Several readers have objected to my Dec. 29 post on government's responsibility for swine flu shortages. They protested that certain pharmacies other than the one I mentioned do indeed offer the vaccine, and that in fact truckloads of vaccine are being carted away for dumping due to lack of demand.
All very true, I'm sure, so I must expand my point.
For my 15 years in New York, I have obtained my flu shot from my own doctor. I know him, I know his nurses, and I am confident in the cleanliness of his operation. This year, my doctor was not given an adedquate supply of the regular vaccine, and he never was able to obtain any swine flu vaccine, despite having dotted all the i's, crossed all the t's and applied to the proper authorities on time.
He told me that I could go to a makeshift clinic at a public school for a swine flu shot, but that I'd have to wait in line ..for a long time.
Now, I'm of the age that I don't like spending my limited time waiting in school auditoriums for basic medical precautions. Neither am I enthusiastic about popping into a designated drugstore across town where I don't know the staff. Anyway, I try to limit the time I spend in drugstores with my three-year-old, else I'd be liable for hundreds of dollars in bills for broken bottles.
So why didn't they give my doctor vaccine this year? He's not exactly a slouch as doctors go. In fact, he was the chief resident at New York/Cornell, which is equivalent in the world of residents to being the Godfather.
I have a theory. It's because "they're" trying to run private doctors out of business. They've reduced their payments and they've made their lives so miserable with crazy regulatory paperwork that many have stopped accepting insurance. Now, they're cutting off their supply of medicine.
The Mayo Clinic said this month it would no longer accept Medicare patients at its Arizona center because ObamaCare would cut reimbursement so much that it is no longer practical to offer care. This isn't some plastic surgery factory; it's the Mayo Clinic! Mayo said it would "study" the effect of the decision, a clear signal that health care will be in short supply if government persists on its course.
But that's always the case when government officials start believing they are smart enough to be distributors, be it of money (viz. the credit crunch) or medicine.
I hate ideologues, and I don't want to be one myself. I am always willing to hear arguments that would refine my thinking or change my mind. But the government's handling of the 2009-2010 flu vaccine still seems to be less than ideal.
2 comments:
Laurel: Might I suggest that you try to separate a number of separate issues here....some of which are very difficult:
If you ask the administrator in your physician's office, he/she will explain to you that, depending on the locale, the vaccine was allocated by either a local commercial distributor or by a local health department using a CDC-designed methodology.
The intention was that the allocation(s) were based first on a multi-variate risk assessment and then a lottery. In addition to targeting early vaccine distribution for densely populated areas and physicians/clinics with higher-risk patients, CDC models were intended to project the minimum vaccination % necessary to attenuate local outbreaks. This was the theory.
It is entirely plausible that early-on, your physician was classified as having a low-risk practice, and he didn't receive vaccine under the risk metric or the lottery.
CDC vectors do not consider the credentials of the administering physician -- nor is there any rational reason why they should.
Having stated the "facts," now let's become theoretical:
Imagine if you have a city of 7 million people facing a smallpox outbreak and only have 1 million doses of vaccine. How should the vaccine be allocated? Should it be allocated based on a financial auction system? Should be allocated based on a combination of epidemic attenuation and lottery? Should it be allocated based on IQ? Age? Income? Status? etc etc etc.
And, how should these decisions be made? And who should make them?
These are difficult ethical and practical questions, and are even more difficult than deciding who goes to the top of an organ transplant waiting lists. Just imagine a parent with three children and two doses of small pox vaccine.
Just some food for thought...
"Just imagine a parent with three children and two doses of small pox vaccine." Is the government the "parent" and the citizens its "children"?
I thought this was the United States of America - not the Union of Soviet Socialist Republics.
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