Muse Droppings
By:
C.C. Youngren

Why is the Surgeon General an Admiral?

I really shouldn’t get sucked into this health care debate.  I’m such a cynic—so little faith in any real solutions coming from the political apparatus.  The best we can hope for is incremental improvements, and even they may not be measurable. 

But I took my Netlistings colleague’s advice and actually read the darn HR Bill.  Well, I read the headings of each Division, Title, Sub-title, Part & Sub-part and skimmed the text of most—until I got to Division B, Title I, Sub-title E—7f(3)(C)…

“ (C) AVERAGE MEDICARE DRUG PROGRAM FULL-BENEFIT DUAL ELIGIBLE REBATE AMOUNT.—For purposes of this subsection, the term ‘average Medicare drug program full-benefit dual eligible rebate amount’ means, with respect to each dosage form and strength of a covered part D drug provided by a manufacturer for a rebate period, the sum, for all PDP sponsors under part D and MA organizations administering a MA–PD plan under part C, of—
“ (i) the product, for each such sponsor or organization, of—
“ (I) the sum of all rebates, discounts, or other price concessions (not
taking into account any rebate provided under paragraph (2) for such
dosage form and strength of the drug dispensed, calculated on a per-unit basis, but only to the extent that any such rebate, discount, or other price concession applies equally to drugs dispensed to full-benefit dual eligible Medicare drug plan enrollees and drugs dispensed to PDP and MA–PD enrollees who are not full-benefit dual eligible individuals; and
“ (II) the number of the units of such dosage and strength of the drug
dispensed during the rebate period to full-benefit dual eligible individuals enrolled in the prescription drug plans administered by the PDP sponsor or the MA–PD plans administered by the MA–PD organization; divided by
“  (ii) the total number of units of such dosage and strength of the drug dispensed during the rebate period to full-benefit dual eligible individuals enrolled in all prescription drug plans administered by PDP sponsors and all MA–PD plans administered by MA–PD organizations.”

…and got a severe case of the giggles. 

It was fatigue and not inherent humor that caused the reaction I suppose—that internal reading voice in my head had become Eric Idle in ludicrous-speed Python.  I finally figured out what got divided by what, but the question remains: is this an example of even incremental health care reform?  Frankly, I do not know.

I do have some more general, and more essential questions, which should be kicked around a bit; or, if they are being kicked, got lost in the flee-circus din of “death panels,” creeping socialism, and the excellence of Cuban brain surgery.

Isn’t (health) insurance a little like micro-socialism anyway?  Taking from the collective pool to spend on the immediate needy while the Commissars skim off the top seems to play as a familiar tune.  It could be asked the other way round too: isn’t socialism a little like a great big HMO?  Either way, reality is always less satisfying than fantasy.

IS there a minimum level of health care to be guaranteed to all?  There seem to be a number of nay-sayers out there.  On one extreme there are the “no expense, no treatment, no facility or technology should be denied anyone for lack of financial resource” advocates.  That is, minimum = maximum.  Sitting out on the other limb is the “personal responsibility” crowd—minimum = zero.  Rejecting those extremes seems easy to do (if you’re not a talk-show host).  That would mean there is some finite set of conditions/treatments between all and none to provide a safety net, and beckons the harder question.

What would be the provisions of a minimum health care standard?  A question worthy of at least another 1018 pages of painful detail and agonizing choices to be sure.  I am guessing that the slipping of the “Public Option” into the shadows is less due to the creeping socialism vitriol (see above), than the politics of avoidance in making precisely the tough choices necessary to define the boundaries of minimal care.  This is a cynic’s view, admittedly, but The Bill(s) seem to concentrate on the who (receives care), and the Byzantine address of the how (Insurance Exchange, etc.) with only a cursory nod to the what (see the overly hysterical response to Living Will advice, etc.). 

While our pols may find some immediate cover in the who-over-what strategy, the inevitable lurks around the corner.  This Magnus Opus will ultimately force a transfer of public benefits from the elderly to the presently uninsured.  That may not be bad or cruel or dumb—it just is a financial reality.  Identifying which ingredients get shuffled in this recipe will be the contentious battle being avoided now.  Maybe there is a cadre of souls who planned it this way; knowing that putting off critical decisions to when there is no choice but to make them is the only way to get them made at all.  Tip your hat to them.  

Oh yes, why is the Surgeon General an Admiral? A Vice Admiral actually, his boss, the Assistant Secretary of Health & Human Services, is an Admiral. Naval rank in the U.S. Public Health Commissioned Corps traces its origins to an act "for the relief of sick and disabled seamen" passed by Congress and signed into law by (that socialist?) President John Adams in 1798.  There was once a string of Public Health Hospitals (up & down each coast at least).  I spent 30 hours in one at Stapledon, Staten Island, with a concussion years back.  All I remember from the experience is that I was discharged without the splitting headache which accompanied my admission.

Today the Corps of 6,000 full-time public health professionals—Including physicians, nurses, dentists, pharmacists, dieticians, therapists, researchers & engineers, etc.—aspire to fulfill a central mission to “protect the health of the country's population.”  That mission includes four broad categories of action: (1) promote healthy behaviors; (2) promote healthy and safe communities; (3) improve systems for personal and public health; and (4) prevent and reduce disease and disorders.  I performed an electronic search of the 1018 pages of the HR “Affordable Health Care” Bill to see if I missed a reference to the U.S. Public Health Service; it isn’t mentioned—not once.

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