Wednesday, September 25, 2013

Disillusioned with government

There are many reasons and ways to distrust government, God knows.  As a card-carrying liberal, I have always thought of the good things government can do.  But the more I get involved in government programs, the less I trust.

Here is a beautiful example.  What could be more important to kids than vaccines?  Aside from clean water supplies, there have arguably been no measures more important for saving lives.  Public health demands that children be vaccinated.

In this country the great preponderance of vaccines are dispensed by private medical offices.  No problem there – in general, they do a good job.  Enter, government!

The government says, why should patients on Medicaid get vaccinations the way all the private patients do?  Let’s do it our way!  Instead of having local offices purchase the vaccines and charge for them (with overhead included in the charge), let’s buy the vaccines ourselves (it’s called the Vaccines For Children program, or VFC), ship them to the doctors, and have them give the vaccines to the Medicaid kids.  And since the offices don’t pay for these vaccines, let’s not pay them anything except for administering the vaccines – let them order, receive, inventory, refrigerate, etc. for free.  In other words, if an office agrees to see Medicaid children, let’s make sure they lose money on the deal, because they will have to pay for their overhead out of their own pockets.  That’s their reward.

But wait, you say you’re not satisfied, you say you want more for your money – tell ya’ what I’m gonna do!  Not only will you get no payment for overhead, but if you somehow drop a dose on the floor, you will have to pay us the cost of that vaccine.

And that’s not all.  In addition, we will dictate how you will store your vaccine; it can only be in approved refrigerators and freezers, which you have to buy out of your own pocket.

And even that’s not all.  Some states (hello, Connecticut) will also supply “free” vaccines for even those kids covered by private insurance, so the practices can lose overhead on those kids also!

And then, let’s regulate some more.  Let’s make sure that if a practice has a shortage of a certain vaccine for the VFC program, you can’t borrow from your private stock to vaccinate a kid and replace it later, or vice-versa, no matter how good your record keeping.

And there’s even more – let’s mandate that all vaccines have to be stored separately according to who purchased it.  Here is what Graham Barden, terrific public spirited pediatrician from North Carolina has to say:

Just when you thought the CDC's requests could not get crazier.  The CDC thinks it is reasonable to have separate VFC, Private, S-CHIP, 317, State supplied vaccine. Five complete sets of vaccines. The bean counters want to make sure no one can say they are not counting beans!  Paperwork is now the measure of our success.”

As I said, I have always believed in government.  But when I get up close, government doesn’t seem so nice to deal with.

Budd Shenkin

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