Bad News for Kids Healthcare

A new Federal Report out yesterday finds that states will be running out of health insurance next year... oh well, I guess their parents can just go buy private health insurance! According to the New York Times...

Twenty-one states will run out of money for children’s health insurance
in the coming year, and at least nine of those states will exhaust
their allotments in March if Congress simply continues spending at
current levels, a new federal study says. The findings added urgency to bipartisan talks on Capitol Hill intended to overcome an impasse over expansion of the State Children’s Health Insurance Program. States, unsure of federal money, are drafting contingency plans in case it runs short. Officials
in charge of the child health program in California said Tuesday that
they were adopting rules to allow the state to create a waiting list
and to remove some of the 1.1 million children already on the rolls.

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Republicans for healthcare, helping the poor?

Odds are, at this point, that we'll see a Democratic President elected next time around. Does that mean we'll have better social policies and a government that actually sets out to achieve social justice? Maybe. I think to get there we'll need political philosophies on both sides of the aisle that include social justice as its goal.

Thus far, the current crop of Republicans don't offer much hope. Appealing to the most conservative and libertarian base to oppose even expanding health care for poor children for fear that it might cut in to insurance company profits through undue competition.

Yet the times, they are a changing. The New York Times Magazine this week reports on a growing generational shift in the Evangelical movement. Younger evangelicals are calling for actions to help the poor, protect the environment and provide health care -- not just banning abortion and outlawing homosexuality and evolution in schools. In reading the piece, I can't help but feel they have the more compelling -- and the more Christian argument. After all, Christ didn't talk much about evolution in schools, but he waxed on and on about the poor, the sick, and the afflicted. Did Christ want tax cuts? The Gospel says he told his followers to pay their taxes.

So can Republicans find a philosophy that meshes with this new social argument for feeding the poor and treating the afflicted that also call back their Evangelical flock? The Washington Post's Michael Gerson has a good analysis and and answer -- if anyone is listening.

There are, in fact, two belief systems contending for the soul of the
Republican Party, but one is not liberalism. The two intellectually
vital movements within the Republican Party today are libertarianism
and Roman Catholic social thought -- a teaching that has influenced
many non-Catholics, including me. While it affirms the principle of limited government -- asserting the
existence of a world of families, congregations and community
institutions where government should rarely tread -- it also asserts
that the justice of society is measured by its treatment of the
helpless and poor. And this creates a positive obligation to order
society in a way that protects and benefits the powerless and suffering.

No presidential aspirant can win without a message of solidarity, a
vision of justice and hope that includes the whole country. A
Republican Party that does not offer a robust agenda on health care,
education reform, climate change and economic empowerment will fade
into irrelevance.

But the moral stakes are even higher. What does a narrow,
anti-government conservatism have to offer to urban neighborhoods where
violence is common and intact families are rare? Very little. What hope
does it provide to children in foreign lands dying of diseases that can
be treated or prevented for the cost of American small change? No hope.
What achievement would it contribute to the racial healing and unity of
our country? No achievement at all.

As the Republican candidates attempt to prove themselves the
exemplars of conservatism, they should consider what that philosophy
can mean: the application of conservative and free-market ideas to the
task of helping everyone.

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Screen For MRSA

New JAMA Report out this a.m. that MRSA -- a antibiotic resistant staph infection -- is more common that thought. We see a ton of it come in the door at our hospital. That's the little secret of MRSA is that it is out there in the community. It shows up in hospitals and nursing homes because it is a skin bacteria that tends to get introduced into the sterile areas of the body through invasive practices in the hospital. As the New York Times explains:

MRSA, which was first isolated in the United States in 1968, causes 10
percent to 20 percent of all infections acquired in health care
settings, according to the disease control agency. Resistant to a
number of front-line antibiotics,
it can cause infections of surgical sites, the urinary tract, the
bloodstream and lungs. Treatment often involves the intravenous
delivery of other drugs, causing health officials to worry that overuse
will breed further resistance.

We see a lot of it from drug users who shoot up of course (they always claim it is a "spider bite") but we're also seeing it in folks who get small breaks in the skin allowing infection to enter.

The bacteria can be brought unknowingly into hospitals and nursing
homes by patients who show no symptoms, and can be transmitted by
contact as casual as the brush of a doctor’s lab coat. Highly
opportunistic, they can enter the bloodstream through incisions and
wounds and then quickly overwhelm a weakened immune system.

So how do you decrease MRSA -- besides washing your hands of course?

The findings are likely to stimulate further an already active
debate about whether hospitals and other medical centers should test
all patients for MRSA upon admission. Some hospitals have had notable
success in reducing their infection rates by isolating infected
patients and then taking extra precautions, like requiring workers to
wear gloves and gowns for every contact.But other research has
suggested that such techniques may be excessive, and may have the
unintended consequence of diminishing medical care for quarantined
patients. The disease control agency, in guidelines released last year,
recommended that hospitals try to reduce infection rates by first
improving hygiene and resort to screening high-risk patients only if
other methods fail. Dr. Lance R. Peterson, an epidemiologist
with Evanston Northwestern Healthcare, said his hospital system in the
Chicago area reduced its rate of invasive MRSA infections by 60 percent
after it began screening all patients in 2005.

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How Science By Cascade Caused Bad Diet Advice

The New York Times has a great article about how the American Diet was lead astray by the assumption that eating fat makes us fat. The Times had a head start on "The Big Fat Lie" by running a Times Magazine cover story on the subject a few years ago. Now the author -- science writer Gary Taubes -- has a new book out "Good Calories, Bad Calories" describing how bad science and bad information may have played a role in our national obesity. As Taubes wrote in July of 2002:

"If the members of the American medical establishment were to have a
collective find-yourself-standing-naked-in-Times-Square-type nightmare,
this might be it. They spend 30 years ridiculing Robert Atkins, author
of the phenomenally-best-selling ''Dr. Atkins' Diet Revolution'' and
''Dr. Atkins' New Diet Revolution,'' accusing the Manhattan doctor of
quackery and fraud, only to discover that the unrepentant Atkins was
right all along. Or maybe it's this: they find that their very own
dietary recommendations -- eat less fat and more carbohydrates -- are
the cause of the rampaging epidemic of obesity in America. Or, just
possibly this: they find out both of the above are true."

"Over the past five years, however, there has been a subtle shift in the
scientific consensus. It used to be that even considering the
possibility of the alternative hypothesis, let alone researching it,
was tantamount to quackery by association. Now a small but growing
minority of establishment researchers have come to take seriously what
the low-carb-diet doctors have been saying all along. Walter Willett,
chairman of the department of nutrition at the Harvard School of Public
Health, may be the most visible proponent of testing this heretic
hypothesis. Willett is the de facto spokesman of the longest-running,
most comprehensive diet and health studies ever performed, which have
already cost upward of $100 million and include data on nearly 300,000
individuals. Those data, says Willett, clearly contradict the
low-fat-is-good-health message ''and the idea that all fat is bad for
you; the exclusive focus on adverse effects of fat may have contributed
to the obesity epidemic.''

Yet, if fat isn't as bad for us as we've been lead to believe, why has the medical community been in harmonious agreement on the subject -- incorrectly -- all these years? Today's Times article explains that a "cascade" of theories piled upon each other despite clinical evidence to the contrary. How?

"....the architects of the federal “food pyramid” telling Americans what
to eat, went wrong by listening to everyone else. He was caught in what
social scientists call a cascade. We like to think that people
improve their judgment by putting their minds together, and sometimes
they do. The studio audience at “Who Wants to Be a Millionaire” usually
votes for the right answer. But suppose, instead of the audience
members voting silently in unison, they voted out loud one after
another. And suppose the first person gets it wrong. If the second person isn’t sure of the answer, he’s liable to go along
with the first person’s guess. By then, even if the third person
suspects another answer is right, she’s more liable to go along just
because she assumes the first two together know more than she does.
Thus begins an “informational cascade” as one person after another
assumes that the rest can’t all be wrong."

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A Socialized Medicine History Lesson

Great piece in Slate Magazine about the history of the term "Socialized Medicine" as a judybat to whack back attempts at health care reform. While Bush never ceases to amaze, I was floored when he used this as the argument for opposing the expansion of children's health care. Socializing costs of anything is one thing governments can be good at -- whether it is to pay for an aircraft carrier or health insurance for 43 million people. The current system already socializes the costs, but does so inefficiently, at greater cost to employers and those with insurance. That said, this is really a political tool to maintain the status quo, not a philisophical difference. As such, it may be a desperate, loosing one at that. As Slate concludes:

Newt Gingrich, then House minority whip, blasted Clinton's plan as a throwback to the kind of "centralized, command bureaucracies" that were dying across Eastern Europe.

But if these attacks ginned up some hostility to Clinton's plan, the real problem was more fundamental. As political scientist Jacob Hacker has argued, the basic obstacle was nothing less than the government's failure to have adopted a comprehensive health insurance plan decades earlier. As a result, the system that emerged by 1994 entailed such a crazy quilt of private interests—corporations, small firms, insurers, doctors, unions, HMOs, and so on—that moving all Americans into a new framework without worsening anyone's situation had become virtually impossible. Many of these interest groups (including doctors) actually favored reform in the abstract. But no particular plan was going to please them all.

Perhaps, then, the socialized medicine scare tactic really has run its course. The Republicans' decision to dust it off for one more battle may say more about their party's continued sprint to the right-wing extreme than about any intrinsic public hostility to government social programs. If this is the case, then Democrats might be wise to offer health-care proposals that don't upend the status quo, while brushing off the socialized medicine attacks as atavistic Cold War-era alarmism. Which seems to be, for the moment, precisely what they're doing."