Wednesday, April 29, 2009

How Well the Administration Does with H1N1 Swine Flu Has Implications for the Success of Healthcare Reform

In a prior post, the Disease Management Care Blog warmed up to the idea of unleashing the heavy hand of government in another area of public health. The topic of sugared beverages is relatively narrow and, what's more, taxation is the one thing that government does well.

Not long after the keyboard cooled off over that posting, the DCMB became aware of another proposed $1.5 billion government foray. This one is far more expansive. The H1N1 Influenza A Swine Flu emergency has prompted the White House to request an additional $1.5 billion in supplemental funding from Congress. The number is apparently based on the cost of vaccine, the purchasing of anti-viral drugs and first responder protective gear as well as supplemental funding going to the State and other local agencies.

This, thinks the DMCB, will be the defining moment for the idea of expanded Federal involvement in health care. This is big and very visible. If the Administration appears competent and does this right (or if they're lucky), momentum for reform will grow. If the government proves impotent in changing the course of this emerging epidemic (or if they're unlucky), second thoughts will emerge and public support for health reform could wane signficantly.

Good scenario: The Centers for Disease Control, in partnership with pharma, makes good progress in developing a vaccine. Enough anti-viral treatment medications are available to patients who need it. Hospitals and clinics reasonably keep up with the additional demand for services. Public health messaging has the three C's: consistentcy, calmness and correctness. If the virus turns out to have mild symptoms for a vast majority of cases and dissipates, count the Administration lucky. The public credits the Administration for a job well done.

Bad scenario: Whether deserved or not, the public perceives that an effective vaccine's arrival is being delayed. The Administration fails to 'play well' with pharma, who distrust the Democrats. What's more, finger-pointing develops over who is to blame. Reports of shortages of anti-viral drugs begin to pepper the evening news. Patients can't get appointments and there is the spectacle of people outside emergency rooms waiting to be seen. In the meantime, the more nimble local health resources (small physician offices and retail clinics for example), supported by commercial insurers, come through in providing all the necessary care without the special involvement of the Feds - who are a dollar short and a day late. The messaging confusingly varies between CDC, the White House and the States. Too many people with the virus die. Bad luck, the virus turns out to be the mean species originally seen in Mexico with the twin features of high transmissibility and higher than normal lethality.

The DMCB thinks the odds may be slightly tilted toward bad scenario. However, it thinks and hopes there will be good luck (from a prior post, here's why). Despite the best efforts of the most competent government in the world, it takes a long time to develop and test a vaccine, demand for anti-viral drugs currently in the pipeline may outstrip supply and anyone feeling unwell will clog the healthcare system no matter what the messaging is. The good luck news is that the disease so far is appearing to be relatively mild for the patients we know about, the actual number of H1N1 cases is still relatively low and may stay that way.

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