Homeland Security Watch

News and analysis of critical issues in homeland security

August 13, 2009

A Healthy Homeland

Filed under: General Homeland Security — by Christopher Bellavita on August 13, 2009

There is something intuitively appealing to me about possible parallels between a healthy homeland and a secure homeland.

Homeland security is about terrorism, disasters, national security and a few other things. Could it also be about health care?

The national attention is  focused on health care. From an “all imaginable hazards” perspective, one might make the case that health care is a homeland security issue. I think there is a case, but its pulse is weak.

Public health is the most obvious connection to homeland security. Presumably a significant fraction of the country’s 50 million uninsured will delay seeking professional care if they develop flu-like symptoms this autumn. In a naïve theory about how things happen, this delay in seeking treatment could speed the spread of a Round Two H1N1 event.

But the little I know about pandemics suggests insurance status will not be a huge part of a prevention strategy. By the time symptoms show up in anyone — insured or not — the virus has already been shared.

If H1N1 or a related biological event gets really bad this fall, that might shine a wide light on the inadequacy of the country’s medical surge capacity. We already know there are nowhere near enough ventilators, for example, to take care of the hundreds of thousands of people who might need to be hospitalized. Where else is our medical care system vulnerable?

Public health and hospital capacity are  important concerns. But it would be a stretch to tie them to the current health care debate.

Is there a compelling economic argument that can link homeland security and health care?

Approximately 20 cents of every dollar spent in this country goes to health care — actually, medical care; but any productive discussion about the difference between the two concepts has been drowned out by the squealing over euthanasia gulags.

If health care spending were contained, reduced, or directed more efficiently and effectively (pick your argument) that might free up funds for other concerns more directly related to preparedness, resilience, or rebuilding our infrastructure (pick your argument).

Perhaps.

Congressman Peter DeFazio represents the district I live in. He held a town hall meeting on Wednesday to talk about health care and to find out what his constituents have to say.  DeFazio is also a member of the House Committee on Homeland Security. I asked him (on a local radio talk show Wednesday morning) if there was a link between security and health. He tried to make a connection, but it didn’t sound like his heart was in it.

He was about to head off into the uncertainty of an August 2009  town hall meeting.  My sense was he was primed more for death camp, socialism, and Obama-wasn’t-born-in-this-country questions, rather than noise from left field (ok, right field).

I went to his 9:30 AM town hall meeting.  I was expecting to see a few youtube moments.

When I arrived, there were more than 400 people waiting to get into a room that held 250 people. They were waiting to talk about health care.  The room was too small, so someone decided to move the meeting into a parking lot.

400 people. And this is in a town where three people in front of you at Safeway is a crowd, and something to talk about at night.

My initial thought when I saw all the people was “What would we have to do to get 400 people to show up to talk about the Quadrennial Homeland Security Review or about anything that has to do with homeland security?”

I couldn’t think of anything.

DeFazio answered questions for an hour. He agreed with some people and disagreed with others about a full plate of the usual issues: tort reform, payment systems, abortion, immigrants, quality of care, choice, costs, insurance companies, Medicare.  Even euthanasia and socialism had the opportunity to rear their vacuous skulls.

No one brought up homeland security.

Facts, rumors, and more than a few sad personal stories and fears about medical issues filled the sometimes raucous parking lot. A few people yelled and interrupted questions and answers with talking point slogans. But only a very few.

(In a caricature of media distortion, at least one local television station featured a video that focused mostly on the screechers.)

There were a half dozen police officers standing in the wings. But the crowd policed itself, occasionally lifting signs that asked for discussion instead of disruption.

At the end of the hour, DeFazio said his goodbyes and moved on to the next town hall. Most of the 400 people left to resume their day. But a lot of people hung out in the parking lot talking about health care.

I doubt anyone’s mind was changed by this shchi of Q & A and street theater.  I went away still unable to make a convincing connection between homeland security and the current health care conversation.

Or so I concluded as I walked back to my car.

During the rests of the day I thought about people in Iran who had been arrested and tortured for daring to do what the people in my town unreflectively consider their inalienable right. Someone made those signs that asked for Discussion and not Disruption, or warned about the Evils of Obamacare, or demanded a Single Payer System. In many countries, getting caught with a political sign can shift your life forever.

One thing our present fixation on health care demonstrates is that in many parts of the country representative democracy is pulsatingly alive.  In spite of youtube and other media tumescence, people can come together in a public place, talk with — occasionally yell at — elected officials, agree or disagree about issues they care about. But they care.

I wish we could see that kind of passion in homeland security.

But maybe I did.

Perhaps that’s what I saw today.

defazio-town-hall

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6 Comments »

Comment by William R. Cumming

August 13, 2009 @ 10:35 am

A useful summary of one town-hall meeting. Certainly a slice of Americana or was it HUMANA? Anyhow thanks for the post.

Now to try and answer your question? How does health care relate to HOMELAND Security?

First an extract from your post:

Public health and hospital capacity are important concerns. But it would be a stretch to tie them to the current health care debate.

Chris! Respectfully I disagree. What I find most interesting about the healthcare debate is that even for the active armed forces, retirees, and other veterans the medical support is largely contracted out and very expensive. We are locked in the notion that Health Care is something that the market can provide for in an efficient and effective manner. Except of course that most humans when faced with a health crisis will do whatever it takes to get well. Let’s talk MEDICARE a moment which is being used by both sides in the health care debate for their own purposes. Post WWII the rising costs of hospital and physician care was in the process of bankrupting middle class Americans who could not cover the costs of their parents generation who might have had Social Security (those born before its creation received transition payments that were obviously not insurance because they had never contributed to the system during their working years because it did not exist.)These aging parents of the WWII generation had no medical coverage or insurance for the most part. Okay so the passage of Medicare in 1966 was as much a financial issue supporting the middleclass as a medical program. Also it allowed at the time a very profitable industry to develop. When working the NIXON era Wage-Price-Rent freeze as enforcement liaison to the various boards and Cost of Living Council on the staff of Ed Preston, Assistant Commissioner of IRS for Stabilization I accompanied in late 1971 some audit types to HEW to gain better undertanding of Medicare financing arrangements. When the IRS folks asked about the HEW (now HHS)audit trails and guides for the Medicare program the HEW types said “Waht are audit trails?” Okay so the first statutory Inspector General was at HEW for which establishment I had some but miniscule responsibility. MEDICARE fraud still huge.

But where did these crazy notions of things like Public Health Care and Social Security come from? Well the real history is Bismarck Germany (even before unification) where it was quickly understood that troops fought harder and longer if they knew when mobilized that their families had some kind of survivor benefits. In other words it was part of the German War Machine!

Faced with that kind of knowledge note that Social Workers, not the military and not the fiancier/rentier class led the NEW DEAL it was understood that our democracy (republic)had to provide certainty for its elderly and sick just to compete with what was being offered by the autocracies of Europe. So in reality these basics had to do more with military mobilization and societal expectations that developments in medicine or pensions.
So here is the linkage. No public health and no public health preparedness no national security or national defense. And so you don’t think this is just Bill Cumming shooting from the hip. This is still the national policy. What is my proof? Two specific examples.

First the nation’s blood supply. During Desert Storm and Desert Shield I had almost 500 phone calls from DOD types and other federal agencies. By the way a fellow named Richard Marilley wrote EXECUTIVE ORDER 12742 not to be confused with the EO establishing the NCS EO 12472! The former EO was written to deal with the fact that Congress had allowed the Defense Production Act to lapse. Anyhow, there are a series of DMO still published in Title 44 of the CFR. What are DMO’s? They are Defense Mobilization Orders and cover a variety of subjects. All issued pursuant to authority under the DPA or other authority. Check out for example, DMO 325 concerning Health Care Professionals. There used to also be one for the nation’s blood supply but it was revoked by FEMA based on the written promise of HHS after Executive Order 12919 was written and published delegating the health arena to HHS that they would publish a replacement. Why this example? First the nation’s blood supply is not in great shape as those who follow ARC (American Red Cross) issues can tell you. The problem was the expectation of major casulaties in Desert Storm. Luckily or may not just luckt the casualties were minimal. However a standby arrangement was worked out to give priorty for the nation’s blood supply to the Armed Forces. This proved not necessary but might have well happened. The point is that this type of allocation and priority may well need to be done. The best two examples I give of President’s weighing in on priorities and allocation stem from the Truman Administration. At the start of the Korean War, the Naval put out contracts for light trucks that could have been met at the time by American industry. Of course if the Navy contracts had been honored, the ARMY and Air Force would have recieved no light trucks nor would the “essential civilian economy” a term undefined but mandated to be protected in the DPA. An historical artifact, Albert Speer who led the German Wartime Economy from 1942 on had to get HITLER to demobilize some armed forces in order that critical defense production could occur. Hey even now DOD always assumes they can procure anything from the private sector? Sometimes even money not enough!

So blood supply is one clear example where Homeland Security, Homeland Defense and the Armed Forces all are claimants on the nation’s resources.

This is why I support President Obama’s merger of the NSC/HSC staff even though the National Security community in general does not have a clue as to the sensitivities of our federal system.
Apologize for the length of this blog but to summarize a phrase once heard Jacques Gansler say (and quoting from memory so may be totally off base)–“In reality there is not a Defense Economy and a Civilian Economy–there is only one economy and one industrial base.” Failure to articulate the connections does not mean they don’t exist. And I assume that this quick but lengthy comment probably suffers from failure to make that linkage but does not mean that others cannot do better.

Comment by Mark Chubb

August 13, 2009 @ 10:58 am

Chris, I had no idea you were based so close to where I am (just up the road in Portland). I too have been given pause over the extent to which the public has engaged the health care reform debate.

Despite being an immensely complex and often esoteric topic it has stimulated considerable discussion, much of it focused on important aspects of the problem and indeed some very plausible solutions. Nevertheless, I fear the fires of passion stirred up by this issued are still generating more heat than light.

As such, I wonder whether similarly vigorous discussion of homeland security policy would serve us all that well. (Haven’t we seen some of that already with the debate over civil liberties stimulated by the Patriot Act and revelations of torture and extraordinary rendition?)

As a nation, we certainly need to do some critical thinking about the intersection between homeland security and other policy concerns, including national defense and civil liberties, but this discussion has more to do with the alignment of interests within government and across its various administrative levels and bureaucratic domains than it does with mobilizing other interested or affected parties.

The reflective yet productive approach advocated by people like Stephen Flynn are unlikely to stimulate much passion. While that’s probably a good thing, I take your point that the lack of an identifiable much less vocal constituency advocating such a position is unlikely to emerge. But that certainly doesn’t mean it won’t receive thorough and thoughtful consideration by policy makers.

Give me a call next time you are heading to Portland. I welcome a chance to meet and chat with you over coffee or lunch.

Comment by J.

August 13, 2009 @ 1:05 pm

In the immortal words of Rodney Dangerfield (Back to School): “Good teacher. He really seems to care. About what I have no idea.”

About the last thing I would conclude from the “town halls” is that people are passionate about health care. Their passions lie elsewhere – hate for the administration, fear of losing entitlements, fear of Big Government.” I don’t think they are passionate about having good health care as much as more personal issues.

As for homeland security, not much to do there. I think people expect the government to provide security, so as long as there isn’t another 9/11 or Amerithrax, they aren’t “passionate” about what government’s doing. Same with defense, really. There are those of us “passionate” about defense issues, and then there’s those who either shill for the industry or use it as a political goad. The rest of America dispassionally watches hundreds of billions of dollars go… somewhere… and kids shipped off to war (as long it isn’t their kids).

I’m in a cynical mood today.

Comment by Christopher Bellavita

August 13, 2009 @ 7:35 pm

William — I respectfully disagree that we are disagreeing. I agree with you that there is a link between homeland security and public health. In the current national conversation I don’t hear much talk about the state of our public health system. Mostly about medical care. Since I obviously did not make that clear in my original post, the fault is in my writing.

Mark — I do not perceive many people were ever involved in a public discussion of civil liberties, the patriot act, torture, etc. There were the occasional demonstrations and lots of ink and bytes, but this health care debate feels different to me (maybe it’s just the lack of sun in the northwest). I have a friend who says, “if you can’t read my mind, this conversation is over.” What I meant, but obviously did not make clear, was a hope for a similar kind of passion in the “home” or community part of homeland security. I agree about the role policymakers can and ought to be playing in homeland security. One definition of homeland security refers to community resilience — not just for disasters, but for the other elements of community that can get lost in a “Bowling Alone” culture. I look forward to having coffee with you.

J — I welcome your cynical mood. I believe cynics have extraordinarily high standards. So, to paraphrase the famous Carl Spackler, “you got that goin’ for you, which is nice.” I experienced an energy in that crowd yesterday that was more about “other” than about “self.” There was more than a little “self” orientation, but there was also a sense of community that in my less cynical moments I hope could emerge in something both creative and helpful. So I got that goin’ for me, which is also nice.

Thanks to all three of you for taking the time to write.

Comment by William R. Cumming

August 15, 2009 @ 9:45 am

A statisic I have heard several times but never actually been able to document is that there was a 65% mortality rate in the health professions from the 1918 Flu Pandemic and numbers were not fully restored until about 1940! Hoping that important statistic if true can be documented and serve to remind US of impact of incidents/events on responder population.

Comment by William R. Cumming

August 19, 2009 @ 11:30 am

P.S. Just heard or saw in writing that the DUTCH government has decided NO vaccinations for H1N1 because of its lack of virulence. Time will tell on that decision.

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