COVERAGE: The Pandemic Motivator

We write all the time about the economic and moral imperative for covering all Americans. Today, we'd like to address the public-health we're-all-in-it-together pandemic flu imperative for covering all Americans.

We don't yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don't have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that's 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they'll try to ride it out because they can't afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don't have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don't have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven't read yet. Comment, please, if you know—and no, we don't mean specialists are heartless or don't care about patients, we just don't know how well someone who's only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there's the whole sick pay problem. President Obama told us to stay home if we're sick, and think about what to do if our kids' schools close. That's easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don't all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don't have paid sick leave, and nearly 100 million workers don't have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation's immigration policy, having an untreated contagious disease among illegal immigrants isn't good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn't just the morally correct and economically sensible thing to do. It's the self-interested healthy thing to do. So let's do it.