New Shingles Vaccine

[Dodi Schultz]

The FDA has just announced that Zostavax, a new vaccine against shingles (Herpes zoster), was licensed yesterday for people aged 60 and up. (That doesn't mean it's not good for people under 60, only that that was the age group in whom it was tested and proved safe and effective--well, relatively; see below.)

I was in the national three-year study of 38,000 people in whom the vaccine was tested, and it turned out when they broke the code (the study was double-blind) that I'd received the real stuff. Which doesn't mean that I absolutely won't get shingles: the vaccine seems to work as a preventive around 50 percent of the time (about 65 percent for those under 70); for the rest, it appears to decrease the severity of the illness. And I gather that it can be VERY severe.

Shingles is a reactivation of the same infectious agent (the varicella-zoster virus) that causes chickenpox, and you can get it only if you've previously had that common childhood disease. (There's now routine vaccination for children, which of course they didn't have when most of us were kids.) If you're in that category, you might want to talk to your doctor about the new vaccine.

--Dodi

[Judy G. Russell]

This is really VERY good news, Dodi, and particularly for people who must get chemotherapy (which has a tendency to trigger shingles attacks). Getting the vaccine in advance to help stave off the attack will be terrific.

[Jeff]

The FDA has just announced that Zostavax, a new vaccine against shingles (Herpes zoster), was licensed yesterday for people aged 60 and up. (That doesn't mean it's not good for people under 60, only that that was the age group in whom it was tested and proved safe and effective--well, relatively; see below.)

I was in the national three-year study of 38,000 people in whom the vaccine was tested, and it turned out when they broke the code (the study was double-blind) that I'd received the real stuff. Which doesn't mean that I absolutely won't get shingles: the vaccine seems to work as a preventive around 50 percent of the time (about 65 percent for those under 70); for the rest, it appears to decrease the severity of the illness. And I gather that it can be VERY severe.

Shingles is a reactivation of the same infectious agent (the varicella-zoster virus) that causes chickenpox, and you can get it only if you've previously had that common childhood disease. (There's now routine vaccination for children, which of course they didn't have when most of us were kids.) If you're in that category, you might want to talk to your doctor about the new vaccine.

--Dodi

I don't know if I had chicken pox and there's no one alive who can tell me, but I did have shingles a few years ago, over the top of my head and almost to my right eyelid. And that was way too close to blindness in that eye.

So, I'm now 62. What does the study say about that history?

- Jeff

[Dodi Schultz]

Judy, I didn't know that chemo can increase the likelihood of shingles. I do know (from my own writings, which include several books on lupus) that corticosteroids can and do increase that likelihood--and shingles can even recur (generally, fairly unusual).

Jeff, if you've had shingles, then you DID earlier have chickenpox. As I said, shingles represents a reactivation of the same virus; it doesn't occur as an initial infection.. RECURRENT shingles is unusual, except under special circumstances (see above).

--Dodi

[ktinkel]

I do know (from my own writings, which include several books on lupus) that corticosteroids can and do increase that likelihood . . .Thanks for that information. I get regular (several times a year) steroid injections into my back; and smear plenty of cortisone junk on my skin for psoriasis.

I will ask the doctor for this vaccine as soon as I see him again. A friend had shingles. It was horrific to watch (and for her to go through), and I have no interest in adding that to my ailments!

[Judy G. Russell]

Judy, I didn't know that chemo can increase the likelihood of shingles. I do know (from my own writings, which include several books on lupus) that corticosteroids can and do increase that likelihood--and shingles can even recur (generally, fairly unusual).Chemo has all kinds of nasty side effects and, of course, there are some corticosteroids that are given in part to ameliorate the effects of chemo. Vicious cycle for some folks, for sure. Thank heavens for this vaccine!

[Jeff]

Shingles is a reactivation of the same infectious agent (the varicella-zoster virus) that causes chickenpox, and you can get it only if you've previously had that common childhood disease. (There's now routine vaccination for children, which of course they didn't have when most of us were kids.) If you're in that category, you might want to talk to your doctor about the new vaccine.

--Dodi

I did that. The doc said it will be $150, and you have to pay for it yourself as none of the insurance companies nor medicare have bought into it.

- Jeff

[Lindsey]

I did that. The doc said it will be $150, and you have to pay for it yourself as none of the insurance companies nor medicare have bought into it.

But hey, this is the best health care system in the world, right? :cool:

--Lindsey

[Jeff]

But hey, this is the best health care system in the world, right? :cool:

--Lindsey

Yup, it sure is... for those providing it. July 1 my health insurance goes up to $808 a month, with a $6,000 a calendar year deductible. The doc just decided that I need my cholesterol knocked down, which will raise my monthly drug bill by about $50 to $300. Can we add $800 and $300 as fixed monthly expense? Plus everything less than a total of $6,000, which starts anew every Jan 1. Can't have nothin major started in the fall, regardless... You don't want to know what it was like in Europe; green wouldn't look good on you.

- Jeff

[Lindsey]

Yup, it sure is... for those providing it.
And that, I am afraid, is the reason we don't have universal health care. :(

What we've got is not a system that is sustainable.

--Lindsey

[earler]

While your insurance cost seems to high to someone who lives in europe and pays $3000 per year for him and his wife to cover costs not paid by the french social security, your calculation is faulty as to your costs. Since you pay $300 monthly for drugs you only have an additional $2400 to pay out of pocket beyond the $1108 monthly.

-er

[earler]

Please cite a country where the government medical insurance is operating with success today.

-er

[Jeff]

And that, I am afraid, is the reason we don't have universal health care. :(

What we've got is not a system that is sustainable.

--Lindsey

That's for damned certain. The only way insurance works is by spreading the risk. As the rates continue to go up, more and more people can't afford it, the size of the risk pool shrinks, and repeat heading toward zero. I'm already paying for most of three or four people with no insurance who show up at emergency rooms knowing that for the most part they can't be refused. And repeat toward the size of the whole population. At some point this whole affair is going to implode and we will have a single payer system, but not before a hell of a lot of people go through a hell of a lot of pain, with not a few of them dying in the process because the ER's will start to refuse.

- Jeff

Ummm, do I smell a troll around here?

[Lindsey]

Please cite a country where the government medical insurance is operating with success today.
I'm not saying anyone's is perfect, but any other industrialized country has a better functioning health care delivery system than the U.S. Paul Krugman has had extensive coverage of this issue in his column over the last several years.

International comparisons show that the United States has achieved a sort of inverse miracle: we spend much more per person on health care than any other nation, yet we have lower life expectancy and higher infant mortality than Canada, Japan and most of Europe.

(Krugman, "Our Sick Society," NY Times, 5 May 2006)
For lower-income working Americans, lack of health insurance is quickly becoming the new normal. That's the implication of survey results just released by the Commonwealth Fund, a nonpartisan organization that studies health care. The survey found that 41 percent of nonelderly American adults with incomes between $20,000 and $40,000 a year were without health insurance for all or part of 2005. That's up from 28 percent as recently as 2001.

<snip>

Taken together, these stories tell the tale of a health care system that's driving a growing number of Americans into financial ruin, and in many cases kills them through lack of basic care. (The Institute of Medicine, part of the National Academy of Sciences, estimates that lack of health insurance leads to 18,000 unnecessary American deaths -- the equivalent of six 9/11's -- each year.) Yet this system actually costs more to run than we would spend if we guaranteed health insurance to everyone.

(Krugman, "Death By Insurance," NY Times, 1 May 2006)
Let's start with the fact that America's health care system spends more, for worse results, than that of any other advanced country.

In 2002 the United States spent $5,267 per person on health care. Canada spent $2,931; Germany spent $2,817; Britain spent only $2,160. Yet the United States has lower life expectancy and higher infant mortality than any of these countries.

But don't people in other countries sometimes find it hard to get medical treatment? Yes, sometimes -- but so do Americans. No, Virginia, many Americans can't count on ready access to high-quality medical care.

<snip>

It's true that Americans generally have shorter waits for elective surgery than Canadians or Britons, although German waits are even shorter. But Americans do worse by some important measures: we find it harder than citizens of other advanced countries to see a doctor when we need one, and our system is more, not less, rife with medical errors.

Above all, Americans are far more likely than others to forgo treatment because they can't afford it.

<snip>

Taiwan, which moved 10 years ago from a U.S.-style system to a Canadian-style single-payer system, offers an object lesson in the economic advantages of universal coverage. In 1995 less than 60 percent of Taiwan's residents had health insurance; by 2001 the number was 97 percent. Yet according to a careful study published in Health Affairs two years ago, this huge expansion in coverage came virtually free: it led to little if any increase in overall health care spending beyond normal growth due to rising population and incomes.

(Krugman, "Pride, Prejudice, Insurance," NY Times, 7 November 2005)

--Lindsey

[Lindsey]

I'm already paying for most of three or four people with no insurance who show up at emergency rooms knowing that for the most part they can't be refused.
Yes, exactly, that's where a large part of the inefficiency comes from. Add to that that they probably wouldn't have to be at the emergency room getting expensive treatment if they had an option to get preventive care at an affordable price.

More Krugman:

That's why insurance companies don't offer a standard health insurance policy, available to anyone willing to buy it. Instead, they devote a lot of effort and money to screening applicants, selling insurance only to those considered unlikely to have high costs, while rejecting those with pre-existing conditions or other indicators of high future expenses.

This screening process is the main reason private health insurers spend a much higher share of their revenue on administrative costs than do government insurance programs like Medicare, which doesn't try to screen anyone out. That is, private insurance companies spend large sums not on providing medical care, but on denying insurance to those who need it most.

What happens to those denied coverage? Citizens of advanced countries -- the United States included -- don't believe that their fellow citizens should be denied essential health care because they can't afford it. And this belief in social justice gets translated into action, however imperfectly. Some of those unable to get private health insurance are covered by Medicaid. Others receive ''uncompensated'' treatment, which ends up being paid for either by the government or by higher medical bills for the insured. So we have a huge private health care bureaucracy whose main purpose is, in effect, to pass the buck to taxpayers.

("Health Economics 101," [I]NY Times, 14 November 2005)

--Lindsey

[earler]

Krugman doesn't know much about medical insurance. As I've said before, every country has problems, often worse than those in the usa. In france, do get full coverage you must pay extra. Otherwise, co-pay for drugs is 30%, sometimes as much as 85%. Need an mri? Good luck unless you are in a major city like paris and your specialist has a friend in one of the 2 hospitals with such equipment. Dental work? Other than extractions, nada. Glasses? You get a fixed sum of $50 or so. Need a pediatrician for your children? Good luck since most are leaving the profession. Got skin problems? Count on 3 to 6 months to get an appointment with a dermatologist unless you are in paris, then it will be just a month or 6 weeks.

The uk? Well, there is a waiting list of many months for much surgery. In fact, the british government has been paying to send patients to provincial hospitals in france for surgery.

There are many reasons why medical care is so much more expensive in the usa. First there are those malpractice premiums. Bush has tried to put a cap on malpractice awards, but congress wouldn't go along, especially the democrats. It seems that most malpractice lawyers are democrats and pay for heavy lobbying, too. Doctors tend to have patients go through a full battery of diagnostic tests because of the possible risk of a malpractice suit. I understand that 100% of obstetricians have been sued at least once.

A major problem with medical insurance is that it isn't insurance but subsidy. Unlike say automobile insurance where you are insuring in case you are unfortunate to be in an accident, with health every one uses it. So, it is a subsidy. Those who are healthier subsidize those who are ill. Jeff speaks of icu's making health insurance more expensive? How so. The insurance companies don't pay. It's one government or another, local or national.

I won't deny the situation in the states is a mess. However, it is worsened by the many who voluntarily self-insure though they earn enough to pay for insurance. The poor get care through icu's, an expensive method. Hillary wanted to foist a system like we have in france ($15 billion deficit last year for medical, by the way) when the real solution is to create a tax credit to make people (who can) buy insurance. If they don't do it they pay the money as tax. Of course, you have to put reasonable caps on malpractice suits, too.

That won't resolve the problems since medical care costs more and more so insurance costs more. The day will come when people of a certain age will be led into a room with nice music and.....



-er

[Lindsey]

Krugman doesn't know much about medical insurance.[/QUOTE
Oh, and you're the international expert, are you? Krugman is an economist; what professional credentials do you bring to the table?

[QUOTE=earler]As I've said before, every country has problems
I never said otherwise. But please cite a study that says that France has worse health care outcomes than the U.S. I don't think you can. Everything that I have seen in recent years puts the U.S. near the bottom of the heap, in spite of the fact that we lead the pack in what we spend. Even in the UK, though they have tried to set up their program on the cheap, people are healthier than in the U.S.

There are many reasons why medical care is so much more expensive in the usa. First there are those malpractice premiums.
Wrong. That's a red herring. Malpractice payouts are less than 1% of US health care costs. Malpractice premiums are also less than 1% of US health care costs. (http://www.centerjd.org/air/pr/AIRhealthcosts.pdf, http://www.msnbc.msn.com/id/8551575/, http://www.factcheck.org/article133.html)

But it's interesting that you blame the failure to pass tort reform legislation on Democrats when the Republicans are in control of Congress.

A major problem with medical insurance is that it isn't insurance but subsidy. . . . Those who are healthier subsidize those who are ill.
This is the way insurance works, Earle. Auto insurance, fire insurance, insurance against theft -- those who are lucky "subsidize" those who are unlucky. But you're looking at it the wrong way. Insurance is a way of managing risk. Everybody pays a little bit so that nobody has to pay a whole lot.

the real solution is to create a tax credit to make people (who can) buy insurance. If they don't do it they pay the money as tax. Of course, you have to put reasonable caps on malpractice suits, too.
Bull. Cite me one place in the world where such a system is in place and working successfully -- successfully being where longevity and infant mortality measures come up to the standard of France or Germany or the UK, and where the total cost doesn't significantly exceed what those countries are paying.

--Lindsey

[earler]

The tax credit has the advantage of not beggaring the insurance companies and the medical profession. As always in politics it is best to adapt what one has rather than overlay with a new system that will cost much more without being necessarily more efficient. Of course, for those unable to buy medical insurance they would make a minimal contribution. Thus, everyone would have coverage.

As has been pointed out by others, medical insurance isn't really insurance but based on mutual subsidization since everyone uses medical care. Not everyone's house burns down, not everyone is burglarized, not everyone's car is involved in an accident. So, yes insurance is a way of managing risk. Other than major medical care, medical insurance is subsidies. Those who are sicker are subsidized by those who are healthier.

The reason the tax credit scheme is not used elsewhere is because those countries adopted a socialized health scheme a long time ago. But, because of the increased cost of medical care and diagnosis, they all have moved to a system that reimburses less and less, so those who can afford it buy supplemental insurance. Those who can't use icu's.........just like in the usa.

-er

[Lindsey]

The tax credit has the advantage of not beggaring the insurance companies and the medical profession.
Yeah; it just beggars the taxpayers. You know, those guys who are already having trouble making ends meet.

rather than overlay with a new system that will cost much more without being necessarily more efficient.
And what data do you have that suggest that it would be both more costly and less efficient? Everything I have seen says that the current system itself is more costly and less efficient than single-payer systems in place elsewhere.

Of course, for those unable to buy medical insurance they would make a minimal contribution. Thus, everyone would have coverage.
Huh? Would you care to put that in plain English? Those who cannot afford medical insurance are probably not going to qualify for tax credits, either, so how are they covered? Seems to me tax credits equate to yet another subsidy for the well off. And if nobody else is currently using such a system, what data do you have to suggest it would actually work?

so those who can afford it buy supplemental insurance. Those who can't use icu's.........just like in the usa.
Uh, no. I don't know what you've been reading, but people don't routinely use ICUs here.

--Lindsey

[Karl Semper]

Uh, no. I don't know what you've been reading, but people don't routinely use ICUs here.

--Lindsey

I think that he means the "emergency room" not the "intensive care unit".

I am not completely satisfied with our medical care system either. The company that I work for just saw a 30% increase in our insurance premium.

Having been under both the German system and the US system of health care, I will say that I prefer the US system. Granted since I was privately insured in Germany, I had the advantage of having much better access to doctors, but the care that the primary physician gave was not as good as the care given in the US by my primary care physician. The availability of physicians, even in smaller communities in the US is much better than in Germany. Specialists and advanced diagnostic equipment is significantly more accessible in the US than in Germany.

As an example an emergency room physician in Germany after an acident at work sent my wife back to work with a broken nose without even taking an xray. The next day she had to go the emergency room again, by then it was very obivous that something was wrong and an xray revealed that she had a broken nose. I can do without that kind of care.

[Judy G. Russell]

Having been under both the German system and the US system of health care, I will say that I prefer the US system. My own view is that there's no really good reason why we can't combine the best of both worlds.

[Lindsey]

The availability of physicians, even in smaller communities in the US is much better than in Germany. Specialists and advanced diagnostic equipment is significantly more accessible in the US than in Germany.
I suspect this is a function of something else you mention in your message:

The company that I work for just saw a 30% increase in our insurance premium.
You have employer-paid health insurance, which means that your access to health care here in the US is at the high end of the scale. If you had to pay for the entire policy out of your pocket, and without the benefit of access to a group plan, you likely would find your access far more limited: able to use only certain doctors, for example, or eligible for only certain treatments and medications. And if you could not afford insurance at all, your access would be more limited still. Overall, the figures say that citizens of the US have less access to health care, and especially less access to preventive care, than do citizens of Germany. I know that runs counter to what is intuitive to most people here in the US, but that's what the numbers say.

It's an insane system; it makes no sense whatsoever that the quality and price of the insurance that is available to you should depend on who you work for. But it's the way we have set the system up. And it means that people who are self-employed, or who work for small businesses, have difficulty getting affordable insurance. And heaven help you if you lose your job, or if your employer doesn't provide group insurance and you make too much money to be eligible for Medicaid.

The next day she had to go the emergency room again, by then it was very obivous that something was wrong and an xray revealed that she had a broken nose. I can do without that kind of care.
You know what? That sort of thing happens in the US, too. That's why there are malpractice suits. One experience with one physician proves nothing about the quality of the system as a whole. And, again, the longevity and infant mortality statistics tell us that the US is not getting good value for the enormous amount of money that is spent here on health care. We're lagging Canada and Germany and France and the UK and just about any other advanced country you'd care to mention.

--Lindsey

[earler]

I meant to say emergency rooms, not icu's. Mea culpa. My point remains the same.

I said that those who couldn't profit from the tax credit, i.e. those who earn too little, would be covered by the safety net, albeit making a minimal payment.

-er

[Lindsey]

My point remains the same.
The point you would seem to be making, it seems to me, whether you intend it or not, is that inadquate insurance results in inefficiency and higher total cost in the long run, which is pretty much what I am saying, too. The question is how to provide efficient health care delivery. The figures show that the US system ain't it, and that the European systems are far more efficient.

I said that those who couldn't profit from the tax credit, i.e. those who earn too little, would be covered by the safety net, albeit making a minimal payment.
What safety net? In this country, we've been working at tearing it full of holes for the last 25 years. The movement conservatives see safety nets as discouraging individual initiative, and thus a moral evil.

--Lindsey

[earler]

Inefficiency is rife in all medical care systems. In a government run one it is mostly the excessive bureaucracy and poor allocation of resources. In the american system it is in large part due to too many resources (e.g. there are far more mri systems than really required in the usa), often concentrated in urban areas, the fear of litigation that has led to too much diagnosis (it isn't just the premiums for malpractice insurance but the extra cost for all those tests).

You speak of figures proving that european systems are more efficient. However, those only cite the percentage of gdp used for medical care. It is much higher in the states for several reasons, few which of have anything to do with efficiency. As me old pappy said, there 3 kinds of lies: lies, damned lies and statistics.

As for safety nets, well they exist everywhere and even the most rabid of conservatives doesn't confuse them with moral evil or 'discouraging individual initiative'. Everyone gets medical care one way or another. The real problem is how they get it and its cost. No one has the magical solution, in the usa or here in europe.

-er

[Judy G. Russell]

Everyone gets medical care one way or another.Are you out of your cotton-pickin' mind? Do you even know anyone here in the US who doesn't have and can't afford insurance? I do, and I have seen how they have suffered because they can't get medical care at all -- or at least not unless and until the situation is critical. Not everyone here without insurance runs off to sit for 6-8 hours in an emergency room hoping they will not lose their jobs while getting the only kind of care that might (not will, but might) be available to them without insurance. The reality instead is grim beyond words. Asthma and allergies left totally untreated. Cancer left undiagnosed until there is no treatment.

The notion that everyone has medical care is just flat out wrong.

And as a postscript, from today's Washington Post: "Emergency medical care in the United States is on the verge of collapse, with the nation's declining number of emergency rooms dangerously overcrowded and often unable to provide the expertise needed to treat seriously ill people in a safe and efficient manner."

[Lindsey]

Inefficiency is rife in all medical care systems. In a government run one it is mostly the excessive bureaucracy and poor allocation of resources. In the american system it is in large part due to too many resources
Nope, sorry, the studies don't agree with you there. They show that the chief source of inefficiency in private insurance systems in the US is overhead -- the paperwork associated with screening people out. In the US, the government-run systems (Medicare, Medicaid, the VA system) are far more efficient, because they don't spend a lot of resources trying to screen people.

As me old pappy said, there 3 kinds of lies: lies, damned lies and statistics.
Well, sorry, but until you can provide me with something more substantial than anecdote and opinion, I'm going to stick with the hard numbers.

Everyone gets medical care one way or another. The real problem is how they get it and its cost.
Nope, as Judy has said, they most certainly do not. There was a guy here in Richmond who used to be the sports anchor for one of the local TV stations. But then the station decided they wanted someone younger and flashier and louder and let him go. He fell on hard times and eventually lost his health insurance. Then he developed cancer at a young age, and he was forced to decide between feeding his kids and getting treatment for himself. He opted to feed his kids. And he's now dead. And his case, unfortunately, is not unusual. The statistics cite an alarmingly high percentage of Americans who have foregone treatment or not filled prescriptions because they could not afford it.

So don't tell me that everyone gets treatment. They don't. Not here.

--Lindsey

[earler]

If people didn't get treatment the mortality rate in the usa would approximate that of haiti or ghana. Since it isn't, people do get medical care. That it isn't optimum quite often, and that it actually costs more because of the use of emergency rooms and the lack of prophylactic medicine, well it is obvious. That the system requires serious reform, yes I agree, too. But, to ape the ones in europe is not the answer. Whatever is eventually done has to be done in the context of the systems now in place.

-er

[earler]

As I said to lindsey, your argument would mean the mortality rate in the usa would resemble that of ghana or haiti. It doesn't. The rich get care, the poor get care, and so does the middle class. But it is the middle class that is squeezed because they have to pay and can't afford it. The poor can't pay and use hospital emergency rooms and medicaid.

-er

[earler]

By the way, I've never picked cotton. I'm told it is quite arduous.

-er

[Judy G. Russell]

I'm afraid you just don't get it here. There is no such thing as universal medical care in the US.

[Lindsey]

If people didn't get treatment the mortality rate in the usa would approximate that of haiti or ghana. Since it isn't, people do get medical care.
Eventually, perhaps. But only after their conditions have become far more expensive to treat, and with much less chance of a good outcome.

But, to ape the ones in europe is not the answer.
Why not, when they get better results at less cost?

--Lindsey

[Dan in Saint Louis]

If people didn't get treatment the mortality rate in the usa would approximate that of haiti or ghana. Since it isn't, people do get medical care.
EARLE, you seem to present this as if it were an all-or-nothing situation. It has grey areas. Yes, people in the US can get health care -- if they have enough money or are employed by a company that provides insurance. Were my premiums not mostly covered by my employer, my health insurance for 2004 would have been $13,826.44. It has increased faster than inflation since then. What fraction of US residents do you think can afford that?

[Wayne Scott]

Lindsey: The real cost of malpractice suits is not the payout of claims. The real cost is the enormous amount of money (and, no, I can't give you an exact reference for that) spent for "defensive medicine." Valueless and expensive x-rays, lab tests, MRI's, CAT scans, consults with specialists are performed every hour of every day to make sure that if a patient has a bad result, that patient can't sue because it wasn't done.
I believe that we generally have excellent health care in the US, but we have a lousy health care delivery system. The problem is that NO ONE has come up with a really good delivery system. Even I, brilliant as I am and as you think I am, have a good idea of how to set up a good health care delivery system. The one the Junior Senator tried to foist off on this nation was one of the worst in countless ways.
Your statement about the fact that we are near the bottom of the list in longevity and infant mortality is a reflection of the fact that we have, for example, 12 million or so illegal aliens in this country (and I have no idea of a way to deal with that, either, except that I'm sure the position of the Republican "leadership" in the House is wrong, wrong, wrong), and that we have a large population of Blacks who are generally neglectful of preventive health measure and that our reservation Indians are generally poorly served.
You have one 84 year old friend whose longevity is pretty good, but in the slums of Virginia, there are enormous numbers of dark skinned people whose illegitimate babies are dying or in ill health.

[Wayne Scott]

Lindsey: The real cost of malpractice suits is not the payout of claims. The real cost is the enormous amount of money (and, no, I can't give you an exact reference for that) spent for "defensive medicine." Valueless and expensive x-rays, lab tests, MRI's, CAT scans, consults with specialists are performed every hour of every day to make sure that if a patient has a bad result, that patient can't sue because it wasn't done.
I believe that we generally have excellent health care in the US, but we have a lousy health care delivery system. The problem is that NO ONE has come up with a really good delivery system. Even I, brilliant as I am and as you think I am, have a good idea of how to set up a good health care delivery system. The one the Junior Senator tried to foist off on this nation was one of the worst in countless ways.
Your statement about the fact that we are near the bottom of the list in longevity and infant mortality is a reflection of the fact that we have, for example, 12 million or so illegal aliens in this country (and I have no idea of a way to deal with that, either, except that I'm sure the position of the Republican "leadership" in the House is wrong, wrong, wrong), and that we have a large population of Blacks who are generally neglectful of preventive health measure and that our reservation Indians are generally poorly served.
You have one 84 year old friend whose longevity is pretty good, but in the slums of Virginia, there are enormous numbers of dark skinned people whose illegitimate babies are dying or in ill health.
In the middle of this brilliant posting there is a phrase "have a good idea" which should read "have NO good idea."

[Wayne Scott]

The FDA has just announced that Zostavax, a new vaccine against shingles (Herpes zoster), was licensed yesterday for people aged 60 and up. (That doesn't mean it's not good for people under 60, only that that was the age group in whom it was tested and proved safe and effective--well, relatively; see below.)

I was in the national three-year study of 38,000 people in whom the vaccine was tested, and it turned out when they broke the code (the study was double-blind) that I'd received the real stuff. Which doesn't mean that I absolutely won't get shingles: the vaccine seems to work as a preventive around 50 percent of the time (about 65 percent for those under 70); for the rest, it appears to decrease the severity of the illness. And I gather that it can be VERY severe.

Shingles is a reactivation of the same infectious agent (the varicella-zoster virus) that causes chickenpox, and you can get it only if you've previously had that common childhood disease. (There's now routine vaccination for children, which of course they didn't have when most of us were kids.) If you're in that category, you might want to talk to your doctor about the new vaccine.

--Dodi
Indeed, Dodi, this is a wonderful piece of news. There are many, many people who have long term hideous pain from shingles.
This won't save as many lives as the other new breakthrough of the HPV vaccine, but it will prevent a lot of awful pain.

Wayne

[Lindsey]

Lindsey: The real cost of malpractice suits is not the payout of claims. The real cost is the enormous amount of money (and, no, I can't give you an exact reference for that) spent for "defensive medicine."
Enormous? I'm not so sure. If it were enormous, it should be readily measurable. It isn't. What few studies have been done to try to quantify the cost of defensive medicine are inconclusive. See http://www.factcheck.org/article133.html

The one the Junior Senator tried to foist off on this nation was one of the worst in countless ways.
You are, I presume, speaking of Sen. Clinton; she is not, I would note, the only junior senator in Washington. She has as much seniority as George Allen, but it's funny, isn't it, that nobody ever refers to him as "the junior senator"?

The Clinton health care plan had problems, certainly (chiefly, it seems to me, that it was too timid and didn't go far enough in overhauling the current system), but the sad thing is that the Republicans, rather than trying to work out a solution to the problem they thought would be acceptable, took the issue as a way to "get" President Clinton by spiking a high-profile initiative. And that has left us with what we have today.

Your statement about the fact that we are near the bottom of the list in longevity and infant mortality is a reflection of the fact that we have, for example, 12 million or so illegal aliens in this country
I have not come across any studies that blame undocumented aliens for those things. (Political pundits, yes; people with actual figures, no.) The greatest at-risk group is African-Americans, not Latinos.

But never mind that; the studies also show that white, middle-aged Americans are not doing especially well in the comparative health department, either. (This article (http://www.technewsworld.com/story/50414.html), BTW, is as good a lay analysis of the infant mortality problem as I have seen.)

I agree with you that we need to get a handle on the illegal immigration problem, and the current proposals on the table don't strike me, either, as being especially good. It's a very difficult problem to tackle, and I don't know that it's resolvable in the current political climate, unfortunately.

--Lindsey

[earler]

Bear in mind that rampantly increasing obesity among americans in general, not just "white middle-aged americans", is a significant reason why americans die younger than the french or the japanese.

-er

[Lindsey]

Bear in mind that rampantly increasing obesity among americans in general, not just "white middle-aged americans", is a significant reason why americans die younger than the french or the japanese.
Oh, that's part of it, certainly. But I don't know that Brits are especially known for their wholesome diets, and they're significantly healthier than Americans, too.

There are lots of other lifestyle things that play into it, as well. Krugman had a column commenting on that not so long ago as well. Americans work longer hours and take less vacation than their European counterparts. (And I could inject here that many of them have to if they want to be able to pay for health insurance...) We design communities in ways that cause traffic congestion (and thus additional stress) and are unfriendly to walking and cycling.

But we're also falling badly short of the mark when it comes to delivering health care.

--Lindsey

[earler]

Less obesity in the uk. Japan has the longest lifespan among major countries, followed closely by france, where I can assure you people eat more balance meals than in the usa. Far fewer carbs and sugar.

-er

[Lindsey]

followed closely by france, where I can assure you people eat more balance meals than in the usa. Far fewer carbs and sugar.
Oh, I'm sure they do. They have more time and better markets. The 60-80 hour workweeks that are not uncommon here don't leave a lot of time for preparing proper meals.

But even with all that taken into account, it doesn't change the fact that we have significant numbers of people who do not have adequate access to health care.

--Lindsey