Was it only three months ago that former Bush Whisperer Karl Rove was attacking the “monstrosity” of House stimulus bill H.R. 1 for including $870 million for pandemic flu preparations?
In his Feb. 5 Wall Street Journal column, Rove called questionable not only money for flu threats, but $462 million for the Centers for Disease Control (CDC), $2 billion for the National Institutes of Health, and $4 billion for health programs targeting smoking cessation and obesity.
Rove is a firm believer in “trickle-down” economics, of course. As such, he found the Democratic spending plan all wrong. After all, just how is money for public health going to stimulate the economy?
Obviously, a healthy population tends to make everything work better, including the economy. But leave aside Rove's pretense that he actually cares about creating jobs for ordinary Americans. The real trouble with his conservative "free-market" politics is the dim view it offers of the very idea of government leadership in anything other than ensuring global military supremacy or tax breaks for the wealthy. (Or, we might add, ensuring a politico such as himself a lucrative career).
Indeed, in the archaic world of Republican politics, apparently even public health has to justify itself in some profit equation. Anything less is just “nanny state” socialism, which to the conservative mind-set ranks up there with evolutionary science as one of those just really wrong concepts.
Unfortunately, the Democratic majority in Congress chose to offer a sop to unhappy Republicans by stripping funds for flu preparedness from the February stimulus package. (A later spending bill funded $156 million for flu pandemics.) Now the Obama administration has had to ask Congress to newly allocate $1.5 billion to combat the new H1N1 swine flu threat.
But whether or not the current flu threat turns into a genuine pandemic, it is at best a cautionary tale. “From SARS to avian flu to the current escalating outbreaks of swine influenza,” warns California Nurses Association leader Deborah Burger, RN, “it has become increasingly clear that we are risking a major catastrophe unless we act to restore the safety net, and devote the resources that are needed to protect the public.”
Indeed, there are reasons for concern. A recent AFL-CIO survey found more than a third of health care facilities have no written pandemic emergency plan in place. The survey also found a third of the respondents believe their workplace either is “not ready” or only “slightly ready” to address the safety needs of medical workers during a pandemic. Consequently, 43 percent of those polled thought a significant number of their co-workers in the medical field would not come to work during a pandemic.
There's no lost irony in that finding. Because it's those actually infected with the virus, not healthy medical workers, that should stay home from work or school. Yet almost 50 percent of private sector workers have no paid sick days, Think Progress reports (April 27). Incredibly, 86 percent of food service workers in the United States have no sick pay. Of course, even those with sick pay often face considerable workplace pressures not to call in sick.
There's more irony in state governments cutting public health budgets, as they have done in recent years even as politicians of both parties tout “homeland security” as a priority. In Georgia, the state's preparedness director told the Atlanta Journal-Constitution report he did not believe the public health system could handle a major pandemic lasting two to three months (May 10). In the current recession economy, at least 40 percent of state health departments also expect to lose staff through layoffs or attrition this year, according to a Reuters report (May 2).
The current swine flu threat highlights not only the deleterious impact of market economy values, but also of poverty and for-profit medicine on society's ability to ensure quality health care for all. And that includes across borders. In Mexico, where poverty is rampant and the death rate from swine flu far exceeds the United States, a course of antiviral medicine costs between $50 and $100. This is an unaffordable price to many Mexicans. Unfortunately, even the low-cost government clinics cannot overcome the reality that medical care in Mexico is often a last resort for the poor. “Delaying medical care is a characteristic of poverty,” observes Paul J. Gertler, a professor of economics at the School of Public Health at the University of California at Berkeley. "For people living close to the edge, taking off a day to visit a doctor or staying home sick is literally taking food out of their mouths” (Washington Post, May 5).
Notably, significant historic advances in public health tend to occur less from some medical “miracle” than from broad social measures to improve the public's quality of life. In a recent BMJ survey (formerly British Medical Journal), 11,000 readers cited improved sanitation as the single greatest medical advance since 1840. Sanitation was defined as access to clean water and effective sewage disposal. In turn, such sanitation improvements were made possible by greater understanding of the germ theory of disease, which along with antibiotics, anesthesia, contraceptives, tissue culture and other achievements rank among many notable scientific medical advances. Tellingly, the germ theory was met with widespread ridicule when first proposed by 19th century Hungarian physician Ignaz Semmelweis. For his simple proposal that physicians wash their hands before surgery, Semmelweis was long harassed by the medical experts of the day. But eventually the truth won out.
And what will our future bring? Will the day come when the list of great medical advances is expanded to include the wisdom that health care is something too sacred to be sullied by the dark brush of the profit motive?
Hopefully so. But it will take relentless activism such as that shown by the courageous physicians who this past week disrupted the Senate Finance Committee hearings on health care “reform.” The Finance Committee was just fine in 2009 with excluding backers of non-profit, single-payer health care from the hearings. But in the long run perhaps their efforts on behalf of the insurance lobby to marginalize the single-payer solution will be as successful as the now forgotten critics of Semmelweis once were in silencing a maverick doctor’s new ideas about how disease spreads.
Now, as a subtype of influenza virus A floats through the air, menacing our world with its specter of suffering and illness, we ought to remind ourselves that full membership in the human community should not limited by the ability to make a co-payment.
In other words, health care belongs to everyone. Health care is a human right.