The 40 million Americans without health insurance are 40 million chinks in our nation's biological armor; 40 million opportunities for anthrax, smallpox or some yet unknown form of biological warfare to breech our defenses and put the security of the United States at risk. How can we hold the line and secure the American people from biological attack? Universal health care, that's how. Arguing the national security merits of universal health care is both good policy and good politics. But advocates must, in particular, make the biowarfare case for universal health care if they want it to be an effective electoral issue in 2004 -- and if they want to someday see an America in which every person has normal access to basic care.
There are two ways to deal with a biological attack: prevent the initial release of the biological weapon or detect the attack and minimize its effects. As we saw during the post-September 11 anthrax attacks, even when on high alert it is next to impossible for our national-security apparatus to prevent the initial release of certain biological weapons.
The Bush administration's plan to vaccinate millions of Americans against smallpox -- beginning with hundreds of thousands of military personnel and hospital and emergency workers -- suggests that it knows how little we can do to prevent certain weapons from being released. Though the smallpox vaccine Dryvax has been approved by the Food and Drug Administration and was the same vaccine given to millions of Americans until 1972, it can have serious side effects. According to the Centers for Disease Control and Prevention, for every 1 million people vaccinated, we can reasonably expect dozens of cases of life-threatening reactions such as brain swelling, as well as one or two deaths. Given these risks, it would have made little sense for the Bush administration to support a vaccination program unless it lacked confidence in our national ability to prevent an initial smallpox attack.
Because it is so difficult to prevent the release of biowarfare agents -- we still don't know who perpetrated those mail-borne anthrax attacks -- it makes perfect sense that our national strategy should focus on detecting an attack and stopping it from spreading. A smallpox vaccination plan is one part of that approach. To the extent that vaccines prevent more illness than they cause, they are sound public health policy both in peacetime and in war. Other plans have focused on improving detection and response, which would help public health officials and medical and emergency workers diagnose biological attacks and identify suspicious patterns of illness more quickly. The CDC is developing a health-alert network to educate doctors and nurses and to link medical workers nationally via the Internet. The Center for Civilian Biodefense Studies at Johns Hopkins University has even proposed the creation of an advanced Physicians' Biodefense Network that would use the Internet and satellite-connected handheld devices to create a real-time alert system that would be operational at all times.
Vaccination and networked alert systems are both worthy pillars of a national biodefense strategy -- but without universal health care, they rest on a shaky foundation. In a general sense, a strong, healthy population will always be less vulnerable and more resilient in the face of disease. But more specifically, people without normal access to health care are much less likely to have access to preemptive vaccinations against biowarfare diseases. That is especially true when it comes to smallpox, where health-care providers must closely monitor patients during the days and weeks after vaccination because of the serious potential side effects. People without normal access to health care also are less likely to get accurate, credible information about diseases from the medical professionals we are training to respond to biological attacks -- information that could be critical to a calm and coordinated national response. But most important, people without normal access to health care do not have doctors or nurses who know their medical histories, who can check out the "flu-like symptoms" that could be the early stages of a biowarfare infection; they are therefore far more likely to spread highly contagious diseases such as smallpox completely undetected. Even the most robust physicians' biodefense network depends on people having normal access to those physicians in the first place.
Universal health care ought to be the foundation of our national biodefense strategy, but the very Democrats who have championed universal health care in the past and who are carrying the banner forward into 2004 are failing to make that case. Democratic presidential hopeful Howard Dean -- the former governor of Vermont and a physician himself -- has been a longtime advocate of universal health care, and while in office actually won such coverage for 98 percent of Vermont's children. Sen. John Kerry (D-Mass.) has publicly argued for universal health care in recent weeks, and there were indications that Al Gore might have made it a signature campaign issue. But the mantra of these and other advocates continues to be the predictable social-justice rationale: They cite the United States as the only industrialized nation that fails to guarantee basic health care for all its citizens. Certainly there are those among us who find it morally unacceptable that the wealthiest nation on earth, the nation that has been a beacon of freedom and hope to so many, is also home to people with nowhere to turn when they fall ill. But in most cases, people who think that way already vote Democratic. Those kinds of arguments only go so far when trying to win over the independents and swing voters whose support will be necessary both for electoral victory and for any major overhaul of the health-care system.
Republicans will spend the next two years trying to convince those voters that the GOP is the party better prepared to defend the American people from foreign attack. So when a major policy transformation such as universal health care -- which Democrats have advocated for years on other grounds -- happens to coincide with our national-security needs, Democrats ought to open their eyes and make that case. Otherwise, in the aftermath of the 2002 Republican electoral victory, it will be too easy for conservatives to paint Democratic calls for universal health care as a tactical leftward shift designed to refocus party loyalists -- or as Democrats embracing their true bleeding-heart selves.
Democrats who go the extra step and call for a single-payer health-care system will be especially vulnerable to such attacks. When Gore told an audience at a New York City synagogue that he has "reluctantly come to the conclusion that we should begin drafting a single-payer national health-insurance plan," many on the right panned him as a born-again radical. As Jonathan Cohn argued in a Nov. 22 piece for The New Republic Online, there are solid policy arguments for this kind of plan, including more freedom to choose one's doctor (because every doctor would accept the single national insurer) and lower health-care costs (through a significantly expanded risk pool). But despite these advantages, a survey conducted by National Public Radio, the Kaiser Family Foundation and Harvard University's John F. Kennedy School of Government suggests an uphill battle for Democrats. The 2002 National Survey on Health Care found that Americans "are not eager to make sweeping changes" to the current health-care system, and that only 40 percent support the idea of a national single-payer system. However, this could very well change if Americans saw universal health care both in traditional terms and as the foundation of their defense against biological attack.
With universal health care, we have a chance to create a system that will improve the health of all Americans while at the same time making our country more secure from forces that would do us harm. That is the case that Dean, Kerry and other Democrats must make if they want the issue to gain traction against Republicans in 2004, and if they want universal health care to become an American reality. Until then, we just have to hope that none of the 40 million Americans without health insurance gets sick. After all, those flu-like symptoms could be a run-of-the-mill cold -- or something much worse for us all.
David L. Englin is a military officer stationed in Washington, D.C. His views are his own and in no way reflect the position of the U.S. Department of Defense.
