During the past two weeks, as the terrorism-alert logo on America's television screens switched to orange, I began receiving the same worried phone calls from my patients that I had received during the fall of 2001. They told me they were not sleeping, thinking constantly about bombs or rushing to buy emergency supplies. In the months after September 11, they had desperately sought gas masks and Cipro; now, they told me, they were buying duct tape and plastic sheeting.
It now appears that President Bush plans to privatize Medicare, meaning that HMOs could soon assume a prominent place in America's health-care system for the elderly. Past experience has already taught us that such a scheme won't work for seniors, who are likely to have multiple health-care needs that must be addressed in a timely manner. Bureaucratic restrictions, referrals and refusals governed by outside insurance are anathema to very sick people who must get tested and treated quickly before they are overcome by illness.
The way out of our current Medicare conundrum doesn't lie in privatization but in extending coverage and forcing changes in how drug companies behave. But Bush's plan won't help accomplish these goals -- and it will probably make things worse.
Medicine depends on probability: the probability of a disease occurring, the likelihood that it will spread or can be prevented, the odds of a side effect resulting from a tool of treatment or prevention. A risk-benefit analysis evaluates the risk of a disease versus what doctors can do to prevent or treat it. With smallpox, the greatest problem recently has been an exaggerated perception of its risk. The public is divided into two camps: those who are afraid of smallpox and those who are afraid of the vaccine.
Vladmir Putin's decision to storm and gas a theater in Moscow -- where Chechen terrorists had taken about 700 hostages -- was an obvious call; circumstances had left him with little choice. But if the decision to storm the theater was fundamentally just, the execution of the operation by security personnel raises a number of troubling questions. And most disturbing is the question of whether more than 100 lives were sacrificed carelessly because of a lack of adherence to basic principles of emergency medicine and rescue.