Be prepared, and be careful not to do
Your good deeds when there's no one watching you
If you're looking for adventure of a new and different kind
And you come across a Girl Scout who is similarly inclined
Don't be nervous, don't be flustered, don't be scared,
Be prepared(Tom Lehrer, Be Prepared)
The recent stories that CDC has not been able to determine the effectiveness of tax dollars meant to improve response to bioterrorism comes as no surprise. Not because CDC has misspent the money (which they probably have) or because they have been negligent in seeing if the money is well spent. The answer CDC gave is essentially the correct one. There is no good way to evaluate it, Congress's demand that they set criteria for the purpose notwithstanding:
"The difficulty comes down to, how do you measure (improvement), how do you quantify that, so you have something you can track over time, something you can use to identify gaps that have to be filled," said the CDC's Dr. Richard Besser. He oversees the Office for Terrorism Preparedness and Emergency Response.The government began awarding money for bioterrorism preparedness in 1999, sending $40.7 million to the states. In 2002, the total jumped to $950 million. That is about one-quarter of what the U.S. spends each year on bioterrorism and emergency preparedness - not counting the money for preventing a pandemic.
[snip]
CDC officials point to two reasons for the lag in developing the measures.
For one, the CDC is a scientific organization. It makes recommendations based on scientific data, but such data does not exists when it comes to showing which steps taken by health officials would bring about the best result during a particular emergency.
Also, the agency had difficulty getting health departments to agree about what the government should measure.
"Every health department is different, so where one may have strengths and they feel very confident in measuring something, another may have that as a weakness and feel less confident," said Donna Knutson, a senior adviser at the CDC.
State officials who attended the health officials' conference say many measurements are still unclear.
"I don't think they're asking things that are measurable," Kimberly Allan of the Virginia Department of Health said at the recent meeting of public health officials. "The right questions are not being asked."
Allan said the questions were too broad and hard to answer. But she said she did not have suggestions for improving them.
"Everything is so slippery and vague," added Karen Brady, preparedness coordinator for Tennessee's Health Department. "I could answer the questions five different ways." (AP)
This is a classic "nailing jello to the wall" assignment. But the money was handed out stupidly and I have every confidence the evaluation will be equally stupid. Here's what should have been done, in our not-so-humble opinion.
Take the billion dollars and give it to state health departments in the form of block grants for core areas of public health infrastructure: vital records/surveillance, maternal and child health, health service assessments (but not service delivery), substance abuse, local public health, etc. The current system puts strings on the use and forces many health departments to spend money on unasked for purposes and to do it quickly. Instead, let the state and local health departments spend it in these areas in ways they see fit. The result is guaranteed to be better than shoveling $1 billion and restricting it to bioterrorism uses (whatever that means). This will eliminate a vast amount of transaction cost to get the money and the ridiculous state plans, full of lies and new administrative layers and inane safeguards to make sure the money is spent on the intended purpose, bioterrorism. We now see what good the "safeguards" have been.
How will we know if the states have used the money "properly"? We don't know that now, despite trying to force them to do it. We don't even know what proper spending means in this case. The new "measurement" boondoggle will just create more paperwork and even less productive use of the money. Most state and local health departments have a much better idea of how to use the money than CDC. CDC can't even manage its own house.
State and local health departments are starving for resources. At one point they saw bioterrorism money as a savior. Instead it created further distortion in public health as money flowed in to support unwanted and unneeded activities (like small pox vaccination programs) at the same time money for essential public health services was drying up. This caused personnel reassignments that hurt both the traditional programs and provided little of use in emergency preparedness.
The old adage is that when public health works, nothing happens. The strategy of emergency preparedness appears to be that nothing should work until something happens.
Being prepared means prepared for anything, not just an anthrax attack. Prepared for seasonal influenza as well as a pandemic. Prepared for a hepatitis outbreak in a fast food chain. Prepared to provide services to substance abusers. Even prepared to provide adequate maternal and child health services. Prepared to provide reliable and accurate data when needed. Prepared with a working immunization program with good coverage. Prepared to help those with HIV/AIDS.
You know. Prepared.
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I can't help but notice: it sounds as though the best way to "be prepared" is to have universal health care.
All of those things are best accomplished with universal health care.
Joseph: Universal health care is an important element of being prepared, we agree. But health care and public health are not identical, although related. You need not only to deliver health services but to have a public health infrastructure to make that delivery effective and useful.
Public school funding was the pilot project for this plan. You require tons of new measurement activities until institution is so caught up in self-examination that it can no longer serve its public. Then when you pull out funding, based on ever more whimsical measurement requirements, the public is not there to support the institution.
My fifth grader has spent 3 weeks a year in the last three school years taking standardized tests to comply with No Child Left Behind. Two neighbor families have pulled their kids out of our otherwise stellar public school because "all they do is take tests" and home schooling looks like the better option.
perhaps in Massachusetts, the State knows how to use the money, but most don't and a lot of it will wind up disappearing into general funds. There are plenty of people with measurement training at CDC--most of them are psychologists or sociologists. The epi/MD mindset of the place means that Gerberding & Co. have no idea how to use these people. The kind of measurement training common to even PhD epi programs isn't terribly useful here and health economists often have a viewpoint that's poorly integrated into program planning and adminsitration.
It's very simple, in my again not-so-humble opinion. Tests or measurements create perverse incentives to fulfill those tests and not the real outcome. The broader the real outcome such as 'preparedness' or 'happiness' the more likely your tests will end up measuring something inane and ridiculous such as how many fliers did you send out or how many movies you watched last month.
Or did not watch.
See?
"the public is not there to support"
Yes, that is the target.
"health care and public health are not identical"
Would you care to expand? What each does? Why each is needed? Maybe the bits and pieces, and an effective order, we can demand of our representatives? And what we must do for ourselves?
Greg: Health care delivery is focused on the individual, not on populations, which is the focus of public health. More importantly, public health is prevention oriented, i.e., investing in services and policies designed to prevent people from getting sick and needing to seek health care. Surveillance, substance abuse, outbreak investigations are just three examples of routine public health that are not health care delivery. Most health departments are taken with tasks that are not concerned with health care delivery.
The Gerberdinator isnt the brightest bulb in the socket for sure. I dont think that UHC is a good idea for a number of reasons. This stuff with Walter Reed and the military is a good example. W. Reed hospital is well over 100 years old in some sections and it should have been torn down years ago. Bottom line to this is that it would mean that a bunch of politicians end up with an inept administration that would just keep on bottomless pitting the tax base until there was simply nothing left to tax.
This is the prime example of what happens when a group of politicians get control of money. First thing the Dems and Reps did in the last few days was to vote...and that vote contained several billion dollars for VA reform. Big surprise. Has to come from someplace. As a veteran we all are told never to depend on the VA for anything even though its part of the big package when you sign up. Well, you think these guys were treated badly, wait and see what UHC would do. All sorts of UHC country contributors here and I havent heard too many good things about it other than everyone is covered. But its also a health care rationing system. You get cared for when someone is good and damned ready too.
Kind of like Gerberdinator.
Randy: Easy for you to say. You've got health insurance. I've seen first hand what universal health care can do in Sweden and Canada. We are the only industrialized country without UHC and our health statistics reflect it. I've also worked in a VA hospital. The one I worked at is a lot better than many community hospitals. It's the fact that vets have been abandoned by the government that hurts. If government health care is so bad, why do members of the congress use it?
I'd give my eyeteeth to have the FEHB plan.
Melanie: We had the opportunity to take part in the FEHB plan and declined. It's expensive. Many guys where we work are paying out of the nose plus jumping at the opportunity to work overtime to just cover the expense.
There just isn't any good plan out there that I've ever found.
Members of congress use it revere because they get the Red Carpet treatment, and they are the only one's to get that treatment. (Compliments of the taxpayers).
And would you really treat them just like anyone else?
Right!
In Mels case I would like to see people who flat cant get insurance any other way at least be medically covered minimally. That is one bad shit problem she has but health care isnt a right. Its a perceived notion. Yeah, I have insurance and it would be gone 10 seconds or less after I developed a condition precluding it. Mel got it early and she should have access. For folks like her, I have no problems even paying the tax bill. But for the costs that employers have had to bear across the years that is no longer cost effective. They cant compete with someone in Pakistan or China where they havent got shit for healthcare.
As you say be prepared and do all thats possible. Else devil will take the hindmost. Run Forrest Run!
Amongst OECD countries, the US will be amongst the top few (number, I know not) of those where the amount paid for health care through a general redistributive mechanisms of wealth (as opposed to insurance, which redistributes health or risk..) such as tax collected by the State is low. That is not 'bad' in itself...
But, when redistribution is done, it is shunted to particular categories (poor children, the elderly), and not to everyone. This resembles charity - giving to particular categories of persons in need (such as single mothers, etc.) or those who are 'deserving' in some way (veterans) rather than the considerations of the whole population (nation, State, etc.) It leads to competition and victim-hood, neither of which are desirable in this area, imho, but that is another point.
The second particularity is the paternalistic aspect. The employer is responsible for the health of his employee and must contribute financially very heavily. (Ideally. Of course, on the ground...) As Randolph pointed out, this is not a viable arrangement as things now stand, or at least it isn't for many, viewed in an economic light. It is also very bad for the labor market. Most Europeans find the idea that a work-contract, where one sells labor and the other buys it, should include responsibility for the employee's health, really, really outlandish. Why shouldn't, for example, the employee be responsible for the boss' health? If the boss kicks the bucket, the employee is on the street. Why shouldn't the boss be responsible for the employee's housing, as well? - as in the days of slavery? And so on. The free market principles that the US claims to espouse are actually violated and distorted by these shenanigans.
(The third is insurance, which has slipped away from the mutualist, non profit model.)
Americans tend to be terrified of Kommunistic State procedures; they see powerlessness, submission to higher authority, and high taxes. The system they actually have - dressed up in a lot of jargon - is medieval in its spirit, and as it was then, expensive and wasteful, with the 'only' place for economies to be implemented in cutting off the 'poor' or 'certain categories', etc. This is a system that cannot easily be changed, which is another blow against it. The world moves on, adaption is necessary, common sense needs a look in: one needs not so much to 'be prepared' but to be able to 'react' (I suppose revere will say that is much the same thing..)
One pov, one angle, only. I mention it because these ideological roots are not usually mentioned as such, but drowned in a lot of argument about money and politics as empty slogans.
The following is certainly not an example of "Kommunistic State procedures", but the fear of the Bird Flu seems to have produced an intersting result, in some of the Kiwi communities.
Here is: Fear of Pandemic Flu, brings people together!
via http://birdflunewsflash.wordpress.com/
Its a huge step towards communism Ana. I also dont want the "state" making decisions for me or jacking up the rates as the Germans had to month before last to prop up the system that has basically as all systems do, gone broke.
Whenever they need money they simply jack it up another notch as the providers slip out of the business. In and out, in and out. Jacked up they are in, losing money they slip out. Then you end up with the one big provider giving shitty service and then saying they need to jack it up again.
Tan06 has the same problem in the Netherlands. She is a health care person and she hates the system and is now having to get as I understand it, supplemental insurance to cover what that great UHC doesnt. So whats the diff at the end of the day except that you gave over your freedom to the state to make decisions about something that really isnt in any constitution in the EU or the US?
Right to health care is a perception, not a right. Let BF come in on top of a UHC plan and then watch what happens. It would bankrupt the countries providing it, then the lawsuits because the ones that died waiting to get it would be off the scale.