The CDC, Obamacare, & Ebola

Watching the news these days, it’s clear that there’s a lot of anxiety about Ebola. Nightly news segments speak of the mysterious virus spreading through western Africa, sounding like a chapter of The Hot Zone or a narrative in The Coming Plague. Newspapers show doctors in biohazard suits, surrounded by victims like a scene out of The Last Ship. Then there are the emails from groups warning readers of the pending pandemic perpetuated not only by international travelers but also the Obama Administration’s actions to contain and treat the situation. The onslaught of dire predictions has lead to plenty of debate about the government’s response.

First off, a quick definition of what Ebola is and what it is not.

Ebola is a virus that is thought to originate from bats, which then adapted and/or mutated to other species (including monkeys) and then become virulent to humans. The worst symptoms include high fever, bleeding, and rapid loss of bodily fluids. Mostly occurring in Africa (Ebola is named for the Ebola confluence of two rivers where it was first found), there have been five different strains and 24 confirmed outbreaks, with death rates typically spanning the spectrum between 25% and 90%.

Ebola is not an airborne sickness. It has never been and likely never will be. It is spread through direct contact with bodily fluids (blood, sweat, feces, etc.). It is also not untreatable. When someone has the symptoms of Ebola, they are isolated and given fluids to keep them hydrated. Doctors also treat specific symptoms, such as fevers. Even with new drugs being rushed into trials, these simple treatments have proven effective in patients that can make it through the worst of the disease’s progression. Ebola has also never been a major health concern outside of Africa; cultural factors – such as a distrust of public health officials and religious practices that encourage contact with those affected – likely contribute to this.

The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), the two organizations arguably best equipped to fight Ebola, have been on the ground in Africa since July. Other international organizations have also sent volunteers, and the U.S. Agency for International Development initially contributed $15 million (and more is likely to come). President Obama has ordered that 3,000 military personnel go to Africa to help treatment, operations, and education to help the 1,000 CDC officials already dispatched; an additional 1,000 troops might be sent later. So far, $175 million has already been spent and some estimate that figure will rise to $750 million in the next four months. The Congressional Research Service put together a good overview of Ebola response at the federal level.

For its part, Congress has introduced measures to help fund the fight against Ebola. The Senate passed Senate Resolution 541, introduced by Senator Chris Coons (D-DE), that called for $175 million to be spent. Congresswoman Karen Bass (D-CA) introduced a similar, though less detailed, resolution in the House. The sentiments were included in the Continuing Appropriations Resolution of 2015 (H.J.Res. 124), which keeps the government in operation until December, also included an $88 million one-year authorization. After negotiations, the figure was revised down to $40 million. Also, Congresswoman Rosa DeLauro (D-CT) included $30 million for combating Ebola in H.R. 5464, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2015 (the bill would need to be amended in light of the Continuing Resolution’s enactment). It is likely that more funds will be required if trends continue and the U.S. maintains its presence and monitoring efforts.

Much of the debate surrounding the issue in Congress and in the media has been about what the government should or shouldn’t do to prevent Ebola’s spread to the U.S. Laurie Garrett at Foreign Policy does well to dismiss ideas to keep Ebola out of the U.S. by denying entry for those traveling from West Africa, pointing out that similar attempts during the swine flu epidemic proved ineffective and that it is “patently wrong” to fear that Ebola will become an airborne pathogen.

Yet Garrett goes on to suggest that when and if Ebola becomes a significant health threat in America, Affordable Care Act (ACA) mandates will help to ensure people receive care instead of being turned away at emergency rooms. “America’s special vulnerability to Ebola is its limitations on access to health care,” she says, fearing that if those with the disease are turned away, they could spread the virus to the broader public. She then commends recommendations from CDC officials calling for a mandate to admit patients with fevers and to take recent travel into account when prioritizing care, and warns that budget cuts to health departments since 2008 might help magnify the crisis.

First, a simple declaration: the CDC, Institutes of Health, and many other department agencies can (and have in the past) provide a valuable service to Americans in the event of an international health epidemic. Officials in centralized roles can monitor outbreaks and coordinate response efforts with state and local health departments should a health crisis occur. This is not only practical but constitutional, likely in line with what the Founding Fathers meant in the “general welfare” clause.

However, the potential outbreak of a virus that has little chance of spreading through America doesn’t entirely justify the one trillion-dollar ACA program. Putting aside the massive costs of ACA, though, the mission and function of the public health sector has not significantly changed since ACA became law and mandating health plans to help stave off an epidemic is like buying volcano insurance for your Chicago townhouse: there simply isn’t enough risk to make the purchase necessary. Plus, let’s not forget the fact that in the West – unlike in African countries overwhelmed by the outbreak – there is a level of trust between the public and health officials, and a lack of cultural customs and traditions like touching dead bodies at funerals, that make widespread transmission of the disease much less likely (I’d think Garrett would agree with me on this point).

Third, the recommendations by the CDC would likely still be effective if the ACA was not law. Hospitals are on the front lines of health problems and administrators take government warnings seriously. Assuming that a drastic increase in regulations, bureaucracy, and government oversight would somehow incent hospitals to take Ebola or any number of other health issues more seriously than they already do fails to consider this (though I don’t think Garrett would venture this far, she is trying to connect more coordination with better outbreak outcomes).

Fourth is the seen versus unseen in this pendulum of the ACA and Ebola. If the ACA never happened (or was repealed), the federal government would have at least $319.5 billion in additional funding to fight Ebola in and outside of the country. Sure, this might seem trivial now but in a world of limited resources (and even more limited health resources), even one tenth of ACA funds could fully finance Ebola mitigation efforts while whittling down the deficit. It would not solve every problem (health care would still need reforming) but other pressing needs could be resolved.

Hopefully, the Ebola outbreaks in Africa will soon be contained, especially with the world’s best fighting force now on the job. And I sure hope that taxpayers get some mental relief, knowing that America is well equipped to fight it (I’d say in spite of ACA). Recognizing what Ebola is, and understanding what is already being done to prevent its spread, should keep alarmists at bay. When it comes to diseases, fear really is the thing to fear.