H1N1 (Swine Flu) and Health Care Reform
A Widespread Crisis Could Crush America’s Medical System
Aug 27, 2009
In Hurricane Katrina’s aftermath, healthcare pundits decried the lack of access to quality medical care for the region’s poor. These individuals - most of whom were not mobile due to illness or lack of transportation - were stranded in a situation where they were not only medically underserved; many were bereft of any medical care whatsoever. (Franco C, et al. Systemic collapse: medical care in the aftermath of hurricane Katrina. Biosecurity and Bioterrorism. 2006;4[2]:135-46)
A similar situation may be brewing just over the horizon, but on a frighteningly more expansive scale: America’s healthcare system - having disenfranchised a large number of U.S. citizens (46 million uninsured and 25 million underinsured, according to Sara Collins, economist and assistant vice president with The Commonwealth Fund) - may be fulminating conditions that will make a serious epidemic or pandemic utterly unmanageable.
Can Health Care Reform Prevent Another Collapse Like Katrina?
In an atmosphere of contention, American politicians and healthcare experts are tackling the job of reforming a well-entrenched (some would say self-serving) system of medical care delivery.
This reform must include universal access to necessary medical care, widespread availability of health information technology (including the ability to freely share medical records among healthcare providers), a stronger focus on preventive care (as opposed to acute intervention), and a revamping of payment structures.
Without such changes, a universal medical crisis such as a pandemic will be met with fragmented, inefficient, and marginalizing approaches that will thwart any containment efforts.
Early detection of a novel disease mandates that those people who fall ill have ready access to health care. Survival of infected persons - and the continued wellness of society as a whole - depends on prompt diagnosis, appropriate quarantine and treatment, and coordinated sharing of information among medical providers.
People who are poor, who have underlying medical conditions, or who are otherwise vulnerable (i.e., uninsured) suffer disproportionately in emergency situations. (Keim M, Giannone P. Disaster preparedness. In: Cittone GR, ed. Disaster Medicine. St. Louis: Mosby, 2006:164-73)
The recent outbreak of H1N1 in Mexico caused higher mortality there than in other countries, partly because many infected persons delayed seeking care due to its cost. (Lacey M, Malkin E. First flu death provides clues to Mexico toll. New York Times. April 30, 2000)
In the United States, lack of health insurance - or less-than-optimal insurance coverage - is often cited as the reason for people delaying medical treatment. Without meaningful healthcare reform that provides universal coverage and improves record-sharing technologies, the populace is left vulnerable to epidemic or pandemic strains that can gain an insurmountable foothold if care is delayed in a relatively small number of individuals.
Some countries with publicly-funded health plans have established systems whereby medical information is readily and quickly shared by medical providers. Reports of new disease outbreaks, effectiveness of treatment modalities and adverse effects, levels of mortality, and characteristics of affected patients are rapidly available to public health experts and individual practitioners.
The lack of a similar health information technology, not to mention the large number of people who aren’t even a part of the database, makes it generally impossible to take advantage of such information in the United States.
Are We Destined to Repeat the Lessons of Pandemics Past?
For a few brief weeks in the spring of 2009, the phrase “swine flu” sparked a touch of fear in the hearts of people around the globe. Afterward, as everyone who hadn’t been touched by the pandemic resumed their routines, complacency returned.
Six months later, warnings from the Centers for Disease Control, the World Health Organization, and a multitude of local health departments regarding a potentially catastrophic resurgence of H1N1 haven’t nudged people from their apathy. Even a large number of health care workers have admitted that they will eschew vaccination should it be offered to them. (Maria Cheng. Half of health workers reject swine flu shot. Associated Press. August 25, 2009)
Unfortunately, H1N1 is mirroring the influenza virus of 1918 in disturbing ways; although its virulence to date has been less than originally feared, it is noteworthy that the Spanish flu wasn’t a particularly nasty bug during its first summer on the planet, either.
If, as some experts predict, the novel H1N1 virus returns in force this winter, a poorly-organized or discriminatory healthcare system - indeed, the system Americans currently enjoy - will fail to address the needs of infected masses of people until the wave of contagion has swept beyond any reasonable hope of control.
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