Lack of Health Care For All Creates U.S. Security Risk

From President Bush on down, our leaders are finally getting serious about the risks of bioterrorism. But in all of their proposals -- for early detection, for stockpiling vaccines, for upgrading hospitals -- they continue to ignore one of the weakest links in our homeland defense: the armies of Americans without health insurance.

Health experts say the early detection of illness is one of the best ways to counteract bioterrorism. But how can we do that when nearly 40 million Americans lack access to basic health insurance?

Many of the low-income workers least likely to have health insurance are among the most likely to be on the front lines in this new age of bioterrorism. Consider biological weapons delivered by mail. Fortunately, Postal Service employees, government staffers and police officers all participate in public health plans. But what about the private security guards, mailroom clerks and receptionists who handle private companies' mail? These clerical and support workers are among those least likely to have employer-provided health benefits. Many of these uninsured workers, unable to pay for costly appointments and tests, might forgo early diagnosis or treatment. That could delay the discovery that they -- and others around them -- are victims of biological warfare.

The danger would be even greater if the biological agent were contagious after infection. The unwitting accomplices of bioterrorists could then be poorly paid restaurant employees, maids, nannies, janitors, barbers and others who, because they lack insurance, may avoid visiting either private doctors or emergency rooms until it is too late.

How, not Whether

Thanks to the anthrax attacks, the debate about whether every American should have health insurance should be over. The only question now should be how to provide universal coverage.

The nature of America's new war on terrorism suggests two guiding principles: Universal insurance should be citizen-based, not employer-based. And a single-payer funding method should be avoided because it would be too expensive during this period of military buildup and economic weakness.

Immediately after Sept. 11, well before any signs of anthrax surfaced, political leaders from Bush to Sen. Edward Kennedy, D-Mass., called for emergency provisions to extend the health-care coverage of those who had lost their jobs as a result of the attacks. In times of national crises, they reasoned, the problem of losing one's job should not be compounded by the simultaneous loss of health insurance. This stopgap measure begs a deeper question: Why continue an employer-based system in the first place?

Job Jumping

Tying health-care benefits to employers made some sense at the height of the Second Industrial Revolution, when most workers aspired to lifetime jobs with one firm. But now that the average job tenure in America is only 3 to 5 years, it no longer does. Replacing this antiquated link between employers and health insurance with a new citizen-based system could make basic health benefits universal and fully portable, both from job to job and during periods of unemployment.

Repeated failures to enact a single-payer system in this country suggest that we should look at another way to pay for universal, citizen-based health care. A better approach: require all Americans to buy their own health insurance, just as most states require drivers to purchase their own auto insurance. The government would subsidize those too poor or sick to pay for coverage. This is essentially what Switzerland does today.

Our health-care system was created by accident during World War II. Because wages were frozen then, employers attracted workers with benefits such as health insurance. As a result, employer-based insurance became the foundation of the U.S. health-care system. The sad result today of that accident of history is 40 million Americans without access to basic care. In this new era of bioterrorism, that is not only a personal disaster for those struggling to stay well without health insurance, it's also a threat to the security of all Americans.