Markkula Center of Applied Ethics

Is smallpox the real threat?

By Margaret R. McLean

While the US. Centers for Disease Control speeds up plans to vaccinate hospital workers against terrorist-introduced smallpox, a more insidious catastrophe threatens the health of all Americans. Post 9/11, we focus on protecting ourselves against a biological assault, but our crumbling health care infrastructure is a more immediate danger.

The prestigious National Academy of Sciences recently warned of a health care "crisis" as the system is increasingly unable to meet current, let alone future, needs. Health care costs are rising at close to 10 percent per year. Prescription prices are soaring. Insurance premiums are going up even as benefits are curtailed.

In contrast to the government-provided health care in other developed countries, we have chosen a market-driven health care system. Such a system has its advantages, such as innovation and efficiency. But, we don't seem to be getting what we pay for through our taxes and insurance premiums. Medicare, Medicaid, and private insurance do not adequately cover physician and hospital costs.

In 2001, 1.4 million Americans lost their health insurance as they lost their jobs or were priced out of the market or both. Today, 41 million Americans do not have health insurance-6.6 million of these are Californians. Surprisingly, 30 million uninsured Americans live in families where at least one adult works.

Those who lack consistent and coherent health care coverage typically forego medical treatment until expensive emergency services are needed-last week's deep cut is today's rampant bacterial infection; foregone stitches become IV drips.

While it is obvious that the number of uninsured people climbs as unemployment increases and prices rise, it is also true that the number of uninsured grew during the boom years of the mid-1990s when 43 million Americans-and 8 million Californians-did not have health insurance. If we could not provide access to health care in the halcyon days, what are we to do now?

The steady growth of the number of uninsured over the past decade has caught Sacramento's attention, where two bills on health insurance are in front of the state legislature. One proposal slips every Californian into a "single payer" system from cradle to grave. Another is a "pay or play" plan that requires businesses either to provide health insurance or to pay a tax that covers the uninsured. These are not easy fixes-big answers carry big price tags.

It helps to recognize that we all have a stake in health care, that it is part of what ethicists call the common good. Health care for Californians-like education-cannot be accomplished by individuals acting on their own. It is a social good, which can be provided only by working together for our mutual wellbeing. We are all responsible for creating the conditions in which people can be and stay healthy.

Even in the current bust, we should stoke the fires of moral courage and provide health care coverage to all those who need it. The National Academy strongly suggested that Washington use a few states as laboratories to study the effects of making health insurance available to everyone. California ought to volunteer.

Odds are we will remain fixated on terrorism and war. But if we do, we increase the odds that we will fall victim to inadequate treatment for such common ailments as heart attack and stroke well before we are threatened with smallpox.

True homeland security requires more than a plan to respond to biological attack. It requires serious, nonpartisan action to reverse a deadly drift toward denial of routine medical care for millions of Americans.

Margaret R. McLean is the director of biotechnology and health care ethics at the Markkula Center for Applied Ethics.

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