Swine Flu Madness and American Health Care

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May 4, 2009 by D Stack

They are coming for us

They are coming for us

It has been quite the week here on planet Earth. An influenza virus in Mexico which was just beginning to register has advanced around-the-clock cable news coverage. I believe Joe Biden gave some words of wisdom. Something along the lines of “OMIGOD WE’RE ALL GONNA DIE!!! RUN FOR YOUR LIVES!!!”

The White House then clarified his remarks to be something along the lines of “stay calm”.

In all seriousness the advice given is pretty good. Practice basic hygiene. Don’t go to work or school if you are sick. Call your doctor if you are sick, though don’t trot to the emergency room at the first sign of sickness.

My six-going-on-seven-really-soon year-old daughter was asking me about the swine flu a few days ago. She asked if we were planning on going to Mexico any time soon. She informed me, in a very serious tone, that “people are dying there”. Yes, swine flu has even entered the American consciousness. I explained to her how we’d be careful to not get it but if we did get it we’d go to the doctor and they’d help us out. I also talked with her about flu vaccines. Having had a bad case of the flu about a few years before she was born I’m hoping to avoid a repeat performance and have had a flu vaccine every year since.

Now while all this advice is good it runs into problems of our health care system. It presupposes a few things:

  1. You have the ability to easily stay home from work. Many Americans have zero sick days per year.
  2. You have medical insurance. Many Americans have jobs which do not provide medical insurance. Or don’t have jobs at all.

A personal anecdote. One month after my oldest daughter was born the startup I was working at went out of business. So there we were with my wife on maternity leave, me unemployed in the summer of 2002 (about the worst point of the previous recession), and our first child just born. With lots and lots of trips to the doctor. Out-of-pocket was not an option. I’d either need to sign up for COBRA (paying what my old employer paid plus my own contribution) through my former employer or we’d need to sign up for my wife’s insurance with very high premiums. And with her on maternity leave no corporate-match. And to add to the worry if my former employer were to dis-incorporate it was uncertain if the COBRA would do any good. We wound up paying something close to a thousand dollars a month for that (800 comes to mind) – not an easy expense with a new baby and two then-unemployed parents. I lucked out and landed a new job in short order but it was not something we’d’ve been able to sustain for long.

So it is natural that many people without insurance or financial resources hold off medical care for as long as they can. A day home sick from work could endanger their job. A trip to the doctor would need to be paid out of pocket. So many wait until it is too late and wind up going to the emergency room. This clogs up the ERs and also results in care very late in the game – often times too late. If I were a betting man I would bet this is likely what happened to many of the flu victims in Mexico. And people coming to work sick can infect their co-workers.

So while many associate guaranteed health care with “socialized medicine” it would seem reasonable to have some sort of national health care guarantee. The state of Massachusetts, where I live, has been working on universal health care. There are tax penalties in Massachusetts for those who lack health insurance and either fully or partially subsidized health care programs for those making up to 300% of the poverty line. I don’t think it is the perfect solution, but one thing which makes it more effective in Massachusetts than in other states is the fact that Massachusetts has regulations prohibiting insurers from blocking or raising rates for people with pre-existing conditions. Paul Krugman points to this example in his book The Conscience of a Liberal. He also suggests that a government program be available as an alternative for those who desire it, allowing consumers to choose between corporate and government-run health care options, with subsidies for the unemployed and underemployed. (As an aside, I remain unconvinced a competitive market is really capable of rendering the best health insurance option given its objective is to make a profit which means a need to deny care.) It should be noted that this is not socialized medicine. If it were taken to the ultimate extreme, with only a government-run insurance program, then it could possibly be defined as socialized insurance. But most nations with universal health care still have privately provided care.

In addition to the need for universal health care there is also a clear need for workers to have additional guaranteed rights – the very least of them would seem to be the right to stay home without penalty if they are ill. This would seem to be a good program for employers given that sick workers can infect other workers, but I would imagine that many such employers might find it more expedient simply to deny sick time and replace sick workers with healthy ones. In many jobs, such as retail, this may be a no-brainer. This is why some form of regulation is needed – the invisible hand does not always work to the benefit of the individual worker.

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