Public Health: Disease, Epidemic & Pandemic Threat (merged thread)

[Watcher In The Middle]

you use the term "Universal healthcare", you are screwed. That's the standard code phrase (political speak) for 100% government controlled and provided healthcare, and battle's over at that point - you lose.

Is what we have now really that good - well, not really (and that's being polite). Could we have designed such a disorganized out-of-control rolling cluster of a health care delivery system if we had tried to? - probably not - to get this screwed up, we had to let this whole mess improve with age.

But, doesn't matter - "Universal healthcare" is DOA because of everything it brings to the table.

On the associated topic,

The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is too late and the infection/spread rates are totally out of control.

That's only partially true, and there's much, much more to it. And "Universal Healthcare" will in no way make it better - probably little, if any effect at all. Here's why (as an example I'm personally aware of).

Most local Health Departments part in the health "food chain" can be broadly summarized as follows (bottom to top):

1. Local Entities/providers:
1.a Local health care providers (individuals/practices)
1.b Hospitals, clinics
2. Local Health Departments:
2.a Environmental Health (Food Safety; Well & Septic, Solid Waste, Radon, etc., etc., etc.)
2.b Clinical Health (provide services to individuals; WIC, etc.)
3. State Public Health
4) Federal Public Health:
3.a CDC
3.b NIH
3.c DHS (don't even get me started on them; with their "grants" to local health departments of such useful items as HAZMAT suits that nobody ever used, radiation detectors, 'lightweight' GPS units which were the weight and size of Chicago street paving bricks, etc.)
3.d Others

Ok, let's start here: Most of the work gets done by the locals. Any hospital doing even a halfway decent job (which honestly, most of them do a decent job at this part) already have in place a rapid response environment (usually digital) for tracking "unusual events" such as infections, unusual situations, etc. The problem in most cases isn't the locals at all.

The problem (at least here in IL) is with our wonderous, quite inept state government. Right around 2001/2002, I believe, the feds set aside $$$$ for each state to create real time digital reporting, run by each state public health agency to quickly identify and report such outbreaks and incidents to the state public health agencies, and consequently to the feds - bypassing the local health departments, because they had been "ineffective" up to this point.

So, our state took the money and ran with it - giving big bucks to a politically well connected firm to create from scratch a new, miracle, magical digital system which would allow the state folks to track everything in every which way known to mankind. And what they did was to spend all the big money (and it was supposedly ended up being in excess of $10 mil, but who really knows) to create a digital version of the paper process that already was in place.

Now, there were at least 2 private companies that already had digital systems that existed, were battle tested by the hospitals which were using them, but no, we got to create our own from scratch. Which we did, right here in IL. And guess what, the local Health Departments are charged with training and getting all the local health providers to use this monstrosity of a system - and guess what, it blows chunks. I mean, it is really terrible to use, nobody who is on the front lines wants to use it, you can easily kill 15+ minutes just putting a single record into this thing, it's a complete and total waste.

And then just to top things off, and let's make things just a little bit worse, then you have to throw in HIPA (Health Insurance Privacy Act) requirements right on top of this thing, so let's just make things a little more complex and even more difficult.

So, here's the hard reality. It's 9:30 AM, and I've got a patient with symptoms that probably should be reported, but we're on the treadmill of seeing patients, and I don't have 5 minutes, much less 15 minutes. It's going to wait, and hopefully staff can get some free time to deal with the reporting system. Course, I'll have to get the 185 page manual out with the step-by-step instructions, and the 3 level logins and passwords required to get in, oh, and btw, what's our state assigned 30 character identifier for our medical practice?

Oh, and btw, the feds are supposedly as happy as clams about IL and their new infectious disease reporting system, even though most everybody who really has to use it thinks it's a mostly worthless piece of crap.

Btw, if you really want to see the true back story, get a copy of the paper reporting forms used before this new system was put in place, and then get a copy of the full user manual for the new system. After you look at the two separate items, it's pretty apparent that the overriding design process was: "Do it the same way it's always been done, only do it a little better".

/End of rant