Monday, April 20, 2009

"… what will you do when the Communists take over?"

Last February, while examining the problems of mismanagement in the face of major disasters in China, I reviewed an old joke about Leonid Brezhnev concerning the displacement of Communism by consumerism. Viewed from the other end of the telescope here in the United States, we continue to experience the failure of attempts to reform a health care system overcome by consumerism on the grounds that any reform brings a threat of "socialism." However, regardless of the political labels that get thrown around, the bottom-line question for any governmental policy is whether or not the public good is being adequately served. From this point of view, a brief Reuters report from Beijing, filed last night, deserves to be read in its entirety:

Chinese children with AIDS, especially from rural families, are going without treatment because their families are too poor to afford it, despite a government policy of free treatment, an activist group said on Monday.

Some families don't even know AIDS treatment programs exist, it said.

"China has made great progress in the fight against AIDS, but far too many children are getting the wrong AIDS treatment," said Sara Davis, executive director of Asia Catalyst, which issued the report.

As many as 10,000 Chinese children may be HIV-positive, most because of botched blood transfusions or transmission from their mothers. They are concentrated in central Henan province, where the blood supply was contaminated in the 1990s, or in Yunnan province in the southwest, a hub for drug trafficking.

In 2005, 9,000 cases of children contracting HIV from their mothers were reported. Many children with AIDS die before the age of five, often undiagnosed.

Some live too far from hospitals and others have been turned away from hospitals and schools that fear contagion from AIDS patients.

China guarantees free drug treatment for AIDS, but many poor families cannot afford the associated fees or treatment for other diseases which may strike the weakened children.

The government provides generic versions of four drugs for front-line treatment, but many patients have developed resistance.

Asia Catalyst called for the Chinese government to "fill in the gaps" by extending coverage for additional medical costs, and providing cheaper second-line drugs.

One may ask rhetorically where the "public good" resides in this story. On the other hand we may also ask whether we can raise the it-can't-happen-here flag when the same question is applied to our own country's approach to "managed health care" (where the scare quotes apply primarily to that adjective "managed"). It is, to say the least, chilling to contemplate that, when it comes to what I have previously called "the reduce-the-surplus-population philosophy of Ebenezer Scrooge," the public health policies of China and the United States are closer than we may have wished to imagine.

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