The chutzpah of Senator Collins

Irony isn't dead. But it's on a ventilator. No wait. There aren't enough ventilators. So maybe it's just having labored breathing. From February 9:

The target grew out of discussions among a group of moderate Republicans, led by Sen. [Susan] Collins [of Maine], aimed at reining in costs and better targeting federal funds toward job creation. The effort amounts to "rebuilding" the Obama package, according to an individual familiar with the talks. The package would include tax cuts and investments intended to create jobs, such as infrastructure projects, but it would step back from spending projects that don't immediately lift the sagging U.S. economy.

After meeting with Mr. Obama, Sen. Collins expressed concern about a number of spending provisions, including $780 million for pandemic-flu preparedness. "I have no doubt that the president is willing to negotiate in good faith, that he wants to have a bipartisan bill," Sen. Collins said. (Senator Collins's website)

Let me see. We're talking about cutting $700 million out of a $700 billion bill. Back of the envelope, that's 0.1%. Fast forward to Monday of this week:

In a letter to the U.S. Department of Health and Human Services, senators Joe Lieberman of Connecticut, an Independent, and Republican Susan Collins of Maine, top members of a homeland security committee, complained that because health officials admitted no mistakes, the same problems will arise again.

"This approach raises doubts about our capacity to respond effectively to the ongoing epidemic," the senators wrote, "but also to prepare effectively for what could be even more serious epidemics in the future." (Robert McCoppin, Daily Herald [Chicago])

So whose mistakes were they, Senator Collins? You're in appropriate company. Holy Joe Lieberman, who represents the insurance industry in the Senate, could, I'm sure, teach you a new word: Chutzpah.


The H1N1 pandemic should have come with an announcement: this is a test of the public health emergency system.

If this had been a virulent virus, there's a decent chance you might have been dead before you got the vaccine.


Those who study emergency preparedness say that the trickle of vaccine, and the failure to get it to those who needed it most, show that we remain unprepared for widespread health emergencies - and slow to address the problem.


The main problem, critics say, was failing to get the vaccine quickly to those who needed it most, particularly children with chronic medical conditions who were most at risk of dying from flu complications.

DuPage and Kane counties [Illinois] eventually had special one-day outreach programs, but local parents were generally mystified why there were few provisions for children with special health problems, while there was often no enforcement of who should get the shot. (Daily Herald)

OK, let's pause here. You know what's coming but I'm determined to shove it down your throat. This isn't really about vaccine distribution or responding to emergencies. It's about a public health system and all its vital parts that doesn't work because politicians like Senators Collins and Lieberman don't have a clue about what constitutes Homeland Security. If you play a shell game with public health resources by moving people, money and resources away from bread and butter public health activities this is what you get. If you are worried about a pandemic, why do you care about maternal and child health services and elder services? Because if you want to reach pregnant women and disabled children and the infirm and at risk elderly you need to have the infrastructure. Without it you have piles of vaccine but no outreach to get them to those who need them. Without vital records you can't make accurate and timely reports to CDC to find out if flu is rising or falling. Without health services experts you don't know how many beds are available and how many are staffed or even where they are.

And when a vaccination program goes into high gear, you can't just reassign them. They have to keep functioning. Even in an emergency you need to keep doing the routine or the system fails. It's not like we haven't discussed it (ad nauseam: here, here, here, here, here, here, here, here, here, here, oh hell, so many places I can't even count).

Are we prescient? Hardly. Anybody with more than two neurons who wasn't using one to breathe with and the other to take bribes from the insurance and drug industries could figure this out. But I'll say the old adage again: when public health works, nothing happens.

Unfortunately Senator Collins thought it was, when nothing happens no need for public health to work. But that was February. She's singing a different tune now. Like any good hypocrite.


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While I mainly agree it must, in the interest of fairness, be noted that she was arguing NOT about whether ot not the money should be allocated, but if the economic stimulus bill was an appropriate place to do it. To her it was an example of putting through projects that had nothing to do with the need for economic stimulus. Mind you, I disagree: a more virulent bug would/could devastate any budding recovery - any means to prevent that did belong in the package - and the health care sector would get money into the economy at least as quickly as any other. But we should present her argument as it was.

As to the rest, we have had this discussion before - too few dollars does not excuse too much stupid and the public health sector had stupid down almost as much as the media did this time around. The original well thought out plans (in Illinois it included utilizing VFC participating pediatricians as part of the early distribution roll-out, and at a national level it included plans on how to prioritize in case of a significant shortage) were ignored and chaos allowed instead. DuPage County is my practice location and it was pathetic. Pediatricians who care for all - including Public Aid and uninsured and underinsured - were not given any to get to their known highest risk patients while the massive outreach programs handed it out to healthy 30 year olds. More dollars wouldn't have solved the lack of communicating neurons possessed by those who were in charge.

Did the distribution of the vaccine work *anywhere* in time and smoothly? Certainly here in the UK, "too few, too late" sums up the situation, since GPs did not get the vaccine for their own, plus risk group use until 3/4 through the second wave. Meanwhile in Germany, the government put so little effort into advertising the vaccine (including the major snafu that they ordered the adjuvanted Pandemrix for the general population, but the non-adjuvanted Celvapan for members of the government) that every German was truely vaccine sceptical by the time Pandemrix became available and the distribution of the vaccines was so badly organised that the few who wanted it, could not get it.

So, in which country did it go well, I wonder...

what amount would be appropriate

So, when the "Big One" pandemic finally shows up and kills a few dozen million, will there be more shouts about dumb politicians not paying attention to the science, or shouts about dumb scientists not solving real-world problems?

Well I am a half full or half empty glass on this one Revere. The UK system is about to collapse too along with the Swedes. Costing too much money. But these monkeys and be aware that a certain Mr. Kerry sleeps with the insurance companies too are all screwing around with something that we should all agree upon. That is of course that it should all be agreed upon. Yesterday a 722 page bill was put up into the amendment hopper and at least this mug was going to be read. Its crap and there isnt a communist out there that wouldnt love it but, at least it was going to be read.

This is high drama at its finest. We are seeing the economy falling apart at the seams, spending has now reached the federal debt limit and we are talking about spending ....More money.

Its worth noting that the fed deficit limit has been raised like 400 times since inception. In all but like 12 cases, there wasnt military spending in it. So to me that means that the social(ist) welfare system is about to collapse. The dollar is tanking faster and faster and while Rome is burning the Congress is fiddling with a turnover deficit. That is to say that there will soon be no way to repay it. A permanent deficit that will continue to knock us over as a country. If that happens all of this will become a moot point.

I think I said this would happen in December of last year here. You wont like what my next prediction is either- That is that there will be a war and a big one.

By M. Randolph Kruger (not verified) on 17 Dec 2009 #permalink

M.Randolph Kruger, often I disagree with your posts but on the following I simply wish I could--"You wont like what my next prediction is either- That is that there will be a war and a big one"--a not unreasonable prediction as you don't give a time boundary. And hey, look what seems to be going down in Pakistan.

As a resident of the UK and someone with first-hand, up-close-and-personal experience of the NHS at several levels, I can assure you that rumours of its impending demise are greatly exaggerated ....mostly be people intent on claiming that "socialised medicine doesn't work."

Yes, the flu preparedness in this country well and truly sucked. Badly. We have a number of incompetent top administrators in place who concentrate more on PR than substance. And we do have funding shortfalls in places, and perpetual issues like number of cleaning staff available in hospital wards and what should community nurses actually be responsible for, and are the elderly being shorted some services because no-one has ever quantified what "frail" as a descriptor actually means, etc. However, the NHS is still capable of providing a robust service to the majority of the population and in the majority of situations, and is neither tottering on the brink of bankruptcy nor of collapse despite a major shortfall in the current recession. It is entirely possible that some services will be either lost or cut back, but there are ways of managing services which minimise this loss, a number of which are already on the table. To be perfectly honest, worse things happened to the NHS in the 80s.

So, although I could make unkind comparisons to some of the systems available in Europe, I can also say that I am more than happy to be here.

By Luna_the_cat (not verified) on 18 Dec 2009 #permalink