Penguin.com (usa)

Q: What do you foresee being the biggest health risk children will face this fall?

Probably H1N1 ("swine") flu. But that's not because it will cause devastation—most health experts anticipate that this flu will be similar to (or even milder than) regular seasonal flu. The reason I think it is going to cause problems is that H1N1 will likely spread throughout schools, causing school closures. Parents will need to find something to do with their kids during the day because it is plausible that even well kids will need to be home for a little while. When 1 parent can stay at home, this doesn't present a huge problem; but when both parents work there is now the issue of missed days, oftentimes with financial implications, and depending upon how widespread this becomes also the possibility of short-term decreased productivity for our country as a whole.

Q: What should we do to protect children from H1N1 and other flu strands?

Teach basic hygiene: hand washing, hand washing, hand washing. I love that the Department of Health and Human Services is teaming up with Elmo to send a message to the youngest audience. We also have to get better about staying home when sick. Again, this is an issue of pragmatism: if both parents work, sometimes it seems impossible to have 1 stay home with a sick child. But that sick child will undoubtedly pass the infection on to several others because the virus spreads when we touch our mouth or nose or eyes and then a doorknob or a pencil or a desk. Sending a sick child to school only passes the dilemma onto another family a few days later.

Q: As a mother of two young children will you give your kids the Swine Flu vaccination?

I don't even know if they will qualify to get the new vaccine. There is talk that the number of doses may be quite limited, and if this is the case then initially only very young children (under 4) and older children with chronic medical issues will have access. While it is anticipated that there will eventually be enough doses for everyone who wants one, the priority groups will get it first. My kids don't fit into either of these categories. I did, however, already give my kids their seasonal flu vaccine—some 2 months earlier than usual. I did this to leave the option for H1N1 vaccine open since it is unclear how many weeks need to pass between seasonal flu vaccine administration and H1N1 flu vaccine administration.

Q: How do you feel about the current Health Care crisis? In your opinion does there need to be a complete overhaul of the current system? Do we need a public option or can reform happen without it?

I agree with those who say this is a crisis of health care coverage much more than it is a crisis of health care. Everyone in this country needs to have access to health care, and in my opinion that means preventive health care as well. We all know that prevention is far cheaper—not to mention far kinder—than acute care. I just don't quite understand why the insurance companies are not being asked to become not-for-profit companies. Much of our current dilemma stems from the fact that insurance companies have profited at every turn. And when we call for 100% coverage, unless the insurance companies become not-for-profit, they stand to gain even more. Doctors have been willing to take cuts in every direction for years. By the time I enrolled in medical school (now 16 years ago) we all knew we were going into a public service field; no one in my class thought of medicine as a means to get rich. There is an entire generation of doctors who entered the field willing to participate despite the financial disincentives. How has this occurred in parallel with insurance companies profiteering more and more?

Q: Do you feel that health care is a human right or one's individual responsibility?

It's both. It is our responsibility to care for ourselves, to ensure our own health and well being. Just like it is our responsibility to be socially conscious and to self-govern and to stop at a red light, it is our responsibility to care for our own health. But health care is a right too. We have invested in a massive health infrastructure in this country. Most of us buy into a system of insurance so that if we ever need it, we will have care. It's our right to do this. In my opinion, what health care is not is an entitlement. You are not entitled to everyone else's time and resources if you aren't going to give back. It seems pretty clear that as insurance premiums have risen, the group of uninsured has multiplied. But where does entitlement to free care fit in? If you cannot pay for it, do you still have the right to expect it? My answer would be that everyone should have the right to health care, that it should be affordable to everyone. If you can pay a dollar, then pay in a dollar. Moving insurance coverage to a sliding scale gives everyone the responsibility for—and the right to—their own health care. That's a little pie-in-the-sky, I know. But so was the question…

Q: It is said that over nine million children in the US lack health care coverage. Do you feel that children are at the center of the current debate?

Children are at the center of the debate because they are the future sick adults. Preventive care is critical to minimizing disease later on. Two out of every three adult Americans is overweight or obese; one out of every three children is the same. We already know that a massive burden will be placed on our health care system as a result: today's adults face chronic illnesses like diabetes and heart disease in record numbers. If we don't address this issue among our children, we are going to see far more pathology, not less. This is going to cost more, not to mention reduce the quality of life for many Americans as they age in the face of obesity. This is just one little example. Now factor in dental disease, infections (like sexually transmitted diseases), addiction, traumatic injury (from riding bikes without helmets or driving in a car without a proper restraint system), and the multitude of other topics that pediatricians and family practitioners cram into preventive health care visits. The future financial savings as a result of good preventive care is inestimable.