Our country remains under siege eighteen years since White House Chief of Staff Andrew Card uttered the words, “America is under attack,” into the ear of George W. Bush at an elementary school in Florida. Only the enemy has both diversified and proliferated. America is under attack by both natural and man-made causes. But a small Health and Human Services program may be what stands between these increasing attacks and the safety of America’s citizens.
Hurricane Dorian, August 2019
Since 1996, the number of national disasters declared by the President of the United States has increased 4-fold. National disaster declarations, a disaster that is beyond the scope of local or state capabilities, have increased from an annual average of 30 from 1960 through 1996 to over 120 annually over the last 20 years. Major hurricanes, storms classified as category 3, 4 or 5 storms, have risen 3 percent annually on a trended basis since 1970. Between 2 and 3 million Americans were affected by flooding each year, from 2000 through 2015, compared to less than one million impacted annually in the 1990’s, according to the Emergency Events Database (EM-DAT).
Future national disasters will be less deterred due to the reduction in emergency preparedness funding over the past few years. Decreased preparedness funding is a symptom of our nation’s complacency as the terror of 9/11 and brave calls to “Never Forget” fades from our collective memories. Similarly, funding to improve hurricane response has ebbed as the horror of Katrina is relegated to history. We are facing a world in which natural disasters are rising and preparedness funding is falling. This threatens us all, particularly as man-made crises rise dramatically.
We are facing a world in which natural disasters are rising and preparedness funding is falling.
We have seen the number of annual mass casualty incidents (MCIs) skyrocket 170 percent since the Columbine shooting introduced America to mass shootings 20 years ago. Even more troubling, the number of victims claimed annually by MCIs has increased 270 percent since Columbine, according to a Mother Jones database on US Mass Shootings from 1982-2019. We can expect MCI’s to increase or, at least, continue unabated in the near term as leaders in politics and popular culture continue to lead us further down the path of political polarization, which has a near perfect correlation with MCIs.
In the near term, we must respond to growing national crises by first growing our response capabilities. Right now, the responsibility for responding to national crises falls first to our first responders, including those medical professionals in ambulances, hospitals and acute care facilities that bear the ongoing burden of nursing our injured citizens back to health. Too often we look to our hospitals to absorb the costs of treating those impacted by natural or man-made disaster without the requisite funding support from federal, state and local governments.
The general public often assumes hospitals are profiting from rising healthcare costs. To the contrary, hospitals continue to operate on very slim margins. According to SEC filings, the average profitability, measured as Net Income Margin, or Net Income divided by Net Revenue, of our nation’s two largest for-profit hospitals over the last three years is 5.7%, nearly 1/5 the profitability of our nation’s largest pharmaceutical company, which generated an average Net Income Margin of 25% over the last three years. Furthermore, hospitals must care for anyone who enters their emergency room, regardless of whether that person has health insurance or is uninsured. In the latter case, hospitals deliver the same care often without any ability to recover the cost.
Natural and man-made disasters are on the forward march while decreasing preparedness funding provides a strong tailwind. As we head into this increasingly chaotic, more complex future, do we really want to underfund preparedness while forcing our hospitals to bear the increasing burden of response? What happens when America’s hospitals can no longer afford to bear the primary burden of caring for those injured in our nation’s next catastrophic national disaster?
Increasing funding for the Department of Health and Human Services’ (HHS) Hospital Preparedness Program (HPP) is our best hope to ensure our hospital infrastructure is prepared to continue supporting our response to national disasters.
We must unite to ensure our federal government supports the ability of America’s hospital infrastructure to respond to rising national disasters. Increasing funding for the Department of Health and Human Services’ (HHS) Hospital Preparedness Program (HPP) is our best hope to ensure our hospital infrastructure is prepared to continue supporting our response to national disasters. The HPP is the only source of funding for health care systems to prepare for and respond to medical emergencies. The program enables hospitals and health care networks with different ownership to band together and share resources when a disaster overwhelms a single hospital or health care network. This collaboration among health care systems is critical when events like the Las Vegas Route 91, Dayton or El Paso mass shootings overwhelm a single hospital. According to the U.S. Department of Health and Human Services, over 80% of our nation’s hospitals and health departments participate in the program and 96% of those who participate believe that the program decreases morbidity and mortality during disasters.
Nearly twenty years ago from Ground Zero, President George W. Bush assured a devastated country that we will not falter or fail and that peace and freedom will prevail. The Hospital Preparedness Program provides us the resources to learn from our past tragedies so that we do not falter in our response to the next disaster and thereby ensure peace and freedom will not perish.