmit viruses as well. I hate it when people say “I don’t have any germs” because they don’t have any symptoms. And doesn’t everyone know about that phase in a virus when they feel great and they think it’s over, but it’s not? The sneaky little virus just wants you to think it is. Damn sneaky creatures, viruses.
April 30th, 2009 at 11:08 pm
Wiley,
If you were responding to me, I wasn’t saying that we should have food and water in case we become sick, but that we should in case of quarantine of others, curfews, lock-downs.
May 1st, 2009 at 6:41 am
My experience with past flu epidemics is that the doctor’s office is a great place to pick up the flu if you do not already have it. I would give the healthcare system a wide berth in this case, too.
May 1st, 2009 at 10:48 am
If an employer gets a record for mistreatment, it can become hard for him to find good employees and he’ll fail.
Which is why Wal-Mart, with its well-known record of mistreating workers, failed and never became a big national corporation. Meanwhile, back in the real world….