PrintApril 8, 2010
H1N1 and Health Care Reform
The government that mismanaged the H1N1 vaccine is stepping up to do an even worse job on ObamaCare. As a general pediatrician and medical practice owner, I have been surprised at our inability as a society to apply the lessons of the recent past to our current health care debate. Those who know me will recall that I was especially aggravated over the H1N1 debacle of late last year.
Unlike seasonal flu vaccines, the entire H1N1 vaccine distribution process was taken over by the federal government in the form of the Centers for Disease Control and Prevention (CDC). While the debate over the H1N1 vaccine distribution problems has become moot, there is an extremely important lesson to be drawn from the experience.
The basic problem is exactly the same one that Friedrich von Hayek described back in the 1940s in his book, The Road to Serfdom. To boil it down, the reason why the distribution of the H1N1 vaccine was such a failure is that no centralized authority could gather and process all of the necessary information to efficiently manage anything.
Think about it for a moment. In a country of 300 million individuals, each with his or her own specific medical and social circumstances, the federal government decided that it could manage H1N1 vaccine for the entire population. How exactly did they expect to figure out the needs of the individual? Did they even care about the needs of the individual? In my office, we have numerous children with serious medical needs including asthma, sickle cell anemia, congenital heart defects, etc. Despite this, we found that we had no ability to obtain H1N1 vaccine to administer to these children in a timely fashion. On the rare occasion that we were able to get through to the local public health department, we were instructed to send our patients to one of their local vaccine "clinics," where sometimes hundreds of people were gathering and, no doubt, infecting each other.
On the other hand, the American medical community manages the seasonal flu vaccine distribution system from the bottom up. Each patient and doctor has important information that filters upward, and the invisible hand of capitalism distributes vaccine supplies in a relatively crisis-free manner.
At the time of our troubles with obtaining H1N1 vaccine, we had absolutely no difficulty in contacting our local vaccine sales rep to place orders for seasonal flu vaccine. During the severe vaccine shortages of the past, we were able to appropriately prioritize our limited vaccine supply simply because we had the necessary information about our patients. It should not come as a surprise to anyone that private companies competing for customers would have more incentive to be responsive to their clientele than a government bureaucracy.
So we have in the H1N1 flu distribution story a recent example of the failure of a top-down government program to manage a relatively straightforward medical situation. Despite this, a significant portion of the population remains convinced that centralization will improve medical care. I will submit that although the Patient Protection and Affordable Care Act is astonishingly long and complex (perhaps the most so of any legislation in the history of mankind once), it can never be intricate or responsive enough to fulfill the needs of the individual.
So we have in the H1N1 flu distribution story a recent example of the failure of a top-down government program to manage a relatively straightforward medical situation. Despite this, a significant portion of the population remains convinced that centralization will improve medical care. I will submit that although the Patient Protection and Affordable Care Act is astonishingly long and complex (perhaps the most so of any legislation in the history of mankind once), it can never be intricate or responsive enough to fulfill the needs of the individual.
I believe that if the medical needs of the individual patient are important, then we still need bottom-up, free market, patient-oriented reforms. The H1N1 situation remains a valuable cautionary tale that should provide us all (especially physicians) with a measure of motivation to fight for repeal and replace. Otherwise, be prepared for long lines, shortages, favoritism, and inefficient production far into the future.
Dr. Arie Friedman, M.D. is a general pediatrician and medical practice owner in Lincolnshire, Illinois. His blog is Stuffy Noses and Sore Throats, and he may be reached at arie@premiepeds.com.
