Health Culture Daily Dose #6

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In today’s Dose:

Health care reform
(Congressionional Budget Office numbers; Why Maggie Mahar isn’t worried; Kevin MD, Daniel Callahan)

Foodborne illness
(Cookie dough)

Industrialized agriculture
(Food Inc.)

The risk society
(Jodi Picoult novels)

Health care reform

  • A recent Ezra Klein Klein column in the Washington Post discussed the bad news this week from the Congressional Budget Office. Health care reform will cost $1.6 trillion over 10 years, not the $1 trillion the Senate HELP committee was targeting, and that’s with one-third of the uninsured still without coverage.

[H]ealth reform has just gotten harder. The hope that we could expand the current system while holding costs down appears to have been just that: a hope. … The question now becomes whether we want health-care reform that achieves less of what we say the system needs, or more. Doing less would be cruel to those who have laid their hopes upon health reform. But doing more will be very, very hard.

I have always thought that reform would be very hard. I knew that conservatives and lobbyists would fight with every weapon at their disposal–and that they wouldn’t mind distorting the truth, which is what they have done by making a mountain out of CBO’s preliminary mark-up of the Senate’s rough draft. …
The headlines are correct in one sense: reform is not “inevitable.” This is not a Greek Drama where the final Act is written in the stars. As I have said all along, the battle will be fierce, and, in the end it will not be pretty.
Those who have been gouging the system will have to be gored. Imagine a slaughterhouse with gobs of fat and pools of blood on the floor. But the White House understands that the alternative is to pour billions of tax-payer dollars into a $1.6 trillion dollar medical-industrial complex that, too often, provides profits for the industry, but no benefits for patients. This administration is too smart to let that happen.

This is an excellent post, especially if you enjoy getting into the nitty-gritty of the economics and politics of health care reform. I came away from it with a sense that Obama and his White House advisors are on top of this issue and doing a good job. The post is followed by extensive comments.
Maggie Mahar has a first rate mind. I highly recommend her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much and the recent documentary of the book, produced by Alex Gibney (director of Enron: The Smartest Guys in the Room).

  • This is from a February “Room for Debate” commentary in the New York Times, but it’s still worth reading. The topic was “Ideas for fixing health care.” There’s a piece by Dr. Kevin Pho, the prolific blogger at Kevin MD, on the need for more primary care doctors. He comments on what’s happened in Massachusetts since 2006, when the state offered universal coverage. (He practices primary care across the border in New Hampshire.)

In its most recent annual survey, the Massachusetts Medical Society found that the average wait time for a new patient to see a primary care doctor averaged 50 days. When you consider that this is a state with the highest density of physicians per capita nationally, it is frightening to think what the wait times would be in other parts of the country should universal coverage be enacted on a federal level. … When patients wait that long to see a physician, they inevitably find their way into the emergency department for care that ordinarily can be handled in an office setting. … [P]atients who have obtained state-subsidized insurance visit the emergency department at a rate 14 percent higher than the average Massachusetts resident. … [W]hile any attempt at covering the millions of Americans without health insurance is a laudable goal, doing so without addressing a health care system ill-equipped to deal with millions more patients has the potential to make an already grim situation worse.

There’s a piece by Daniel Callahan, who has written many great books on bioethics and health policy.

[President Obama, in his recent speech,] said that his administration will seek “a cure for cancer in our time,” and he linked that effort with a large investment in preventive care as “one of the best ways to keep our people healthy and our costs under control.” … [A]s progress has been made in managing cancer, the costs of caring for cancer patients has steadily risen. … The National Cancer Institute has estimated that the cost of colorectal cancer will increase by 89 percent between 2000 and 2020. … The public will have to be convinced that it is not an attack on the value of life to say no to the kind of cure-driven medicine that has brought great benefits but also some nasty ethical dilemmas.

Foodborne illness

  • What’s interesting about the recall of Nestle’s cookie dough is that it’s hard to explain how the product became contaminated with E. coli. The contaminated dough has been making consumers (especially children) sick since March, but it was only when CDC researchers pooled their findings that all fingers pointed to the dough.

Cookie dough contains raw eggs, so what you’d expect is salmonella poisoning. You’re not supposed to eat the dough raw, of course, but evidently as many as 39 percent of consumers do. From a story in the Washington Post:

Because the appearance of E. coli 0157 in cookie dough is so unusual, investigators are looking at a broad range of possible factors, analyzing the ingredients, the plant’s equipment and interior, the health of workers and whether the facility is located near cattle. Federal officials are also considering whether the dough might have been intentionally contaminated.

As one shopper commented: “When I heard about the recall, I thought, ‘Is nothing safe anymore?’ … If bacteria has gotten into Nestlé’s Toll House cookie dough, then everything is suspect.”

Industrialized Agriculture

Kristof’s comment: “Go see it, but be warned that you may not want to eat for a week afterward.”

The risk society

  • Ginia Bellafante, a television critic for the New York Times, has an article in the Sunday Times Magazine on the novels of Jodi Picoult. The article features a discussion of the role of children in late 20th century literature and our current obsession with children who are sick or endangered.

The endangered or ruined child has emerged as a media entity within a culture that has idealized the responsibilities of parenthood to a degree … unprecedented in human history. The more we seek to protect our children, the more we fear the consequences of an inability to do so.

What does it mean that “children-in-peril” literature and news coverage has become such a focus of interest? Is it simply the reality of living in dangerous times? Bellafante finds in Picoult’s novels a modern message about parenthood.

[Her novels] have the effect of questioning the redemptive value of motherhood. Really, why would anyone bother? …
Picoult’s books and the whole cultural machine devoted to maniacal worry about children often seem like a reflection of our collectively sublimated ambivalence about having children to begin with.
In so many of her books children seem like more work than most ordinary people can handle. If Picoult’s fiction means to say anything, it is that parenting undoes us perhaps more than it fulfills, and it makes a thousand little promises it can never keep.

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