Back again: Measles

Copy a couple of these articles and give them to your school nurse to pass out to people who say they don’t want to inoculate their kids.

• New York Times, measles at highest level in years
• Washington Post, CDC cites biggest increase in measles since 2001
• Reuters
• Los Angeles Times
• ABC News
  

In 1991, we could have inoculated every unvaccinated child under the age of 10, in Dallas County, for much less than $20,000. Then the epidemic hit. One of the early hospitalizations for the company I worked with was $100,000. One kid went in, and after $1 million of care, spent the rest of his life in a local hospital (another decade).

The economic arguments for measles vaccination should be clear.

Update: Bug Girl is right (see her comment below):  Go check out Orac’s post on the issue, “Antivaccinationsim versus measles in the U.S.:  Are the chickens coming home to roost.”  I was posting in a hurry; Orac is posting after visiting the issue several times.  Contrast Orac’s views as a physician with those of people who tend to get herded into panics without the facts, only through the fault of not having the facts about the dangers of the diseases they let off the hook (make no mistake: most of these people are well-meaning).

My more complete measles story, below the fold.

As part of the “Reagan Revolution,” in 1981 the Senate Labor and Human Resources Committee held hearings on health program reauthorizations.   In 1981 measles was mostly a memory in the U.S., and there was talk that the disease could be eradicated from this country.  Reagan’s budget office took an odd view on the issue:  Since the disease was almost wiped out, they reasoned, why bother to spend the $3 million a year planned for the next five years to finish the job?  Surely, they reasoned, parents would get their kids inoculated against such a dread disease; and surely well-meaning philanthropists would step in to cover the cost, and the $3 million a year could go to savings.

I was on the staff of Committee Chairman Orrin Hatch.  I had set up the first committee press office, to make available to the public the work of the committee, to let in the sunshine on processes most people still consider mysteries (“working against ignorance since 1971 . . .”).  In assembling the press packages, I was struck by the power of the few statements in favor of continuing the spending, and the general feeling among all witnesses that it was a done deal.  The committee approved the cuts later, it was rolled into the massive Reconciliation Bill dealing with budget matters, and the federal support for eradication of measles was pulled.

This was not a big hearing.  Industry and budget types were there; the wire services picked up copies of the testimony, but I don’t recall that there were more than two or three people at the press table at any one time.

In the afternoon, one of the witnesses, some guy with CDC as I recall, asked to meet privately with the chairman, and because no one wanted to meet with the guy he eventually got shuffled to me (I usually got all the crank calls, too).  I wondered at the time whether I should get his name, but he was pleading a lost cause.  Nothing I could do to help him.  This is what he said:

The nation can save $3 million in the first year, and maybe for a few years after; but sometime soon there will come a measles epidemic, and because the government stopped short of eradicating the disease, people will die, he said.  Children will die, he said.  Poor people will not be able to afford vaccinations, people will fail to get their kids inoculated, and there will be an epidemic.  Don’t make the cuts, he said.

More than four years later I left the Labor Committee, staffed the President’s Commission on Americans Outdoors, and then moved to the Department of Education.  Sometime after I graduated from law school, I got out of government and moved to Texas to do airline real estate work.  One day I picked up the newspaper to see that the U.S. had a measles epidemic, with more than 5,000 kids ill, and more than a dozen deaths already.  Ultimately there were, in California alone, 18,000 cases, 3,500 hospitalizations, and 70 deaths.  Directly medical care and outbreak costs, in California alone, were $31 million, more than double the amount “saved” from the federal budget over the five years it had been projected necessary to completely eradicate measles from the U.S.

Out of airline real estate, I was detailed to look at ways to control the health care costs of a large corporation with more than 100,000 employees and more than 250,000 people covered under its health plans.  I was told to be creative, to suggest any and all possibilities to reduce health care costs.  We had kids then, and I was rather surprised to discover this company’s plan did not cover the costs of measles vaccinations.  The insurers explained that measles vaccines cost about $33.00 at a private physician’s office, and that they did not regard it as high priority because “as the federal government concluded, measles is practically eliminated.”  I asked whether the company could track measles among employees and dependents, and we found more than two dozen cases in the area around Dallas.  Company costs, from parents missing work, was in the tens of thousands of dollars.  The health care costs were staggering, though.  Fewer than a dozen cases required hospitalization, but of those cases, none cost less than $10,000, and at least one was well over $100,000.  The insurance company’s choice to forego the cost of the vaccines had cost the company more than five times the costs of the vaccines.

The finance poobahs were adamant:  $33 saved was $33 saved, and there was no way to predict who would get measles.  So the costs of the disease could not fairly be ascribed to the failure to inoculate kids (this is just one of the crazy corporate accounting schemes I’ve discovered over the years; I’m not making anything up).  For the final presentation, I wondered about the company covering the cost of vaccinating every kid NOT covered by the company, reasoning that if we could prevent others who  might infect our kids from getting the disease, our covered kids wouldn’t be likely to get it.

Public health people said that for $9,000 in Dallas County, they could have vaccinated every kid under the age of 5 who was not already protected against measles.

Prevention is much less expensive than treatment after a disease is contracted.  In the case of measles, savings can be made even with small investments in vaccinating <i>others</i>.

The company did not change its health plan (I do not know whether they have done so yet).

In the process of that study, I also discovered that as much as 20% of the costs of hospitalizations  to insurance companies was allocated to help the hospitals pay for care given to indigent patients.  Consequently, measles in the community costs all insured people more than they may realize, if the cases get complicated and require hospitalization.  Dallas County had incurred well over $1 million in costs from indigent people with measles during the epidemic.

The guy from CDC was right.  Without federal support, measles vaccinations fell off dramatically.  Measles came roaring back.  And hundreds died.

If you’re thinking of avoiding a measles vaccine for your kids, please explain to me how you would rationalize that if your kid died from measles complications.    I can’t figure it out for myself.