by Salahuddin Khan

Created on: August 08, 2009   Last Updated: August 12, 2009

Imagine, God forbid, that a terrorist act renders a major urban center afflicted with some health impacting issue, which, of course is usually the terrorist's intent. Aside from the abhorrence and condemnation, we would have to suppose that droves of people would need to seek medical attention. They would go or be taken to a local hospital and get treatment.

The matter would naturally give rise to a state of emergency and people might get some relief for medical expenses to the extent that insurance wouldn't cover them, which is the mandated FEMA policy in these matters.

If the supposed terrorist was sprinkling radioactive dust or anthrax from an airplane, we would reasonably expect taxpayer dollars to pay for the F-16s that would try to vaporize the offending aircraft and its occupant. In other words, to mitigate the threat of a collective harm, this democracy has established a principle with which few would argue, namely that "defense", as a common good, is the prerogative of the government and thereby, the taxpayer.

Yet no such "common good" principle applies to the treatment of the victims on the ground beyond whatever might be available after insurance is exhausted when the event qualifies, as this of course would, as a national or state emergency. Strangely, we can boil this down to the principle that no expense would be spared by the taxpayer to prevent a willfully-initiated systemic threat from manifesting (military measures), while for naturally occurring, systemic threats of non-willful origin, we're left to fend for ourselves with our health insurance, if we have any. The role of the willfulness of the cause seems on the face of it to be an unreasonable basis for determining who pays.

The question arises then as to how we might draw parallels between spreading the burden of collective protection among taxpayers and, at least for some kinds of illnesses or conditions, the provision of taxpayer funded health care. The terrorism example is pretty clear cut as it relates to establishing a cause for health care needs.

There's a helpful fine line between before and after the event for example, which serves as a galvanizing basis for having public sympathy for recipients of the health care, so taxpayer payment for victims seems eminently acceptable. But for many systemic threats to health, it would be difficult to figure out where to draw the line.

Clearly, contagious disease occurs in ways which involve the full gamut of disease progression from

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