On July 4th, a flash flood in Kerr County, Texas killed 27 young girls and counselors at Camp Mystic, a Christian girls' summer camp whose staff alumni included former first lady Laura Bush. The campers and more than one hundred other local residents who also perished in the flood reacted too late, or not at all, to the National Weather Service's flash flood warning and emergency text alerts issued at 1:14 and 4:30 A.M., respectively. According to an article in the New Yorker, "many people simply ignored the warnings, or had their phones silenced or turned off." The article mentioned that after a flood in 2015 that killed 13 people, Kerr County officials decided against installing a $1 million siren system that would have warned upriver towns when a flood was coming.
In Vermont, which also experienced devastating flash floods in 2023 and 2024, the political response was different. In order to reduce the risk of recurrent floods, legislators passed a Flood Safety Act that gave the state broad jurisdiction over all of its waterways:
Beginning in 2028, when the new regulations take effect, Vermont’s rivers will be managed not as channels but as “corridors,” which will comprise all the land within the river’s natural meander pattern, plus fifty feet of riparian borders on both banks. The river will have the freedom to move and reconnect to floodplains. Riverside property owners will no longer have the automatic right to armor banks; in some cases they must allow the river to meander, even if that means it meanders through their land.What does preventing and preparing (or not) for flash floods have to do with health care? Our federal government is trapped in cycles of short-term thinking. Even before the current shutdown, it had been nearly 30 years since Congress last passed the dozen annual appropriations bills that collectively constitute the federal budget prior to the October 1 start of the fiscal year. Most of the time, it passes "continuing resolutions" (CRs) that maintain spending at current levels and kick the can a few months down the road. (H.R. 1, aka the "One Big Beautiful Bill Act," which in large part precipitated the current legislative standoff, was an omnibus bill that also bypassed the normal budget process.)
Without action, the enhanced health insurance marketplace premium tax credits that Congress initially passed in 2021 and extended in 2022 will expire on December 31. Not only will the rollback of the tax credits place additional burdens on working class people and jeopardize small businesses, it is projected to lead to 340,000 jobs lost in 2026, the majority in states that voted for President Trump in the 2024 election. Trump may not care, since they can't vote for him again in 2028, but the Republican Party should, and their myopia will likely result in lost seats in next year's midterm elections.
The Department of Health and Human Services has ceased planning for long term health threats. Layoffs have decimated key staff at the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ), two organizations that are essential to carrying out any coherent strategy to address the epidemic of chronic diseases. The U.S.'s exit from the World Health Organization means that the CDC has been receiving far fewer samples of circulating influenza viruses that are essential to selecting strains for next year's flu vaccine. The U.S. Preventive Services Task Force, which AHRQ last convened in March, had its second meeting in a row canceled. HHS officials are publicly blaming the shutdown, but the government was open when the previous meeting was canceled in July (no explanation was ever given).
It's plausible that the Trump administration and its health officials are of the mindset that the COVID-19 pandemic was a once-in-a-century event, like the "superstorm" that inundated a large swath of lower Manhattan in 2012. But a better analogy than hurricanes is the periodic flash floods in Kerr County and neighboring Kendall County that have given their collective valley the moniker "Flash Flood Alley." Due to an epidemic of short-term thinking, a flash flood of preventable disease and deaths is barreling right toward us, with phones silenced, no early warning siren, and no way to evacuate to higher ground.
