Daily Archives: 16 February 2012

Quick insurance thoughts (mandates and exemptions)

“The core problem is that inserting employers between health insurers and individuals created an unnecessary tension between the provision of certain goods and the consciences and preferences of employers.” More in response to 13 Feb’s The Daily Show. Bottom line: de-coupling insurance from employment would likely be a positive step.

Why the individual mandate was deemed important and a consideration of whether it is the right tool for the job. But if it isn’t, then what is?

“The link between the mandate and interstate commerce is the claim…that the individual mandate will discourage people from “free riding”… But what if the individual mandate actually doesn’t accomplish that goal? That is, suppose the individual mandate, as written into the law passed by Congress, doesn’t actually apply to most of the people who obtain health care without paying for it (e.g. accessing the emergency room)?… Uninsured patients may be broadly divided into two groups – (1) those with (a) low income or (b) preexisting conditions, who can’t afford insurance; and (2) those who are generally healthy, have moderate or high incomes, and choose not to obtain insurance. The individual mandate will impact mainly the latter group – a group with very low rates of uncompensated care, and very low consumption of health care at all… Of the (1a) low-income uninsured, most will be either covered by the health reform law’s vast expansion of Medicaid eligibility… Individuals with (1b) expensive pre-existing conditions will be able to obtain coverage at premiums substantially below their health care expenditures, and thus have a powerful incentive to obtain insurance even without that mandate. This leaves those with (2) income high enough that their health insurance premium is less than 8% of their income, too high to qualify for Medicaid, and healthy enough that they are likely to find health insurance a bad deal financially.”

you’re not helping: seriously, CIA, we have enough problems convincing people to get vaccines, polio and otherwise

Posted on by hlanthorn

“At the behest of CIA officials, Afridi reportedly launched a fake polio vaccination campaign in Abbottabad last year, using it as a front to gather DNA samples from people thought to be relatives of the elusive Osama Bin Laden. This elaborate scheme would later contribute to the frenetic manhunt for and subsequent assassination of the Al Qaeda leader.

“(Before this) happened, one could brush aside negative perceptions about the polio vaccine, terming them baseless and ‘agenda-driven’, but not this time,” Fazal Shah, a development sector professional based in the northern district of Mardan, told IPS.

Religious leaders and tribal elders who had hitherto been highly successful in generating public support for the polio vaccine – by breaking myths about the vaccine being life-threatening, made of haram (forbidden) ingredients or causing infertility among both male and female recipients – found their efforts seriously hampered by Afridi’s hoax vaccination drive.”

Rest of article. (h/t KFF)

Update 6 March 2012 (h/t KFF)

“The CIA’s use of the cover of humanitarian activity for this purpose casts doubt on the intentions and integrity of all humanitarian actors in Pakistan, thereby undermining the international humanitarian community’s efforts to eradicate polio, provide critical health services, and extend life-saving assistance during times of crisis like the floods seen in Pakistan over the last two years,” the InterAction coalition wrote to the CIA director, David Petraeus.

Update 18 Oct 2012 (h/t Humanosphere)

“News reports out of Pakistan on the polio efforts there vary wildly, saying two very different things. Some say the efforts to vaccinate against polio are moving forward despite opposition from the Islamists, and from locals still mistrustful of health workers thanks to an ill-conceived fake vaccine ploy by the CIA… This report seems to indicate things are actually getting worse.”

Update 24 December 2012

“Yesterday, a male polio worker was fatally shot, and today four women were killed within about 20 minutes of each other in three apparently coordinated attacks in poor Karachi neighborhoods, including Gadap, where the July shootings occurred. Another woman was killed in Peshawar. Taliban insurgents have repeatedly threatened campaign workers, but so far no one has claimed responsibility for the current or previous attacks.”

Nice editorial 3 Jan 2012

“Pakistan now has a three-fold responsibility: addressing systemic polio eradication impediments, getting vaccination back on track with appropriate security cover for more 90,000 vaccinators, and reaching out to the masses with the right information to ally mistrust. At a minimum this would demand the will to prioritize action, the intent and ability of political factions to work collaboratively, and the ongoing injection of resources. With parliamentary elections forthcoming, all these will be in short supply.”

Further comment on recent polio worker killings via the lancet 4 Jan and time.com 4 Jan.

Nice post from Amanda Glassman and Charles Kenny (19 Dec 2012).

This situation unfortunately follows allegations that US security agencies used a Hepatitis B vaccination campaign as a vehicle for intelligence gathering (see here).  And it is clear that such allegations have had a chilling effect on vaccination programs—for example in Nigeria (see here)–even when completely baseless.

Given that, it is in our own interest to make crystal clear that the US supports global public health programs to improve global health alone and that US-backed public health interventions will not be used to gather intelligence. While far from a panacea, it might help persuade a few more parents to get their kids vaccinated, or a few more local leaders to back down from a boycott.  In the battle against global communicable diseases like polio and measles, every little bit helps.

Wired update 11 January 2013 (h/t humanosphere)

Worldwide, the polio campaign depends on the efforts of volunteer and low-paid vaccinators who work solo or in small teams, and there are signs that the Taliban intimidation has kept those teams at home. In Pakistan, both The News and The Frontier Post are reporting that “lady health workers” are staying home out of fear or as a result of family pressure… The crisis in Pakistan is not just about the changeable fortunes of the polio campaign, which has waxed and waned in public opinion since its launch in 1988. It is specifically in response to the admitted-to ruse by the CIA