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By Bruce Jacobs

swinefluIt was a good week to have the Swine Flu, whether I did or not.  Rainy, cold, lots of football and baseball playoffs to watch on TV, new books by Lorrie Moore, Pete Dexter, and Phillip Caputo.  Who wants to go out, anyway?

The scratchy throat that always heralds some sort of head cold began last Thursday.  By Friday, it morphed into dizziness and soon nausea, followed by sleep, three hours in the middle of the day, hardly a little nap.

Saturday my head was full in earnest. A kind of cold achiness between my shoulders replaced the nausea.  I shoveled down Ibuprofen and regular hits of pseudoephedrine, which in our family are referred to as reds and whites – red for its daytime buzz and white for its nighttime drowsiness.  Sunday I was too rundown to do much of anything.  I watched endless hours of Jack Bauer’s 24-hour exploits…exploiting the hell out of all sorts of bad guys as he always does.  On Monday I could feel everything kind of crack open, and I knew I was on the downhill slope.  Soon, this flu too would pass.

Meanwhile in Washington

As the bug worked its way through my body (and soul), the news was pretty much full of two big issues:  H1N1 vaccine shortages and the ongoing debate about health care in the United States. The health care debate seemed almost surreal in my current state of aches, sniffles and coughs, especially compared to the simple information and instruction coming my way about Swine Flu through doctors and public health officials. But there it was, resting like a blanket over Congress.

Under the covers, Congressmen and their staffs huddled in backrooms reconciling over 5,000 pages of health care reform bills.  Much of the debate is about the minutia of Medicare reimbursements, prescription drug benefits, insurance co-ops, public options (which one?), mandates, insurance regulations, and tax credits––all the little details that lobbyists get paid millions of dollars to tailor so their clients can save billions.

What creeps out into public view is the politics of it all: sweeping claims that health care reform will bring socialized medicine (as if Medicare hasn’t already), that a public option will reign in rising insurance premiums (although only 5-10 percent of the public will be eligible to receive it), and that this legislation will resolve a public policy issue that dates back to the days of Teddy Roosevelt. Those who are closest to the action know best that whatever emerges will only be an incremental change, slowly phased in over the next five years.

Rising health care costs won’t be contained until Congress addresses the central problem: the costs, not the federal subsidies available to pay them.

Health care reform is a muddy debate we can only understand when the media invokes its favorite metaphor, politics as sports. The winning formula will be the one that gets 60 senators to step up to the plate and close off a filibuster against it.

H1N1 Explained

How refreshing it was then to see public health officials respond to the “Swine Flu” threat––a dangerous new virus that could at any moment break out into a pandemic––with simple facts, common sense advice and Internet links to other useful information.

The first important step was dispelling the mistaken impression that Swine Flu comes from eating pork. It gets its name because the first strain discovered back in 1976 was carried by pigs. The 2009 version has been rechristened by its laboratory name, H1N1, a more neutral moniker that connotes a viral germ that can be inoculated against. The second, even more important step, was starting early in a variety of private medical labs developing a vaccine to prevent it, a process that can take 5-6 months in chicken eggs, but, as the news media now tells us, might have been accelerated to 4 months if we incubated it in caterpillar larvae. Don’t you just love the media for their contribution to public health?

Knowledge is Power

mexicofluOver the course of the summer, we have all learned how to wash our hands, cough into the crook of our sleeve and stay away from work when we are sick to avoid infecting our colleagues. Although there was a certain amount of global hysteria when large outbreaks of this flu hit Mexico, in a matter of months everybody settled down.  It doesn’t hurt that it quickly was shown Swine Flu isn’t nearly as dangerous as plain old seasonal flu. It is merely new and more contagious.

As I went through my boxes of Puffs tissues these last few days and read news stories about the vaccine, I could sense that the system was working.  We were all told to stay away from hospital emergency rooms unless really blown away by the disease. We were advised when, where, and how vaccines would be available (with some caveats regarding exact dates and amounts).  We accepted the use of simple over-the-counter treatments of pain relievers and antihistamines.  We understood the cost of the vaccine would be either free at public health locations or very small if we chose to get it at private providers.  And our employers wouldn’t hassle us if we called in sick or demand “doctor’s slips” to demonstrate we weren’t faking it.

Even President Obama weighed in with a declaration of a National Health Emergency: which is not really a crisis sort of thing, but rather a fairly standard statute allowing many state and federal regulations to be waived in order to provide more timely and efficient care.

The Public Good and The Profit Motive

This final step in the Swine Flu care process is perhaps the most applicable to the script of the show going on in the health care reform theater.  What it does is essentially bypass many of those mandated licensing, pre-approval, in-network/out-of-network, and HIPAA rules that turn the simple delivery of health care into something like trying to get electricity turned on in Mexico.

The acquisition and preparation of the H1N1 vaccine is also an indicator of a future path for drug development.  Five global drug manufacturers were selected based on their experience and capacity to deliver 250 million doses.  They were given specifications but were free to produce at their own designed efficiency – an efficiency which seems to have been overestimated, as is not uncommon for new product launches.

The US government popped for the $1.5 billion cost (about $6 each) so the drug companies got theirs.  The price for each shot is cheap enough, however, that consumers can even easily pay for it if the government would decide only to provide free versions to certain qualified groups.

Nothing is Perfect – Especially Our Bodies

The downside in all this is that the process is not going to be perfect; some people are going to die of the Swine Flu.  Many of us who shun vaccines or don’t get one in time will have a week or so of misery.  The press will forget that this flu is not as dangerous as other flu’s, and instead, make the inevitable vaccine distribution hiccups into some kind of life-threatening political failure.

But the American health system, such as it is, is an amalgam of government agencies and private health care providers that responded as it should, with calm concern and forward-looking emergency plans.

No one raced out to sell “preventive” face masks that protect no one as they did in Mexico. The weapon of choice in the American anti-flu campaign was information. Behind the public awareness campaign, there was a coordinated and quiet campaign to link health professionals at the state and local hospitals to the necessary resources, to establish uniform procedures for treating patients and create fallback plans if––and this is no idle threat––the contagion becomes an epidemic.

A Real Threat

H1N1 is nothing to sneeze at. One doctor I know wishes Emergency staffs were put on extended shifts during the height of this flu season, additional mechanical ventilators and oxygen were on stand-by, and a better network of back-up doctors were available. The threat of an epidemic breaking out is real. But it’s hard to justify staff overtime in the middle of a recession and unused ventilators are a hard item to sell on Ebay. And so far, the more common flu’s (yes, there are many kinds) have put more of our citizens out of commission than H1N1.

That, of course, hasn’t dissuaded some people from tying up expensive hospital space and physician time because they want “expert” care.  Even in the best of times, we have a propensity to believe money can buy health when the truth is common sense and common knowledge of how to prevent disease is our best defense.

Maybe that’s all it takes.  More readily available knowledge about disease and care options.  A few simple preventive guidelines instead of a million specific exercises, elaborate diet charts, and personal behavior prohibitions.  Drug prices that are high enough to be reasonably profitable for manufacturers yet low enough to be affordable to consumers.  And a significant reduction in prohibitive health care access regulations that lower efficiency and higher costs.

For the price of a week of personal discomfort, I think I have unlocked the secrets of health care reform.  Instead of a priority list of those who should have first access to the Swine Flu vaccine, I suggest we have a list of those who should not get it at all.  At the top will be all those who have made the health care debate into a political ping pong match. Let them spend a few days under the weather so they too can return to work ready to get something done that is workable and reasonable.  We’re not trying to save the world here, just give everyone a decent shot at good, affordable health care.


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