You'd have to be living under a rock to be unaware of the debate that's currently going on about health insurance in America. In fact, debate may be too generous a term for it, as the discussion has gotten downright vitriolic and full of scare tactics.

For those who are interested in health policy and in how other countries have handled these issues, I highly recommend T. R. Reid's new book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. 

In a search for both a solution on a personal level and insights about other nations' health care systems, Mr. Reid takes his chronically aching shoulder to doctors around the world. He describes the varied recommendations he is given for his own healing and he talks with physicians and patients about what it is like to work and receive care in a variety of systems. He also discusses the history of the various systems and how they came to be. Contrary to what you might expect of a book about health care policy, it's a fascinating read. I couldn't put it down. 

There are two central themes in this book, both of which are crucially important as we look at reforming the US system, and neither of which is getting the attention that it deserves.

The first question that we must answer is this: Do we, as a nation, believe that some basic level of health care is a right to which everyone should have access? If the answer to that question is no, then we can stop right there. If it's okay with us that people die for lack of access to basic medical care, and if it's okay with us that people go bankrupt because of medical bills, then our system is fine just as it is. 

We must take our heads out of the sand: any of us may be one layoff away from being uninsured and uninsurable, and so any of us (except the very wealthy) are potentially at risk of medical bankruptcy under our present system.

The second theme in Mr. Reid's book, and the one which I've not seen discussed elsewhere, is the idea that our national cultural "personality" and values need to be a part of the conversation as we design our health care system. 

For example, equality is important to Canadians; economist Uwe Reinhardt is quoted in the book as saying, "Canadians don't mind the waiting list so much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time." 

The archetypal British "stiff upper lip" is reflected in the advice a British doctor gives to Mr. Reid about his aching shoulder: "You are living your normal life without much impairment. So [shoulder replacement surgery is] not indicated."

And contrary to the what the "socialized medicine" scare-mongers would have you believe, the capitalist ethic thrives within many of these systems. The difference, relative to the US system, is generally that the system which delivers a basic level of care to everyone is a non-profit enterprise.

These may or may not be some of the values that we think are most important for our system, but without conscious attention to these questions we will almost certainly not get what we want. It may very well be that none of these systems are exactly right for the personality and values of our American culture, but right now values are not even part of the conversation. We can't design a system that meets our needs until we've clearly expressed what those needs are.

What values do you think our health care system should reflect? You can share your comments here, and I'd also encourage you to share them with your friends and family and your Senators and Representatives.

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I just read an excellent and very disturbing article from the New York Times about the failures of the USDA to assure the safety of ground beef. The article is required reading for anyone with an interest in the safety of our food supply, which is to say anyone who eats food that they don't personally grow and harvest.

We all know that meat needs to be handled in certain ways after we buy it at the store: 

1. It must be kept refrigerated or frozen.
2. Meat should be used or frozen by the use-by date on the package.
3. Meat must be cooked to a certain temperature, which varies depending on the type of meat. (And yes, I'm aware of the irony that the safe-cooking data in the linked article comes from the USDA, given that I'm about to criticize them.)
4. Hands, utensils, and surfaces that have come in contact with raw meat must be thoroughly washed afterward.

These aspects of food safety are under our control, but it is important to remember that no amount of good hygiene in the kitchen will guarantee that your family is safe if the meat that you buy was contaminated at its source. With some highly virulent strains of bacteria, a very small number of residual bacteria can cause serious illness. 

I'm very much in favor of personal responsibility, but we have become so far removed from the sources of our food that we rely on the integrity of the food producers and the government agencies that regulate them. We have to trust that the USDA has our public health interest in mind.

The NYT article describes failures at several points in the meat-safety chain. Slaughterhouses, meat packers, and stores may all share some of the blame, but ultimately the USDA is the agency whose inspections and policies can keep contaminated meat out of our food supply. 

The USDA has been criticized for not having enough inspectors and resources to inspect with the frequency and level of detail that would identify hazards before they get into the food supply. While that may well be true, consumers need to be aware that guaranteeing public health is not what the USDA sees as its primary mission.

Here's the quote from the NYT article that really got me riled up: 

Dr. Kenneth Petersen, an assistant administrator with the [USDA's] Food Safety and Inspection Service, said that the department could mandate testing, but that it needed to consider the impact on companies as well as consumers. “I have to look at the entire industry, not just what is best for public health,” Dr. Petersen said.

Really? A meat packer's profit margin can trump public health? Is that what the USDA is for?

The USDA's mission statement doesn't specifically mention public health. In its Strategic Plan Framework, found at the same link, the activities at the top of the list are about "expanding markets for agricultural products." Food safety and health are mentioned, but much farther down the list. If the order of the items on that list reflects the priority they are given, then the USDA is more interested in helping the agricultural industry sell more stuff than it is in making sure their stuff is safe for people to eat.

Caveat emptor.

So how can we protect ourselves and our families?

• First, always follow the rules for safe meat handling and preparation. Don't cut corners.
• Eat less meat, especially ground meat. Ground meat is much more susceptible to contamination as any one batch contains meat from many sources, so it can spread rapidly.
• The safest way to get ground meat is probably to buy a cut of whole meat and either grind it yourself, or have it ground for you at the store. Many supermarkets can do this for you, and any butcher shop can.
• If you buy meat that was raised and produced locally, you may be able to ask questions about how it was processed and what testing was done for contamination. Small farmers tend to be more open with this information than large corporations.
• And, unfortunately, you need to remember that food safety concerns aren't just relevant to meat. Going vegetarian will protect you from unsafe ground beef, but similar issues are found in many other areas of the food supply.

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