Swine Flu is Peek at Government-Run Health Care Future

No need to guess how well or badly government-run health care would be run. We have a test case that tells all. Swine flu.

More than 1 million Americans have been infected, more than 5,000 have been hospitalized, and 302 have died. That's so far. But judging from the incidence of the flu at summer camps, an epidemic will hit in a few weeks when kids are back at school.

Fear not. Your government is on the job. As it was when Hurricane Katrina hit, or is when you line up to renew your driver's license, or when you dial 911.

The government has ordered 195 million doses of the vaccine for delivery by mid-October so that the vulnerable population can be immunized. Each person will require two shots, about three weeks apart; two weeks later the body will begin producing antibodies. So even if all of the doses are delivered on time, we will be running behind the expected outbreak.

Small problems right up front. Vaccines take a long time to manufacture and test, and all of the stuff is made by companies outside the U.S. Those companies plan to give their home countries priority access to limited supplies.

Bloomberg reports that Melbourne, Australia-based CSL confirms that its "first commitment is to Australia." So, too, with France's Sanofi-Aventis and Britain's GlaxoSmithKline and AstraZeneca.

So there will be a shortage here. The government originally claimed that 120 million doses of vaccine would be delivered by mid-October; it now concedes it will have only 45 million doses by then.

In fact, no one really knows how many doses will be delivered or needed, because experience with ordinary flu vaccine shows that the portion of the people who should have shots and actually do roll up their sleeves or bare their rumps varies widely -- from 15 percent for pregnant women to 40 percent for those for whom shots are recommended.

Enter our government. The Centers for Disease Control and Prevention is advised by a 14-member panel of medical experts, the Advisory Committee on Immunization Practices, which recommends that 159 million Americans be given priority -- health care workers, pregnant women, children, young adults, and people 24-65 years of age with asthma and other medical problems.

But if there is a severe shortage, healthy children over the age of 4, and all adults except pregnant women and health care workers would do without. That would hold demand to about 40 million doses. Maybe.

So much for the rationing theory. Doctors in the field doubt such a scheme will work because they would hesitate to deny vaccinations to people over 65 who request them, and that once news of a shortage gets around, people don't bother to show up and vaccine goes to waste.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University, told the New York Times, "tight prioritization will result in vaccine being unused. When you have vaccine, just give it."

Then there is the problem of hospital utilization. The government says too many victims rush to hospitals. So Kevin Yeskey, director of the Office of Preparedness and Emergency Operations, wants only the sickest to go to hospitals. Others should see their doctors. Fortunately, Yeskey doesn't (yet) have a panel to define just who among the stricken is sickest, leaving the matter where it belongs -- to the patient's judgment.

What does this tell us about President Barack Obama's plan for extending government's role in managing our health care system? First, that the government is incapable of advance preparation for a health care problem, even with ample warning.

Second, that its plan to gather statistics that will tell all doctors what is the best and, more importantly, the patient-preferred course of treatment for all Americans afflicted with a wide variety of diseases is nonsense.

After years of tabulating data on ordinary seasonal flu, the government does not even know how many people will want to be vaccinated, and how many would rather take their chances with the flu rather than with a possible reaction to the vaccine.

Third, it is not even clear that any expert-concocted rationing scheme is more efficacious than Schaffner's plan to "just give it." And finally, if some members of an expert panel charged with deciding how to allocate scarce vaccine were left "shaking their heads in confusion and dismay," as the New York Times reports, we should worry indeed about the experts' ability to make far more complicated rationing decisions, especially those involving use of end-of-life resources.