Swine Flu Hearts Our Health-Care System
The President's Council of Advisors on Science and Technology released its big report (pdf) on H1N1 on Tuesday. Some of the news was pretty sobering: The council estimates that swine flu could infect up to half of the population this year, hospitalizing 1.8 million and causing as many as 90,000 deaths — about double what we'd expect from an average flu season. And that's assuming there's not a dangerous mutation that makes the virus either more lethal or more communicable. Matters aren't helped, unfortunately, by our fractured and inefficient health-care system.
Because the most severe outcomes appear to be concentrated in certain groups, based on data thus far with 2009-H1N1, it is logical to assume that focusing mitigation efforts on those groups will have disproportionate public health benefits. In addition to accelerating the availability of vaccine, it is important to develop clear guidance about the means of access and appropriate use of vaccines and anti-viral drugs for these groups and to communicate that guidance to them and their health care providers promptly and effectively (discussed in Chapter 7). We note that the complex and distributed nature of the U.S. healthcare system poses logistical challenges in accomplishing these goals, which will require considerable planning.
We have a tendency to judge the health-care system primarily by its capacity to deliver extremely sophisticated and advanced care for traumatic injuries and catastrophic illnesses. The sort of stuff you see on "House," say. But we think much less about its role as a public health infrastructure — its ability to deliver flu shots, and make sure that all of the country's inhabitants have a trusted medical professional they can see if they're sick.
On those measures, our system performs terribly. It's simply too fractured to do anything different. Almost 50 million Americans have no insurance. Many more are underinsured. Many don't have a particular doctor or even medical center where they feel comfortable receiving care. Many are uncertain about what is and isn't covered in their health plan. Many have recently been uninsured, and so have no regular contact with the medical system and haven't established an obvious way to begin having some.
The backstop to all this chaos is that you can go to an emergency room when things get really bad. That's fine for a car accident. It's not good for preventing the spread of the flu. You don't go to the emergency room when you're a bit sick. You go when you've become really ill. Which not only increases the likelihood that you wait until you get really sick, but with the flu, that you infect many others along the way. That in turn gives the flu more opportunities to mutate into something much worse. And let's not even talk about our insistence on keeping the illegal immigrants who prepare our food and clean our homes from seeing the doctor, as if H1N1 can't be transmitted by people who don't have a green card.
Photo credit: By Mark Humphrey — Associated Press
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