Homeland Security Watch

News and analysis of critical issues in homeland security

October 2, 2013

Obamacare and Resilience

Filed under: General Homeland Security — by Arnold Bogis on October 2, 2013

Obviously, the federal government shutdown is garnering a lot of media attention.  Running a close second is Obamacare – both as the point of contention in Congressional deliberations and the opening of the health care insurance exchanges that occurred yesterday.

What has been largely, if not completely, ignored is the impact on the resilience that comes with the implementation of this new health care law. You can agree or disagree with the policy levers utilized by the Affordable Care Act (ACA – though both sides of the debate resort to using the term “Obamacare”), regardless it aims to achieve the goal of providing millions with affordable medical insurance.   This is not only good for individuals’ health and economic outcomes, but it improves our overall resilience.

Kevin Horahan, an analyst with the Department of Health and Human Services Office of the Assistant Secretary of Preparedness and Response (ASPR), described this outcome in an ASPR blog post:

People who are healthy before a disaster strikes are more likely to remain healthy during and after a disaster, and they are less likely to need the kinds of care that you can only get in an emergency room. When people are healthier to begin with, they are most likely going to be more resilient during a disaster situation.

Community resilience – the sustained ability of a community to withstand and recover from adversity – is improved when its members are better able to withstand and recover from adversity. Health is a key part of community resilience. By increasing access to coverage and affordable care for millions of people, we also help our communities become more resilient.

Having actual insurance is a very positive end unto itself.  However, what could potentially be even better is an increased awareness of one’s (or loved one’s or friends or neighbors) potential medical vulnerabilities and the ability to possibly address them without professional assistance in an emergency.  I touched on this concept in an earlier paper:

In order to begin the process of developing community medical resiliency it must first be recognized that it is a specific subset of this concept. It is about having the knowledge to not be a demand on the health care system. The medical care of citizens has been the exclusive domain of the health care community with no expectation by the general public that they can provide for themselves after an incident. This limited perspective has led to the unreasonable expectation that during large scale medical events citizens must seek medical care via their traditional avenues such as Emergency Medical Services (EMS) and emergency departments. There has been little or no effort to provide the citizens with the basic education, expertise, or knowledge which could sustain themselves, their families and neighbors for even a short period of time during an emerging crisis.

Reducing the demand side of the equation will require a shift beyond the conventional concepts of community preparedness. Individuals will need to be educated to develop personal responsibility for their own healthcare and those within their family.

The very debate on the merits of health insurance likely increases resiliency.  Purchasing needed insurance from an exchange definitely does.  And learning about what impact, if any, that Obamacare will have on an individual’s life should be viewed as another potential lever by officials concerned about this issue at all levels of government.
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Comment by William R. Cumming

October 2, 2013 @ 4:16 am

Excellent post! Obviously to me but obviously not to others is that public health and safety has to more than merely regulation but also bottom up resilience for all citizens and residents of the USA and all sectors of the economy impacting public health and safety.

It is increasing clear that information is often denied the public when private interests will benefit from the exploitation of the commons in ways detrimental to resilience. Disclosure will help be one corrective. Examples! Insurance can help to promote resilience but not if it provides expensive and unnecessary coverage or worse encourages moral hazards such as construction in hazardous areas.

Please notice that little in Obamacare is about resilience and more about financing of health care without effective regulation of costs.

And the shutdown is being manipulated by both parties.

Comment by Arnold Bogis

October 2, 2013 @ 8:10 pm

Thanks Bill. I just wanted to say that regardless if resilience was on the mind of anyone involved in the creation of Obamacare’s, it can add to resilience by increasing the number of people with insurance and by having folks think about their personal health situation.

I would wager that a lot of laws, activities, and initiatives whose creators never once thought of the word “resilience” nonetheless increases it.

Comment by William R. Cumming

October 2, 2013 @ 10:08 pm

Agree Arnold. And many creators of laws, activities, and initiatives do not realize by doing so they undermine resilience.

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