Latest on H1N1 status

College campuses are already sites of mini-epidemics, and a friend's workplace in California has had a rash of cases in the past 3 days. With schools starting, we should expect H1N1 to ramp up fast.
My favorite source of info on H1N1, and up-to-date info on whether and how it's changing, lethality, etc., is CIDRAP at the University of Minnesota. Here's a link to CIDRAP's latest info (as of yesterday-Friday Aug 29). Good news is that the virus hasn't mutated. Bad news is that some young healthy people are getting serious viral pneumonia, that MUST be treated fast. Good news is that resistance to main anti-viral drug (Tamiflu (tm)) is still isolated and rare. But, getting care right away if lower respiratory tract is involved is important!
For a list of signs and symptoms of serious swine flu infection, see my posting of Aug 1, 2009,
Check into my posting of June 26 for information on what you should expect your physician and hospital emergency room to do when you do seek care..

"Public Option" out! "Choice and Competiton" in!

I hoped it would happen. The Obama Administration has seen the light and is ready to give up on a Medicare-linked public option (the only kind that could give the public plan an unfair advantage in a reformed marketplace). Now, the buzz-words from HHS Secretary Sebelius and Gibbs (WH Press Officer) are "Choice and Competition". I love it!

The problem with the insurance market has NOT been the evil insurance companies. The problem has been a failure of market regulation to guard against the four sources of market failure in health care insurance:

1. adverse selection bias into health plans -- If health insurance coverage is voluntary, and insurers can't deny coverage, only the old, or sick, or vulnerable will apply.
2. Cream skimming by health plans -- When insurers CAN deny coverage, or charge different rates to different people, only the healthy will be able to get insurance;
3. Incentives for over-use by the insured -- (this is called "moral hazard" by economists, a term that I consider to be incredibly stupid because it doesn't help me understand the problem. It's just an economist's way to keep normal people from thinking they know anything.) It's simple: if you don't pay the doctor anything (or very little) for a visit, or a test, or a procedure, etc., you'll have no incentive to restrict utilization or keep the doctor honest when he/she bills the insurer.
4. The provider is your "agent" in making health care decisions. Well, we pay him/her for that, don't we? Yes, but in this fee-for-service world he/she has an incentive to do more, or at the very least not to conserve resources. So, for example, the doctor may not get any money from ordering an MRI to rule-out something very unlikely but horrible, but he has no incentive NOT to order it, and it will justify a return visit (for which he'll be paid).

If problems 1 and 2 are fixed through regulation -- health insurance must be mandatory for all & health plans cannot discriminate either in coverage or premiums -- and if plans must compete for your business, then most of these problems will dissipate over time. It's the only way to get control over health care costs without leading to a single-payer system. (And I'm against a single-payer system, because Medicare and Medicaid are NO role models for efficiency and effectiveness in health care.)

More on the Pros and Cons of the Public Option

Richard Thaler (a well-known economist, born in NJ, too!) has a good piece in today's NY Times on the Public Option controversy surrounding health reform: "A Public Option isn't a Curse or a Cure." He says what I said (but I'm not such a well-known economist). He even refers to Victor Fuchs as the "Dean of Health Economists"... did he read my blog post of June 1? (ha ha...don't think so, but I like to brag anyway).
Thaler points out that, given a level playing field, government run enterprises NEVER out-compete private enterprises. Only if the public plan can exact concessions from providers (through legislative means) that private plans can't, will it be successful. Thaler emphasizes the capacity of the private sector to innovate. That's JUST what I said in my final opinion against a public plan, in my July 22 post. I see the potential for hospitals and doctors to integrate into stronger networks that encourage innovation under a system of competing regulated private insurance. That's our best hope of being able to evolve a system that balances quality, costs and access to care.
One point missing from the Thaler article is that to be on a "level playing field" with competing private plans, the amount that the public plan pays to physicians must NOT be tied to the Medicare Part B fee schedule, as is currently in the bill passed by the House last month. That bill requires that physicians be paid the Medicare fee schedule +6% (in hopes that will appease the AMA). But that amount is sure to be held below the amounts that private plans can negotiate. Sounds good on its face, but it strengthens fee-for-service medicine at a time when that mode of operation has been shown to lead to overuse of visits, procedures and tests. It will slow down innovation, and it will drive out private insurers because doctors will have a choice whether they must accept the private insurance fees. If the public plan can piggy back on the Medicare rules for physican fees and participation, it will have a big cost advantage.

Health Reform Debate-- more agreement than you'd think.

Here is a great interview by Terry Gross of Fresh Air of Paul Krugman of Princeton and Stuart Butler of the Heritage Foundation, on health reform. They agree on most things, such as whether employer health benefits above a threshold should be taxed, whether individuals should be forced to get health insurance, and whether health plans should be regulated so that they must give decent benefits and take all comers.
The one area on which they totally disagree is whether there should be a "public option" offered along side all the competing health plans.
I've already concluded that the public option would add to the long-term drag on true reform of the delivery system that is already caused by Medicare. But, I thought that the two of them made the best case possible for each side, so you should listen. We all need to understand what's at stake with health reform.

Save, Save Save!....er, no...Spend, Spend, Spend!

Am I the only one tired of the mixed (confused?) signals our economic "leaders" (Larry and Tim and Ben) are sending about what we should do with our money? We Americans have spent ourselves into a debt hole in the past 20 years, courtesy of China, mainly, which has bankrolled us. Just a few months back, we were hearing about the crisis in credit card debt due to our profligate spending on cheap Asian goods over the past 20 years.
Now we consumers are being blamed for the failure of the economy to respond to the gadzillions being poured into it by the government. If we just save it, they whine, then all that spending won't do what they want it to do. Make the economy look better and therefore make THEM look better.
So, what should I do? Here's how I'm thinking about the save vs. spend dilemma. Part of me wants to save save save for the rainy day that I absolutely KNOW in my gut is on the way. That day will bring torrents of inflation, mainly through collapse of the dollar, but also because oil prices will gradually sneak upwards. But, if I save, I must put my money in something that's inflation-proof, and those investments are hard to find. Especially since the big guys like Goldman Sachs chew up idiots like me who might try to invest in commodities. I really do not know how to invest in commodities.
On the other hand, I've wanted a lot of gadgets that look like fun. HDTV, smartphones, laptops, kindles, fitness monitors, new big computer screen, new desktop, Wii, etc. etc. And, new furniture, too. And new PJ's. All of these are made in China now. So, once China makes good on its hints that it will switch its currency away from the dollar, all those goodies will get much too expensive for me. So, I'm on a China spending spree right now.
I'll save later-- my savings will be in the form of higher taxes paid to the government when the bill comes due. Since I can't keep everyone else from spending their stimulus-gotten dollars on cheap China, and since I'll have to share in the forced saving known as paying back government debt through taxes, I might as well have a few gizmos to show for it.

Warning Signs of Serious Swine Flu in all patients

WHO just published guidelines for patients to know whether and when H1N1 (aka swine flu) influenza has turned nasty and now requires immediate attention by medical professionals. The title is "pregnant women", but scroll down to last section, which deals with all patients. Here they are for easy access in the coming months (September and later) when the swine flu is expected to hit USA hard again.