January 15, 2006

Was the Widespread Use of Asbestos STILL the Right Decision?

Rachel Maines argues in her book (Asbestos and Fire: Technological Tradeoffs and the Body at Risk) that asbsestos was worth it based on lives saved. It’s not an argument to be dismissed out-of-hand:

Rachel Maines argues that the risks associated with the widespread use of asbestos in America were worth the lives saved.

“More children died in fires than adults are dying now of asbestosis and mesothelioma,” Maines said.

In 1948, fire deaths in America reached 11,000 — 40 percent of which were children, she said. Today there are about 3,000 fire deaths in the country per year.

Thanks to asbestos — a product that doesn’t catch fire, weaken, conduct heat or absorb heat — the fire death rate in America fell by three-fourths between 1900 and 1970, Maines said.

Anywhere people assembled, the use of asbestos in construction exploded in the middle of the last century: schools, theaters, sky scrapers, restaurants, homes.

….. “Even if we had the information about the latent effects of asbestos we still would have protected our children,” Maines said.

One of the deadliest fires claiming the lives of children occurred in 1957 at Our Lady of Angels School in Chicago. In one hour, the rapidly burning wooden structure, killed 90 people — mostly children. (from the book) “….. fire-prevention professionals and school officials examined all the evidence from the fire and concluded that the pre-code building, constructed in 1910, was unsafe in part because of its floors, walls, wainscoting, and partitions were combustible…”

….. In the book, Maines details many more of America’s deadliest fires and how asbestos, discovered to be a fire retardant wonder product, grew to be omnipresent in building materials.

Between 1950 and 1970, the volume of asbestos in manufacturing and construction equaled approximately five-to-10 pounds per person per year.

“There is so much of it in our buildings,” she said. “There is no way to get rid of it in our lifetime or our children’s lifetime. It’s out there protecting us right now.”

So in response to tragedies, asbestos use soared. Legally speaking, it made sense for builders to use it to defend themselves against future fire-related litigation. Instead, the tables got unfairly turned on the manufacturers when the harmful effects of the material became known:

….. Maines argues that manufacturers are not to blame for those who have asbestos-related illnesses today.

“Building codes called for it,” she said. “We arrived at these codes through a democratic process. We are responsible for asbestos.”

Post World War II, the Federal Housing Authority and the Veterans Administration began funding mortgages for millions of GIs, Maines states. Homes had to be inspected and meet Underwriters Laboratory (UL) code which required furnaces be wrapped one-and-a-half-inches thick in asbestos.

“It’s not the fault of companies,” she said.

“The mass conspiracy theory is laughable,” she said.

If present at the World Trade Center Towers on September 11, 2001, it might even have bought most of those who perished enough time to escape:

The book also raises a chilling point about the collapse of the World Trade Center.

Would asbestos have saved the four-hour rated, fiberglass-insulated twin towers from incineration? A four-hour building code rating means that people would have that many hours to safely escape a burning building.

“Most engineers doubt that with the weight of the buildings and the jet fuel, neither one could have withstood those forces,” she said.

Skyscraper builder Donald Trump testified before a congressional committee that asbestos would have prevented the buildings from crumbling.

I think Maines’ “solution,” national healthcare coverage, fails to reflect the reality of asbestos litigation. The class-action suits have never been about mere reimbursement of healthcare costs, they have, if based on legitimate cases, been about getting compensated for shorter life spans and loss of ability to work and function normally in life. At their most cynical, they have been about pretending to be ill and getting compensated for all of the previously mentioned items anyway.

Maines states that no other country has experienced the massive litigation costs associated with asbestos, but that isn’t because we don’t have socialized medicine. It’s because we have an out-of-control tort system with no cap on compensatory or punitive damages, and no enforced sanctions with teeth against those who bring frivolous or fraudulent lawsuits. And even she says, “Litigation should not be a substitute for a social system.” Our attempt to make it so has had very costly results, for a product whose full slate of benefits appears to vastly exceed even the high-end estimates of its long-term costs.

Kelo Update: An Outrageous Handoff in LA

Filed under: Economy,Taxes & Government — Tom @ 1:27 pm

S.O.B. Alliance member Large Bill (additional HT to Atlas Shrugs) points to a delayed Kelo effect case in Los Angeles that is an outrage.

In a nutshell, a furniture company was worn down legally in an eminent-domain proceeding, where LA County claimed to be planning to build a new animal shelter. But now the County wants to sell the property ….. to another furniture company! And it appears that political contributions may have been involved in making this betrayal occur.

Read the whole article, go to Large Bill for his thoughts, and catch my more detailed comment there.

UPDATE, Jan. 17: The Happy Carpenter isn’t happy at the moment: “Thanks again, Justice Souter, for the Kelo ruling — a gift that keeps on giving.”

No Sugar-Coating, Please:
Medicare Part D Is Off to a Poor Start

Filed under: Consumer Outrage,Taxes & Government — Tom @ 11:04 am

This LA Times report is primarily about California. I have anecdotal information relating to Ohio that confirms the problems cited, and expands on them.

Medicare Part D, the prescription-drugs-for-seniors plan, is off to a glitch-ridden start for too many people. Regardless of whether you were for or against the bill, everyone should agree that much of what is happening shouldn’t be:

State Orders Help for Elderly as Medicare Glitches Spread
California joins other states in giving seniors emergency assistance. Bush’s signature program draws sharp criticism nationwide.
January 13, 2006

SACRAMENTO — California officials ordered emergency action Thursday to cover drug costs for 1 million elderly citizens, many of whom have been denied life-saving medications or charged exorbitant amounts because of glitches in the new federal prescription drug program.

The action by Gov. Arnold Schwarzenegger’s administration capped a day in which the Medicare prescription drug program — one of President Bush’s signature domestic policy initiatives — came under sharp criticism from members of Congress and governors of both major political parties.

Critics said the program, which Bush has touted as the most significant advance in Medicare in 40 years, was fast becoming a public health emergency. California officials said that as many as one-fifth of the 1 million elderly, poor or disabled state residents who were switched into the federal program on Jan. 1 could be wrongly denied their medications because of flaws in the program.

….. The root of the current problems is a provision of the Medicare prescription drug law that automatically switched about 6 million (nationwide–Ed.) elderly, low-income and disabled people into the new program Jan. 1.

Those people had previously been covered by Medicaid — Medi-Cal in California — the joint state-federal healthcare program for the poor.

Moving that many people into the new program, all at one time, appears to have overwhelmed the complicated Medicare drug benefit system.

In designing the program, the Bush administration did not want the Medicare drug benefit to be administered directly by the federal government.

Instead, it devised a public program run by hundreds of competing private drug plans, each with its own prices and coverage policies.

In many cases, pharmacists and patient-advocates say, elderly people are being denied benefits because of inaccurate or outdated information in computer databases used by the government and the individual health plans to interact with pharmacies.

In some cases, there is no information on a beneficiary, or the computer says the beneficiary is ineligible for coverage. In other cases, cost-sharing information is wrong, and pharmacists are being told to charge beneficiaries hundreds of dollars when in fact they have co-payments of only $1 to $5.

….. “People are walking out without their medicine across the board — high-blood-pressure medicine, insulin, pain medication,” (a senior advocate) said, adding that the problems were putting people at risk for stroke and other health problems. “This is the most vulnerable population.”

….. Under the plan, the state will use its own money to essentially continue the coverage that patients had under Medi-Cal before Jan. 1. Providing the coverage will cost the state as much as $70 million over the next two weeks.

State officials here and elsewhere said they would ask Congress and the Bush administration for reimbursement.

….. Healthcare advocates in California praised Schwarzenegger for stepping in to provide assistance, but questioned why it took nearly two weeks for the governor to act.

“We knew this train wreck was going to happen,” said Angela Gilliard, a lobbyist for the Western Center on Law and Poverty in Sacramento. “We’ve been saying there was no way when they flipped the switch on Jan. 1, people wouldn’t be harmed. No way. We’re glad the state acted now.”

Dr. Jack Lewin, chief executive of the California Medical Assn., said Schwarzenegger had “saved thousands of lives.”

“This may be the single most important healthcare action he has taken as governor for the nearly 1 million of the neediest patients in California,” Lewin said.

….. But Sen. Max Baucus (D-Mont.) wrote Health and Human Services Secretary Michael Leavitt on Friday to express disappointment with the transition for low-income seniors.

“Switching drug benefits from 50 state-based Medicaid programs to dozens of Medicare prescription drug plans would be complicated under any circumstance,” wrote Baucus, who voted in favor of creating the benefit in 2003.

“But this task is particularly challenging since these individuals are among the sickest and most vulnerable of all Medicare beneficiaries. Yet despite the awareness of potential problems, [Medicare] has failed to adequately protect these beneficiaries.”

OK, The Times and certain politicians quoted in the complete article are taking advantage of the troubles to fantasize about repeal (dream on) and to maximize the political fallout. The larger point is that it should not have happened, and that the administration is close to handing its opponents a potent political weapon. Ideally, everyone should shut up on the bigger issues for just a few weeks and concentrate all of their heat on getting those involved to get their act together, and quickly. But in the real world this won’t happen, and the adminstration had to know that anything less than a smooth transition would bring out the worst in some people and politicians.

One thing a lot of people don’t realize is that Medicare covers all people over 65 plus many disabled individuals, regardless of age. On what appears to be a safe assumption that the vast majority of those who were in Medicare and not in Medicaid before January 1 have NOT been affected by the glitches, here’s the impact:

  • Low-income Medicare seniors who had been covered by Medicaid for prescription drugs, where there was no co-pay, have been switched into Medicare Part D automatically, with co-pays of $1 – $5. Some aren’t aware of this, and of course are less than pleased to find out. While some may not want to crank up the sympathy meter for these situations, the fact is that if you’re just getting by, didn’t know it was coming, and are on, say, 3 or more drugs, those deductibles may truly represent money you don’t have, and could have had, if you had known.
  • Many of the Medicaid patients put into Medicare Part D are on psychotropic medicines and are not in full control of their faculties. Patients such as these who were not able to make a managed-care choice were arbitrarily assigned to various managed-care companies in their respective states. Some of these patients are, contrary to what was promised, walking out of the pharmacy without their medicine — maybe they didn’t bring any money for the co-pay, since they never needed it before, or maybe one of the database or other problems described in the LA Times article occurred. Some of these patients must have their meds or they will lose control, i.e., become violent or suicidal. While the “saved thousands of lives” quote in the article is ridiculous hyperbole, I’m not looking forward to reading stories of even a few real violent crimes committed by people who tried to get their meds, couldn’t, and lost it.
  • Some managed-care companies are second-guessing previously made doctor decisions, in some cases made years ago, concerning dosages and/or the number of pills of different dosages that can be obtained on one visit to the pharmacy, which could upset treatment routines that were put in place for specific reasons.
  • Doctors and nurses are beside themselve because of having to spend untold hours on hold trying to straighten out these situations, sometimes having to give up because the wait times are just too long. I have been told by someone distantly but definitely familiar with the situation that thousands of additional phone support people have been brought in by Medicare (and perhaps, and hopefully, by the managed-care companies) to alleviate the problem.

The fact is that they had two-plus years to get ready for this. It should have been handled better.

Once the dust settles, which had best be no more than 2-3 weeks, I want an answer to this question: How much money are the states going to save on an ongoing basis by relinquishing responsibility for a significant portion of Medicaid prescription costs to Medicare? I suspect the answer is: A LOT.

Which leads to my next question: Could the nation’s still-overburdened taxpayers please get that money back?

In the meantime, if you think that anyone you know might be adversely affected by this transition snafu, check up on them and make sure they are being properly taken care of.

UPDATE: MarketWatch.com (free registration required at 24-48 hours) — “Medicare benefit off to rocky start”

Positivity: “Baby Noor” Leaves Hospital

Filed under: Positivity — Tom @ 7:01 am

This follow-up to a previous Positivity post on January 1 has captured the nation’s imagination in the meantime. She left the hospital Saturday afternoon:

Iraqi ‘Baby Noor’ Leaves Atlanta Hospital

A 3-month-old Iraqi girl with spina bifida, brought to the United States by soldiers, has been released from an Atlanta hospital after surgery.

Neurosurgeons at Children’s Healthcare of Atlanta operated Monday on Baby Noor, as she’s being called, and said Friday they will continue to monitor her condition, CNN reports.

The surgery realigned and enclosed her spinal column after the birth defect was exacerbated because it was left untreated in Iraq, possibly because of a lack of access to medical facilities due to war.

Spina bifida sufferers have a spinal cord exposed because vertebrae don’t enclose it completely.

Georgia Army National Guard’s 48th Brigade soldiers discovered Baby Noor during house-to-house raids in Baghdad.

U.S. officials and charity groups coordinated with the soldiers to bring her to Atlanta for surgery.

Dr. Roger Hudgins said they will keep an eye on fluid buildup to prevent a second surgery.

He said she will most likely never walk but would have died without the operation.