Dr. Marc regularly answers readers’ questions on matters relating to medicine, healthcare and politics. To send a query, click here.
Dr. Marc reacts to the current direction of Medicare:
First: The rhetoric being used by the right wing arguing for healthcare privatization is basically that a better product at the lowest possible price occurs based on competition and the laws of supply and demand. The problem with this thinking is that in the world we live in today, where HMOs already control a significant segment of the health sector, the corporate upper crust gets richer (the CEO of Aetna earned $20 million two years ago), and there is no system in place to insure that the patient gets proper or even minimum care, and no guarantee that the working parts of the system (doctors, nurses, technicians) are properly reimbursed for their work.
So-called healthy competition can only be possible in an environment where healthcare workers have strong unions and patients have strong consumer advocates fighting for their interests. Unions and advocacy groups are crucial to the American way of life. But currently, the situation in healthcare is different. HMOs all look the same, they all offer similar inefficient, ineffective, insincere products at a premium cost to the patients. To be sure, they are constantly decreasing what they pay to providers, but the savings goes into their own pockets, not back into the system. The term for this uniformly poor product is not competition but collusion. Expanding this private system to include the elderly and the infirm would be to expand the problem, not its solution.
The solution is to centralize healthcare under governmental control, where there is at least a basic health insurance available for all. The government bureaucracy may have many inefficiencies, but it nonetheless better serves the public than a corporation motivated strictly by profit. Patients are a large constituency and can, and should, influence re-election if the system is not going well.
Second: Prescription drugs should be covered for all elderly, but the first question that must be addressed is, At what cost? Many of these drugs are overpriced duplicates of one another. The government should not be asked to swallow these prices but should use the entire group of elderly as a cohort to force lower, more reasonable prices. This is the current system throughout much of Western Europe, and one of the main reasons drug prices are so much lower there.
I live in Missoula, Montana, and, in the woods at least, we currently have a lot of mosquitos. How worried should I be about the West Nile virus? We’ve been told to wear bug spray with DEET in it for protection, but I wonder if DEET is safe for me or my child?
DEET is safe, and good to have in insect repellent. West Nile will be back this summer, but only in small numbers (1,000 or more nationwide). The chances of you encountering it are extremely low. Still, removing stagnant water (mosquito breeding grounds) using insect repellent and wearing long sleeves are always good ideas when biting insects are around.