The American health care system is exceptionally good at cutting-edge technologies. The top five American hospitals together conduct more clinical trials than any entire European country.

Yet over all, our health care system has failed us. Troll through World Health Organization data and cringe: Americans live shorter lives than Greeks, our kids are twice as likely to die by age 5 as Portuguese children, and American women are 11 times as likely to die in childbirth as women in Ireland. Over all, we rank well below most European countries in our health statistics (for which you can also blame the Danish in your hand as you read this).

The larger problem is that we over-invest in clinical care like CAT scans and underinvest in public health. There should be a Nobel Prize for Public Health, so that we might get more great minds wrestling with nonmedical pieces of the health puzzle, like industrial hog farms that can serve as breeding grounds for viruses and bacteria, from swine flu to MRSA.

President George W. Bush did an excellent job making preparations specifically for a flu epidemic, partly because of the avian flu scare and partly because he read a book about the 1918 influenza epidemic. But he and other presidents starved the broader public health system, so that today it is in desperate shape.

Hospitals lack spare beds, ventilators and staff to cope with an epidemic. One study found that a flu epidemic would mean that 10 million Americans would need to be hospitalized  compared with a total of nearly one million beds in America, about two-thirds of them occupied. Last year, Representative Henry Waxman ordered a review of “surge capacity” in hospitals available for a terror attack, and found that more than half the emergency rooms studied were already operating above capacity.

We don’t know whether this swine flu will be as lethal even as a typical flu season (the boy who died in Texas last week has already received more attention than all 36,000 Americans who die in a typical year of the flu). So far it has been mild in this country, but we know that the first wave of flu in 1918 caused few deaths but was followed three months later by a different form that killed tens of millions of people around the globe.

We do know we need to take precautions. These include not only washing our hands with soap and water, but also instituting far-reaching health care reform in the coming months.

“If a severe pandemic materializes,” Dr. Redlener said, “all of society could pay a heavy price for decades of failing to create a rational system of health care that works for all of us.”