Boston            

            She was sick of people acting like flu, even a front page flu like H1N1, was a new problem.  Didn’t I realize that regular, ordinary flu already killed nearly 40,000 US citizens alone?  Being a health professional she quickly lowered the figure from what had grabbed me down to 36,000 which is the Center for Disease Control (CDC) number of deaths from common flu.  Of course, she added, “these are mostly old people, so no one seems to care.”  Hmmm…I checked that as well, and the CDC estimates that 90% of these deaths are citizens over 65, which isn’t really all that old, is it?

            She wanted flu shots at all nursing homes, hospitals, and wherever old people gather.  Made sense…just like I have been lobbying for computer terminals to access benefits at big box stores and everywhere else.  I mentioned to her that I had seen swine flu stations in the Atlanta and Charlotte airports with charges of between $35-$45 dollars.  She scoffed. 

            What are the costs?  Seems the in-store clinics at Targets, Wal-Mart’s, Walgreens, CVC, and elsewhere get get it done between $15-$25, while you wait.  A “frugal” blogger listed places where the shots are available for free in different communities.  Some places were administering flu shots in drive-by windows with people not even getting out of the car! 

            Interestingly, the CDC estimates the cost of treating flu alone is $40 billion.  I’m not sure if this includes lost work time.  I saw another figure that put the cost at $75 billion and up, which I bet does include lost time for employers.

            A little organizing math, OK?  If one got flu shots to 300 million Americans and the cost of each shot from production to delivery was as high as $5 per pop, it would run $1.5 billion to try to really prevent and immunize flu.  Seems like a bargain almost. 

            Let’s say such an effort were sufficient to cut the morbidity rate from common flu in half to only 18,000 deaths, saving 18,000 lives.   We would be spending $83,000 for each life we were saving.  I’m not sure how Sarah Palin’s “death panels” would see that.  Many elderly folks might not be worth 80 large.  Of course if we saved $20 billion of what we are spending now to keep them alive each living survivor would save “us” $1.1 million apiece by staying alive, so to speak.  I’m sure the real public health experts have the real numbers, but no matter how you chop and dice this, it’s cheaper to inoculate against common flu that spend the money to treat it, and the added lagniappe is that 18,000 plus folks would still be alive through another flu season! 

            This is a different twist on the public option, but what’s wrong with public health and common sense?

Pittsburgh

All of this made me wonder about the comments in the papers that are putting real leverage around the healthcare debate in the hands of people like Senator Mary Landrieu from Louisiana where I vote.  Reportedly, Landrieu is buckling at the public option, and just as driving around Pittsburgh again made me wonder what was happening to the base, such a position in Louisiana is also a head scratcher given how many of the state’s citizens are working, but lower income, and have no insurance.

These perplexing “individual mandates” that might make lower income workers have to come up with a couple of grand per year as a penalty for not being insured would be a slap in the face to legions of voters especially in the cities of New Orleans, Baton Rouge, Shreveport, and Lake Charles who have been the margin of victory for Landrieu for years.  Senator Arlen Specter of Pennsylvania is a “new” Democrat in the sense that he has come into the party recently to hand on to his seat, but I wonder if he hasn’t traveled the same roads through the neighborhoods of Pittsburgh, because the contrast with Landrieu is stark.  He’s saying he’s going to hold out for a “public option” to protect the poorest workers, and talking about reducing the mandate charges down to as low as 3% of income on the test.

Did I say this was all complicated?  Absolutely!  And, the more complicated, the more difficult it will be to make the deal.

But, the fine senators in every state need to take a look at their base and step up and represent finally!  The negotiations in the Senate may make great drama, but I bet the accountability back home is going to be real if the base is ignored.