- The Washington Times - Wednesday, April 29, 2009



While the barely 6-day-old swine-flu outbreak has health authorities around the word on alert and normally less conscientious Americans washing their hands regularly, it also points to some significant problems underling the public health policy.

The ultimate outcome remains uncertain, but there are just 64 confirmed U.S. swine-flu cases, and people should not panic. The U.S. public health community is more prepared for a potential outbreak as a result of the SARS (severe acute respiratory syndrome) and avian flu scares in recent years. Since 2006, $6.2 billion has been spent stockpiling antiviral medications, improving epidemiological surveillance and vaccine production.

President Obama requested Tuesday that Congress add $1.5 billion in funds to his emergency supplemental spending bill to address the swine-flu outbreak despite previous assurances from the administration that it had enough money to deal with the problem. Such myopic thinking, based only on current political necessity and not possible need, has come to define the way our government deals with infectious disease outside of a few high-profile areas like HIV/AIDS, which have long-term impacts.

Although state and local health departments - the first public health officials to respond to a crisis - are better prepared than in the past, they have not received pandemic-flu preparedness funding since 2006. The recession also has resulted in staff and service cuts in some areas. Other major problems and holes remain in the public health system. One of the major concerns is the dearth of front-line medical responders, most important general practitioners and infectious disease specialists across the nation.

Of recent medical school graduates, just 2 percent are entering the field of primary care medicine. The lack of general practitioners means the very sort of physicians who should be reporting their findings to local health authorities and the Centers for Disease Control and Prevention are in short supply, resulting in a further stressing of emergency and other medical resources should the disease move into pandemic status. A similar lack of effective infectious-disease specialist outside of major medical institutions makes efficient and effective treatment and spotting of outbreaks more difficult.

Dr. Michael S. Saag, director of the Division of Infectious Disease at the University of Alabama at Birmingham says the reasons for the lack of primary care physicians and infectious disease specialists are economic. He points directly to the incredibly low reimbursement rates of Medicare and Medicaid to such physicians for seeing patients.

The problem is that the entire government physician payment system, which guides private insurer payment as well, focuses money toward invasive procedures and not seeing patients. “The people who are doing primary care can’t make ends meet in their practices,” said Dr. Saag, who runs one of the top infectious-disease clinical and research programs in the nation.

Dr. Saag published findings in 2006 showing the maximum a physician could make treating a patient with HIV or any other infectious disease over the course of a year was $359. Under that scenario, the maximum the physician could collect with a practice of 1,000 patients was $350,000 annually for rent, staff salaries, equipment and other business expenses before even being compensated for his own work. “We are getting screwed; we can’t make ends meet,” Dr. Saag said. “The bottom line is, if you are a young medical student thinking about a career path, why should you choose primary care? You can’t make it.”

The response from within the political sphere also shows the lack of serious engagement on this issue. Although House and Senate hearings have been scheduled for this week, one only needs to look at the interchange on Capitol Hill this week to see the pointless politicization that already is taking place. Republican Sen. Susan Collins of Maine and newly enshrined Democratic Sen. Arlen Specter of Pennsylvania are fighting off senseless attacks from President Obama’s nonprofit promotion outfit Americans United for Change and liberal bloggers for helping kill more than $800 million in pandemic planning in the economic stimulus package. While the funds are needed, they surely would not have been doled out yet and likely have no impact on this situation as it currently stands. The myopic thinking behind such attacks and the short-term pandemic-flu funding allocated in 2006 would be sad if it were not for the fact that Congress ultimately will decide the public policy fate on this issue once again.

Problems extend internationally as well. The World Health Organization is arguably the most effective U.N. agency. In charge of coordinating the worldwide scientific response to any disease outbreaks, WHO Director-General Dr. Margaret Chan may be uniquely positioned to deal with the spread of swine flu around the globe after having headed the slow-going but ultimately effective containment of Hong Kong’s 2003 SARS epidemic. It is unfortunate that her group is beset by the same sort of ideological and geographic problems that turn the United Nations into a joke.

WHO held a convention last year aimed at establishing a worldwide oversight structure for prescription drug research and development. It also has published numerous dubious policy papers, including a 2007 paper attempting to define an international right to good heath. Let’s hope the same sort of expertise that had the group leading the eradication of smallpox in the 1970s will be applied to its swine-flu efforts.

Christian Bourge is a senior editorial writer for The Washington Times. His views can be heard every weekend on “The Capitol Hill Blues” radio show on XM Satellite Radio 165.

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