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After Katrina: Will lessons be learned and progress made?
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27' Number 10, 2005
Editorial After Katrina: Will Lessons Be Learned and Progress Made? Last October's issue of Clinical Therapeutics included an editorial titled, "Health and Health Care in the United States: An Insufficiently Important Policy Issue? ''1 in which I expressed my disappointment that the tragic events of the previous 3 years had overshadowed pressing domestic health care policy issues. As was anticipated, health care policy did not play a significant role in the outcome of the 2004 presidential election. Now, a year later, in addition to the ongoing conflicts in Afghanistan and Iraq, other catastrophic and heartbreaking events continue to divert attention and resources from the fundamental flaws in health care financing and delivery in the United States. As a result, my concern that critically important health care policy issues are being ignored, intentionally or not, has intensified. If it takes a national crisis to induce fundamental rethinking and reform of the status quo, then we have experienced that crisis. It remains to be seen whether or not anything changes, but Hurricane Katrina and its aftermath should serve as a wake-up call for the United States in a number of ways. Not only was the sorry state of our nation's disaster preparedness and emergency management capabilities vividly exposed, but the cost of ignoring growing levels of poverty2,3 and the gaping holes in the country's health care system4,s came more clearly into focus. Until the human suffering and horror associated with this type of natural and man-made disaster 6 were broadcast into our living rooms, it was easy to forget about the plight of the most vulnerable of our fellow citizens. The editors of The Boston Globe recently wrote, "The people whom Katrina exposed to a shocked nation had no jobs, no decent housing, no healthcare, and no useful educations before everything was washed away. They cannot be left with no hope. ''7 The devastation and disruption caused by Hurricane Katrina and the subsequent flooding were amplified for people with serious medical conditions. Those whose medications were washed away or depleted due to the lack of additional supplies are among those suffering potentially serious consequences. 8 A surge in deaths is anticipated among the poorest evacuees, due to heart disease, strokes, and other ailments, as a result of inadequate or unaffordable medication supplies) There is no doubt that the hurricane caused a great deal of additional physical and emotional trauma, but the health of many of those affected was already seriously impaired; for them, the health care system was already broken. A survey of randomly selected adult Katrina evacuees in Houston-area shelters during the second week of September found that -50% of them had no health insurance. 1° In addition, with a health care system so heavily reliant on employment-based health insurance, the news that an estimated 363,000 jobs were lost by the end of September as a result of Hurricanes Katrina and Rita was not at all welcome. 11 An Institute of Medicine report, The Future of Public Health, states that the mission of public health is "the fulfillment of society's interest in assuring the conditions in which people can be healthy. ''12 Based on this goal, it is obvious that our nation's public health system had already failed many of the people most directly affected by the hurricanes, independent of the failures of the medical care system. I am increasingly concerned that our collective disbelief and outrage over what we saw (or experienced firsthand) as a result of Katrina are dissipating rapidly, and the prospect for forging a commitment to substantive change may be slipping away. Although numerous individuals and groups have been criticized for exploiting Katrina for short-term political and/or ideological gain, 13 we ought to see this tragic event as a chance to begin the process of fundamental reform. As asserted by New York Times columnist Nicholas D. Kristof, "In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees--a national health care system that looks less like a tightrope and more like a safety net. ''14 However, in the immediate future, the nation's budgetary realities may produce very different results, is Instead of developing strategically planned and deliberative health care reform, there may be hastily initiated and ideologically motivated budget cuts that would further erode the safety net. We need health and health care to be public policy priorities in this country. Health is a public good. It should not be seen as a liberal-versus-conservative issue; it should be considered an issue of utmost importance for peo-
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pie in both "blue states" and "red states." We must use the clear and convincing evidence provided by Katrina as the impetus to move in a direction that will benefit all of our nation's citizens, especially the most vulnerable among us--they are the ones who suffer most. Their disproportionate burden is a direct result of the continued lack of political courage and action to bring about meaningful and equitable health care change. Stephen Joel Coons, PhD Contributing Editor REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9.
10. 11. 12. 13. 14. 15.
Coons SJ. Health and health care in the United States: An insufficiently important policy issue? Clin Ther. 2004;26:1686-1687. Airman D. The disaster behind the disaster: Poverty. New York Times. September 18, 2005:§3:5. KristofND. The larger shame. New York Times. September 6, 2005:A27. ApplebyJ. Even the insured can buckle under health care costs. Available at: http://usatoday.com/money/industries/health/ 2005-08-30-heatth-care-crunch-survey_x.htm. Accessed October 6, 2005. Krugman P. One nation, uninsured. NewYork Times.June 13, 2005:A17. Ripley A. How did this happen? Time. September 4, 2005:52-59. On the backs of the poor. Available at: h~p://www.boston.com/news/globe/editorialopinion/editorials/articles/2005/10/06/ on the backs of the_poor/. Accessed October 6, 2005. Kristof ND. A health care disaster. New York Times. September 25, 2005:§4:11. Kerber R. Diabetics put at risk amid hurricane exodus: Shortage of drugs, supplies reveals holes in government disaster plans for patients. Available at: http://www.boston.com/business/articles/2OO5/lO/OS/diabetics_put at risk amid_hurricane_exodus/. Accessed October 5, 2005. Morin R, Rein L. Some of the uprooted won't go home again. WaskingtonPost. September 16, 2005:A1. Crutsinger M. Hurricane-related job losses increase to 363,000. Available at: http://www.usatoday.com/money/economy/ employment/2005-10-06-jobless_x.htm. Accessed October 6, 2005. Institute of Medicine. The Future o[Public Health. Washington, DC: National Academy Press; 1988. Exploiting Katrina. Available at: http://nytimes.com/2005/10/03/opinion/03mon2.htm]. Accessed October 3, 2005. KristofND. Medicine's sticker shock. New York Times. October 2, 2005:§4:13. Klein R. GOP seeks cuts to ease cost of cleanup: Plan targets Medicaid, other social programs. Available at: http://www. boston.com/news/nation/washington/arficles/2OO5/lO/O1/gop_seeks_cuts to ease_cost of cleanup/. Accessed October 7, 2005.
doi:l 0.1016/j.clinthera.2005.10.015
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=: :: Clinlcal:Therap~utlcs/Volume
27' Number 10, 2005
Editorial After Katrina: Will Lessons Be Learned and Progress Made? Last October's issue of Clinical Therapeutics included an editorial titled, "Health and Health Care in the United States: An Insufficiently Important Policy Issue? ''1 in which I expressed my disappointment that the tragic events of the previous 3 years had overshadowed pressing domestic health care policy issues. As was anticipated, health care policy did not play a significant role in the outcome of the 2004 presidential election. Now, a year later, in addition to the ongoing conflicts in Afghanistan and Iraq, other catastrophic and heartbreaking events continue to divert attention and resources from the fundamental flaws in health care financing and delivery in the United States. As a result, my concern that critically important health care policy issues are being ignored, intentionally or not, has intensified. If it takes a national crisis to induce fundamental rethinking and reform of the status quo, then we have experienced that crisis. It remains to be seen whether or not anything changes, but Hurricane Katrina and its aftermath should serve as a wake-up call for the United States in a number of ways. Not only was the sorry state of our nation's disaster preparedness and emergency management capabilities vividly exposed, but the cost of ignoring growing levels of poverty2,3 and the gaping holes in the country's health care system4,s came more clearly into focus. Until the human suffering and horror associated with this type of natural and man-made disaster 6 were broadcast into our living rooms, it was easy to forget about the plight of the most vulnerable of our fellow citizens. The editors of The Boston Globe recently wrote, "The people whom Katrina exposed to a shocked nation had no jobs, no decent housing, no healthcare, and no useful educations before everything was washed away. They cannot be left with no hope. ''7 The devastation and disruption caused by Hurricane Katrina and the subsequent flooding were amplified for people with serious medical conditions. Those whose medications were washed away or depleted due to the lack of additional supplies are among those suffering potentially serious consequences. 8 A surge in deaths is anticipated among the poorest evacuees, due to heart disease, strokes, and other ailments, as a result of inadequate or unaffordable medication supplies) There is no doubt that the hurricane caused a great deal of additional physical and emotional trauma, but the health of many of those affected was already seriously impaired; for them, the health care system was already broken. A survey of randomly selected adult Katrina evacuees in Houston-area shelters during the second week of September found that -50% of them had no health insurance. 1° In addition, with a health care system so heavily reliant on employment-based health insurance, the news that an estimated 363,000 jobs were lost by the end of September as a result of Hurricanes Katrina and Rita was not at all welcome. 11 An Institute of Medicine report, The Future of Public Health, states that the mission of public health is "the fulfillment of society's interest in assuring the conditions in which people can be healthy. ''12 Based on this goal, it is obvious that our nation's public health system had already failed many of the people most directly affected by the hurricanes, independent of the failures of the medical care system. I am increasingly concerned that our collective disbelief and outrage over what we saw (or experienced firsthand) as a result of Katrina are dissipating rapidly, and the prospect for forging a commitment to substantive change may be slipping away. Although numerous individuals and groups have been criticized for exploiting Katrina for short-term political and/or ideological gain, 13 we ought to see this tragic event as a chance to begin the process of fundamental reform. As asserted by New York Times columnist Nicholas D. Kristof, "In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees--a national health care system that looks less like a tightrope and more like a safety net. ''14 However, in the immediate future, the nation's budgetary realities may produce very different results, is Instead of developing strategically planned and deliberative health care reform, there may be hastily initiated and ideologically motivated budget cuts that would further erode the safety net. We need health and health care to be public policy priorities in this country. Health is a public good. It should not be seen as a liberal-versus-conservative issue; it should be considered an issue of utmost importance for peo-
162o: :: :i
::::::::::
::
:
i::::::
::
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Editorial
pie in both "blue states" and "red states." We must use the clear and convincing evidence provided by Katrina as the impetus to move in a direction that will benefit all of our nation's citizens, especially the most vulnerable among us--they are the ones who suffer most. Their disproportionate burden is a direct result of the continued lack of political courage and action to bring about meaningful and equitable health care change. Stephen Joel Coons, PhD Contributing Editor REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9.
10. 11. 12. 13. 14. 15.
Coons SJ. Health and health care in the United States: An insufficiently important policy issue? Clin Ther. 2004;26:1686-1687. Airman D. The disaster behind the disaster: Poverty. New York Times. September 18, 2005:§3:5. KristofND. The larger shame. New York Times. September 6, 2005:A27. ApplebyJ. Even the insured can buckle under health care costs. Available at: http://usatoday.com/money/industries/health/ 2005-08-30-heatth-care-crunch-survey_x.htm. Accessed October 6, 2005. Krugman P. One nation, uninsured. NewYork Times.June 13, 2005:A17. Ripley A. How did this happen? Time. September 4, 2005:52-59. On the backs of the poor. Available at: h~p://www.boston.com/news/globe/editorialopinion/editorials/articles/2005/10/06/ on the backs of the_poor/. Accessed October 6, 2005. Kristof ND. A health care disaster. New York Times. September 25, 2005:§4:11. Kerber R. Diabetics put at risk amid hurricane exodus: Shortage of drugs, supplies reveals holes in government disaster plans for patients. Available at: http://www.boston.com/business/articles/2OO5/lO/OS/diabetics_put at risk amid_hurricane_exodus/. Accessed October 5, 2005. Morin R, Rein L. Some of the uprooted won't go home again. WaskingtonPost. September 16, 2005:A1. Crutsinger M. Hurricane-related job losses increase to 363,000. Available at: http://www.usatoday.com/money/economy/ employment/2005-10-06-jobless_x.htm. Accessed October 6, 2005. Institute of Medicine. The Future o[Public Health. Washington, DC: National Academy Press; 1988. Exploiting Katrina. Available at: http://nytimes.com/2005/10/03/opinion/03mon2.htm]. Accessed October 3, 2005. KristofND. Medicine's sticker shock. New York Times. October 2, 2005:§4:13. Klein R. GOP seeks cuts to ease cost of cleanup: Plan targets Medicaid, other social programs. Available at: http://www. boston.com/news/nation/washington/arficles/2OO5/lO/O1/gop_seeks_cuts to ease_cost of cleanup/. Accessed October 7, 2005.
doi:l 0.1016/j.clinthera.2005.10.015
1621