Archive for June, 2007

Bipartisan Support for More Provider Health IT

June 25, 2007

medical-computer-monitor.jpg

There’s a place for healthy partisan differences, and a place for bipartisanship. This initiative goes into the latter category. Whether you’re a free-market radical, a single-payer advocate, or something in between, better collection and analysis of information will help the delivery of medical care.

(Single-marketers take note: Primary physicians in Europe and the UK are well ahead of their U.S. and Canadian counterparts in the adoption of IT.)

A group of Senators that includes Ted Kennedy, Hillary Clinton, and Orrin Hatch has sponsored  a bill called The Wired for Health Care Quality Act of 2007. It provides $163 million over a four-year period (that’s not very much) to help providers who don’t make very much money adopt news IT strategies. It would also help states create low-interest loan programs for them, and provide funding for local and regional initiatives to collect and share health data.

The bill would also require that HHS designate an organization to create health care performance measures, which is an important step forward. If adopted, this bill will help create the electronic infrastructure for a better health system - whatever you imagine that system to be.

I don’t think there’s enough money in the bill.  It provides $40 million and change per year for four years.  That’s less than a few dozen costly medical cases will cost in each of those years.  But it’s a start, and that’s a good thing.

Mandates Aren’t From Heaven

June 20, 2007

mandate-of-heaven.jpg

I don’t like Mondays - mandates. I don’t think mandating health coverage is a winning issue for Democrats or the left, despite the fact that most Democrats and progressives seem to think it is. I wrote a piece for the progressive TomPaine.Com website explaining why:

The health reform debate has divided Democrats and confused the public. Plans have been offered by Presidential candidates, several states, and Sen. Ron Wyden. The success or failure of these plans, and perhaps of the Democratic Party, may eventually hinge on the public’s reaction to one issue: mandates that require individuals and/or employers to buy health insurance.

The rest of the piece is here.

Freedom and Health: Trans Fats, New York, and The Nazi War On Cancer

June 5, 2007

nazi-boot-crushing-cigarette.jpg

I was in Columbus, GA recently with an hour to kill. Columbus is a college town on the Alabama border that hosts at least one used bookstore. There I saw a small gathering of the usual counterculture-looking college town hangers on - closer in age to 30 than 20 - talking heatedly about the news of the day. Their topic was New York City’s new ban on trans fats, but unlike their counterparts in Northern college towns they were adamantly against it. I sat down on one of the beaten-up old armchairs and joined the discussion about balancing health with individual freedom, telling them about Nazism’s little-known role in pioneering cancer research.

It’s safe to say that my companions fell into the cohort that some political scientists call “left-libertarian.” According to at least one online quiz (of absolutely no scientific validity), I’m a left-libertarian too. Left-libertarians believe that government should take care of the needy and ensure equal opportunity, but are adamant in their defense of civil liberties and individual freedoms.

In pop-music terms, left-libertarians want to fund AIDS research because, like Dionne Warwick and Elton John, they believe “that’s what friends are for.” They don’t like speed limits, though - because, like Sammy Hagar and Van Halen, they “can’t drive 55.” While I’m attracted to the left/libertarian perspectives, I also see the limits of the philosophy: I don’t like wearing helmets on a bike, but then why should society pick up the health costs that ensue because of my bad judgment? New York City could simply require that restaurants post notices when they use trans fats, but many people don’t understand the issue. Should the penalty for their ignorance be a painful death?

My friends in Columbus were clear about this last question: Yes. If you choose not to learn about your own health and make informed decisions, then you must take responsibility for the consequences. Do they eat foods with trans fats? I asked. They unanimously answered yes.

Germany under Hitler took the opposite approach. As documented in a fascinating book called The Nazi War on Cancer, the German government undertook some groundbreaking research on cancer prevention during the 1930s and 1940s. The health of the German people was considered a state resource, as these slogans made clear:

Your body belongs to the nation!

Your body belongs to the Fuhrer!

You have a duty to be healthy!

Food is not a private matter!

The German tradition of social insurance (pioneered under Otto von Bismarck) was only one reason for the country’s emphasis on preventive health. As author Robert N. Proctor writes, another was the fact that “Nazi officials wanted productive, high-performance workers, free of sickness and full of love for their work. Many of (Nazi Germany’s) innovations … must be seen as part of this effort to engineer a high-achieving worker.”

Today’s cancer patients are sometimes led through visualization exercises where they are encouraged to think of their cancer cells as an invading army and their white cells as a resisting force. Medical students in Nazi Germany, on the other hand, were often shown illustrations that depicted cancer cells as Jews invading the “body” of the German state. German planners pursued (but never enacted) a comprehensive Cancer Law that would require all cancer cases to be registered with the state, while also including some very forward-thinking protections against exposure to X-rays, radiation, and quack cures for the disease.

Natural foods were a long-standing part of German culture, dating back at least as far as the 19th century, so alternative health practitioners figured into early discussions of the Nazi cancer hygiene program. Naturopaths were, however, eventually disappointed to find that their profession was not supported by the leaders of Germany’s anti-cancer program.There is perhaps no more profound expression of Nazism’s twisted ethical perversion than the fact that it outlawed vivisection as unnecessarily cruel - then threatened to send vivisectionists to the concentration camps.

Does that mean that aggressive cancer prevention is the hallmark of a totalitarian and exploitative state? Hardly, although conservatives and some corporate interests would like us to think that.

Proctor asks, “Do we look at history differently when we learn that Nazi leaders opposed tobacco … (and) worried about asbestos-induced lung cancer?” I think so.” Yet he also is clear about the need to avoid facile parallels between the Nazis’ cancer efforts and the legitimate public-health activities currently underway:

“Those who point to Nazi environmentalism sometimes extract from this the message that there is a fascist danger inherent in any state-sponsored public or environmental health protection … Tobacco does cause 80-90 percent of all First World lung cancers, and none of this is diminished by the fact that Nazi scientists were the first to prove the point.”

Where does that leave us regarding New York’s ban on trans fats? My friends in the bookstore were adamant: Trans fats should be legal, even if one of them dies someday as a result. But why should everybody else pay the social and medical cost for your bad decisions, I asked? It’s the price of freedom, they replied.

Do I need or want the freedom to die unnecessarily? My mind says no, and if I were an elected official I would probably support the ban on trans fats. My heart? That’s something else altogether. I don’t want anybody telling me what to do.

But then, as my driving record shows, I can’t drive 55 either.

To buy The Nazi War On Cancer by Robert N. Proctor, click here.