Religious Exemption from the Individual Health Insurance Mandate

In view of today’s Supreme Court decision upholding the individual health insurance mandate, I’d like to make a few brief comments on certain legal, religious, and moral implications.

As the law now stands, (1) citizens may opt out of buying into the national health insurance system based on a religious conscience exemption; but (2) only members of certain state-recognized religions, like Christian Science, can apply the exemption.  This is a huge problem.  The federal government has no business telling us what is and what isn’t religious conscience.  If someone, unconnected with an established religion, were to decide, based on honest and informed examination of conscience, that buying into a national health insurance plan is immoral, then he or she should have the same right to exemption as a Christian Scientist.  This principle – which affirms the conscience of the individual – is explicitly stated in Article 18 of the Universal Declaration of Human Rights:

Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

The operative words here are “either alone or in community”, with emphasis on “alone”:  you don’t have to be a member of any specific church to have a conscience, or to have the right to act on that conscience.

It is entirely possible that a person’s moral reasoning may following along these lines:

1. At least half of all health problems are the result of wrong moral choices (overeating, intemperance, risky practices, etc.).

2. When bad health is the result of wrong moral choices, the ensuing pain and inconvenience motivates one to improve morally (or to not make moral errors in the first place).

3. If medical treatment is too inexpensive, it reduces motivation to avoid or minimize the immoral choices that produce sickness.

4. To force other people to subsidize a system that, in a sense, encourages immoral/unhealthy life choices is unethical: it forces the moral people to be complicit in a system that hurts others.

5.  Moreover, it is basically unjust to require one person to pay for the consequences of someone else’s wrong moral choices.

6. Further, the entire health industry today is a Tower of Babble – a vast, corporate-run system that subordinates human welfare to profits and materialistic values.  By marrying this monstrous system to the federal government, it threatens to make things worse, and also more difficult to change.

An individual could therefore potentially conclude that he or she has a moral duty – to others, to oneself, and to society – to opt out of the national health insurance plan.

Where does this leave us?

We’ll have to see what happens in the coming weeks.  But it appears there will be an important opportunity here for philosophers, moralists, theologians and civil libertarians.  The first three groups need to flesh out the basic argument sketched above concerning the link between physical health and health of the soul, and the moral implications.   I would suggest that this argument is fully consistent with Greco-Roman philosophy (e.g. Stoic and Natural Law ethics), as well as traditional religious (Christian, Jewish, Buddhist etc.) thinking.  Civil libertarians will have to tackle the problem of the federal government presuming to require affiliation with pre-designated religious organizations as grounds for a religious conscience exemption.

p.s.  Here is the law relating to religious exemption from the Patient Protection and Affordable Care Act (PPACA):

RELIGIOUS CONSCIENCE EXEMPTION — Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.

and here is section 1402(g)(1) of the IRS tax code:

(g) Members of certain religious faiths

(1) Exemption

Any individual may file an application (in such form and manner, and with such official, as may be prescribed by regulations under this chapter) for an exemption from the tax imposed by this chapter if he is a member of a recognized religious sect or division thereof and is an adherent of established tenets or teachings of such sect or division by reason of which he is conscientiously opposed to acceptance of the benefits of any private or public insurance which makes payments in the event of death, disability, old-age, or retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system established by the Social Security Act). Such exemption may be granted only if the application contains or is accompanied by -

(A) such evidence of such individual’s membership in, and adherence to the tenets or teachings of, the sect or division thereof as the Secretary may require for purposes of determining such individual’s compliance with the preceding sentence, and

(B) his waiver of all benefits and other payments under titles II and XVIII of the Social Security Act on the basis of his wages and self-employment income as well as all such benefits and other payments to him on the basis of the wages and self-employment income of any other person, and only if the Commissioner of Social Security finds that -

(C) such sect or division thereof has the established tenets or teachings referred to in the preceding sentence,

(D) it is the practice, and has been for a period of time which he deems to be substantial, for members of such sect or division thereof to make provision for their dependent members which in his judgment is reasonable in view of their general level of living, and

(E) such sect or division thereof has been in existence at all times since December 31, 1950.

An exemption may not be granted to any individual if any benefit

or other payment referred to in subparagraph (B) became payable (or, but for section 203 or 222(b) of the Social Security Act, would have become payable) at or before the time of the filing of such waiver.

 

Related posts:

• The Heathcare Reform Crisis: America’s Second Wake-Up Call
• The Social Contract, Thoreau, and the Individual Health Insurance Mandate

Right to die might kill health care reform – Washington Times

SMITH: Right to die might kill health care reform – Washington Times.

“Several aspects of the legislation are troubling from a constitutional perspective. However, not all of these aspects are raised in the state lawsuits. Ultimately, the Supreme Court may confront the constitutionality of the legislation in the context of a lawsuit brought by an individual citizen, not the state governments.

“For example, the mandate requiring individuals to purchase health insurance raises potential problems, not merely because the congressional authority to pass it is questionable, but also because it interferes with individual rights regarding health care choices…”

Read full article here.

Health Care Insurance or Else

Health Care Insurance or Else.

Here is the video to go with the preceding post.

Sen. Orrin Hatch with Greta von Susteren: Insurance mandate unconstitutional, totalitarianism

Health Insurance or Else

Sen. Orrin Hatch with Greta von Susteren: Insurance mandate unconstitutional, totalitarianism

On Wednesday, March 24, 2010, Sen. Orrin Hatch (R-Utah) was interviewed by Greta van Susteren, host of the Fox News program “On the Record.” In his remarks [video here] Hatch broached the real issues: that the way the Democrats have approached reform goes against our vision and deepest sentiments as Americans as to what this country is and should be.

Here are some quotes from the interview:

“Back on Hillary-care they had a mandate in there. I didn’t realize it, I didn’t pay any attention to it. We were trying to defeat Hillary-care. The more I studied since then, the more I’ve looked at it, the more I’ve come to the conclusion it would be unconstitutional to force people to buy something they don’t want to buy.

It would be the first time in history that the government could tell you that you have to buy something you don’t want to buy.

Now, they say you have to buy auto insurance. No you don’t. You don’t have to drive if you don’t want to. That’s just part of the privilege of driving. But in this case they are going to make you buy insurance even though you don’t have any desire to, any reason to.

And frankly, it would be the first time that your liberties would be taken away from you where you would be forced to do something you don’t want to do. I just don’t think that is constitutionally sound.”

Another quote:

“One of the things about this bill is the mandate is a big part of it. They want to force people to do whatever they want them to do. That’s what you call totalitarianism. It is not really good government.

And in this country we believe in liberty. We believe in freedom. We believe people ought to have choices. We believe they can make their own choices. If they choose not to buy something, that is their privilege. They can suffer the consequences if they don’t. But if they choose not to buy it, that’s their privilege.

But to have the government come in and say you have to buy this or we are going to penalize you, that’s not America. That’s not what we believe in. That’s not what helped build this country.

I understand the arguments behind mandating and everybody’s got to buy insurance. But then it comes down to what kind of insurance? A policy that the federal government designs for you? They are going to make a big determination as to what kind of policies you are going to have.

You basically lose your individual freedom if the government can tell you that you have to buy something you don’t want.”

He further remarked:

“If you look in the history of this country we’ve never had major sweeping piece of social legislation — that is any good — that’s been passed by just a partisan vote.

And Republicans want health care just as badly as they do. We think we should have started over and gone step-by-step to bring in the things that we mutually can agree on first, and then compromise on the things that we can’t initially agree on.

That’s how it’s done around here. That’s what brings people together. That’s what gets rid of the animosity. That’s what helps us to become functioning Americans working together.”

Government Healthcare Reform: Paradoxes and Quandaries

Government Healthcare Reform: Paradoxes and Quandaries

Suppose a medical treatment costs $500 a year and will save a patient’s life with 100% certainty. (That’s more or less the case with HIV infection; if issues of drug royalties are put aside, it should cost no more than $500 a year to manufacture and administer a cocktail of antiviral medicines which are nearly 100% effective in suppressing the viral infection that leads to AIDS.) If an American can’t pay for this hypothetical treatment, should society provide it for free?

For this specific example, I say yes. Whether this is a right or not is another question. Perhaps it’s better seen it as an issue of social justice, not a right per se. A person doesn’t technically have a right to receive free healthcare, because that amounts to saying that another person can be forced to pay for it. With greater confidence we can say that there is a social obligation to provide for the health needs of the poor. People are required by conscience, duty, and justice to do this.

Consider now a second example: a medical treatment that costs $10 million per patient, and has only a 1% chance of success. If there were no other treatment, a billionaire, someone with plenty of money and nothing to risk, might choose this treatment. Does a poorer person, someone without $10 million, have a right to receive the treatment at the public expense? Common sense says no.

Between these two extremes are many actual disorders and treatments. For example, there are many very expensive treatments for late-stage cancer, often with limited chance of success, perhaps at best extending life at a low quality for a few months. Does justice require that society pay for these treatments for the poor?

These considerations illustrate how issues of social justice and ethics, some potentially involving intensely personal religious and spiritual values, must play a role in determining appropriate allocation of healthcare and associated financial resources. In a traditional society these issues would be sorted out with attentive deliberation, kindness, fairness, and wisdom. None of these are virtues which anyone suggests modern governments enjoy a superabundance of.

–

Does one have a social responsibility to contribute to the healthcare costs of the poor?

Does society have a right to fine a person who does not?

Does government have a right to require one to be employed in order to pay for healthcare of other people?

If jobs with good working conditions are scarce, does government have a right to require one to work for inconsiderate or exploitative employers? Is one required to work under conditions that may involve unreasonable stress and stress-related illness?

May government require us to work ourselves sick in order to pay for public healthcare?

Could a hypothetical evil society exist wherein corporations and governments cooperate to exploit the workers — the government forcing people under threat of fines and imprisonment to be employed? The element of choice being removed from the worker, would employers be tempted to neglect workers’ needs and welfare?

Would it be ironic if, under the name of socialist principles of justice and egalitarianism, a more capitalist (in the negative sense) system of worker exploitation is created?

–
There is no cure for the common cold. Therefore it cannot be that said anyone has a right to receive treatment for the common cold. If an effective cold treatment were invented tomorrow, would that create a right that did not exist before?

If a treatment exists which nobody can afford, does anyone have a right to that treatment? As soon as one person can afford it, does that immediately produce a right of everyone in society to receive the treatment?

–
Consider the issue of efficiency. Under the Obama healthcare plan, citizens would be required to buy insurance policies that are, compared to a few years ago, exorbitantly expensive. Many, if not most health economists would claim that healthcare costs today are unrealistically inflated. In theory we could design more efficient, alternative healthcare and healthcare financing systems that cut the costs by 1/2 or 2/3. Or said another say, many believe that government intrusion into healthcare financing (e.g., Medicare), has radically increased healthcare costs and inefficiency. If justice demands that poor people receive healthcare, does that also mean it demands their access to insanely overpriced healthcare? Or does justice only demand that richer citizens contribute towards the medical expenses of the poor at a level commensurate with reasonable and realistic prices?

–
When Robin Hood meets the rich man in the forest, well may he say, “Stand and deliver! I take from the rich and give to the poor!” The rich man, if he has a conscience, can little complain. Robin does him a favor, for all applaud justice truly served. Let him toss his bag of gold, have a jolly good laugh, and be on his way.

But what if Mr. Hood says, “Stand and deliver. Yield thee up three bags of gold. One for the poor man, one for my own services, and one for the extra fees I levy on the poor. For I run the clinics, which, though mean and miserable, are most expensive. They are staffed with my lazy friends, and we buy overpriced supplies from crooked merchants who bribe us. But none of this is your concern. Three bags of gold, I say, or else.”

–
Do people have a right to healthcare?
Do people have a right not to starve in a land of plenty? Does government policy officially prevent starvation?

It is commonly said that the three necessities of life are food, shelter, and clothing. There are people in America without food and shelter. Why is the government more interested in healthcare than in these more fundamental necessities? Could it be that the government is unduly influenced by special interest groups — pharmaceutical companies and insurance corporations?

Is the government’s interest more in justice, or power?

–
Suppose we allow there is a right not to starve. And suppose it should cost $5 per day to feed someone. What if the government created an extremely inefficient program that cost $20 per day to feed a poor person. And then the government said that all food distribution to the needy must occur within this program. Do the poor ehen have a right to demand that the rich pay $20 per day for their food? Or would justice require only that the rich pay $5 per day?

If the rich pay $5 per day towards the food of each poor person, and the government cannot spend this money efficiently, would it not be the government which is unjust? If the government is unjust, is it the duty of the rich to compensate for this? Would there be a stronger moral obligation to change the government?

Liberals, Conservatives, Joan Baez and Ending the Nation-State

Liberals, Conservatives, Joan Baez and the Nation-State

The other night I saw a reprise performance of the recent American Masters episode on the life of folksinger and political activist, Joan Baez.

It was a good program and showed what a remarkable person Joan Baez is.    She walked the walk, even to the point of voluntarily accepting incarceration several times because of her (nonviolent) opposition to the Vietnam War.

But one detail that caught my attention was a brief remark by Joan in a film clip from an early 1970′s protest:  she was  exhorting people to “end the nation-state”.

End the nation-state?  Sounds like a good idea to me — where do I sign up?

And here was Joan Baez, one of most visible “liberals” of the second half of the 20th century, saying something I agree with, even though I am a political libertarian — which most people consider a conservative position.

But there was no mistake.  Joan Baez wanted to end the nation-state.   That was the wish of liberals in the 1960′s (as with John Lennon’s song, “Imagine there’s no countries; it’s easy to do….”).  It seemed obvious to anyone with good sense that governments were the cause of wars, and that governments served generally to suppress what is best in human nature.

To liberals, the government was the problem, not the solution.  The government was causing the war in Viet Nam, and hurting everyone.  Liberals wanted to reduce government power and to end the cultic worship of governments.

But roll things forward 35 years.  Now so-called liberals are supporting massive government-run healthcare.
They’re militant about it, insisting that “poor people have a right to healthcare, and the government
should supply it, whatever the cost.”  This is not only different from the liberalism of the 60′s,  it’s really the complete opposite.

In the 60′s and 70′s, the view was that if governments would get out of the way, people could sort out their own problems.  I can say that for sure, because, at least in the 70′s, I was there marching and singing “give peace a chance.”  People were thinking, “Life is good.  If governments would get out of our lives the natural impulse to enjoy life and to love and help others would manifest itself spontaneously.”

That’s still my view.  If John Lennon were alive today, I’d like to think that would be his view, too. Somehow I just can’t imagine him singing, “Hooray for government!  Let’s give them more power!  Let them pick our pockets and design aversive, government health programs, so we can all stand in line, put up with terrible service, and be at the mercy of arrogant public officials.”  No, that’s not how a working class hero would see things.

So the great irony is that true conservatives and true liberals are on the same side:  both groups want a world which affirms human values, welfare and happiness.  And opposed to these things is an ever expanding “statism” — a vast, inhuman, oppressive machine.

This is a rather important idea, and bears further thought.  Consider how much the media makes of the supposed opposition between “conservatives” and “liberals.”  What if this turned out to be all bunk!  Could it be that human beings are in basic agreement about core values — and in an instinctive aversion to abusive government power?  And could it be that the dominant economic institutions try to invent a false conflict in order to divide and conquer the population?

The Individual Mandate is a Radical Alteration of the Social Contract

The Individual Mandate is A Radical Alteration of the Social Contract

Part of the health care reform bill currently being debated by the House of Representatives is the individual mandate. By this provision, everyone would be required — by law — to have health insurance, or else be charged with a criminal offense and face fines or possible imprisonment.

This would be a radical and unprecedented change in relationship between citizens and government. The government would be saying, “you must be part of the system — our system — or we’ll fine or imprison you.” That violates your basic freedom as a human being.

At face value, the arrangement seems no different than mandated car insurance, which already exists. But there’s an important difference. Nobody has to drive a car. If you don’t want to be forced to buy car insurance, walk or take the bus. You aren’t compelled. You retain your freedom to participate or not.

Similarly, everyone is required to pay income tax – but only if you have income. If you really don’t want to pay income tax, you can, in theory, quit your job and just live off the land. Few do this, but the possibility of choice has a major implication. Since you’re free to opt out of the system, your participation is voluntary. That’s the essence of the social contract, and the basis by which governments are accountable to citizens. Without the voluntary aspect, there is no social contract, because a contract cannot be compulsory. If you’re forced to participate, your condition is that of slavery and servitude to the state.

A further implication is that you’d be effectively forced to have a job so that you can pay for health insurance. True, nominal programs would help the unemployed buy insurance, but these would likely be inconvenient and complicated. Most Americans would feel it necessary to work and to buy insurance.

People should work because they want to, not because they have to. When they have to work, it affects the workplace: companies then don’t need to supply good benefits or working conditions to retain employees. So with the individual mandate, not only would you be a slave to the state, but to the corporate system as well.

The individual mandate’s closest analogy is military conscription. But at least the draft — itself controversial — applies to a dire emergency — war. The individual mandate is, at best, a convenience of the government, not a social necessity.

Thus, as with 9/11 and the ensuing Patriot Acts, the government is trying to use problems in the health care system to justify an expansion of power – at the cost of your freedom.

What we have in the United States is a health crisis, not a health insurance crisis. Legislators seem unable to comprehend the difference. The problem is not that many Americans lack health insurance, but that health-care costs are too high. We should be focusing on new ideas for reducing costs – based on technology, innovation, competition, and individual initiative – not trying to expand the current insurance-based system that has produced the crisis.

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Part of the health care reform bill currently being debated by the House of Representatives is the <i>individual mandate</i>. By this provision, everyone would be required — by law — to have health insurance. Otherwise you’ll be charged with a criminal offense and face fines or possible imprisonment.

This is a radical and unprecedented alteration of the fundamental relationship between American citizens and their government. The government would be saying, “you have to be part of the system — our system — or we’ll fine or imprison you.” This violates your basic freedom as a human being.

At face value, the arrangement seems no different than mandated car insurance, which already exists. But there’s an important difference. Nobody <u>has</u> to drive a car. If you don’t want to be forced to buy car insurance, walk or take the bus. You aren’t compelled. You retain your freedom to participate or not participate.

Similarly, everyone is required to pay income tax – but only if you have income. If you really don’t want to pay income tax, you can, at least in theory, live off the land. Few do this, but the possibility of choice has a major implication. Since you’re free to opt out of the system, your participation is voluntary. That’s the essence of the <i>social contract</i>, and the basis by which governments are accountable to citizens. Without the voluntary aspect, there is no social contract, because a contract cannot be compulsory. If you’re forced to participate, your condition is that of slavery and servitude to the state.

Moreover, by legislating the individual mandate, the government is saying, “we have the right to pass a law that will require your participation in any program we dream up.”

A further implication is that you are effectively forced to have a job so that you can pay for health insurance. True, nominal programs will help the unemployed buy insurance, but these will likely be inconvenient and complicated. Most Americans will feel it necessary to work and to buy insurance.

People should work because they want to, not because they have to. When they have to work, it affects the workplace: companies then don’t need to supply good benefits or working conditions to retain employees. Not only do you become a slave to the state, but to the corporate system as well.

The individual mandate’s closest analogy is military conscription. But at least the draft — itself controversial — applies to the dire emergency of war. The individual mandate is only a convenience of the government, not a necessity.

Thus, as with 9/11 and the ensuing Patriot Acts, the government is trying to use problems in the health care system to justify an expansion of power – at the cost of your freedom.

What we have in the United States is a health crisis, not a health insurance crisis. Legislators seem unable to comprehend the difference. The problem is not that many Americans lack health insurance, but that health-care costs are too high. We should be focusing on new ideas for reducing costs – based on technology, innovation, competition, and individual initiative – not trying to expand the current insurance-based system that has produced the crisis.

Seven arguments against a doctor’s office visit for flu

Seven arguments against a doctor’s office visit for flu

1. Unless the patient has *serious* pre-existing conditions the flu will pass by itself.

2. After two days of symptoms, pharmaceutical treatments (i.e., Tamiflu or Relenza) will probably have little or no benefit.

3. The best treatment for flu in any case is to stay in bed.  A trip to the doctor’s office places serious and potentially unnecessary stress on the patient and his/her immune system.

4. The patient exposes others to flu virus.

5. In principle, a prescription for Tamiflu or Relenza could be made without a physical examination.  Patients can accurately take their own temperature and report their symptoms by phone.

6. The best reason for an office visit is indirect:  to take a throat or nose swab/sample for flu virus confirmation, either via a rapid (immediate) test or by sending it to a lab for culturing and more accurate testing.  This has public health value, because it helps track flu in the community, but does not benefit the actual patient.

7. There’s no logical reason not to sell rapid influenza test kits in pharmacies (without a prescription) and to let patients use these at home.  Note that these tests have relatively low diagnostic sensitivity (50-70%): they produce many false-negative results.  However the tests have diagnostic specificities of more than 90%:  they produce few false-positive results; thus, if a positive result occurs, the patient probably has flu and Tamiflu or Relenza can be prescribed.  This could be done by phone or fax based on a patient’s self-test.  Thus, for 50-70% of patients with flu, an unnecessary and counterproductive office visit could be avoided by means of a self-administered rapid test.

The above just outline some of the obvious considerations.  The main point is that this subject needs to be examined at the level of public health policy and some sensible guidelines established.

More information on flu testing:

http://www.cdc.gov/flu/profesionals/diagnosis/labprocedures.htm

Protect Yourself from the Flu – Video

Protect Yourself from the Flu

A leading flu vaccine producer, GlaxoSmithKline (GSK), has generously released this audio-visual presentation, originally developed for their employees, to the public:

GSK flu prevention video

When the new window opens, press the “Next” button on the lower right to continue.

This is the best presentation of its kind available today. Watch it yourself and show it to your family and friends.

If enough people follow the simple, common-sense steps outlined here, it can have a significant effect on reducing the swine flu pandemic. Because pandemic disease transmission follows an exponential pattern, even minor preventive steps like those explained here can have a major impact on total disease incidence.

Public Policy and Rapid Flu Diagnosis

This post follows up on an earlier one concerning the value of mathematical models, computer simulation, and operations research in dealing with pandemic and inter-pandemic (seasonal) influenza.

There’s a lot that can be done to control flu, once its known to be spreading. We can shut down a school, for example. But the key is to suit an intervention precisely to the need, and not to overreact. We can shut down *a school*, and not all schools in an entire city or country.

To accomplish such tailored intervention, information is crucial: we need to know who actually has the flu, and what strain of flu they have.

A current problem is that the majority of flu cases are not formally diagnosed. People get flu-like symptoms; they suffer for a week; they get better — and that’s that. Then they tell people “I had the flu”. Yet many of these people might not have had the flu at all. They may have had a cold, or food poisoning, or some other infectious disease.

Fortunately, fast, simple, and potentially inexpensive tests exist to diagnose flu and to identify viral strain class (e.g., A or B strain)  exist. However, currently, these tests usually require a visit to the doctor.

As a result, only a minority of people with the flu receive a test. First, why visit a doctor in the first place? You’re sick in bed, suffering from symptoms. The last thing you want is to get into a car (much less a bus) and visit a doctor. Besides the inconvenience, that stress is harmful (remember, the classic treatment of flu involves staying in bed getting lots of rest). Further, by traveling and sitting in a doctor’s office reception area one risks contaminating other people.

Many doctors will not request a flu test anyway. Why should they? It’s added cost and inconvenience.  And from a clinical management standpoint, a confirmed diagnosis of flu is of little value. In most cases the treatment is the same: stay home, rest, and drink  fluids.

Note this is different than for bacterial respiratory tract infections; there one wishes to identify the bacteria in order to select an optimal antibiotic.

Potentially a flu test could be of value in deciding to prescribe Tamiflu. However, Tamiflu has a short window of efficacy. If a doctor suspects flu, then the logical thing would be to prescribe Tamiflu immediately, rather than wait for the results of a lab test.

Recall what happens with a flu test. A cotton swab is inserted into the nasal passages, collecting a mucous sample. The sample is then sent to a lab for processing. It could take a day or longer for the sample to reach the lab. Then it might wait several hours before processing. And then it might take another several hours for someone to phone or fax the results to the doctor. By that time the window of opportunity for Tamiflu would have potentially passed.

A Paradigm Shift

What we need to recognize is that the real value of flu testing is not to benefit an individual patient, but society. That is, the main value is epidemiological, not clinical.

A flu test should be routinely performed so that we can track the spread of flu virus during an outbreak and to make judicious interventions on that basis.

Because of this, we should consider paying for flu tests out of the public coffer, instead of billing patients individually. Further, we should consider streamlining the flu assay process. Here are some suggests towards that end:

1. Develop even faster, cheaper tests. The tests are already simple. A flu antigen test can be performed in 15 minutes, using paper tabs, analogous to a home-based pregnancy test. However, currently these are performed in a lab, by a trained technician. The costs are not currently stated online, but a reasonable guess would be at least $50. What would be ideal is a home-based test, purchasable at a local drugstore. With many more test units being sold, one could easily imagine the price dropping to $10 or even $5 without loss of total revenue to manufacturers.

2. Mobile flu test units. It might take a while to overcome institutional resistance to a home-based test. In the meantime, we could in the US develop something that is already common in Europe: lab courier. Lab couriers are people who can come to your home and pick up a something like a urine sample and take it to the lab for processing.

Option 1 a no-brainer. Eventually this will likely happen. The only question is when. Again, there is probably institutional resistance to overcome. In a sense, this takes work away from doctors and labs.

Option 2 requires a little analysis however. All the parameters involved are straightforward. We can estimate how many people would use such a service (hopefully, if the cost is low enough, nearly everyone with suspected flu). We can also estimate the potential value to society. By tracking the spread of a flu outbreak with almost complete accuracy, we could issue local alerts, close schools, etc. We could optimally distribute antiviral drugs, and launch rapid-response immunization programs. We could also prevent hysteria and unnecessary closures. By tracking an outbreak with complete precision, we could potentially prevent a pandemic.

How much would that be worth? To judge from government investments in bird flu contingency plans, billions of dollars.

The question is whether a publicly financed mobile flu-test units, or some other innovative program, would be cost-effective, in terms of saving money and reducing morbidity and mortality. These are, in principle, simple calculations to make, and perhaps someone at a public health school or the CDC will run them!