When it comes to a Bird Flu pandemic, the problem that America faces is not immunizations, though there needs to be a crash program to get one ready and stockpiled. Nor is it whether or not to use the military to run quarantines, though most health experts agree this is a really stupid idea (no surprise there--it was Bush's), because quarantines only really work if the people trust the ones in charge, and having the military fencing people in would only lead to mass efforts to sneak through the line.


The real problem is that the public health system in the U.S. is almost non-existent.


Think about it. There is no system of primary care for the 45 million Americans who have no health insurance. Even those with Medicaid have only the most limited access to primary physicians and end up having to use emergency rooms at hospitals for most of their care because ordinary doctors won’t accept Medicaid.


Given this sorry fact, and the reality that decades of conservative governments--Republican and Democrat--in Washington have gutted funding for health clinics in urban communities, what are poor people going to do when they get the flu? Most will ignore the early symptoms and go on with their lives as best they can.


If they are the working poor, they will continue to go to work, because most lower-paying employers don’t offer sick leave, and people need money for food and rent.


All this means massive exposure of those on the transit system and at work to early stage flu--which is when the disease is most contagious. It also means massive exposure to the rest of us, since many of those low-wage workers work in the service industry, handling our food, our clothes, our mail, etc.


The only solution to this disaster-waiting-to-happen is for the Bush administration and the Congress to immediately start a crash program to re-establish the network of primary care health clinics that were common in medically underserved urban and rural areas in the late 1960s. While they’re at it, they should pass a bill mandating a policy of 5-10 paid sick days for all employers, large and small. Sure, the Chamber of Commerce will howl bloody murder, but everyone, even rank capitalists, needs to realize that if people are afraid, or are unable to afford to stay home when they’re "feeling puny," we’re all at risk.


For that matter, even ignoring the humanitarian and personal threat issues and just using Republican/DLC cost-benefit logic, the cost of an epidemic, in terms of lost economic growth, medical costs, increased taxes, etc., which will reportedly be in the hundreds of billions of dollars, will be at least an order of magnitude and more likely several orders of magnitude greater than the cost of providing primary healthcare for all Americans, and granting everyone sick leave.


For that matter, if Bush really wanted to protect America (and not just have an army of occupation in the U.S. to play Commander-in Chief with), he would shut down the War on Iraq, bring the troops home, and put the military medical corps to work in our cities.


If it's important to rebuild the dikes around New Orleans to prevent the next flood, it sure is important to rebuild these medical "dikes" in our cities to prevent the next viral tsunami that is sure to strike sooner or later.


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