What your doctor should know to do about Swine Flu

Sister Janet tells me that Swine Flu (or, if I were more PC, "novel H1N1") is the scourge of the Chicago area right now. Probably everywhere, but who's counting? While number of cases reported seems low, that's because little testing is going on. So, anyway, suppose you or your kid gets sick with flu like symptoms, especially including gastro stuff (almost 40% of cases), here are two good guidelines for how you should be handled by doctors and emergency rooms. These are intended for doctors, but I can read them, so you can too. We should, having lived long enough by now, know that doctors and hospitals don't always follow best practices (witness the high rates of hospital-acquired infections in this country!)

• First is World Health Organization's Patient Care Checklist. You can take it with you to the ER and keep yourself occupied while waiting to be seen.
• Second is the CDC's guidelines for use of anti-viral drugs in children and adults.

I got these sources from the University of Minnesota's CIDRAP daily on-line newsletter. If you're a health nut, you'll really enjoy getting it too. I knew about the Nestle's chocolate chip cookies real fast.

Pharma's "gift" to the Medicare patient.

Perhaps you heard -- Pharma just got together with AARP to announce that they will offer a 50% discount on patent-protected brand name drugs for Medicare patients once the patient reaches the "doughnut hole" -- the point in annual spending ($2700) when Medicare takes a breather and the patient is responsible for 100% of his drug bill. (Later in the year, once the patient's total spending (out-of-pocket + Medicare-paid) reaches $6154, catastrophic coverage kicks in, and Medicare gets generous again). Though the details are sketchy, one account says that all the savings will go to the patient. That is, the full cost of the drug will count toward achieving the catastrophic limit, so the patient will get credit for the other half of the drug's price, too. The Medicare plan won't gain any savings. Sounds like a good deal for the patient, but not if it takes the pressure off drug companies to keep total prices down, and if it induces patients and their docs to order more brand name drugs. Then the cost of the drug plans will rise, and both the gov't (us) and Medicare enrollees will pay more in premiums. Also, how can the administration be considering using the savings to pay for health reform when there don't appear to be any savings to the program itself?

If, however, Pharma means that the patient's actual spending will be what counts toward the catastrophic limit, then the patient won't gain as much, and he won't gain anything if the total costs of his drug coverage take him to the catastrophic limit. He'll just get to the limit more slowly during the year.

So, it seems for now that everyone is being duped but the drug companies. Or is everyone (AARP, Prez Obama, drug industry) trying to take credit for something that's too byzantine for us to follow?

White House Whitewash of Ratings Agencies

Way back in one of my earliest blogs, Nov 5 to be exact, I issued a guide to good radio programs on the web that explained the sources of the meltdown in a way that I could understand. A long list of programs, but here's what I said about those rating agencies:

• Are the real culprits the Ratings Agencies (S&P, Moody's, Fitch)? -- I think so, and here's the best explanation! C-Span -House Hearing on Credit Rating Agencies - Henry Waxman (D), Chr. This is a 4-hour hearing, boooring... but if you can navigate to the statement of Sean Egan, Managing Director, Egan-Jones Credit Rating Agency– minute 31:13-39:10 - and again in answer period 44:00-46:05, you will want to start knitting quietly in true Madame DuFarge style! See Hearing.

So, I've been anxiously awaiting the Administration's proposal for regulatory reform to see what they're going to do about these rogue agencies that gave AAA ratings to junky credit default swaps. Last week's Treasury Report outlining the proposals made me think there is no hope, because those ratings guys & their regulators were almost completely let off the hook, except for an Obama-style sermon about how they should go forth and sin no more.

Before I could write a scathing blog piece, however, the Wall Street Journal did it in an editorial that lays out the perfidy of our financial leaders in both the private and public sectors. (WSJ-The Triple-A Punt) Here's a couple of choicest comments from that editorial, which you can read on the web free.

• "Without the ratings agency seal of approval -- required by SEC, Federal Reserve and state regulation for many instituitonal investors -- it would have been nearly impossible to market the structured financial products at the heart of the crisis."
• The Fed's standards for banks "...allowed Wall Street firms to claim that highly-rated mortgage-backed securities on their books were almost as good as cash as a capital standard."
• The treasury's report "..blame[s] the victim. 'Market discipline broke down as investors relied excessively on credit rating agencies'."
• "..the Fed, which until recently would accept as collateral [from banks] only securities that had been rated by S&P, Moody's or Fitch, has lately acknowledged the flaws in this approach."

WSJ wants the government to embrace full reform of the entire ratings system. So do I. It's ironic that the Federal regulators that played the biggest role in causing the ratings debacle -- the Federal Reserve and the SEC -- come out as winners in the reshuffling of regulatory powers under the plan. Only hope now is Congress -- Do you live in Connecticut? Threaten Senator Dodd with further exposure as a patsy (or collaborator) in his role as Banking Chair as he fights for re-election. Live in Mass? Write Barney Frank telling him to find his inner populist! Live in California? Tell Henry Waxman you expect him to walk and chew gum at the same time -- he can reform the agencies while he reforms health care. Here's how to email any member of Congress.

Babies born to Unmarried women - 40% in 2007

This was a hard-to-believe statistic I learned from the latest Data Brief issued by the National Center for Health Statistics. Of all babies born in 2007, 40% were to unmarried women. The percentage is rising among all age groups, not just teens; it's rising even in women 25 years of age and older. For example, the birthrate for unmarried women between 30 and 34 years old was 21 per 1000 births in 1980. By 2006 it was 55 per 1000 births.
That doesn't mean that Daddies aren't around, of course. But is it the Brangelina effect; or is it the greater economic independence of women and reluctance of men to have children; or is it the continued existence of a marriage tax that is undermining the institution of marriage?
I'm not sure how bad this is for society, if at all. Just don't know the evidence to comment. But it sure did surprise me.

Just took the new Alzheimers 5 min test & passed!

Hooray -- no nursing home for me this week. British Medical Journal just reported on a new 5-minute test for Alzheimers, just 2 pages long. It's supposedly much more sensitive than other tests. Here's a link to the test on-line. It's biased in favor of Brits and against Americans because of one cultural question. So, don't freak over that one. Haven't found the scoring system yet but will post when I do. Best for you to answer every question successfully. That way you'll have a perfect score and know that you, too, will stay in the community for a while, at least.

The "brilliant" Larry Summers

Yes, it's Larry Summers time again. This time it's a piece in the New York Times on the workings of Obama's West Wing economics team. Here are the main descriptions of our Bad Boy in that article :

• the brilliant but sometimes supercilious Mr. Summers
• Mr. Summers, given his prickly personality,
• His argumentative style
• under Mr. Summers, meetings became “endless debating sessions,”
• “Larry Summers is one of the world’s most brilliant economists,” said Mr. Orszag,
• He enriches any discussion he participates in,
• "....pretty good at making the case against anything.’
• The arguments became so heated that Mr. Summers stormed from one meeting,
• “incredibly inclusive” and “listens to the economic arguments"

So, there, amidst the questionable traits, and some good traits, is the ubiquitous "brilliant" description. Why do economists and the press that covers them continue to describe this man as "brilliant?" I'm sick of it. The man was instrumental in fostering public policies that led directly to the immensity of our current "Great Recession" (as we're now calling it). And, he has never owned up in public to his role in it.

So, can we now start referring to him as " the inclusive and argumentative, but mentally challenged, Mr. Summers?"

I'd feel so much better if the press would stop lipsticking the pig.

Robert Reich on GM, bailouts, productivity and US.

My prolific reader friend Lupi sent me link to three pieces by Robert Reich(Labor Sec'y under Clinton) on the future of our economy, as seen through the prism of the GM bailouts. (ReichPartI; ReichPartII; ReichPartIII). She knew I would like them. Reich always makes sense to me, but his sensible ideas never seem to make it into policy.
We really DO need a new political party in this country -- the Common Sense Party? -- the Centrist Party? My advisors tell me I'm a dreamer to imagine that the grass-roots power of the internet could bring about such a thing. I'd follow Reich if he announced such a move.
Turns out Reich has a blog where he posts wonderful stuff on all manner of public policy issues. Check it out here: Reich Blog. I'll put a link to it in the list of blogs here (scroll down to bottom in left column), so you can always find it. Or, just add it to your own Favorites list.

What it's like to be a Public school HS teacher at end of year

Early this week I learned in the Washington Post that students in a local suburban high school are waging a campaign to allow cell phone use in school.
At lunch, at the very least, they say. And today a Post editorial actually endorsed the change. (If that happens, all the more reason to send your kids to private or parochial schools.)
Now our "Teaching Stories" author (Ynonymous) has sent along another description of her life as a high school science teacher in a local suburban public school district. Issue 3- End-of-School-Year Thrills helps to put the state of the adolescent mind into perspective. Why would we want to enable students to self-distract any more than at present? Read it. You'll feel like you're there in the classroom, but you'll be glad it's she and not you!

Do workers need a week of guaranteed sick leave?

Now that we're through taking ownership of the company that makes the cars that we refuse to own, time to turn to improving working conditions for those of us who still have jobs. The Dems (101 of them) in the House have introduced legislation (HR 2460) to require every employer with more than 15 employees to offer 1 hour of paid sick leavefor every 30 hours worked, up to a total of 7 days per year. Read all about it in an informative About.com article. Sen Kennedy says that 89% of low-wage workers (low-wage undefined in article) are without any paid sick leave.
On the face of it, this sounds like a good idea. (Who wants coughing/hacking co-workers at the MacDonalds?) But Lupi R, who has close-up experience with small businesses that compete with low-cost producers in other countries, points out that it will put further strain on those firms struggling to make it in this economy. She believes that workers will be inclined to "use up" their sick leave every year, whether sick or not. Businesses that need to keep running will have to pay other workers time and a half to make up the difference. (As a retired Fed who hoarded sick leave, but only up to the point that I couldn't carry it over into the new year, I'm afraid she may be right. When it's use-or-lose, let's face it, we're gonna use!)
If you accept the labor economists' argument that total compensation is what employers pay (TC= wages + benefits), then greater benefits means higher TC. That makes us even less competitive than we already are. Or, more likely, employers will adjust wages downward to keep TC about the same as before. Of course, not every employer will do this right away, but the more competitive the sector, the more necessary such downward adjustment will be. Some employers will hire fewer workers and squeeze more work out of 'em. (How can that be? Aren't we a bunch of cellphone slaves as it is?) Some might demand higher cost-sharing for health coverage (oh, joy). Things have a way of working through the system. And, if they don't squeeze wages down, that's just more unemployment due to our even more evolved inability to compete globally.
Bottom line for me is that it's better to keep things as they are. If we want to subsidize workers without such benefits, we can do it through the myriad programs we already have to augment their incomes (earned income tax credits; subsidy programs; unemployment benefits, etc.) Mandates on employers, especially small businesses, are not the way to go right now, and perhaps right ever.
Do I sound like a Republican? Jeez! Either way you come out on this, you can weigh in with your congressman in minutes. Here's how.

Health Reform and the "Public Plan" option

The political energy in Washington has centered on two issues of late:

1. Whether there should be a "public plan" option (think Medicare fee for service) along side private insurance companies
2. Whether employers that offer health insurance should be able to deduct those costs as business expenses (a 35% tax subsidy if the company is making money). If so, should the deduction be capped in some way?

Number 2 -- that's important, and maybe I'll figure it out. (I'm not betting on it.)

Number 1- I don't have to figure it out. Victor Fuchs, the dean of health economists, figured it out for me in this week's New England Journal of Medicine. Here's the free link to his article in NEJM. Bottom line: public-schmublic...it's not going to matter that much. It's no panacea for the problems we've got, and it won't kill private insurance. The latter I'm not so sure about. The former -- based on all we know about how ineffective Medicare has been these past 50+ years in controlling costs or assuring quality -- is a slam dunk.