Riding the Ebola Wave

Something changed after the Greatest Generation took care of Hitler and Mussolini and Tojo, when America ended up with the only economy in the world that hadn’t been devastated by that war. America hadn’t been bombed into smoking rubble, and now we knew how to make almost anything on a massive scale, and had the capacity to do so. Incredible prosperity followed, for almost everyone. We built cars, not tanks and planes, and the televisions, and then anything we could think of. Everyone wanted a house in the suburbs, and everyone could have one. There seemed to be good jobs for everyone, and if you didn’t like any of those jobs, you could go into business for yourself. You’d do fine. People had money in their pockets. They’d buy what you were selling, and back then the government wasn’t regulating much of anything. You could sell crap that didn’t work at all and then just move on, and then sell something else that might be a little questionable. Ten years after the war ended, Detroit started selling big wallowing cars with giant tailfins, the same cars as before, but now space-age snazzy. People bought them. Kids bought hula hoops. There was a lot of money sloshing around. The economy exploded in all sorts of directions.

That explosion is what changed things. Those of us born just after the war wouldn’t live our lives like our parents, in one respectable career, rising to the top, or at least to the respectability of loyalty to the firm, and the honor that comes with that. We disappointed our parents by job-hopping and even changing careers entirely, several times. We didn’t stick to anything, but then that was impossible, given how the world kept changing. Old industries died. Whole new industries were invented. Success became a matter of riding the next wave, and then the wave after that. There were many awkward conversations in the early sixties. What are your career plans, how do you want to spend the rest of your life? There was no good answer to that. Where do you see yourself in ten years, and how do you plan to get there – what are the specific steps you must take to get there? Okay, fine – tell me what the world will be like in ten years. You can’t, can you? Baby boomers went off into the world willing to improvise. There was no other choice. Their parents looked sad.

No one settled down, but that was okay, and all of us have our tales of how thing somehow worked out. Teaching high school English in the seventies was fine, but that was a dead end. Moving to California and working in the “real world” wasn’t. The aerospace companies were hiring, and Training and Organizational Development wasn’t much of a stretch, but that was a dead end too – but in the mid-eighties desktop computers suddenly arrived, and all sorts of Human Resources stuff could be automated. Suddenly there was such a thing as Human Resources Systems, another wave to ride, something no one saw coming. Cool – and that led to something else no one ever heard of before, outsourcing, dumping all the tedious systems stuff, letting a contractor do the work, and working for the contractor, not the aerospace company, was cool too. There were no dead ends there. They had other contracts, and running the systems shop at that locomotive factory halfway between Detroit and Toronto was something entirely new – the legacy COBOL-based manufacturing resource planning system, running on a competitor’s mainframe in Texas, was a hoot – but that was a dead end too. Why not quit? A chain of Catholic hospitals in Pasadena needed someone to manage the business operations shop – payroll, accounts payable, general ledger – and that was fine, until the nuns outsourced us all to another contractor, who “streamlined” everything and sent us elsewhere. Fine – it was good to learn their fancy system that handled HMO stuff – contracts and eligibility and such things, so the HMO made good money, by making sure no one was getting any sort of treatment that wasn’t authorized by the bean-counters. It was a slick system for maximizing profits, merciless, or looking at it another way, superbly efficient – but then the HMO that wanted to use it went under before any of us could get there, swallowed up by a larger HMO with a different system. Oh well – a year or two off was fine – and then working for an actual HMO was fine too. It was a way to look at the same set of problems from the inside, but their systems were in chaos and some of us were forced out in the churn.

That was okay. It was time to retire anyway, and looking back at all this, it’s clear that any career plan from 1964 or so wouldn’t have worked. As they say, who knew? Additionally, over all the long and strange years, one does learn what controls one’s fate. Others want to make money. They don’t give a damn about you unless you make them money – then they’re happy with you, if they remember your name. This was nothing like teaching high school English. Thirdly, it’s obvious that sooner or later we’ll all end up working in healthcare, one way or another. The boomers are getting old, needing the medical help age makes necessary, and the days when America knew how to make almost anything on a massive scale, and had the capacity to do so, are long gone. Others, overseas, make what we buy. We have a service economy, where we service each other, coupled with that financial world out there where the rich get even richer selling imaginary assets to each other.

Our parents wouldn’t recognize this world. No one stays in one career. There’s no longer any honor in that, and in fact that doesn’t make sense, not now. That hasn’t made sense since 1947 or so, when laissez-faire capitalism was fully unleashed, when Adam Smith’s Invisible Hand became more important than any of us. It’s every man for himself now, in a world where everything was always changing. There were parents, back in the day, who wanted their son to grow up to be a doctor, someone respected, who really helped others, and made a good living too. The daughter might be a nurse – the same thing, without the good money. They wouldn’t recognize this world, where such people are just tools of others, the ones who make the real money, who run the world.

The Ebola crisis is making that painfully obvious, and one of Josh Marshall’s readers over at Talking Points Memo offers this:

I have a perspective tying together today’s big news brouhahas. My wife is an ER nurse at a major urban hospital owned by the Hospital Corporation of America, the hospital chain once run by Rick Scott. It’s the largest for-profit medical system in the world, and is of course also notable for its “creative billing” practices in the largest Medicare fraud settlement in history. Scott was booted from the CEO position following that fraud investigation, so he’s not directly responsible for current conditions in those hospitals.

But it is obvious to those who work there that the combination of lax training and toxic labor relations “leaders” like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of Ebola or other infectious disease occurs. My wife’s ER has an “Ebola cart” with some lightweight protective gear and written instructions for putting on a PPE [Personal Protective Equipment] but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk.

It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far. As we all now know, PPEs are not easy to put on and take off correctly. Even though nurses all have experience with standard droplet control (they see TB and HIV all the time), Ebola is a special case. They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.

Rick Scott is currently the Republican governor down there in Florida. The largest Medicare fraud settlement in history didn’t hurt him one bit. He said his subordinates did that and didn’t let him in on what they were doing. Scott was booted from his CEO position because he was a clueless executive who hired and trusted the wrong people. He wasn’t fired for the fraud, and he told the voters of Florida he’d end government waste, cutting everything in sight. He told them he’d drug-test everyone on welfare, and they liked that. He didn’t tell them his wife owned the company that would do all the testing and the two of them would make a fortune billing the state. It’s a strange situation, but conservative voters down there wanted someone mean – merciless or, if you wish, superbly efficient – to slap the state into shape. That’s what they got. He runs the state like he ran his hospital chain, ruthlessly – and he’ll make a bundle too, with a bit of slight-of-hand. He spent seventy-five million dollars of his own money to get elected. It was a good investment.

Josh Marshall’s anonymous reader knows this guy and this world, and his wife’s hospital. The hospital can’t handle Ebola. Everyone knows that:

And yet the head of infectious disease at this hospital went on the local news to proclaim the hospital was ready to receive ebola patients safely. They obviously didn’t bother to speak to a single nurse on the front lines. I’m not particularly panic-y about ebola, even though obviously the family members of ER personnel have a lot at stake in Ebola preparedness. But I think that this situation will be the weak link in any major national response.

So many of our hospitals are run by lunatics like Rick Scott who seek only the highest profit margin – they do not invest in training, they build charting mechanisms that are good for billing but not treating patients, they constantly fight with their unionized employees, they lie to the public, etc., etc. We like to imagine that competent, highly-skilled medical institutions like Emory will save us, but we have way more Dallas Presbyterians in this country than we have Emorys. You can see exactly this managerial incompetence—and toxic labor relations – woven through the statement released by the nurses at Dallas Presbyterian today. Also see the head of National Nurses United on All In With Chris Hayes for a similar perspective.

To put it bluntly: we’ve entrusted our national medical system to the managerial competence and goodwill of the Rick Scotts of the world, and that is much scarier than a podium fan.

In case you miss the podium fan thing see this:

In one of the weirdest and most Floridian moments in debate history, Wednesday night’s gubernatorial debate was delayed because Republican Governor Rick Scott refused to take the stage with Democratic challenger Charlie Crist and his small electric fan… Rather than waiting for the governor to emerge, the debate started with just Crist onstage. “We have been told that Governor Scott will not be participating in this debate,” said the moderator. The crowd booed as he explained the fan situation, and the camera cut to a shot of the offending cooling device.

“That’s the ultimate pleading the fifth I have ever heard in my life,” quipped Crist, annoying the moderators, who seemed intent on debating fan rules and regulations. After a few more awkward minutes, Scott emerged, and the debate proceeded, with only one more electronics dispute. When asked why he brought the fan, Christ answered, “Why not? Is there anything wrong with being comfortable? I don’t think there is.”

Rick Scott may not be governor down there much longer. He may be appropriately mean and merciless, but he threw a tantrum like a prissy sixth-grade little girl, thinking it would impress every voter in Florida. That might have been a miscalculation. The whole nation is making fun of him now. The little things matter. Perhaps he made some good points in that debate. No one will remember them now.

Rick Scott, however, may pull this off. He’s a Republican in this unforgiving world, the kind of guy who does what makes economic sense, not matter who gets hurt, and David Stirling explains how that relates to Ebola:

Ebola has been killing people since 1976, so why do we still have no vaccine?

There is no profit for pharmaceutical giants in developing expensive drugs for rare diseases in countries with no money to buy them.

They are interested only in mass-market medicines for First World conditions such as cancer and heart disease, or lifestyle drugs such as Viagra.

Even health experts have ignored Ebola. Two years ago, the World Health Organisation listed 17 neglected tropical diseases (NTDs) that afflict more than one billion people. Ebola didn’t rate a mention – until the current outbreak killed more than 4000 people so far and put the world on alert.

Of course, drug companies are not charities, they answer to shareholders, and for that matter, where’s the financial incentive for governments when the disease afflicts only Africa?

All that is rather obvious – the Invisible Hand has spoken. No, wait – market forces have spoken. Hands don’t speak. They slap people around, which may be the same thing, but someone will make money here. The Washington Post’s Abby Ohlheiser explains how that works:

The Centers for Disease Control and Prevention announced Tuesday that a person has been diagnosed with Ebola in the United States. The market reacted accordingly. The most striking monetary effect of the CDC’s announcement was encapsulated in this headline from USA Today: “Ebola stocks soar after infection hits U.S.”

Yes, the makers of experimental drugs that have a shot at becoming the first confirmed Ebola treatment fared well in the markets after the Ebola-in-the-U.S. news broke.

“The first confirmed Ebola case in the U.S. is fanning fears around the country, but it’s also driving greed in some corners of the stock market,” CNNMoney said.

It was just the latest in a series of boons for those companies.

There wasn’t money in this before. There is now. Just add panic, and the “natural remedy” folks are seeing green too:

One of the more reliable byproducts of something like the Ebola outbreak in Africa (and its arrival in the U.S.) is the marketing of products that aren’t actually drugs as potential cures or treatments for the illness. This is something the FDA anticipated would happen this year, as Ebola began to spread across West Africa. “Oftentimes with public health incidences, like Ebola or even during H1n1, we see products that are marketed, often online, that claim to treat or cure the disease … without FDA approval,” FDA spokesperson Stephanie Yao said in an earlier interview with The Post.

Last week, the agency sent letters to three companies, alerting them that some of their paid consultants were marketing their products – which included essential oils and organic dark chocolate bars – as Ebola cures and treatments against FDA regulations.

That is rich:

Although two of the companies in question made it very clear in statements to The Post that they don’t condone the marketing of their products in this way, one company was promoting the idea itself.

Natural Solutions Foundation claimed in its online marketing materials that its Nano Silver product could cure Ebola, Hepatitis B and C, and H1N1, among other diseases. “WHO, FDA, the New York Times, etc., have gone on a rampage of disinformation to keep you in the dark about natural ways to dispose of dangerous microbes without damaging your beneficial bacteria,” the company added.

The ads will be on your television screen soon, and then there are the hedge fund managers:

It turns out that the spread of Ebola through West Africa prompted some hedge funds to bet on it affecting cocoa prices. The countries hardest hit by the outbreak border the Ivory Coast, one of the world’s largest cocoa producers. According to Bloomberg, the possibility that Ebola will spread there is one of many factors leading experts to speculate that cocoa prices will continue to rise.

A September 24 Moody’s report cited by Bloomberg notes that Ebola control measures might produce labor shortages during the beginning of cocoa’s harvest season in October.

It’s time to play those cocoa futures. There’s money to be made, and we do live in a world where laissez-faire capitalism was fully unleashed long ago. It’s every man for himself, alone, and we are actually all libertarians now. At Newsweek, Victoria Bekiempis discussed how that’s working out in Texas:

The Centers for Disease Control and Prevention confirmed the first case of Ebola diagnosed in the U.S. on Tuesday, in Dallas, Texas. This presents both epidemiological and political questions. Libertarianism is a major political force in Texas, and Libertarianism generally advocates against government involvement in healthcare – so if the 135 Libertarians running for office in the Lone Star State this November were elected, would they want the government to fight the disease?

The answer is more nuanced than one might expect: Most Libertarians interviewed by Newsweek agreed government should intervene to protect public health in exceptional circumstances, but said intervention would have to be very careful and limited – and, perhaps, that it is better executed by the private sector.

That goes like this:

Carla Howell, National Libertarian Party Political Director, says “governmental bureaucracies” involved with epidemic control are ineffective compared to private and voluntary efforts, in addition to costing too much money and violating individual rights.

“The sole purpose of government is to protect our life, liberty and property from harm caused by others in those few instances where the private sector cannot do a better job,” Howell writes in an email to Newsweek. “Containing Ebola in Africa is best left to private charities such as Doctors without Borders rather than the NIH [National Institutes of Health] or the CDC.

“Screening is better handled by airlines and private hospitals that are both liable for damages and fully free of government red tape. (Sadly no such hospitals exist today in the United States).”

Digby (Heather Parton) summarizes the rest:

To be fair, some other libertarians who are running for office in Texas reluctantly agreed that as much as they loathe “government bureaucracies” like the CDC, they have “bigger fish to fry.” Others recognized that quarantines enforced by the proverbial men with guns might be necessary. Overall, they seemed to be more uncomfortable with implications of their belief system in this instance than we usually see. In fact, they remind [me] of the anti-abortion zealots when confronted with the inconvenient fact that if they consider abortion murder they are morally required to arrest the women who have them.

The spokesperson for the national Libertarian party is the only one who is unashamedly willing to spell out the solutions their philosophy truly requires.

Why not be honest about this? Everyone understands now. This is not the world of the Greatest Generation. There’s no respectability in loyalty to something larger. You’re alone. Ride the wave, and then the next one, no matter who drowns around you. We’ve lived our lives like that for many decades now. Now we know what that means.

About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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2 Responses to Riding the Ebola Wave

  1. Rick says:

    Carla Howell, National Libertarian Party Political Director:

    “The sole purpose of government is to protect our life, liberty and property from harm caused by others in those few instances where the private sector cannot do a better job,” Howell writes in an email to Newsweek. “Containing Ebola in Africa is best left to private charities such as Doctors without Borders rather than the NIH [National Institutes of Health] or the CDC. Screening is better handled by airlines and private hospitals that are both liable for damages and fully free of government red tape. (Sadly no such hospitals exist today in the United States).”

    I was wondering how libertarians would talk their way around the Ebola situation.

    Maybe she should ask Doctors without Borders if they think we could all count on them to contain the epidemic in Africa. This was in the news earlier this week:

    “Doctors Without Borders, meanwhile, said Tuesday that 16 of its staff members have been infected with Ebola and that nine have died. The toll highlights the high risk of caring for Ebola patients even at well-equipped and properly staffed treatment centers.”

    In other words, small groups of volunteers can’t handle this alone, especially when so many of them are dying in the attempt.

    Containing this disease in Africa, which is something that certainly should have helped us now had it been done earlier, definitely meets the qualifications of being one of “those few instances where the private sector cannot do a better job”, since drug companies have no incentive to produce for a market where they’re unlikely to make a buck. We should have anticipated this and had our government handle this back in the mid-seventies, when the problem first popped up — either under contract with the private sector, or developed and produced in government labs if the drug companies had decided they didn’t want to sell it to us for what we were willing to pay.

    As for airlines and hospitals? It’s precisely because they would, as Howell says, be “liable for damages” that they might just dodge that bullet by shutting down flights from Africa — something health authorities say would be a bad thing to do — and because they’re “fully free of government red tape” that we could not force them to do something that may not be in their corporate interest, but would be in the interest of the country.

    Our problem, of course, is every few years, we decide to close our eyes and cut the shit out of government spending — making the alleged “hard choices”, without concern for what damage is done.

    This is just another example of libertarian idealism falling short in the real world. Someday, maybe we’ll learn this lesson.

    Rick

  2. Excellent summary; deeply troubling, on many levels, as honest assessments of failure usually are.

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