Got your Tamiflu yet? How about a home respirator and a live-in nurse? If expert predictions of a coming flu pandemic prove right, there's little chance you'll be able to find a hospital bed in which to recover.
Here in Washington, for example, after a long series of hospital closures, there are only 4,346 hospital beds left -- a number that will soon go lower with the closing of Walter Reed Army Medical Center's main facilities. Yet projections show that even a moderately severe strain of a pandemic flu virus would require some 5,000 people to be hospitalized in the District alone. Even if we discharged every patient in Washington's hospitals -- including all the mental patients in St. Elizabeths, all the frail elderly in Hadley Memorial's long-term acute care facility and all the veterans in Veterans Affairs Medical Center -- there still would not be enough hospital beds available to care for, or even to quarantine, highly infectious flu patients.
The same is true nationally. Since 1980 the number of hospital beds available per U.S. resident has declined by roughly 40 percent. Today the United States has only about 965,000 staffed hospital beds. Yet Trust for America's Health, a nonprofit group committed to promoting public health, estimates that the emergence of a pandemic flu virus like the one of 1918 would require hospitalization of 2.3 million people in this country.
There are many sound reasons why the number of hospital beds has been declining. New technology allows for much greater use of outpatient facilities. Galloping medical inflation demands more cost-effective care. But the result is a health care system that is perpetually running at or above 100 percent capacity, and that will be overwhelmed by a pandemic, major terrorism attack or natural disaster.
Fortunately, there is a way to help solve this problem and many others that plague our health care system.
Let's start with the example of Walter Reed. Located just 51/2 miles from the White House, 61/2 miles from the Capitol and six miles from the Washington Convention Center, its facilities, including a hospital built in 1972, are an integral component of the District's emergency preparedness plan. In the event of a mass casualty terrorist attack or other public health emergency, the plan calls for Walter Reed to discharge its noncritical patients and begin treating civilian victims within as little as three hours. Walter Reed is particularly well equipped and well situated to treat not only victims of a flu pandemic but also those wounded by a nuclear or biological attack in downtown Washington. But maintaining this capacity is expensive, and right now Congress is poised to accept the recommendation of the Base Realignment and Closure Commission that the main hospital and most other buildings on the 113-acre campus be razed.
It may well be appropriate for the military to reorganize and rationalize the way it delivers care in the Washington area and many other parts of the country, just as it is for the private sector. Across the Northeast and Midwest, for example, many VA hospitals have lost their patient base because so many aging veterans have retired elsewhere. The Department of Veterans Affairs has announced that it is closing hospitals in Pittsburgh and in Brecksville, Ohio, and it is threatening to close facilities in Brooklyn and Manhattan. But rather than abandon these and other "obsolete" hospitals -- including many shuttered public hospitals such as D.C. General -- we should turn at least some of them into facilities that will stand ready to serve the public in the event of disasters and that between disasters will serve the uninsured and those on Medicaid.
Private health care providers are under such enormous pressures to contain costs that they cannot begin to afford to keep wards open that aren't filled nearly every day. This makes it the proper role of government to ensure we have surge capacity that the private sector cannot deliver. Literally every American, including those with gold-plated health insurance plans, stands to benefit from a health care system built to handle such increasing risks as a flu pandemic, another Katrina, a major earthquake or a terrorist attack.
Such a plan would also go a long way toward both rationalizing the U.S. health care system and making it more equitable. Study after study has shown that Veterans Affairs, by making extensive use of electronic medical records, information technology and provider incentives, is providing health care of far higher quality, and at less cost, than that received by most insured Americans, let alone the uninsured. At the same time, hospitals in the District of Columbia spend nearly 7 percent of their revenue on the uninsured, and the total cost to the local health care system is much higher. Meanwhile, nearly a quarter of all patients in Washington hospitals are on Medicaid, and to hear the hospitals tell it, they lose money on every one.
Message to Congress and local decision makers: Why not turn Walter Reed and facilities like it across the country into pilot projects that can point the way toward true reform and improvement of our beleaguered health care system?
The writer is a senior fellow at the New America Foundation.