As swine flu spreads around the country, it’s only appropriate that the next political donnybrook may concern health care.
Vice President Joseph Biden said a few days ago that for the second 100 days of the administration, “the top of the agenda, the very top, is health care.” Lacing its armor across the field, a group called Conservatives for Patients’ Rights is airing commercials denouncing (and distorting) President Obama’s health care proposals.
Not to be impolite, but Republicans like Karl Rove and Senator Susan Collins (along with some Democrats) lost credibility on this front when they scolded Mr. Obama a few months ago for proposing stimulus spending on something as frivolous as ... preparations for a flu pandemic. (Note to Senator Collins: You might want to remove from your Senate Web site the February article citing your opposition to pandemic preparation.)
The flu crisis should be a wake-up call, a reminder that one of our vulnerabilities to the possible pandemic is our deeply flawed medical system.
“From SARS to avian flu to the current escalating outbreaks of swine influenza, it has become increasingly clear that we are risking a major catastrophe unless we act to restore the safety net,” noted Deborah Burger, the co-president of the California Nurses Association/National Nurses Organizing Committee.
Think of the 47 million Americans who lack insurance. They are less likely to receive flu vaccines (which might or might not help), less likely to receive prompt care when they get sick, and less able financially to stay home from work — and thus they are more likely both to die and to spread the virus inadvertently.
“These are, in effect, 47 million ‘Typhoid Marys’ of the next pandemic — at risk themselves and to their families and neighbors,” said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health.
“This is a most dangerous brew: a dysfunctional health care system, vast numbers of Americans without access to health care, a severe recession, overextended and highly stressed hospitals, and the prospect of a nasty new killer virus,” Dr. Redlener said.
The American health care system is exceptionally good at cutting-edge technologies. The top five American hospitals together conduct more clinical trials than any entire European country.
Yet over all, our health care system has failed us. Troll through World Health Organization data and cringe: Americans live shorter lives than Greeks, our kids are twice as likely to die by age 5 as Portuguese children, and American women are 11 times as likely to die in childbirth as women in Ireland. Over all, we rank well below most European countries in our health statistics (for which you can also blame the Danish in your hand as you read this).
The larger problem is that we over-invest in clinical care like CAT scans and underinvest in public health. There should be a Nobel Prize for Public Health, so that we might get more great minds wrestling with nonmedical pieces of the health puzzle, like industrial hog farms that can serve as breeding grounds for viruses and bacteria, from swine flu to MRSA.
President George W. Bush did an excellent job making preparations specifically for a flu epidemic, partly because of the avian flu scare and partly because he read a book about the 1918 influenza epidemic. But he and other presidents starved the broader public health system, so that today it is in desperate shape.
Hospitals lack spare beds, ventilators and staff to cope with an epidemic. One study found that a flu epidemic would mean that 10 million Americans would need to be hospitalized — compared with a total of nearly one million beds in America, about two-thirds of them occupied. Last year, Representative Henry Waxman ordered a review of “surge capacity” in hospitals available for a terror attack, and found that more than half the emergency rooms studied were already operating above capacity.
We don’t know whether this swine flu will be as lethal even as a typical flu season (the boy who died in Texas last week has already received more attention than all 36,000 Americans who die in a typical year of the flu). So far it has been mild in this country, but we know that the first wave of flu in 1918 caused few deaths but was followed three months later by a different form that killed tens of millions of people around the globe.
We do know we need to take precautions. These include not only washing our hands with soap and water, but also instituting far-reaching health care reform in the coming months.
“If a severe pandemic materializes,” Dr. Redlener said, “all of society could pay a heavy price for decades of failing to create a rational system of health care that works for all of us.”
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