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Location: United States

Wednesday, September 14, 2005

Katrina, Medicare B, and a Healthcare Crisis

It was a perfect storm. Saving its strength for a final assault, it lulled New Orleans into a false sense of relief. Then, with madeningly crystal clear skies above, the survivors of Hurricane Katrina awoke to find the streets flooded. The water rose quickly, drowning the vestiges of hope that clung like Spanish moss to street signs and roof tops and hotel balconies.

Even as the waters were rising, a new flood was beginning. An army of volunteers, from across the truly United States and beyond, came in trains and planes and buses and ships and brought with them food, water, clothing and, most welcomed of all, a way out of Hell. Hundreds of thousands of hard-working, hard-playing, possibly more than slightly foolish people reversed the flood, finding temporary shelter in Houston, and then out to Utah, West Virginia, New York, New Jersey, Pennsylvania, New Mexico, Oklahoma, Arkansas, and possibly every state on the continent.

It was truly a national disaster. It was truly a national rescue effort. It remains a truly national crisis.

It will remain a national crisis for months, even years. As time passes and return becomes even more unlikely for those scattered so far abroad, it may last a generation. As "Okies" fled the devastated Dust Bowl of the Great Plains, so now the Cajuns, Creole, Big Easiers, Nawlinsites - pick a name - will settle in their poverty throughout the country. People who had minimal jobs and survived by supplementing their diets with cheap crawdads and catfish will find themselves ill-suited for the job-market of Des Moines and Phoenix and Santa Fe and Boulder.

Beyond the influx of immediate problems of housing and food, there is a great potential for a lingering epidemic of slow-moving health problems. The water that many of these people waded, swam, and floated through contained raw sewage and toxic chemicals, and was tinged with the hideous sight of dead humans slowly swelling and rotting in the humid Gulf air. After days of exposure, there is no way to wash off what has already found its way into your body through cuts and scrapes and every orifice that isn't water-tight. Now, public health officials hundreds, and in some cases over a thousand, miles away will deal with problems that would otherwise have been contained in a fairly small radius.

The Center for American Progress is right to argue that immediate medical care needs to be among the primary responses of the federal government. Medicaid will provide an initial stop-gap financing of public health facilities. But Medicaid is not the proper tool for the long-term tracking of health problems for this magnitude of problem. For one thing, Medicaid is not truly a federal program, but a joint program between the federal government and the states. Many of the states currently accepting people from New Orleans are already straining to deal with their domestic caseload. The State of Missouri, under Republican Governor Blunt, has practically eliminated Medicaid already. Simply put, the states cannot withstand the financial assault the level of poverty of these people will bring with them.

Medicaid may be a stop-gap for immediate action, perhaps with federal funds or special eligibility standards, but there is a big problem lurking behind the scenes.

My brother recently called some of his friends in Lafayette, La., which is upstream from New Orleans and was spared most of the destructive fury of the storm. His friends had opened their home to three strangers from New Orleans. It's a wonderful, heart-warming story that has been repeated over and over throughout the country. The strangers had a problem, though. In the haste to "forcibly evacuate" this group, not a one of them had time to grab any vital paperwork - not a driver's license, birth certificate, social security card, baptismal certificate, or even a utility bill between them.

How are they going to prove they are from New Orleans to meet any sort of eligibility standards? Their only hope (and this is a cruel twist of fate) is that their fingerprints might have been scanned into the national crime database (assuming that any of them had ever been arrested). Barring that, they are people without faces in an age that demands proof of identity even to cash a paycheck.

I believe I have laid out a program over the last week that would benefit these people, and every state that has taken in the homeless, the suffering, the widowed, the orphaned, and the weak. It couldn't work immediately - Medicaid is free to the recipient and these people will need that for a time to get their roots planted, their homes established, and their hands turned again to work instead of comforting frightened children. But it could work very well for an extended healthcare plan for those who will face a lifetime of health effects from exposure to - well, we honestly don't know what they were exposed to.

New Orleans held something like half a million people before the tragedy. There are easily twice that number of churches in the United States. At the cost of less than $100 per week, these churches could each adopt one person for a year, maybe two. That money would pay for Medicare B coverage for these people to see healthcare professionals where ever they may have been transplanted. It would ensure follow-up coverage so that those who are healthy and able to heal can do so quickly and those who have lingering health problems can be identified early and their case can be tracked for progress.

These are real lives. The suffering is too great to ignore. All it takes is one law to authorize a voluntary program to relieve the burden from debt-crushed states and revive a people that all too often now have eyes that are vacant of hope and brimming with despair.

I wrote days ago that, even though I do not particularly like George W. Bush as a President, I need him to be the visionary leader our times demand. I still do. I was proud to hear him take full responsibility for the failures of the federal response. That's the first step, Mr. President. I still need you to take the next step - and so do the people of New Orleans. Make us strong where we are broken. Leave behind partisanship and ideology and step to the fore with the Compassion you spoke of in 1999. We can save each other. We just need you to provide a means of doing so.

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