Aggressive Treatment

Alex Tabarrok discusses the positive externalities associated with flu shots. Brad DeLong notes the ways in which our present health-care finance system fails to operate with any awareness of the large social value of getting one's flu shot.

Indeed, one thing that seems clear to me is that there are certain segments of the health care universe -- things like vaccinations -- that almost certainly ought to be "socialized" in a pretty strong sense irrespective of what we do with the rest of health care. A public Flu Shot Corps should be running around the city (or the shopping mall, wherever you're likely to find people) with credible badges and uniforms handing out flu shots and hunting people down in their homes, offices, supermarkets, wherever to ensure that getting these things are not only free but as convenient as possible. Then they could give you a sticker (so people stop annoying you) and a lollipop or something. This kind of thinking obviously doesn't apply to the entirety of our health care system (indeed, it might only be a small part) but these kind of simple preventive measures are the highest value portions of the system, and they ought to be pushed on people (not coerced but provided aggressively and conveniently) not charged for. How hard would it be for people armed with Sphygmomanometers to run around testing people and handing out brochures to those with problems?

Comments

It would be easy to have a public corps of sphygmomanometer-wielding busybodies. I imagine they'd get plenty of false positives from people like me. And I can also assure you that unless you first clean up government somehow, the brochures they handed out would have a lot to say about prescription drugs and very little about things like exercise and oatmeal.

Posted by bbartlog | November 13, 2007 9:37 AM

The "large social value of getting one's flu shot" seems pretty sketchy. Influenza isn't polio, we aren't going to get or maintain herd immunity.

Posted by BrianA | November 13, 2007 9:56 AM

I'd bet you've just scared a good number of people off of supporting any increase in the Federal government's role in the health care market.

Posted by washerdreyer | November 13, 2007 10:19 AM

People fear and distrust the government for a multitude of reasons and there's no reason to expect that those people would come out of the woodwork to receive a flu shot. Marginalized and vulnerable populations are perhaps the ones that most need flu shots, but in a community where you have, say, a large number of undocumented immigrants, you're not going to see many of them at a free government-run flu clinic.

Posted by Joe | November 13, 2007 10:35 AM

I think I agree, but other examples might have been better. I've read somewhere that flu shots are not really that effective and there is already quite a few people running around taking blood pressure. It happens in offices, malls, in these trailers they park on the street, plus, of course, every time you go to the doctor.

What I would really like to see is a two-tier medical system. The first tier is nurse practitioner types. You go see them for colds and check ups. They already have these in a lot of places, but they still charge like these are full on doctors. In my brilliant plan, these nurse-practitioner types would charge $20 per visit, basic diagnostic tests $20 a piece, no insurance necessary. They would get paid by salery instead of the fee for services, so the number of people they saw wouldn't matter. It wouldn't be like they had this precious finite supply of medical advice that they dole out on drop at a time, like it is now. Plus they wouldn't need any fancy machinery that they had to pay off via fees. The first tier would be a simple small business which would then funnel into the second tier: the doctor world we have now, which would be covered by insurance. Right now, everyone is treated in tear 2 with all it's hyper-educated doctors and increadibly expensive equipment. We're swatting flys with CAT Scanners.

Posted by cw | November 13, 2007 10:47 AM

I run a homeless coalition in an area where the local health department does not provide any adult immunizations, nor is there any other form of governmental assistance. Our rates of infection each winter have been horrific, with 19 known deaths three years ago. For the last two years, my husband (a physician) has been offering free flu shots, which he and his staff provided at the sites of cold night shelter and meal programs. I don't know many more marginalized and vulnerable populations than the homeless (which includes lots of undocumented immigrants), and our experience is that the homeless have come out in droves both years. The amount of infection among homeless and volunteers was down markedly, and there were no flu deaths last year. The insurance and governmental medical systems have always emphasized acute care at the expense of preventive care, which is economically and morally insane.

Posted by Lenore | November 13, 2007 10:49 AM

I would be willing to "take one for the herd" if the vaccine did not include 25 micrograms of mercury. Injecting a neurotoxin just does not seem like a good idea. Some flu vaccines reportedly do not contain poison, but I have had a hard time finding one.

Posted by dwight meredith | November 13, 2007 10:50 AM

For what it's worth, New York City offers free flu shots for anyone, via a long list of public clinics, although they don't accost you on the street about it.

Posted by Patrick Nielsen Hayden | November 13, 2007 11:17 AM

But in NYC, you'll see that heavily immigrant areas (whether they be documented or not) tend to be less responsive to the flu clinics. It may work with the homeless, but less so with the undocumented.

Posted by bob | November 13, 2007 11:36 AM

People that get flu shots get the flu at the same rate as those that do not. I believe there is nasty stuff in the vaccinations as d meredith pointed out above.

Posted by cheflovesbeer | November 13, 2007 11:50 AM

Ironically, corporations are an ideal vehicle for dispensing this type of health care.

Corporations can easily distribute flu shots and corporations have a vested interest in reducing flu occurrence.

Oddly, my current employer gave away flu shots, but to permanent employees only. Probably because giving flu shots is a benefit and you give temps too many benefits, you have to give the all benefits.

Posted by Sean | November 13, 2007 1:17 PM

I work in a hospital. The flu shots are free and they come to the department to give them. I would estimate that 50% of healthcare workers refuse to get them under these conditions. The reason given generally has to do with a previous bad experince, but other reason are cited.

Now with this being the case, Matt, how do you think you can implement this without coercion?

Posted by Skip | November 13, 2007 2:31 PM

Here's an interesting article about the one place where the state can and does use force in requiring immunizations--

http://www.washingtonpost.com/wp-dyn/content/article/2007/11/13/AR2007111301408.html?hpid=moreheadlines

Posted by Doh | November 13, 2007 5:11 PM

Indeed, one thing that seems clear to me is that there are certain segments of the health care universe -- things like vaccinations -- that almost certainly ought to be "socialized" in a pretty strong sense irrespective of what we do with the rest of health care. A public Flu Shot Corps should be running around the city (or the shopping mall, wherever you're likely to find people) with credible badges and uniforms handing out flu shots and hunting people down in their homes, offices, supermarkets, wherever to ensure that getting these things are not only free but as convenient as possible.
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This happened before you were born, but in the early 1960s this was done with the Sabin oral polio vaccine. There was an advertising blitz for "Sabin Oral Sundays" and people went to schools, fire stations, etc and got their free vaccine. It was dripped into a sugar cube in a small paper cup and you were given the thing to eat.

Everybody went and polio was pretty much eradicted here.

Of course I also remember the mass innoculations for "Swine Flu" in the mid 1970s. The whole country was supposed to get a free flu shot as there was a fear of another 1918 flu pandemic.
My father is a pharmacist and urged me not to get a shot.

The innoculations were stopped after 40 million people got them as the epidemic never materialized and hundreds of people died or developed a neurological disease from the vaccine. Thanks, Dad!

Government lost a lot of credibility about mass vaccinations after that. Some people credit this example of the CDC getting burned badly for their slow response to the beginning of the AIDS epidemic.

So, MY, who foots the liability when people die from vaccine side-effects from your mass program? Virtually every vaccine made will kill at least an infinitesimal percentage of the people who take it. As a society we have obviously judged that the benefits are worth it.

But with a high profile "Flu Shot Corps" the relatives of the people who die will be all over the media and in the courts demanding redress for the government murdering poor little Mary.

What'll that do to the cred for your socialized medicine plans?

Posted by Campesino | November 13, 2007 5:18 PM

What Matt's suggestion assumes is that flu shots actually have a measurable positive impact. They do not. In fact, flu shots are essentially a scam. I would make the counter argument that no one should ever, under any circumstances, get a flu shot.

Posted by Rob Mac | November 13, 2007 7:58 PM

Re: Re: People that get flu shots get the flu at the same rate as those that do not.

Can you cite some professional literature on that? If flu shots were 100% ineffective I have trouble believing the FDA would have approved them for use.

Posted by JonF | November 13, 2007 8:16 PM