47 Million Uninsured: A National-Security Risk

[For a punchier, shorter version of this post, click here.][For comment on Van Jones, click here.]

About three years ago, I wrote a post analyzing the risk of Al Qaeda or another terrorist group releasing a plague in an act of bio-terrorism. That risk, I concluded, is small.

My reasoning was simple. Getting ahold of an existing plague (like smallpox) or engineering a new, highly communicable one would be only the first step. In order to avoid committing collective suicide by releasing it, a terrorist organization would also have to create a vaccine or cure and distribute it among a sympathetic population. In the race to do so, anyone operating in a failed state (such as Afghanistan or Somalia) would be almost certain to lose to advanced nations, which have far superior medical-research and health-care infrastructures.

There is a remote possibility that a terrorist group might create a vaccine or cure in secret. But making sure one is reliable requires large-scale testing, which our or our allies’ intelligence agencies would almost certainly notice. Applying a vaccine or cure to a large population would be even more visible. A group that relied on small-scale secret testing and limited application would be playing medical Russian roulette. So I concluded then—and still do—that nuclear terrorism is by far the more serious risk posed by Al Qaeda and other terrorists.

Yet my reasoning three years ago didn’t take into account a gaping hole in our public-health system. That’s our 47 million uninsured. That hole makes us much more vulnerable to a plague or pandemic—whether or not deliberately engineered—than any nation with a universal health-care system. Here’s why.

The spread of a new communicable disease among a population is all a matter of timing. Three variables are critical: (1) the latency or “incubation” period before symptoms appear; (2) the amount of time (before recovery or death) that infected patients remain contagious; and (3) the number of infective contacts that each contagious patient has per day. The shorter the latency period, the longer the contagion period, and the more contacts, the faster the plague spreads.

Modern air travel increases the risk of a plague’s uncontrollable spread exponentially. If you want to see how, take a look at this video of daily global air traffic. The brightest portions are those inside the U.S. and those connecting the U.S. with other countries. That means that air travel poses a greater risk of communicating a new plague to us—and spreading it around inside our borders once here—than any other nation faces.

Because of that fact, we ought to be better prepared to fight a plague than any other advanced nation. But our huge pool of uninsured makes us more vulnerable.

In a pandemic, public-health workers try to identify and isolate sick people (and their likely infected contacts) as quickly as possible, so they can’t infect others. Because the uninsured have to pay for doctors out of their own pockets (and because most of them are poor), they are less likely to see a doctor until they are really sick. Many remain abroad, infecting others, until they are near death’s door. (Some are also illegal immigrants, who hide for other reasons.) That means their effective period of contagion is far longer than for insured patients.

The uninsured may wait for days of weeks (if still ambulatory) before they even seek diagnosis or treatment. Depending on the virulence of the new disease, they may be contagious during most or all of that time. Unawares, they may pass the disease to a far larger cohort of contacts than do insured people, who often go to doctors or hospitals as soon as they feel sick, where they can be isolated and treated and their contacts traced.

Uninsured people also (on the average) have a higher number of potentially infectious contacts. Most of them work in low-paid jobs in restaurants, schools, day-care centers, cafeterias, hotels, and hospitals. There they have a high number of potentially infectious contacts, including infecting objects and surfaces that others touch. The uninsured don’t generally work in isolated corner offices. Nor do most of them work alone as artists, writers or scientists.

So let’s do some numbers. Our uninsured population of 47 million is nearly one-sixth of our total population of 307 million. Ten contacts per day (on the average) is an unrealistically low number for them, but let’s use it just to be conservative. Assuming those contacts are distinct, we can estimate that (on the average) an uninsured person could infect another five people twice a day.

The statistics are actually more complicated. But at the simplest level, they suggest following: our one-in-six uninsured, if uniformly infected and uniformly distributed geographically, might infect the rest of the population (the other five-sixths of us) in less than a single day. All it would take is a contagion period of a day or two, possibly coinciding with the latency period. (Some pathogens can make people infectious even before they experience symptoms serious enough for them to see a doctor.)

Of course, the same reasoning applies to the failed and failing states where Al Qaeda and other terrorist organizations thrive. Not only do most people in those states lack health insurance; they often have far fewer doctors per capita than any developed nation. So if these terrorist groups are rational, they won’t create a plague that they can’t control or survive.

There is always a risk that terrorists won’t be rational. There was, after all, that Cuban firebrand who wanted the Soviets to fire their already-assembled nuclear missiles at us during the Cuban Missile Crisis. Fortunately for human civilization, the Soviets had both the keys to the missiles and cooler heads.

So the real risk is not plague bio-terrorism, but the next “natural” pandemic. The gaping hole that our 47 million uninsured punch in our public-health system makes us more vulnerable to one than any other advanced nation. And the next pandemic might not be so gentle as the swine flu now appears to be.

So I won’t go so far as to accuse Rush Limbaugh and Sarah Palin of aiding terrorists by doing all they can to keep those 47 million people uninsured (although I’m sure they would so accuse me or any other progressive if the shoe were on the other foot). But I will say this: if I were a terrorist bent on infecting us with a new artificial plague, I would smile every time I thought of that large number of uninsured. And I would be sure to find out where they live and release my plague among them.

And if I were a public-health officer charged with preparing us for swine flu or a later (and perhaps more virulent) pandemic, the uninsured would be what keeps me awake at night. How do you control the spread of a local epidemic—let alone a pandemic—in an age of massive, global air travel when one out of six people has no access (let alone immediate access) to health care?

The uninsured are the Achilles Heel of our public-health system and a huge national-security risk. In any serious pandemic, they could do us in despite our vaunted level of care for those who can afford it and our advanced medical research. Neither of these things will help us against a fast-spreading plague, but getting the uninsured into the system surely would.

Van Jones

True to type, the Republicans are spewing titillating trivia to lure our minds from the life-or-death issue of health care. Their latest kerfluffle concerns a man named Van Jones.

To Republican demagogues, Jones is a twofer. He’s been the recent subject of a personal vendetta by Glenn Beck, the right-wing mouthpiece. Not only that, his skin is a bit darker in color than the President’s or the Attorney General’s, so you can tell just by looking that he’s African-American, and not 100% white with a good tan. Fomenting hate against him, with plenty of pictures, helps gin up the racist Republican base.

To paraphrase Will Rogers, not all Republicans are racists, but all racists are certainly Republicans—especially today. To keep their votes, the Grand Old Party seems bent on riding the tired horse of racism down the gutter and into the sewer, until the last ragged zombie following its banner has expired, still clutching the Confederate flag. How low can the party of Lincoln stoop?

The kerfluffle does have ostensible reasons. Apparently Jones used a cuss word to refer to Republicans, and someone got it on tape. Second, he signed a petition years ago—before he ever got into national politics— implying that Dubya planned 9/11 so he could attack Iraq. (Jones says he didn’t read the petition carefully and neither now believes nor ever believed that.) Can we say “big deal”?

I had never heard of Van Jones before today. He’s apparently a Yale Law grad serving as a green-jobs advocate in the White House. But already I love the guy for two reasons.

First, he got his start in national politics in 2007 by giving Nancy Pelosi a good idea in four words: “clean-energy jobs bill.” His brevity and audacity apparently impressed her. To my knowledge she’s never had an idea in her life, let alone a good one, so I tip my hat to Jones for giving her one.

Second, Jones used a website to put pressure on Glenn Beck’s sponsors after Beck called the President a racist. That was one hell of a good idea. Apparently it hit home: Beck used his microphone to demagogue Jones for a whole week in return.

But I would go further. Jones’ site asks readers to pressure Beck’s sponsors to quit. It would take more work, but I would organize a direct boycott of those sponsors’ goods. If defaming the President directly hurt sponsors’ bottom lines, it would stop.

Boycotts are something that gets my juices flowing. Our country has always had folks like Rush, Glenn and Sarah. (Ask your parents or grandparents about Father Coughlin.) But people tired of their hatred and venom, and their popularity petered out. In those days there were only a limited number of radio stations, and eventually they found better things to air.

Today we’ve got 500 channels and counting. Some of them run on low budgets, and there are always buyers for brightly packaged lies. So I worry sometimes that these jokers might go on forever, poisoning our national debate and distracting us from real issues, until we join the ranks of the third world for real.

Fortunately, the people who supply the microphones are in it for the money. If only 15%-25% percent of us buy the lies, and the other 75%-85% of us (who tend to be wealthier anyway) boycott their sponsors’ products, you do the math. Rush’s and Glenn’s broadcast careers would stop short. (Sarah is a freelancer.) They’d be selling used cars in a down market as they ought.

I might set up a boycott website myself, showing who the sponsors are on a daily basis, once I retire and have more time. So I was pleased as punch to see that Jones had had a similar idea and actually had made a start on it.

In a TV editorial last night, Bill Moyers made an impassioned plea for a fighter in the White House for health care. It was a great bit of writing; it brought tears to my eyes. But while my heart loved it, my head tells me the last thing we need at the top levels of our government is more fighting.

I continue to believe, as I have since 2007, that the President’s style and personality are just right for our times. When those of us my age hear the words “moral majority,” we think of the values of today’s lunatic fringe. But there is a new moral majority today, with a very different morality. That’s why Barack Obama is in the White House. When we hear people say he favors “death panels” or is a Nazi, we want to spit on the people who said it. (Actually, we want to do something that would change one letter in that verb.)

But unlike Rush, Glenn and Sarah, who are busy aiming roundhouse blows at the President’s feet, the President himself is a far more clever and effective boxer. His cool demeanor keeps reminding us and the rest of the nation what the fight’s all about.

We do need fighters in the Administration, but they don’t have to be the President. Rahm Emmanel is a renowned pit bull, who fights (and swears) behinds the scenes. Apparently Jones does, too.

More power to them. There’s a whole lot of people out here who love ya’, Van Jones. Keep that boycott site running, and beef it up! It’s got them worried, as it should.

UPDATE (9/6/09): JONES RESIGNS

Near midnight last night, Van Jones resigned his White House position.

I understand the reasons for the decision, which undoubtedly was ultimately the President’s. The issues on the table are too important to give demagogues more fodder for distraction. They include Jones’ own portfolio of clean energy.

I have always supported the ethos of “No Drama Obama” as the best way to make progress without making waves. Once I even criticized the campaign for not running a tight ship. Now Obama does. Discipline is how Obama won the Presidency, and discipline will be crucial in overcoming determined opposition that uses every lie and trick to win.

Yet Jones’ resignation makes me terribly sad. He may have a checkered history, including former associations with Marxist groups. But if we eliminate anyone who ever slipped up on his taxes or fought nobly for a misguided or quixotic cause, we will end up with a government of intellectual eunuchs.

I hope that won’t happen. Yet I fear that Jones’ resignation is another step in that direction, after Tom Daschle’s withdrawal from consideration as health-care czar last year.

The Washington Post describes Jones as a “towering figure in the environmental movement.” Maybe he is, and maybe that movement will remain his cause. But I see another possible future for him. I see him turning his website, which scared the living daylights out of Glenn Beck, into a powerful instrument to discipline the demagogues and small minds from small states who busy are forfeiting our nation’s legacy and poisoning our future.

The website needs some work. Its graphics look like an example of socialist realism from the last century. But its basic idea is sound. The vast majority of us (in both numbers and economic productivity) ought to be able to use our collective economic power to bring the demagogues and obstructionists to heel.

That idea is long overdue. It may be the only way we can remedy the dysfunctional structure of our Senate that our Great Compromise and the Senate’s seniority system have left us. Jones came up with the idea independently and actually started to put it to work. That’s a cause worth a young person’s passion, and I hope that he and others take it up.

Footnote: You can read the cuss word here. If you can find any progressive or liberal who has never used it to refer to Republicans, let me know.


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