Because costs money to have a public health system that can actually protects the public’s health (boldface mine):
MOUNT VERNON, Wash. — Whooping cough, or pertussis, a highly infectious respiratory disease once considered doomed by science, has struck Washington State this spring with a severity that health officials say could surpass the toll of any year since the 1940s, before a vaccine went into wide use.
Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.
The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts.
Here in Skagit County, about an hour’s drive north of Seattle — the hardest-hit corner of the state, based on pertussis cases per capita — the local Public Health Department has half the staff it did in 2008. Preventive care programs, intended to keep people healthy, are mostly gone.
The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.
…“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”
State health officials estimate that because of incomplete testing and the assumption that many people with mild cases are not seeking medical treatment, perhaps as few as one in five pertussis cases is being recorded and tracked, suggesting that the outbreak is far more widespread than the numbers indicate…
“It’s the largest epidemic I’ve ever seen,” said Becky Neff, the only registered nurse in the 3,700-student Burlington-Edison School District, in Skagit County. Ms. Neff said she had seen 142 suspected and confirmed cases, or about 3.8 percent of the student population from kindergarten through 12th grade.
But with only two nurses processing the disease reports she sends over to the county, down from five a few years ago, Ms. Neff said she had stopped even trying to ask for confirmation.
“They don’t have time to call and say who’s positive and who’s negative,” she said.
Unlike the federal government, states and municipalities are not currency issuers, they are currency users–they can run out of money (or have to borrow at prohibitive rates). Because the U.S. public health system is largely a state run and funded system, states are cutting budgets. With all due respect to Dr. Leibrand, who is being asked to do an impossible job, he should not buy into the false choice of understanding who is sick versus treating ill patients. He should be telling reporters, “We don’t have enough money to respond to this crisis the way a developed nation should.” If nothing else, the non-diagnostic approach means some people will be exposed to pertussis carriers.
What’s truly dreadful is that public health departments, even in flush times, receive pissant amounts of money: we’re talking about restoring a couple of hundred public health workers across the entire state (if that) and a few million dollars for outreach and vaccination.
Instead of arguing about sequestration in Congress (the coming mandatory ~8% budget cuts across the board), they should tear up that stupid debt agreement and supplement cash-strapped states and local governments. And for those who say that it’s hard to figure out how to spend the money, I’m pretty sure that public health workers in Washington state have some ideas about that.
Decades from now, historians are going to look back at us and wonder how we could be so fucking stupid. And so irresponsible towards our children.