HEALTH CARE/Joan Retsinas

A Scrooge-Test: How Much Did it Cost?

The public health focus has historically been to save lives.

Now, to complement Congress’s penny-pinching frenzy, let’s switch the focus to saving money.

Like Thomas Gradgrind, the number-crunching school superintendent of Hard Times, we must weigh the costs, always the costs. Scrooge, another Dickensian number-cruncher, would approve.

Here is a test to assess hard-number facts.

Start with measles. What is the cost of an epidemic? Minneapolis recently had one: 79 cases, with 22 people hospitalized.

a) No significant costs, since few children had side effects – most were OK afterward, as our grandparents were in the good old days before the “state” forced vaccination upon us.

b) No net costs. The money spent on the few children who needed medical care was offset by the savings from not vaccinating everybody. Another argument against massive vaccination campaigns.

c) More than a million dollars.

Answer: c)

The Minneapolis outbreak spurred state and public health officials to mount a campaign of information, along with shots, to reach the many unvaccinated residents. From the state: $900,000; from Hennepin County, $400,000.

We know the human costs of measles: the numbers of people infected (1,677 in 2014, according to the Centers for Disease Control), the possibility of deafness, blindness, even death, and the ease of transmission of this air-borne virus. But the human toll hasn’t swayed public health commitment as much as these cost-numbers might.

Guns

What is the cost of our wild-west freedom to bear arms, wherever and whenever we want? Not just for hunting, but for criminal mayhem, macho showmanship, and protection against bad-guys, including the home-intruders who might be repelled by a homeowner’s 22 (if the intruder doesn’t shoot the homeowner first, or the homeowner doesn’t shoot the toddler who toddles into the line of fire).

a) Nothing. The notion that gun mayhem (including accidents) happens a lot is a myth. Gun-savvy toters know how to avoid accidents.

b) Irrelevant. The cost of keeping guns away from law-abiding citizens would be higher, as they would be at the mercy of the bad guys illegally toting guns. The problem is the toter, not the weapon.

c) Millions.

Answer: c.

Mother Jones, cited in Business Insider, calculated the costs (medical, judicial, legal) at $12.8 million a day. That figure may be far-fetched; we don’t have good data because we don’t allow the government to compile the figures. Some calculations, though, are sound. Consider: we spend $5.2 billion a year on keeping prisoners incarcerated for gun-related crime; a gun injury needing hospitalization can come to half a million dollars; the legal fees for mass shootings mount into the millions. (To try the defendant in the Aurora movie theater massacre, the pre-trial costs came to $5.5 million, partly to interview prospective jurors).

Seat Belts

Those uncomfortable restrictions smack of Big Brother. And our president abhors Big Brother restrictions that thwart corporate profits.

What is the cost of this libertarian stand?

a) Nothing – seat belts save some lives, doom others. In “Die Hard” scenarios the heroes escape from moving vehicles to avoid doom. How can you escape if a belt traps you?

b) Minimal. A crash is a crash is a crash. Fatalists take note. Seat belts mark a perverse government drive to force you to do something you don’t want to do, plus maybe the seat belt makers are in cahoots with government.

c) A lot.

Answer: c)

The North Carolina Trauma Center analyzed data from seven trauma centers for 1989. Data on seat belt usage were available for 3,396. Of these, 1,916 did not buckle up and 1,480 did. The average cost for unbelted patients was $15,250; for belted patients $10,500. All were injured – the seat belts did not save those 1,480 hospitalized patients. But we know that seat belts, in addition to saving money, save lives as well. These data propelled the compulsory rules.

Workplace Safety Rules

Uncle Sam breathes down the back of manufacturers, with dos and don’ts and fines. Does this obsession with safety save money? Yes or No.

Answer: Yes

As many as 4,500 workers die yearly on the job, with another 4.1 million injured or ill because of their workplaces. But states where businesses have instituted “injury and illness prevention” programs have seen success at saving lives.

Crucially, saving lives translates into saving money. Companies paid $74 billion in 2009 for workmen’s compensation benefits.

Conservatives who discount the human toll of injuries should note the money saved by preventing them.

Thomas Gradgrind and Ebeneezer Scrooge did not weep at human misery. They sought not the greatest good but the greatest profit.

So too our president, abetted by his party, discounts the human toll, seeking to retrench a host of initiatives, from environmental protections to the Dream Act. These solons spurn the paternalism of Uncle Sam. Yet they should heed the costs saved from that paternalism.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, October 15, 2017

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