Who Will Judge Your Health Care Coverage?

Two articles in today'[s New York Times referenced health care costs on the reform bill. Stating that the reform bill  focused on health care access, rather than cost-control. Jonathan Bush opined that health reform will be cost-expansionary. But Andrea Sisko, the main author of a government report predicted modest effects on the  growth of health care cost to accompany a marked increase in access as more than 30 million people gain insurance coverage, although the article citing her report notes that growth in health care spending will increase from its 17.3 percent of the gross domestic product to 19.6 percent in 9 years.

Will our government be forced - by economic realities - to make new changes to health care coverage, limiting benefits for conditions now covered, imposing age barriers to obtaining palliative or even curative therapies, or barring individuals from health care coverage for conditions which they developed  as a result of damage which they self-imposed, such as the use of drugs, high risk sexual behavior, abuse of alcohol, and perhaps even consuming types and quantities of foods known to increase the risk of diabetes, heart disease, hypertension, obesity related joint disease and other conditions? Will government move towards pragmatic limits which will reduce scientific research, impose restrictions which favor the young and healthy, and make individuals primarily responsible for the consequences of lifestyle decisions which end-up costing society money?

Who will judge and who will be judged?  Who will live and  who will die?

Who by Fire?

HIV and Male Healthcare Workers

At New York's Downstate Medical School, one of the pathology professors delighted in asking students what US persons were (in recent times) most likely to die of smallpox. His answer, hospital laundry workers, was my introduction to health care workers as victims of work-transmitted diseases.

When researching my chapter concerning HIV infected health care workers in Clark, Boardman, Callaghan's "Health Law Practice Guide," I was puzzled by the lack of evidence of widespread transmission of HIV to health care workers. There were a few lawsuits by individuals who claimed to have contracted HIV infection during the course of their duties, but they were relatively uncommon and there were confounding factors: was the appearance of HIV transmitted from a patient, or the result of lifestype exposure?

As noted in Kaisernetwork.org Daily HIV/AIDS Report , the CDC has published a study in the American Journal of Industrial Medicine suggesting that male health care workers face a more than twofold risk of dying from HIV/AIDS related causes, as well as other bloodborne diseases (Hepatitis B and C). Female nurses were at lower risk of dying from HIV - related causes than women who did not work in health care.

So, we are back to the old questions: is it private personal lifestyle or decreased immunity or increased risk of work-related infection which accounts for these findings. Because there are confounding issues, such as workers' compensation insurance payments and employer liability payments which may be at play, it will take a large, well funded and staffed, and deep study to figure this one out.