Popular Logistics thinks that a health care delivery system in which one out of six people can’t get health care, except by going to the Emergency Room is poorly run, mismanaged, and in a word, broken. We disagree with President Bush , who said “People have access to health care in America. After all, you just go to an emergency room.” We also recognize the public health concerns when one out of six people can’t get access to prescription medications, especially in densely populated areas. Thus, we think that a single payer health care system based on the Medicare model, also known as “Medicare for all,” is the best way to approach health care, from a policy perspective.

Popular Logistics is a non-partisan “blog.” We write about policy; we don’t often endorse candidates. However, we recognize that policy is made by candidates who win. This letter to the Editor, by Phil Steck, published in the Capital District Business Review, shows why we like Phil and why we wish him success in his race to represent New York’s 21st Congressional District.

To the editor:

I read with great interest James Barba’s opinion piece entitled “Health care reform is a business issue.” I applaud him for taking a visible leadership role on this critical issue. I recently had the opportunity to meet with him individually to discuss the benefits of a national single-payer heath care system and other challenges faced by health care providers.

Even before I declared my candidacy for Congress, I have supported single-payer health care, known as “Medicare for All,” because it is a system that is proven and tested. Medicare, the health system for the elderly, has a long history of success despite recent efforts to undermine it. It is statistically the most efficient health insurance care system available in the United States. Single-payer would benefit our economy, by lowering costs for patients, doctors, employers, and government. Single-payer would make us far more competitive internationally because many foreign businesses do not have to absorb the health care costs like their American counterparts.

In addition to hospital industry leaders like Jim Barba, a majority of doctors support single-payer because of the burdens that the current system places on them, primarily additional administrative costs.

As a partner in an Albany law firm, I understand the ever-escalating costs that businesses face in order to provide employees with health insurance. As an Albany County Legislator, I am all too familiar with the problems associated with the patchwork expansion of Medicaid. In Albany County we have worked to keep property taxes the 4th lowest in the state, but 90% of the county property tax goes toward Medicaid expenses. In a single-payer system, that local unfunded mandate is eliminated.

Sincerely,
Phil Steck
Candidate for Congress, NY-21

In a country so harsh about other matters of personal autonomy (sex, in particular) I found it surprising that Iran would have a progressive syringe exchange policy and and a fairly gentle drug regime. From Nazila Fathi’s June 27th piece in the Times,“Iran Fights Scourge of Addiction in Plain View, Stressing Treatment:”

More than a million Iranians are addicted to some form of opium, heroin or other opium derivative, according to the government, and some estimates run as high as 10 million.

In a country where the discussion of some social and cultural issues, like homosexuality, can be all but taboo, drug addiction has been widely acknowledged as a serious problem. It is talked about openly in schools and on television. Posters have encouraged people to think of addiction as a disease and to seek treatment.

Iran’s theocratic government has encouraged and financed a vast expansion in the number of drug treatment centers to help users confront their addictions and to combat the spread of H.I.V., the virus that causes AIDS, through shared needles.

The center in central Tehran, which is called Congress 60 and is run by a private nonprofit agency, is one of 600 centers that provide drug treatment across the country with help from government money. An additional 1,250 centers offer methadone, free needles and other services for addicts who are not ready to quit, including food and treatment for H.I.V. and other sexually transmitted infections.

Iran’s government, trying to curb addiction’s huge social costs, has been more supportive of drug treatment than any other government in the Islamic world, according to the United Nations Office on Drugs and Crime.

It was not always this way. After the 1979 revolution, the government tried a more traditional approach: arresting drug users and putting them in jail.

But two decades later, it recognized that this approach had failed. A sharp increase in the crime rate and the number of people infected with H.I.V., both directly linked to a surge in narcotics use, persuaded the government to shift strategies.

“We have realized that an addict is a social reality,” said Muhammad-Reza Jahani, the vice president for the Committee Combating Drugs, which coordinates the government’s efforts to fight drug addiction and trafficking. “We don’t want to fight addicts; we want to fight addiction. We need to manage addiction.”

Apart from the observation that this is yet another piece of evidence that non-punitive approaches are more effective than “war on drugs” – it also suggest that the Iranian government is capable of changing course, rethinking problems – and thus perhaps – under the right circumstances – able to negotiate.

Tags: drug policy, harm reduction

, heroin, Iran, HIV, syringe exchange

In Case of Emergency – also known as BreakGlass.WordPress.com

— is a blog, like this one, about public health and disaster preparedness. We’ve listed the formal blog name and the URL just to make sure everyone gets it. The author of this blog is doing a much better job than we are in many areas: to give an example, his coverage of the CDC is excellent. We’ll be adding In Case of Emergency to our blogroll, and intend to be frequently linking to their coverage.

Thousands of physicians practice while in rehab, according to Associated Press, covered in Wired . Should they be out on disability?

SAN FRANCISCO (AP) — Troubling cases in which doctors were accused of botching operations while undergoing treatment for drugs or alcohol have led to criticism of rehab programs that allow thousands of U.S. physicians to keep their addictions hidden from their patients.

Nearly all states have confidential rehab programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs….

Now some high school math: According toPhysician Executive, July August, 2005, quoted on BNET Research,on average Primary Care physicians in the U. S. see 85 patients per week. If a doctor sees 85 patients per week, and sees patients 42 weeks per year, allowing time off to play golf, attend conferences, and take vacations, he or she sees 3,570 per year. For 8,000 doctors, that adds up to 28.56 million people per year. The story continues …

These arrangements largely escaped public scrutiny until … California’s medical board outraged physicians across the country by abolishing its … program. A review concluded that the system failed to protect patients or help addicted doctors get better .

Opponents of such programs say the medical establishment uses confidential treatment to protect dangerous physicians.

“Patients have no way to protect themselves from these doctors,” said Julie Fellmeth, who heads the University of San Diego’s Center for Public Interest Law and led the opposition to California’s so-called diversion program.

Most addiction specialists favor allowing doctors to continue practicing while in confidential treatment, as does the American Medical Association.

Supporters of such programs say that cases in which patients are harmed by doctors in treatment are extremely rare, and would pale next to the havoc that could result if physicians had no such option.

Because these events are “rare” doesn’t mean they are acceptable.If “rare” translates to one in 1 million, that’s 29 events per year. Not a lot in a population of 300 million, but too many if you or your child is one of the 29 people. But what is “rare”? One in one million? One in ten thousand? What is the the rate of medical malpractice due to addiction?What is the rate due to operating or practicing medicine while intoxicated?

As a patient, I see a physician when I am sick. I want, expect, and am paying for the advice of a competent expert on a potentially life threatening situation.

Perhaps physicians with addictions should be granted some disability compensation while they undergo treatment. It could be bundled with their disability or malpractice insurance – which seems reasonable, if you view addiction as a disability, and given that it also seems reasonable to expect to see a causal relationship between addiction and malpractice.

David Leonhart argues in the Times

that alcohol taxes have, in effect, been dropping, and that the principal benefits of alcohol taxes – reductions in use (and the consequent harms), and offsetting the costs of alcohol use. From “Let’s Raise a Glass to Fairness,

” published on December 26th:

Since the early 1990s, the federal tax on wine — $1.07 a gallon — hasn’t budged. The taxes on beer and liquor haven’t changed either, which means that, in inflation-adjusted terms, alcohol taxes have been steadily falling. Each of the three taxes is now effectively 33 percent lower than it was in 1992. Since 1970, the federal beer tax has plummeted 63 percent. Many states taxes have also been falling. At first blush, this sounds like good news: who likes to pay taxes, right? But taxes serve a purpose beyond merely raising general government revenue.

Jonathan Gruber: “taxes are way too low on alcohol” ff

Taxes on a given activity are also supposed to pay the costs that activity imposes on society. And for all that is wonderful about wine, beer and liquor, they clearly bring some heavy costs. Right now, the patchwork of alcohol taxes isn’t coming close to covering those costs — the costs of drunken-driving checkpoints, of hospital bills for alcohol-related accidents and child abuse, and of the economic loss caused by death and injury. Last year, some 17,000 Americans, or almost 50 a day, died in alcohol-related car accidents. An additional 65,000 people a year die from other accidents, assaults or illnesses in which alcohol plays a major role. Mr. Cook, besides being a wine lover, has been thinking about the costs and benefits of alcohol for much of his career, and he has come up with a blunt way of describing the problem. “Do you think we should be subsidizing alcohol?” he asks. “Because that’s what we’re doing.”

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