Universal healthcare solves national crisis response

The intersection of public health and national security is often explored within the context of bioterrorism. SARS-CoV-2 disease 2019 (COVID-19) offers an opportunity for us to consider the national security implications of strengthening public health infrastructure and adopting a universal healthcare system. We must remember, a chain is only as strong as its weakest link. Current public health infrastructure failure and a near collapse of our costly, inefficient healthcare system, is no Black Swan. It was entirely predictable as public health professionals have been warning of such a scenario as a result of path dependency. Decisions to defund public health programs, such as the U.S. Agency for International Development (USAID)-funded global program to detect and discover viruses in animal hosts with pandemic potential, and bipartisan failure to create and sustain a federal, single-payer healthcare system that provides comprehensive coverage to everyone absent of costly insurance premiums, high deductibles and gaps in coverage, have led us to be woefully underprepared and lacking the capacity to respond to a significant global public health crisis.

The U.S. spends approximately $3.6 trillion or $11,172 per person each year on healthcare, accounting for roughly 18% of our Gross Domestic Product. The U.S. currently ranks highest in health care spending in the world. Comparatively, only $19 is spent per capita on foundational public health measures and programs, when only $32 per person is needed to meet foundational public health service needs. The U.S. spends more than $2000 per capita on its military budget. In fact, the most recent budget proposal requested more than $700 billion for national security. Both military and healthcare spending has continued to increase while public health spending has continued to decrease with an ill-informed, increasingly rare bipartisan consensus. Healthcare cost has been a known fiscal Armageddon for a while. This amount of spending is unsustainable, risks economic collapse, and puts U.S. national security at risk.

Although the intersection of public health and national security, especially domestically, is seldom examined within the public health community, there is a precedent of certain infectious diseases being declared national security issues. For instance, HIV/AIDS has been declared a national security threat. The U.S. National Intelligence Council has argued that infectious diseases are a threat to U.S. national security, stating infectious diseases will “endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions in which the United States has significant interests.” Public health emergency preparedness (PHEP) has been defined as “the capability of the public health and health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities.” It is clear from the federal response to COVID-19 that PHEP, a critical aspect of protecting our nation’s security, has not been a priority for political decision-makers