Should we greatly expand the federal government's role in regulating and providing health care for all Americans? As his fading poll numbers show, President Obama is having trouble getting us to yes on that question. He seems to be backpedaling from the so-called public option by the minute. And now he's facing a potential foe even more powerful and unpredictable than Congress: swine flu.
It's not lost on the White House that how they handle the largest inoculation program in our history could affect the public's (and Congress's) verdict on whether to entrust new health-care powers to government.
Simply put, if the Feds do their research and administrative work well—and if they are seen as having done so—it will strengthen their case. If they fail—if they are seen as either overreacting or underpreparing, stories about hysteria or confusion could kill "reform," assuming it's still alive come late fall.
"Here is a chance to show government at its best, doing what only government can do well," said a top health-care official, who declined to speak on the record because the person didn't have official permission to do so. "Unless we screw it up."
Deep in the folk memory of this generation of federal and local public-health administrators and epidemiologists is the story of the swine-flu scare of 1976. Forty-six million Americans were vaccinated in anticipation of a pandemic that did not materialize, and for which there was precious little evidence. But dozens died from the vaccine. Critics accused President Gerald Ford of hyping the crisis to help his reelection chances. He lost, and history’s verdict has been just as harsh.
This is a different situation: the chances of pandemic are very real here, and it has already been called a "public health emergency" by the Department of Health and Human Services. Even though the severity of swine-flu cases, at least so far, has been no greater than run-of-the-mill seasonal flu, more than 300 have died in the U.S.
But the prospect of the largest national vaccination program in the history of the world is raising hopes but also stirring fears. The hope is to heroically avert a true global pandemic—not to mention the scary prospect of the swine flu somehow converging with seasonal flu either directly or in sequence.
At the same time there are fears of: mandatory vaccinations (untrue); federally ordered school closings (also untrue), and widespread community disruptions that could result if federal officials decide that the flu outbreak is severe enough to suggest the wisdom of "preemptive school dismissals" (quite possible).
Conservatives already are apoplectic over what they regard as the overreaching statism of the Obama administration. Wait till they whip themselves up into frenzy over mass vaccinations.
Independents, who tend to worry about government spending and the national debt, are going to focus on the potential cost, which could add up to $9 billion, by some estimates, if the entire American population is immunized at once.
And even Obama's core supporters are going to be watching closely. In the lives of African-American, Hispanic, and working class Americans, multiday school closings are especially disruptive. On the other hand, a new Marist poll shows that blacks and Latinos are the most likely to be worried about swine flu affecting their families and especially their children.
But everybody in the country is going to be upset if the swine-flu outbreak turns out to be deadly and faster spreading than anticipated—and if the tens of millions of needed doses of vaccine are not available.
Political division could emerge elsewhere if the vaccine is scarce and officials follow through with plans to control distribution in early stages—with health-care workers and pregnant mothers first on the list, and the elderly (who apparently have additional built-in immunity) last on the lists. Talk about rationing….
Leaders of and experts of an alphabet soup of federal agencies—the CDC, D of Ed, HHS, FDA (and even DHS) will be all over the airwaves in coming weeks. Their demeanor and decisions will serve, however coincidentally, as a test case for government-run health programs beyond Medicare itself.
And President Obama isn't shying away from his role as doctor in chief. He's already repeatedly recommended that everyone be immunized. And next week he is scheduled to speak directly to the nation's school children. He might well suggest to them some simple ways to avoid contracting or spreading flu.
It could be a real-life blend of Grey's Anatomy and Mister Rogers' Neighborhood. We won't know until later whether it is also a lesson on "how a bill becomes a law."