By the way, flu season is heating up. You can check that by clicking the link, or going here. There's lots of the milder influenza B, and some of the nastier influenza A, but on the whole, we've had worse years (but this one is not over.) Luckily, the vaccine this year seems to be hitting the A strains fairly well (one of which is tamiflu-resistant), but the B strains not so well (see part I of this series).
Here's NBC News talking about flu season and pandemics from Friday's broadcast:
This week was also the week the Congress passed the President's 789 billion stimulus bill. There was money for science, and money for health, but not for pandemic influenza planning (removed in conference.) To follow up on that, and to discuss why it was there in the first place, I contacted Jeff Levi of Trust For America's Health for more information. Jeff's been with TFAH since 2005, and its ED since May 2006; more from his bio:
Jeffrey Levi, PhD, is Executive Director of Trust for America's Health, where he leads the organization's advocacy efforts on behalf of a modernized public health system. Dr. Levi oversees TFAH's work on a range of public health policy issues, including its annual reports assessing the nation's public health preparedness, investment in public health infrastructure, and response to chronic diseases such as obesity. Dr. Levi is also an Associate Professor at The George Washington University's Department of Health Policy, where his research has focused on HIV/AIDS, Medicaid, and integrating public health with the healthcare delivery system. He has also served as an associate editor of the American Journal of Public Health, and Deputy Director of the White House Office of National AIDS Policy.
I've met Jeff and heard him present at a number of health-related conferences over the years, where he's been routinely called upon to summarize governmental outlays and involvement, and I've linked and sourced TFAH frequently (in fact, TFAH's Laura Segal joined me in presenting a panflu summary at Yearly Kos in 2007.) Jeff was kind enough to answer a few questions for us.
DemFromCT: TFAH follows government spending and budget items. Can you explain to our readers why pandemic influenza or other public health preparedness and infrastructure funding belongs in a stimulus bill?
There are two levels of argument in favor of including pandemic preparedness in particular and public health programs in general as part of the stimulus bill. First, these do meet the test of stimulating the economy. Much of the nearly $900 million in pandemic money would go toward research and development – biomedical research that is very similar to the work that NIH funds. Ironically, as the pandemic money was being cut as inappropriate to a stimulus bill, the Senate was simultaneously increasing funding for the NIH. In fact, the bioscience sector is a source of high-wage jobs. The average bioscience job paid $71,000 in 2006, $29,000 more than the average private sector job. It has been estimated that each bioscience job generates an additional 5.8 jobs in the national economy.
The public health sector in general is also hurting. TFAH has conservatively estimated that the $5.8 billion in public health spending that was withdrawn from the Senate bill would have created 40,000 jobs – that’s without calculating a multiplier effect in the local economy. State and local health departments are hurting. Recent surveys by the trade associations for state and local health officials have shown that 11,000 jobs have already been lost; another 10,000 have remained unfilled as they became vacant. This gets at the core capacity of health departments to respond to emergencies such as a pandemic as well as to serve a core safety net function during a recession – providing preventive services and direct care for the growing number of uninsured.
As originally proposed by the Administration, the stimulus bill was meant to accomplish two related goals: first, provide direct stimulus to the economy and second, to start building the nation’s core capacities for health reform. Indeed, the funding for creating electronic health records remains in both the House and Senate bills, as well as funding for comparative effectiveness research. The prevention and wellness funds were also designed to increase the capacity of our public health programs to improve the health of communities – so that uninsured Americans (and all Americans) would enter the reformed health care system healthier. That is still a worthwhile goal of any legislation called the Economic Recovery and Reinvestment Act. But as I mentioned above, these investments can also have a stimulative effect.
DemFromCT: And where does that stand in the final bill? [The stimulus bill is here, .pdf summary here.]
The final bill does not add back any of the pandemic money. So this leaves my original comments on that subject intact. We have been told that there will be an effort to include these funds in the omnibus FY 2009 bill that is expected to move soon – but we shall see.
Only other addition is that the final number for public health prevention is $1 billion – down from the $3 billion in the House number, but obviously better than being zeroed out in the Senate bill. This is a major investment ($300 million for immunizations, $650 million for community-level prevention, and $50 million for health care acquired infections) the likes of which the public health community rarely, if ever, sees. I think it is a signal that the Obama administration is committed to investing in prevention and public health – and that public health will have an important seat at the health reform table.
DemFromCT: Do you think professional societies (e.g., IDSA, AAP, APHA, etc) have been visible enough in explaining why public health needs funding?
One of the things that has been quite gratifying about the current fight to preserve the prevention and pandemic funds is the degree of unity within the public health community. We are speaking with one voice. But that said, we still lack the grassroots or even "grasstops" support that so many other issues have.
DemFromCT: You’ve written about the role of the states vs the role of the federal government by helping to produce readiness report cards. What’s the impact of the recession on the grades you’ve already assigned? Do you expect states to be able to deliver on programs already underway? How else does the recession affect the feds and the states?
In releasing our 2008 version of Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism we expressed great concern that some of the progress we have measured over the last six years will diminish as states make budget cutbacks and the impact of federal cuts in preparedness funding are felt. We know that states are cutting public health budgets; we know that states are laying off key personnel and leaving vacancies unfilled. This will inevitably have an impact on preparedness. It will take some time to be able to measure that impact, but we certainly know anecdotally that it is real. That is why the funding for state and local health departments – and state governments in general – in the stimulus package has been so important.
DemFromCT: Do you have any strong feelings about whether health czar and HHS Secretary should be one job or two? Any preferred candidates? If not, how about skill sets for each of the jobs?
I think whether these positions should remain one will be determined in part by the personality and experience of the final choice for HHS Secretary. Tom Daschle had a unique set of skills: a combination of familiarity with the breadth of health issues, in-depth (almost wonkish) understanding of health reform concerns, and tremendous political skills to shepherd policy through Congress. Running HHS is a major undertaking in itself. The policy development around health reform is another full-time job. Jeanne Lambrew, who is the deputy in the White House Office of Health Reform, has the knowledge and depth of experience to do the policy development part. As long as she and the new HHS Secretary have a strong working relationship, this might be a more balanced approach. My bottom line: being sure that whoever is involved in running HHS and/or developing a health reform proposal recognizes that public health and what happens in communities is a critical component of health reform – it’s not just about providing coverage for everyone, as important as that may be.
DemFromCT: Can you touch on why single payer health reform seems to never be a seat at the table?
I have never fully understood why single payer has been so readily delegitimized as an option. I think it suffers from a combination of bad press (being so easily stigmatized as government-run medicine) and the instinctive American discomfort with major structural change. I have always been struck, of course, by the inconsistencies in this debate. We have been willing to embrace single payer for the elderly (that’s what Medicare is) and a national health service for veteran (which has better health outcomes than most private plans). Both are immensely popular programs that politicians eagerly support. I can’t explain why we haven’t created the political will to offer comparable programs to the rest of the country.
Previous parts of Flu and You can be found here.