|WHAT WE’RE READING
Stuff we read this week that made us think.
Keeping an eye on Prop 8 in California
As we’ve already said, sometimes we just want to watch baseball and not think about healthcare. This fall, that’s been harder than usual, thanks to spending on advertising for a California ballot initiative that’s so high the ads are spilling into the national coverage of the World Series. Not being California residents, we decided to take a closer look at what these ads are all about, which led us to this helpful piece on Proposition 8, from California Public Radio. For those who live in the Golden State, you can move along to the next item. For the rest of you, here’s what’s going on. Prop 8, or the “Fair Pricing for Dialysis Act” as it will appear on the California ballot this November, concerns how dialysis providers spend their money. It would cap overhead and administrative expenses at dialysis clinics, by dividing expenses into “allowable” and “other” categories—with anything not directly related to patient care being classified as “other”. Any spending over a proposed limit in that category would have to be paid back to insurance companies. The argument made by supporters is that dialysis clinics—which are used by more than 140,000 Californians each year—are stinting on patient care quality, leading to frequent complaints about quality shortfalls. By limiting non-care spending, supporters hope to force dialysis providers to address these issues.
What’s ensued is the most expensive proposition campaign in California’s history, with more than $120M being spent by both sides of the issue on advertising to voters. Most of that money, as you’d expect, is being spent by dialysis companies—in particular DaVita and Fresenius Medical Care—on the “Vote No on 8” campaign. (Those are the ads that made their way onto the national broadcast of the World Series.) On the “Yes” side of the issue, spending has largely been driven by the labor union SEIU, which has been described as seeking to leverage the issue in an attempt to unionize workers at dialysis clinics. Spending by the dialysis providers will likely continue to grow, as the measure is currently polling at 47% “Yes” to 34% “No”. Industry observers predict that if Prop 8 passes, it could lead the clinics to reduce services in California, leading to access challenges for kidney patients. The dialysis providers are surely concerned over the broader implications of a “Yes” vote as well, which might lead other states to take up similar measures. As is often the case, people across the country are closely watching to see what happens in California—even if we’d all rather just be watching the game.
Remembering the deadliest October
We are drawing to the close of the 100th anniversary of the deadliest month in US history, so it’s a good time to stop and remember that it wasn’t war or pestilence or famine that killed 195,000 Americans in October of 1918, it was something we still battle every year: the flu. A hundred years after the height of the so-called “Spanish flu”, which swept the globe in the midst of the First World War and killed more than 50M people, we are still fighting a war against the genetic descendants of the same virus, armed today with vaccines and an arsenal of preventive measures that were unknown during the Great Influenza. There have been a number of excellent retrospective articles looking back on the legacy of the 1918 pandemic, but perhaps the best place to start is the outstanding web commemoration created by the Centers for Disease Control and Prevention (CDC) that provides an overview of events of the time. From there, move on to the terrific documentary “Influenza 1918” from PBS’s American Experience, which aired earlier this year. And if, like us, your interest is piqued, check out John Berry’s definitive, book-length history of The Great Influenza, which places the pandemic in the context of the history of modern medicine and medical education.
Despite this year’s many retrospectives, the 1918 pandemic has been largely forgotten by history. It is not frequently covered in history classes, there are no major memorials to the victims of the influenza, and aside from the CDC website there’s been little official commemoration of the centenary of the event. (Surprising, since the flu killed more Americans than died in all of World War I.) Perhaps this historical ignorance explains why only 37 percent of American adults got the flu shot last year, a drop of more than 6 percentage points from the year before, according to CDC data released this week. The result? Last year’s flu virus killed more than 80,000 Americans, including more than 180 children—the most in any year since the CDC began tracking the data. So, please: read your history, get your flu shot, and encourage others to do the same.
Stop, you’re scaring the children
We’re officially into the political silly season in this country, with the midterm elections just a couple of weeks away. By now it’s well understood that our country has become incredibly polarized, with the space for reasonable policy debate becoming vanishingly small. Sometimes heightened political passions lead to dark and frightening outcomes, but other times what results is just plain goofy. That’s the case with a new report released this week by the august Council of Economic Advisors (CEA), often referred to as “the White House’s think tank” for its traditional role in providing sober economic policy analysis to the President. (Previous CEA thrillers include “Long Term Interest Rates: A Review”, and “Economic Benefits of Increasing Electric Grid Resilience to Weather Outages”.) What’s on CEA members’ minds this week? The looming threat of socialism in America. In a 71-page piece that spends a lot of time comparing Mao, Lenin and Marx to Sen. Bernie Sanders (I-VT) and Sen. Elizabeth Warren (D-MA), two potential 2020 Presidential contenders, the CEA lays out an argument that growing support for “Medicare for All” (M4A) proposals among Democrats is the first step on the road to full-blown socialism. In case you miss the point, the White House issued a statement reinforcing the argument that M4A would lead to a bankrupt government, shorter life expectancy, and a future of (shudder) “Nordic” conditions in America. As former CEA head and University of Chicago professor Austan Goolsbee told the New York Times, “It feels like the CEA has a lot of time on its hands.”
Whatever you think of Sanders’s proposal for Medicare for All, and there are plenty of reasons to oppose it (not least its glaring lack of detail), it’s risible to argue as the CEA does that it’s in the same category as Lenin’s collectivization of Soviet agriculture or Mao’s persecution of the “landlord class”. This is pure, pre-midterm politics, raising the specter of “socialism” to counter a policy idea that Democrats have identified—correctly—as hugely popular with voters. At least the CEA is operating in the venerable tradition of the Gipper himself, who famously warned against another popular healthcare reform back in 1961, saying that the proposed Medicare program would lead us to socialism, and predicting that “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.” Perhaps this year for Halloween we’ll dress up as a Medicare card. Or maybe as Bernie Sanders, with a Karl Marx beard. Boo!