When War Comes Home, Who Deserves Health Care? Who Pays?

By Phyllis Griffin Epps

In the shadow of war, communities are re-evaluating what policies exist for management of emergencies. The current incidence of anthrax has broadened the focus from the possibilities of mass injuries and trauma to include the threat of bioterrorism and its effects on public health. Early assessments on readiness reveal that the distribution and management of health care in this country has evolved into a situation that is far from ideal. The prospect of managing mass injuries or widespread disease – infectious disease in particular – raises interesting questions about how medical care is delivered during peacetime. In the context of widespread infectious disease, questions arise as to what entity absorbs the costs associated with protecting public health within a system that tightly links an entitlement to medical care with income, insurance status, and, as suggested in Texas, immigrant status. See Where Every Man Is An Island: A Comment on Immigrant Health Care.

That the current networks of health care are ill prepared is beyond question or surprise. The National Association of County and City Health Officials recently reported that only 20 percent of group members have a comprehensive plan to handle an attack of bioterrorism. The existence of a plan bears little relationship to protection from financial disaster, as illustrated by the losses sustained by New York hospitals in recent months. From the cancellation of surgeries and services that generate revenue to the emergency expenditures for the construction of decontamination showers, America’s hospitals must prepare for financial upheaval. The American Hospital Association has assessed the cost of enabling its member hospitals, which number 5,000 or 85 percent of the nation’s hospitals, to respond to a bioterrorism attack at $10 billion.

After years of managed care, low reimbursement rates, and other efforts to cut medical costs, hospitals are leaner and meaner. Hospitals have closed beds, reduced staff and inventories. Whether this bodes well for the administration of emergency care to large numbers remains to be seen.

The need for the nation’s health care providers to assume a role in national security only highlights the distance between the resurgent sense of American community and the current philosophy that underlies a person’s access to medical care in America. The question is how to reconcile the philosophy of care rationed according to ability to pay with the realization that the health of a single person, poor or rich, may be directly relevant to the health of an entire community.

The possibility of bioterrorism or other attack remains too terrible to imagine. The very idea is totally and utterly indefensible and offers nothing to be gained by anyone or by any standard. Bioterrorism would be the very worst way to learn the effects on public health of treating medical care and health as commodities to be afforded or earned.

11/28/01