U.S. health policy in the aftermath of Hurricane Katrina

In a season that experienced an onslaught of major hurricanes, Hurricane Katrina nonetheless stands apart as a seminal social event. Katrina did not merely lay waste to a geographic region; it also exposed every public policy failure essential to community and population health. Nicholas Lemann wrote that, after the levees broke, we watched every single system associated with the life of a city fail: the electric grid, the water system, the sewer system, the transportation system, the telephone system, the police force, the fire department, the hospitals, even the system for disposing of corpses. The US Department of Homeland Security reported that as of September 15, 2005, 90 000 square miles had been declared disaster areas, and over 122 000 persons were housed in shelters throughout the nation. Three months later, in December 2005, more than a million people are still reported to be homeless. Hurricane Katrina exposed a health care system incapable of withstanding the long-term impact of a major disaster. Through destruction and permanent displacement, Katrina illuminated the fundamental weaknesses inherent in the national approach to health care financing, as well as the extent to which these weaknesses can threaten recovery. Yet almost from the moment that health care emerged as a major issue, a battle rapidly ensued over the appropriate scope of the response. Now, several months after this disaster, prospects are increasingly dim that this catastrophic event will yield at least modest improvements in the national policy arsenal for effectively responding to disasters, manmade or national