At the mercy of a health care bureaucracy

By Carol Gee

. . . is not the best place to be when you are sick, or even well. As with several other government agencies, the Consumer Products Safety Commission, for example, either through benign neglect, cronyism, or outright sabotage, puts American at risk from the very groups that should be protecting us. And I am not one of those fuzzy-headed liberals advocating a so-called "nanny-state." The minimums would be just fine, thank you, when it comes to food and drug regulation.

The Food and Drug Administration is headed by Commissioner Andrew von Eschenbach, who was confirmed by the Senate on December 7, 2006 after serving as Acting Commissioner for fourteen months, according to Wikipedia. After a year in office the controversy has not gone away for Dr. von Eschenbach, a Bush family friend. From AMERICAblog comes an MSNBC article headlined "GOP program to destroy FDA is on track."To quote:

Lives are at risk because the U.S. Food and Drug Administration is woefully behind in the latest scientific advances and is underfunded for its vast responsibilities, an expert panel will tell the FDA on Monday.

In a 56-page report titled "FDA Science and Mission at Risk," which has been posted online, officials will hear that inadequate staffing and poor retention, out-of-date technology and a general lack of resources mar the agency's ability to do its job.

A Red Ribbon Day -- December 1 was World AIDS Day. To the Bush administration's credit the fight against HIV/AIDS has not been neglected as badly as we might have expected. In 2004, the U.S. approved a $15 million grant to China to help, according to a Kaiser Family Foundation report that year. To quote:

The Chinese government estimates that there are 840,000 HIV-positive people in the country and that 80,000 people have AIDS; however, some experts believe that those figures are an underestimate. The United Nations estimates that there are at least one million HIV-positive people in China, and the number could grow to 20 million people by 2010 (Kaiser Daily HIV/AIDS Report

China Daily reported on 11/30 that the HIV/AIDS epidemic seems to be slowing a bit in their country. Note that there is virtually no way to verify the following figures. The world is at the mercy of whatever is the official party line on the question. To quote from the article:

The rate of new HIV/AIDS infections in China is slowing and the disease is now mainly being transmitted through sex, Health Minister Chen Zhu said Thursday.

The country will have an estimated 50,000 new infections in 2007, compared with 70,000 in 2005, though groups like men who have sex with men (MSM) are increasingly at risk, according to The Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007), jointly released by the State Council AIDS Working Committee Office and the UN Theme Group on AIDS in China.

That will mean there will be about 700,000 people living with HIV/AIDS this year in the country, up from 650,000 estimated in 2005.

The hospital is not always a good place to go to get well is a cliche to which I vigorously subscribe. Unfortunately my health began to go downhill soon after I retired. I attribute it facetiously to getting my Medicare card. Thus I have frequent and recent experiences of being at the mercy of the health care bureaucracy. And I am one of the lucky ones. I have gotten excellent care. I have no complaints except the outrageous costs. Both my elderly mother and I feel guilty about the charges we see have been billed to Medicare or our "Medi-gap" insurance companies. (The costs of our insurance spirals every year), and the doctors get less reimbursement for their good services. Clearly the health care service delivery system is broken, as is evident by the importance is has a presidential campaign issue.

But it is into that system that we expect to go when we have a life threatening illness or accident. And our experiential satisfaction is highly connected to how we are treated as patients, more than how much it costs. I close with this story as an illustration: "Family Members of Patients Who Die in the ICU Report Greater Satisfaction with Communication and Involvement than Family Members of ICU Survivors." This is according to the National Institute of Health website. To quote:

Family members of loved ones who died in the intensive care unit (ICU) tend to be more satisfied with the care they and the patient received than family members of ICU survivors, according to a study published in the November 13, 2007, issue of the journal Chest. Family members of all ICU patients tended to rate the physical care of the patient highly. But those of ICU decedents tended to be more pleased with their involvement in decision-making and communication, as well as the emotional support, respect, compassion, and consideration they and the patient received, than those of survivors. This study was funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH), along with funding from the Robert Wood Johnson Foundation and the American Lung Association.

The last piece of this for me is the fact that people who work in the health care system are also at the mercy of their own bureaucracies. Cost cutting measures mean low pay rates, a lot of overtime due to staff shortages, and even an epidemic of obesity due to stress-eating or poor diet, etc. It will be interesting to see if health care reform remains as a high a priority for voters, as the beginning of the election year is now upon us.

(Cross-posted at South by Southwest.)