Stephen Flynn, former Coast Guard commander and author of The Edge of Disaster, says that the United States medical system is unprepared to handle a catastrophic emergency such as a flu pandemic or a major terrorist attack.
The problem, Flynn says, is that hospitals have been trying to cut costs.
"The medical community has been moving in the direction of much of our economy," he says, "which is wringing out the extra capacity in order to essentially focus on the bottom line."
Each year, more than 300,000 people are treated in U.S. hospitals for the flu. The common flu is dangerous; more than 30,000 Americans die from it every year. But Flynn is even more concerned by the prospect of pandemic flu, such as the outbreak that occurred in 1918.
Flynn estimates that a pandemic flu outbreak today would result in 80 million infected Americans. If the death rate were similar to that of the 1918 flu, then a current flu pandemic could result in 800,000 deaths in the United States.
There are only 970,000 hospital beds in the entire country, says Flynn, "so clearly we'd have to find a much different way to provide emergency care for people outside of our hospital settings."
Flynn says the United States lacks the federal leadership necessary to organize state and local efforts.
Flynn worries that a medical system that can barely meet day-to-day demands will be caught unprepared by an onslaught of emergency cases.
"We're going to have incidents whether by acts of God or acts of man that are going to place a lot of people in desperate need for emergency care," Flynn says. "And it will be life and death whether or not they receive it."
He says that investing in a medical system that can handle a potential surge is "something that we can't afford not to do."
Flynn endorses alternative solutions that will enforce the medical system without tremendous expense. He says much more can be done to reach out to retired doctors and nurses who could serve as a rank of reserves for medical professionals.
There are also programs that give citizens basic training so that they can assist medical professionals in the event of an emergency.
To inspire such change, Flynn thinks the United States needs to realize that the medical system is moving in the wrong direction.
"The efforts to essentially try to keep costs down and to ultimately make... our medical care system as efficient as possible," he says, "stands in opposition to the need to have surge capacity when things go very wrong."