Hurricane Katrina, Global Warming and America's Health System

Seamus Deane's Letter From America: Logistically at least, Hurricane Katrina explains something about the anarchic mess in Iraq. No situation is so bad that George Bush's administration cannot make it worse, either in a spirit of vengeful opportunism or ideological fury, or bland incompetence, or that mixture of the three that Bush himself incarnates.

Maybe this hurricane has not been made worse by global warming. During the past 60 years, there were more storms in the five year period 1945–49 (21) than in any since; but there were as many hurricanes in the ten year period 1995–2005 and the most severe hurricanes have been in the most recent periods. Hurricane Andrew's destruction in South Florida in 1992 and Isabella's in September 2003 caused most destruction and most political uproar. But the Bush administration's dismissive attitude towards the problem of global warming and its heavily-tainted record in Florida and now in Louisiana, Mississippi and Alabama, helps reinforce the conviction that this government and disaster are natural allies.

So maybe it's not global warming; but now more people than ever are beginning to believe that it is, and that Bush's policies are accelerating its effects. One would imagine that African-American voters in the South would make the Republican party pay in the senatorial elections, even though these are still 14 months away. Yet they will hardly do so in proportion to their anger, partly because they are not registered as voters in sufficient numbers and partly because, as the Presidential elections in Florida have shown, they can be disenfranchised even when they do vote. And, as usual, the Democratic Party has failed to mobilise the African-American vote or anything else; it runs scared in the blast of Bush's pinchbeck, televangelist rhetoric of terror, chauvinism, God, democracy, good-and-evil, war. After the farce of Florida in the election of 2000, it would have been reasonable to expect to see some effort to improve matters so that a uniform and coherent system of voting would have been mandated across the whole of the USA.

Yet, despite that, there have been no new election laws. Chief Justice Rehnquist, a stalwart supporter of the restoration of power to the States at the expense of the federal Government, has died, the hearings for his successor are in process, and the crazy quilt pattern remains. It is one of the few issues on which Republicans support diversity; in electoral law, that means a ramshackle system; that in turn means there are more diverse opportunities to reduce the power of the African-American vote and, indeed, the votes of the poor in general. There can be a political profit in a shambles. And a carefully-appointed Supreme Court can be relied upon to rule according to the ideology of states' rights to preserve the shambles and, with that, the interests of this particular federal government.

But the television coverage has been unforgiving. It is not just the damage and ruin of the hurricane; it is the ruin of the Third World that lives within the First World of the USA that has been exposed. Even the cost of Iraq and Afghanistan combined will not repair the infrastructural damage. But can the political damage ever be repaired? For even in ordinary circumstances, how were most of the people we have seen belatedly hauled from the wreckage of New Orleans ever going to pay for their medical costs? Had they any health insurance? There were a lot of chronically sick people in the Superdome. (And the horrors that went on there were reported more in Europe and by CNN than by most American TV channels and newspapers.)

The chaotic electoral system in the USA is a thing of deft beauty compared to the health-care system. Recently I saw some figures that showed Ireland spent about half the US per capita sum on health; no one has recently accused Ireland of having an enviable health system. Yet all other indices show Ireland ahead of the USA; life expectancy, infant mortality rates, childhood immunisation rates. Much of the money in the USA (as in Ireland) is wasted on excessive bureaucracy. But much of it is wasted because, in imitation of Katrina, the USA prefers to have a shambles in some strategic areas, rather than the organisation for which it is so justly famous in others. Forty-five million Americans have no health insurance. Medicaid is yet another system that varies, like voting practices, from state to state and in no state does it even approach the level of care any European country would provide – including Ireland.

To have "social insurance", what the Europeans have, would be ideologically distasteful; it is also historically unavailable because the American trade unions negotiated only for their particular members, not for the populace as a whole. What is more interesting is the Bush administration solution. Convinced that if people have federally-provided health insurance, they will spend their days and the state's treasure in hospital emergency rooms and in doctors' waiting rooms, the administration proposes private health insurance; so you'll only go to the doctor when you are really sick, especially if there is a big deductible on the insurance. This is called 'moral hazard' insurance. It has been amply demonstrated that the uninsured do not go for medical help even when they should, because they can't afford it. As a consequence they get sicker and eventually, the costs of untreated illness exceed those that even the most ingeniously malingering could have accumulated.

President Bush has offered a health Savings Accounts plan, which in essence asks citizens to pay for their own health-care, 'empowering people' in the President's phrase, in exchange for some tax-free remission. What he is doing again is weakening the levee, as health costs accumulate and, worse, untreated illnesses among the poor rise faster than the waters of Lake Pontchartrain. He'll be well gone when the cascading consequences arrive. But then, with luck, certainly with desert, so too will his administration and the network of ignorant, punitive alliances that have supported the Republican party in its career of serial disaster for the USA and for the world over the past five years.