Amanda Ripley Author of The Unthinkable

IN AMERICA, THE PEOPLE IN CHARGE OF EMERGENCY MANAGEMENT spend millions of dollars a year holding training drills and tabletop exercises. All well and good. But when was the last time that you—the most important person on the scene—got invited?

Thanks to John Solomon for flagging last week’s 5-day nationwide drill in Israel as a model for a meaningful drill. Imagine: a drill that includes the entire population—and features surprise scenarios that require people to take action.

This is the way the brain works. The brain doesn’t learn by reading lists and listening to occasional public statements of officials in grey suits. The brain learns by doing. If we want to train the people who matter most in major disasters—the people who do the majority of life saving—we should invite them to the drill. Otherwise, we’re just play acting—designing emergency plans for emergency officials. Round and round the meta emergencies go.

It’s worth pointing out that Israel’s Home Front Command (similar to our Homeland Security Department) figured this out a long time ago. Human behavior matters more than technology. Look at the English version of their web site and notice the large button at the top labeled: “How to Act in an Emergency.” Click here to find out “How to Behave in a Terrorist Attack” or an earthquake or a fire or a flood. Downright elegant.

In general, I am not quick to point to Israel as a model for the U.S. The threats and context are very different, and I think some of our police departments tend to over-learn from Israel. But not in this case. On this subject, we under-learn.

Israel has got this exactly right. By comparison, DHS offers a mind-numbing list of preparedness and response publications, resources and regulations. From NIMS to NIPP to HSEEP. Ugh. I am unusually obsessed with this subject, and even I cannot bear to stay on this page for more than 6 seconds.

A vivid snapshot of American life in 2009 in today’s New York Times. The piece, by Kevin Sack, details the complex calculations people in Rocky Mount, NC, have to make when filling their prescriptions during a recession. For example, take James S. Crawford, who arrived at the pharmacy just after being discharged for his 3rd heart attack:

“Mr. Crawford, 61, who makes do on $1,800 a month in Social Security and veterans’ benefits, decided he could afford only the heart, blood pressure and acid reflux pills. ‘If I can rob a bank,’ he said, chuckling, ‘I’ll be back for the others.’ Before leaving, he handed over yet another prescription, just for safekeeping. It was for Plavix, an anticlotting drug that helps coronary patients avoid new blockages, and it had been written in early February after Mr. Crawford’s second heart attack. At $160, the co-payment was so high he had never considered filling it.”

Now consider an alternate universe: When I lived in France in 2003, I got sick. I put off going to the doctor because I didn’t know how much it would cost. I had health insurance through Time Magazine, but I had to submit claims on my own because I was living abroad, and I had no idea how good my coverage would be. Anyway, when I didn’t get better after a couple of weeks, I gave in and called a doctor in the village of Fontainebleau, where I lived.

I made an appointment for the same day. On my way there, I stopped at an ATM and took out about 100 Euros, just in case. When I got to the doctor’s office, I filled out a short form and then went in to the exam room, without waiting. The doctor checked me out and decided to prescribe antibiotics and a couple other things. (One of the downsides to universal health care is that a lot of doctors go nuts with the prescription pad.)

Then he apologized. He looked somber. He said that since I was not a French citizen, I would have to pay for the visit out of pocket. I nodded and said I understood. Then he asked me for the equivalent of $20. I handed it over. It was less than I might pay for a co-pay back home. Then he gave me a wad of prescriptions and sent me to the pharmacy next door.

At the pharmacy, the woman who filled my prescriptions also apologized. Because I was not covered by the French health care system, she said, I’d have to pay out of pocket. She looked almost ashamed. Again, I swallowed hard. She gave me a bill for… the equivalent of $15. For three prescriptions including antibiotics (which I did need) and a couple silly things I didn’t need.

I walked out and understood what health care could look like. I had gotten more service for less money than I ever got in the States. I didn’t even bother submitting those claims to my health insurance company. For $35, I’d gotten more than my money’s worth.

I know France has its problems. Believe me. I could go on for days about the excessive strikes, the culture of labor entitlement and the bureaucracy, not to mention the implications of a population that does not clean up dog poop from the sidewalk. I know their health care system isn’t perfect, either. But I am telling you: Americans are getting screwed. Most of us don’t even know what a good health care system would look like anymore.

In France, Mr. Crawford would have gotten his drugs. Why couldn’t he get them here? Because we subsidize the rest of the world (including France) by refusing to negotiate as a country for lower drug prices. We pay more and they pay less. Because our doctors expect to make more than French doctors expect to make, partly because they pay an ungodly sum for medical school. When US docs find they can’t make as much as they expected, they overbook and overcharge. Because of a long list of reasons that are no longer mysterious or acceptable.

So it kills me to read about people in America having to leave life-saving prescriptions unfilled because of the greed and ideology of a minority of politicians and businesses. It pains me to read about the opponents to health care reform dragging out the same old, fear-mongering stories to try to prevent America from joining the rest of the civilized world. Seems to me that Americans deserve a system that is at least as good as the one in France or the UK. (Check out this interactive chart comparing the US health care stats to those of other nations.) 

The Department of Homeland Security has begun thinking outside this universe. According to a Washington Post article, they’re turning to science fiction writers. Apparently science fiction writers flocked to the 2009 Homeland Security Science & Technology Stakeholders Conference and offered imaginative ways to think about threats. This is considered “science fiction in the national interest” by the writers. Their services are pro bono, and most of the writers have a conventional science background, such as a PHd in physics. According to Rolf Dietrich, Homeland Security’s deputy director of research, the writers “help managers think more broadly about projects, especially about potential reactions and unintended consequences.” And how do the bureaucrats, in exchange, help the writers…? A free trip to Washington and a much-needed boost to the self-esteem of sci-fi geeks everywhere.

Fascinating article in the NY Times about “virtual autopsies” being done on soldiers killed in Iraq and Afghanistan. Since 2004, CT scans have been given to every service man and woman killed (autopsies have been performed since 2001)—a new procedure implemented by Captain Craig Mallack, a Navy pathologist.

The CT scans have been valuable pragmatically and psychologically, it seems. For the military, the scans reveal blind spots in equipment. The findings have already led to improvements in body armor and medical gear.

But the detailed analysis is also important to the families of the deceased, who crave information about their loved ones’ last moments. According to the Times, about 80-90% of families ask to see the report—which comes with a warning not to read it alone.

An example of the good that can come from using expensive technology wisely—and then sharing the results.

In case you missed it, Wal-Mart has agreed to a nearly $2 m payout with the Nassau County DA’s office to avoid charges in the tragic Black Friday trampling death of a worker.

The agreement included no admission of guilt by Wal-Mart, but it does exact a promise that the retailer will work with independent experts to implement a better crowd-management plan for post-Thanksgiving Day sales. Wal-Mart also agreed to set up a $400,000 victims’ compensation and remuneration fund and give $1.5 million to Nassau County social services programs and nonprofit groups.

Wal-Mart says the new plans will apply to all Wal-Mart stores in N.Y. What about the other some 4,000 Wal-Mart facilities in the rest of the U.S.? (Not to mention the 3,100 outside the U.S.)

According to Wal-Mart:

“As we explore how we can make our stores even safer for our associates and customers, we will consider how aspects of this plan could apply to stores outside New York.”

Seems to me it would make excellent business (and moral) sense to do more than consider.