Robert A. Guth, writing in The Wall Street Journal, reminds us that the ultimate issue in health is combating the diseases that jeopardize our health. So if, as Guth reports, polio is making a grim comeback, mostly in Africa, then the imperative is to keep polio from making that comeback. Financing of health insurance is secondary to financing of cures.
The Gates Foundation--that's Bill Gates, pictured above--has spent $700 million trying to eradicate polio from Africa, but the disease recently popped up in Tajikistan, and is still present in many countries around the world. For most Americans, fortunately, polio is a distant memory--or no memory at all. Thanks to the efforts of Dr. Jonas Salk and many others, a polio vaccine was introduced in 1955.
But the news from Africa and elsewhere is a grim reminder: The struggle against all the great epidemiological killers of the past is never truly over. As the Journal's Guth records, there's an ongoing policy debate between "vertical" and "horizontal" approaches to health. The "vertical" approach focuses on the disease, while the "horizontal" approach focuses on social conditions, including fighting illiteracy and poverty. It's possible to make a strong argument for both approaches, of course, and the Gates Foundation appears to be embracing both approaches.
But if polio, the virus, returns to America, Americans will quickly be reminded of the wisdom of the polio-fighters of decades past. Salk & Co. didn't fight poverty, they fought polio. And they succeeded against polio. In the scheme of things, their victory was relatively quick and decisive. By contrast, the fight against poverty has been, shall we say, a lot more complicated.
Yet today we can assert that those threatened by polio are more needful of ex ante vaccines, than they are needeful of ex post facto financing of their care--their wheelchairs, their iron lungs.