I’m sure there a lot of health Nazis out there who are reading this and nodding their heads. Our national obssession with obesity—and in particular, the useless Body Mass Index—has warped our perception of everything. (BMI is useless—the healthiest Americans are those who are slightly overweight).

The Health Nazis are already saying our government should force us to diet and exercise. And now, they’ve got the data to back it up! Ok, maybe we don’t need extreme poverty. But coercive methods (denying care to the obese, a fat tax, etc.) would work! Cuba is healthier!

But even we accept these bullshit statistics, Cuba’s is not healthier. You can’t consider this thing in a vacuum, unless your last name happens to be “Moore”.

Consider this: some time back, the NYT ran an excellent article about how seniors in the US today are healthier than seniors have ever been. 100 years ago, if you were lucky enough to reach 60, you were almost certaintly in bad shape and probably bed-ridden. The astonishing improvement is attributed, not to better adult care, but to better early care - prenatal care, early immunization and, yes, better nutrition in the first few years of life.

One particular fact struck me. Children who were in the womb during the great Flu Pandemic, compared to children who came before or after, lived shorter lives and had more health problems. Just their mothers catching the damned flu was enough to affect them for the rest of their lives. It is an inescapable fact of life that good prenatal and early childhood care can set someone up for a lifetime of better health.

The Health Nazis look at Cuba, see weight loss and say, “Hooray!”. I’m sure Michael Moore will joke, “Boy, I sure wish I lived in Cuba! Ha! Ha!” But the negative effects of this wonderful beneficial glorious economic crisis may not show up for half a century, when the children of Cuba grow up to be unhealthy, crippled adults.

Now, forget Cuba for a moment. Forget weight loss and BMI. Concentrate on the principle. We have serious researchers proclaming that starvation was a good thing. Does it really stretch the imagination to think that, once our healthcare is in the government’s hands, some idiot won’t convince them ... well maybe not that starvation is good. But how about that stomach stapling should be mandated? Or even craziers ideas like mammograms cause brain cancer? Or that cell phones should be banned? That reading blogs stunts your growth? That masturbation makes you blind? Can’t you imagine Congress debating the merits of aromatherapy and magnets?

OK, maybe we won’t get crazy ideas like that. But right now we have people who want to mandate the HPV vaccine. And as much as I hate to side with the anti-vaccinators, what happens if we find out that it has long-term fertility effects? It wouldn’t be the first time a supposedly safe OB/Gyn drug caused defects twenty years down the road.

If the government controls healthcare, decisions will not be made by the Wisdom of Crowds but by policy wonks. And policy wonks have an amazing tendency to embrace unproven ideas that later turn out to be bad ones.

“Hey, our methods made Americans skinnier! Hooray! Oh, but now we have a bunch of crippled seniors. D’oh!”

The reason conservatives like me oppose government control is because it limits the damage of dumb ideas and bad policy. If I fall for some whack-job unscientific health nonsense or embrace a seemingly good idea (like vaccinating my daughter against HPV) that later turns out to be bad, the only person hurt is myself and my family. When the government embraces bad ideas—we all get hurt. And the history of government is that they come up with far more bad ideas than good ones.

Such as, you know, communism.

I recently changed jobs.  As most of you know, in the US you get your healthcare as a benefit from your employer.  (It’s an asinine system which has its origins in FDR’s price controls during WWII and it should be scrapped, but for now that’s the way the system works.) When you leave your job you have an option of keeping your currect insurance through a plan called COBRA, which allows you to keep your medical benefits until you find a new job.  The cost of the COBRA insurance is dependent on the plan your employer offered.  For example, I once worked for a company with an astonishing PPO health benefit plan, absolutely top of the line.  Just about everything was a covered benefit, including—I shit you not—aromatherapy, foot reflexology, and acupuncture.  So when I left that company and went on COBRA, I had to pay almost $800 a month to keep that level of coverage.  (For what it’s worth, I think that level of coverage is fucking asinine, but this was a very liberal company and it was attracting liberal employees, so they had to cover all this stupid shit.)

The company I left recently offered an HMO.  Yes, yes, the evil HMO’s from Moore’s movie, who routinely let people die of organ failure.  It offered solid, but not exorbitant coverage.  When I left the company their COBRA rate was $265 a month.  I am currently working freelance at my new company, and freelancers don’t qualify for the company benefit plan, but I made them pay me extra so I could pay for my COBRA.  In other words, I get pretty decent coverage for a very affordable $265 a month.

I went to my local doctor (my GP) because I had a weird rash on my fingers and on my thigh.  He didn’t know what the rash was, so he ordered the routine battery of blood and urine tests, and wrote me a prescription for some lotion to rub on the rash.  The doctor’s visit cost me $20, and the lotion was $15.  The next day he called me and said that they had discovered trace amounts of blood in my urine.  I have a 20 year history of kidney stones, so I knew that in all likelihood I had another stone.  My doctor recommended a urologist in my area, and I made an appointment for the next day.  That’s right, not three weeks from now, but the very next day.  They also said that they were going to need a CT scan of my abdominal area, and made the appointment for me at the x-ray and imaging center.

On the day I went, got my films taken, then walked with the films over to the doctor.  The films cost me nothing, they were 100% paid by insurance.  Sure enough, I had a 1.5 cm stone in my right kidney.  The doctor said I would be a good candidate for lithotripsy, and I agreed.  We looked at the schedule, and he told me that I could get in the next day if I wanted.  I had some stuff at work that needed to be taken care of, and could we schedule it for a few days later?  No problem.  So the surgery was scheduled for July 31, with a quick pre-procedure check in with the doctor the day before.

On the 30th I went to the doctor ($20) and we went over everything.  It all looked good, all systems were go.  Yesterday I went to the hospital with my girlfriend, and we went to the admissions desk.  They checked me in, and told me that there was a $250 deductible for the procedure.  In other words, a day in the hospital, with doctors and nurses and anesthesiologists and everyone else, was going to cost me the whopping sum of $250.  (For comparative purposes, for my girlfriend’s birthday I bought her a handbag which cost more than that.  I’ve spent more than $250 on meals before.) I didn’t have my checkbook on me, but they told me they’d send me a bill. 

The lithotripsy was a complete success, the stone was pulverized completely.  The doctor left a stent inside me to assist in expelling the debris from the stone.  I was written prescriptions for painkillers and antibiotics.  These were $10 each. 

Today the doctor’s nurse called me to check and see how I was doing.  I told her that pain-wise I was fine, but that I still had quite a bit of blood in my urine.  She said that I shouldn’t be bleeding that much, and that I should come into their office right away.  An hour later I was being seen by the doctor ($20).  He thinks that the bleeding is being caused by the stent irritating my bladder and isn’t really anything to worry about.  Nonetheless, he’s scheduled me for a follow-up on Monday.  I’m going to go back in for another series of films (which will cost me $0), which I will then walk over to his office for review ($20). 

As for the original skin rash issue, my GP recommended I see a dermatologist.  He said it was a strange type of eczema, and wrote me a prescription for a different type of cream, which cost me $15.  The rash has almost completely cleared up.

Unlike most people participating on this blog, I have experienced socialized healthcare up close and personal.  I’ve lived in the UK, Noway, Australia, and numerous other countries with single-payer systems.  I’ve had to wait weeks to see a doctor.  I know what it’s like.  I’ve also been on the receiving end of some of the worst issues of the American system, with claims being denied and benefits changing.

The point of this post was to show those of you unfamiliar with American healthcare what a typical experience is like, even for those of us with a dreaded, evil HMO.  Considering the costs associated with the care I received, I don’t think for a second that what I was charged was unreasonable, quite the contrary.  I’m astounded that, for the sum total of a few hundred dollars, I was able to get this amount of care.  In a couple of weeks I’ll have to have another minor procedure to remove the stent, which will cost me nothing since I already met the $250 deductible.

A few things to point out for our European readers:  everything you saw here took place in a matter of days, not months.  There were no waiting lists.  I walked in and got fixed, and all I have insurance-wise is a regular old crappy HMO.  Oh, another thing—every one of my doctors was American, trained at American colleges.  My GP and dermatologist both went to University of California in Los Angeles (UCLA) medical school, and my urologist went to the University of Texas, two of the finest medical schools in the country.

Is there room in the US system for improvement?  Absolutely, without question.  But, having had numerous hospitalizations and surgeries in my life, the episode detailed here is pretty typical of what most people experience.  Which is why the United States healthcare system has the highest level of customer satisfaction of any country in the world.

I strongly encourage you all to read the whole article, but here are some highlights for your perusal.

On the subject of Moore’s claim that Cubans live longer than Americans:

In “Sicko,” Moore parrots the Castroite claim that Cubans live longer than Americans. In fact the figures are practically identical, which actually casts Cuba’s vaunted health care in a negative light. In all nations with high emigration rates, longevity rates skew high. This occurs because the birth is recorded but the death gets recorded in the nation migrated to. So it seems like fewer people die. Naturally, the opposite effect appears in nations with a large influx of immigrants. The death is recorded but the birth was recorded in the nation immigrated from. So generally speaking, a nation with high longevity but known to hemorrhage its people has little to boast about with regard to longevity figures. All they’re proving is that theirs is a miserable place to live and from which massive numbers of people flee.

And few nations hemorrhage people like Cuba—almost 20% of its population since the glorious revolution. This 20% represents those who got out with the clothes on their back and against enormous odds.

This, of course, makes complete sense when you examine it. If a Cuban is born in Cuba but dies in the US, the death is never recorded in Cuba but rather in the US. This makes it seem as if fewer people are dying in Cuba, but all it really means is that massive numbers of people are fleeing the oppression of Castro’s regime. No matter how you look at it, this is a lose-lose situation for Moore - the facts are squarely against him.

On the quality and state of Cuban doctors:

A few years back Castro launched his “Doctor Diplomacy,” wherein he started sending Cuban “doctors” to heathen lands (though their spouses and children were held hostage in Cuba) to heal the sick and raise the dead. This was coupled with “free” treatment of poor foreigners from the Caribbean and Latin American nations in Cuban hospitals. The scheme has gotten no end of gushy reviews in the major media…

Brazil also got a birds-eye view of Cuba’s vaunted “Doctor Diplomacy.” The April 2005 story from Agence France-Presse titled “96 Cuban Doctors Expelled from Brazil” reported: “Federal Judge Marcelo Bernal ruled in favor of a demand by the Brazilian state of Tocantins’ Consejo Regional de Medicina (Regional Council on Medicine) that Cuban doctors be prohibited from practicing in their state.” Based on the results they’d achieved with Tocantins’ residents, the judge referred to the Cuban doctors as “Witch Doctors and Shamans. We cannot accept doctors who have not proven that they are doctors.”

According to a report by the Association of American Physicians and Surgeons, more than 75% of “doctors” with Cuban “medical degrees” flunk the exam given by the Educational Commission for Foreign Medical Graduates for licensing in the U.S. This exam is considered a cakewalk even by the graduates of Mexico’s Tec de Monterrey School of Medicine. Most Cuba-certified doctors even flunk the Educational Commission for Foreign Medical Graduates’ exam for certification as “physician assistants,” making them unfit even as nurses.

So much for those vaunted Cuban doctors we see in Sicko. These are people who do not have the knowledge or skill to pass the exam to become a nurse practitioner, let alone a doctor. Would you want to entrust your health with doctors with reputations such as these? I know the LAST thing I would think of doing is bringing 9/11 rescue workers to a country whose doctors who are routinely expelled from other countries as being too incompetent to practice medicine.

And, finally, on the Cuban infant mortality rate:

In April 2001, Dr. Juan Felipe García, MD, of Jacksonville, Fla., interviewed several recent doctor defectors from Cuba. Based on what he heard he reported the following: “The official Cuban infant-mortality figure is a farce. Cuban pediatricians constantly falsify figures for the regime. If an infant dies during its first year, the doctors often report he was older. Otherwise, such lapses could cost him severe penalties and his job.”

Cuba’s infant mortality rate, though it plunged from 13th lowest in the world pre-Castro to 40th today—is also kept artificially low by an abortion rate of 0.71 abortion per live birth—the hemisphere’s highest by far, which “terminates” any pregnancy that even hints at trouble.

More interesting (and tragic) still, the maternal mortality rate in Cuba is almost four times that of the U.S. rate (33 versus 8.4 per 1,000). Peculiar how so many mothers die during childbirth in Cuba, but how many one- to four-year-olds perish, while from birth to one year old (the period during which they qualify in UN statistics as infants) they’re perfectly healthy.

This is just simply tragic now matter how you look at it. Forced abortions, high maternal death rates, artificially skewed infant mortality rates… this is simply an abhorrent system run by an abhorrent man, Fidel Castro. How Michael Moore could stomach praising this man and this regime after the crimes against humanity Castro continues to commit to this day astonishes me. All I can hope is that more people begin to call out and question Mr. Moore on his words and actions in regards to Cuba. In the face of facts such as these… how can Michael Moore support Cuba or Castro in any way???

A fascinating article [$] in today’s Wall Street Journal reveals that Massachusetts residents wait an average of seven weeks for an appointment with a primary-care physician. The queues apparently have nothing to do with the new Massachusetts health plan — aside from illustrating that a paper guarantee of “health coverage” does not necessarily translate into health care:

What?! You mean universal coverage is not universal coverage? Never! Next you’ll be telling me people in single-payer system have to wait for cancer surgery!

Anyway, he then goes into the reasons we have long primary care waits, something a little too sophisticated for Michael Moore. He talks about licensing - a subtle swipe at the AMA’s government-assisted efforts to stop nurses practitioners from becoming primary care providers. But there’s also this, quoted from the WSJ:

The limited number of endocrine specialists is a not a consequence of limited demand — everyone is aware of the epidemic of diabetes we are facing. There are also shortages of generalists and other specialists, and the reason is the absence of market signals — i.e., market-based prices — for influencing the supply of physicians in various specialties…

The essential problem is this. The pricing of medical care in this country is either directly or indirectly dictated by Medicare; and Medicare uses an administrative formula which calculates “appropriate” prices based upon imperfect estimates and fudge factors. Rather than independently calculate prices, private insurers in this country almost universally use Medicare prices as a framework to negotiate payments, generally setting payments for services as a percentage of the Medicare fee structure.

Many if not most administratively determined prices fail to take into consideration supply and demand. Unlike prices set on the market, errors are not self-correcting. That is why, despite an expanding cohort of patients with diabetes, thyroid disease and other endocrine disorders, the number of people entering this field is actually dropping. Young physicians are accurately reading inappropriate price signals.

What they’re talking about is RBRVS - the Resource-Based Relative Value Scale. This is a scheme concocted at Hah-vuhd University in the 1980’s that Medicare, Medicaid and most HMOs now use. It essentially assigns a value to every medical procedure, supposedly taking into account how much it costs to run a practice, and then reimburses based on the region. The pay scale is then calculated for every doctor individually to the nearest penny. Such efficiency is why Medicare has to siphon off 1-3% of the budget to administer the administration.

RBRVS has been a problem from the second Medicare embraced it and I know a number of doctors who dropped out of the AMA because they went along with nonsense. I can get into specifics—how primary care physicians are impoverished because checkups don’t use many “resources”; while heart surgeons do well because their procedures do. But you don’t need to know that. All you need to know is that the market is being dictated by a small panel of “experts” and has had the same happy effects that price-fixing always has.

People forget what a price is: it’s not really a factor of how much it costs to provide a good or service; it’s a way of communicating to the entire nation the supply and demand for a good or service. If demand goes up, prices go up so that more people are drawn to provide the service. By setting prices based on complex (and incorrect) formulae for how many resources are used, RBRVS takes that information out of the system. The price no longer reflects demand and so physicians are not drawn to specialties that are in high demand - they’re drawn to ones that use lots of resources.

Right now, I’m reading The Wisdom of Crowds, a fascinating economics text that talks about how experts can go badly wrong while large groups can find good answers. This is especially true on extremely complicated problems.

Medical care pricing is a perfect illustration of the Wisdom of Crowds—or more accurately, the Doltishness of Experts. In a true free market, primary care physicians could charge more—or nurse practitioners could serve as less expensive alternatives. Either way, wait times would eventually plunge. But in our government-controlled system, the prices are dictated by 29 “experts” and are badly distorting the market.

RBRVS is just one of many many examples of how Medicare directly interferes with the sound practice of medicine. And if Moore and his ilk get their way, there will be no corrective mechanism, none at all. We’ll all be trapped and still waiting seven weeks for an appointment.

The solution to our healthcare crisis is to get the government less involved, not more.

The first article deals primarily with Moore’s assertions about the nature of Cuban health care, and then goes on to thoroughly fisk Moore’s depiction of European socialized systems. I highly suggest reading the whole article, but these quotes in particular jumped out at me. Be warned - the pictures shown on these links are both graphic and disturbing. Nevertheless, they are certainly things people willing to swallow Moore’s story about the glory of Castro and his socialist health care system need to see.  On the nature of Cuban health care:

I don’t believe Michael Moore is a mere liar. He’s quite well aware that Cubans aren’t as lucky as him to receive first-class treatment when they need it, but he doesn’t care at all, as his everyday sport is going after his native country and get the applause of silly Euro leftists. What “Sicko” purposely didn’t tell you about Cuba is that, other than being a Gulag police state, there are very few—if any—functioning health centers. The rest, as can be seen in these photographs taken and sent in by a non-governamental journalist, are collapsing structures that resemble recently-bombed buildings. This is just the exterior side. Entering a Cuban hospital may be an appalling experience. Hygiene is pratically non-existent, excrements and roaches can easily be found everywhere on the floors and medicines are rarely available for patients. I challenge Moore to support his claims about US healthcare with graphical evidence, but I doubt he’ll be able to find any picture comparable to plenty of others showing the third-world decay of Castroite health. To figure out which side of Cuba’s dual system Michael Moore experienced, you need to scroll down this page from “The Real Cuba.”

Another interesting paragraph from this piece breaks down the actual number of uninsured Americans - a number which is, again, vastly different from the picture Moore paints. These are figures I had been meaning to write about for some time which are appearing in more and more articles that are critiquing Sicko. See for yourself:

As an European fed up with socialized medicine, I would like to express my deepest admiration for American healthcare. Although not perfect and needing more effective free market reforms, the money factor—which “Sicko” lashes out at as source of all imaginary evils—is what keeps it innovative, competitive and efficient. We hear a lot about 45 million citizens who don’t have health insurance. But just who are they? The US Census Bureau couldn’t be clearer:

--38% of the uninsured (17 million) live in households earning over $ 50,000 in annual income

--20% (9 million) reside in households earning over 75,000 a year

--Over 18 million (40%), between the ages of 18 and 34, spend more on entertainment or dining out

--14 million ( 31%) are elegible for health government programs like Medicaid, but choose to opt-out.

So, how many are truly uninsured? Only 18% of Americans.

The second article is a short but again detailed fisking of Moore’s depiction of European health care. According to this journalist, it’s not all roses and sunshine in England and France as Moore would have us believe:

Moore interviewed a physician in the British National Health Service about how wonderful free health care is in Britain, and how satisfied the physicians are in the NHS. He forgot to mention that more than one third of physicians working for the NHS buy private insurance so they don’t have to rely on the “free” care, and that more than 6 million British citizens also buy private insurance for the same reason. He did not mention that this year the health minister admitted that one in eight British patients still wait for more than a year for treatment. He neglected to say that Britain has had to import more than 20,000 physicians in the past three years – chiefly from Middle Eastern and Asian countries – because so few of the British, after sixty years of experience with the NHS, want to enter or stay in the profession.

While praising the superiority of French medical care and the fact that French doctors make house calls – almost as an aside while praising the superiority of every element of French society compared with America’s – Moore forgot to mention that 13,000 Frenchmen died of heat prostration and dehydration during a heat wave in the summer of 2003, when most French physicians were on summer vacation and did not show up in emergency rooms, let alone make house calls.

Beautifully stated. I encourage everyone to read these articles in full and, once again, ask yourself - why isn’t Michael Moore telling us the whole truth?

An Open Letter to CNN from Michael Moore

7/14/07

Dear CNN,

Well, the week is over—and still no apology, no retraction, no correction of your glaring mistakes.

I bet you thought my dust-up with Wolf Blitzer was just a cool ratings coup, that you really wouldn’t have to correct the false statements you made about “Sicko.” I bet you thought I was just going to go quietly away.

Think again. I’m about to become your worst nightmare. ‘Cause I ain’t ever going away. Not until you set the record straight, and apologize to your viewers. “The Most Trusted Name in News?” I think it’s safe to say you can retire that slogan.

You have an occasional segment called “Keeping Them Honest.” But who keeps you honest? After what the public saw with your report on “Sicko,” and how many inaccuracies that report contained, how can anyone believe anything you say on your network? In the old days, before the Internet, you could get away with it. Your victims had no way to set the record straight, to show the viewers how you had misrepresented the truth. But now, we can post the truth—and back it up with evidence and facts—on the web, for all to see. And boy, judging from the mail both you and I have been receiving, the evidence I have posted on my site about your “Sicko” piece has led millions now to question your honesty.

I won’t waste your time rehashing your errors. You know what they are. What I want to do is help you come clean. Admit you were wrong. What is the shame in that? We all make mistakes. I know it’s hard to admit it when you’ve screwed up, but it’s also liberating and cathartic. It not only makes you a better person, it helps prevent you from screwing up again. Imagine how many people will be drawn to a network that says, “We made a mistake. We’re human. We’re sorry. We will make mistakes in the future—but we will always correct them so that you know you can trust us.” Now, how hard would that really be?

As you know, I hold no personal animosity against you or any of your staff. You and your parent company have been very good to me over the years. You distributed my first film, “Roger & Me” and you published “Dude, Where’s My Country?” Larry King has had me on twice in the last two weeks. I couldn’t ask for better treatment.

That’s why I was so stunned when you let a doctor who knows a lot about brain surgery—but apparently very little about public policy—do a “fact check” story, not on the medical issues in “Sicko,” but rather on the economic and political information in the film. Is this why there has been a delay in your apology, because you are trying to get a DOCTOR to say he was wrong? Please tell him not to worry, no one is filing a malpractice claim against him. Dr. Gupta does excellent and compassionate stories on CNN about people’s health and how we can take better care of ourselves. But when it came time to discuss universal health care, he rushed together a bunch of sloppy—and old—research. When his producer called us about his report the day before it aired, we sent to her, in an email, all the evidence so that he wouldn’t make any mistakes on air. He chose to ignore ALL the evidence, and ran with all his falsehoods—even though he had been given the facts a full day before! How could that happen? And now, for 5 days, I have posted on my website, for all to see, every mistake and error he made.

You, on the other hand, in the face of this overwhelming evidence and a huge public backlash, have chosen to remain silent, probably praying and hoping this will all go away.

Well it isn’t. We are now going to start looking into the veracity of other reports you have aired on other topics. Nothing you say now can be believed. In 2002, the New York Times busted you for bringing celebrities on your shows and not telling your viewers they were paid spokespeople for the pharmaceutical companies. You promised never to do it again. But there you were, in 2005, talking to Joe Theismann, on air, as he pushed some drug company-sponsored website on prostate health. You said nothing about about his affiliation with GlaxoSmithKline.

Clearly, no one is keeping you honest, so I guess I’m going to have to do that job, too. $1.5 billion is spent each year by the drug companies on ads on CNN and the other four networks. I’m sure that has nothing to do with any of this. After all, if someone gave me $1.5 billion, I have to admit, I might say a kind word or two about them. Who wouldn’t?!

I expect CNN to put this matter to rest. Say you’re sorry and correct your story—like any good journalist would.

Then we can get back to more important things. Like a REAL discussion about our broken health care system. Everything else is a distraction from what really matters.

Yours,
Michael Moore
[email protected]
www.michaelmoore.com

P.S. If you also want to apologize for not doing your job at the start of the Iraq War, I’m sure most Americans would be very happy to accept your apology. You and the other networks were willing partners with Bush, flying flags all over the TV screens and never asking the hard questions that you should have asked. You might have prevented a war. You might have saved the lives of those 3,610 soldiers who are no longer with us. Instead, you blew air kisses at a commander in chief who clearly was making it all up. Millions of us knew that—why didn’t you? I think you did. And, in my opinion, that makes you responsible for this war. Instead of doing the job the founding fathers wanted you to do—keeping those in power honest (that’s why they made it the FIRST amendment)—you and much of the media went on the attack against the few public figures like myself who dared to question the nightmare we were about to enter. You’ve never thanked me or the Dixie Chicks or Al Gore for doing your job for you. That’s OK. Just tell the truth from this point on.

After years of limited success cajolling and pleading with miners to take voluntary tests to check their HIV status, mining firm Gold Fields adopted modern marketing tactics.

“We said ‘let’s up the game, let’s dangle a carrot so people can come and know their status’,” said Stella Ntimbane, group HIV/AIDS coordinator for Gold Fields.

Now each of the company’s South African miners who takes an HIV/AIDS test gets a lottery ticket, offering chances at monthly prizes of cell phones, televisions and cash, plus a final sweepstake. One lucky worker will drive away in a new pick-up truck.

It is just one example of how firms are stepping up the battle against a disease affecting up to one in three miners. They are also sending mobile treatment units to the bush near mines where sex workers operate and blanketing the region with millions of condoms.

Gold Fields’ game, which also pits the company’s mines against each other to win the big final prize, has gone a long way to overcome fear and denial linked to HIV/AIDS.

“We’re getting queues at the testing stations, it’s like 1994,” Ntimbane said, referring to the year when new black voters flocked to polls to elect Nelson Mandela president.

Since October, more than 5,000 miners have taken tests, accounting for nearly a quarter of the total 22,000 taken by Gold Fields workers during more than a decade. Gold Fields employs around 43,000 permanent workers in South Africa.

If tests reveal full-blown AIDS, workers are offered free anti-retroviral treatment to curb progress of the disease.

Free test.  Free drugs.  Meanwhile, a group of UN diplomats has taken a private jet to a conference in Zurich to dine on foie gras and discuss ways in which AIDS medication might someday be distributed on the continent.

Right now the rates are between 5 and 10 percent in the UK.  The article I linked says that if they cut the rate by 30%, they could save 55 million pounds.  That’s about 110 million dollars.  I assume the same holds true for the United States.  Cut the rate of HAI, reduce cost across the board and treat more people with the same amount of money.

So what causes HAIs?  Poor cleaning procedures certainly add to it.  Visitors, patients and staff who don’t wash their hands, who sneeze staph bugs all over the place, a lack of attention to sterilization, or simple cleanliness, all of that can contribute.  But where are these superbugs coming from in the first place?

Over-prescription of antibiotics, for starters.  I just ran into a doctor trying (in a small way) to stave this off myself - I had a severe sinus infection that required a short five-day course of antibiotics.  A week later the symptoms were back, only less severe, and the doc recommended that I use a nasal irrigation solution with salt water, and let my body fight it off.  Reason?  So as not to give the little nasties a reason to mutate into stronger, harder-to-kill wee beasties.  She’s made it a habit to try to let the immune systems of her patients fight these bugs and only prescribe antibiotics when it’s clear that they can’t.  Side effect of this way of thinking: Less cost at the drugstore, as I, and my insurance company, did not have to buy another round of pills.  Money saved.  Bugs defeated.

One last thing: I know the first reaction many will have will be to blame the NHS for this story, but I really don’t think it’s a symptom of government control.  I think it’s a combination of everything I listed above.  I think we have it just as bad here in the US.  Of course it will be worse in hospitals with less funding - staff is overworked, no money to attract devoted, dedicated staff to janitorial and other non-professional roles, and a reliance on meds to get the people in-and-out.  In a nation of 300 million and growing, this will become a larger problem for us than it is for other nations if we go the single-payer route, but the fact remains - clean up the bugs, save a lot of money, regardless of who holds the purse strings at your hospital.  It also has the “side benefit” of getting patients home faster as well, which is kind of the whole point of health care, no?

In conclusion - one way to increase patient care, save money and lower the overall burden on any healthcare system is to be diligent about HAIs.  That will only start when we, the patients, demand that hospital administrators take it a lot more seriously than they do now.  Memos, signs and a once-a-year-or-three training session is not enough.  From the head of the hospital to the new guy in Janitorial Services, everyone has to take it seriously.

Update: Ask and ye shell receive.  We have this report in the Baltimore Sun from June 25, 2007.  Definitely read the whole thing, but here’s a taste.

The new survey found that 34 of every 1,000 patients in the survey had active MRSA infections and that 12 were colonized with the superbug, for a total MRSA prevalence rate of 46 per 1,000 patients.

The most widely cited previous study, published by CDC researchers in June 2005, had estimated that the MRSA infection rate in in-patient hospitals was 3.9 per every 1,000 patients. Based on that rate, it estimated about 126,000 patients each year were infected with the superbug.

The new report didn’t translate its findings into actual numbers, but its author outlined a means of doing so to the Tribune.

The calculation involves 35.2 million people hospitalized in the U.S. in 2005, the latest year for which information is available. Applying the prevalence rates in the new study, the data suggests that 1.2 million hospital patients are afflicted with MRSA each year and that 423,000 more patients are colonized with the superbug.

This is an estimate only, subject to the accuracy of the numbers reporting by infection control practitioners and the limitations of a “single point in time” snapshot of the data, said Jarvis, the study’s author. Many hospitals don’t routinely test patients to see if they’re colonized with MRSA, he noted.

Now, if I’m reading this right, it works out to 3.4% to 4.6% of patients, depending on the criteria you choose.  It appears that the number of patients is difficult to quantify, but if we’re looking for a nice round number of infections in the US 4% seems to be about right.