Hurricane Katrina came ashore a few weeks ago and blew the clothes off the American emperor, leaving the nation bowed and naked. For those not too embarrassed to look at the many ugly truths exposed, there was much to learn.

Most searing were the images of New Orleans’ poor, abandoned to their fate by a nation that has been progressively abandoning its poor for more than a decade. Most tedious, but of great importance, was the truth that America is ill prepared for most large disasters, whether caused by terrorists or by nature. The blame for that extends from the White House to your house.

Hurricane Katrina exposed what those of us on the ground of emergency preparedness all around the nation have known all along – that the billions spent in the days since Sept. 11, 2001 were spit into Category 5 hurricane winds in comparison to the amount of money and force of will needed to be truly prepared for even predictable disasters. We have not spent enough, we have not worked enough, we have not trained enough, and we are not ready. That is why Hurricane Katrina caught this country with its national pants down.

Preparing for emergencies is boring, difficult, tedious work, and akin to putting a new roof on your house. After all of the work and money, nothing looks different and the new roof goes unappreciated unless a disaster strikes, which it may never do. It was all worth the money only if the roof is still on after the storm has passed. Storm-proofing New Orleans (if that is possible) and preparing its population for the next Katrina will cost us upward of $20 billion, and we will not notice the improvement unless another hurricane lands without disastrous results.

Real emergency preparedness takes real work and real money. It involves paying emergency responders for repeated disaster exercises, exercises which strain tight budgets and are like deer with bull’s-eyes tattooed to their rears when the budget hunters come looking for easy targets. You never see the results of all of that money until the disaster balloon goes up.

It involves developing legitimate evacuation plans for cities such as New Orleans and Houston, then practicing the plans repeatedly. It involves hospitals in flood-prone areas moving electrical systems and emergency backup power generators out of hospital basements (the Louisiana legislature refused to approve $8 million to have this done at New Orleans’ two public hospitals, with predictable and deadly results). It requires stockpiling generator fuel, and practicing for disasters until staff go comatose from boredom. And then doing it again, all effort for which hospitals will not be reimbursed.

Real emergency preparedness involves individuals planning their own disaster care, with stockpiled food and water, a personal evacuation plan, contingency planning, and then repeated practice of the plan.

It involves paying billions to purchase emergency communication equipment that allows emergency responders, such as police, firefighters, emergency medical technicians and others to be able to communicate with each other in a disaster. We have known for decades that in many communities those radios cannot talk to each other, leaving firefighters unable to talk to police and both unable to talk to federal and state emergency management experts. In a disaster they might as well all be linked with tin cans tied to strings.

When the planes hit the World Trade Center four years ago this communication problem in New York City had catastrophic consequences. When Katrina hit New Orleans its police and firefighters had the same problem, four years and millions of dollars in federal emergency preparedness funds after 9-11. If you are hit by a left hook once, they call your opponent lucky. If you get hit twice, they call you a sucker.

Some in the American business community have resisted safety initiatives that must be undertaken if we are to protect ourselves from disasters and prepare for the ones we either fail to, or cannot, prevent. The television broadcast industry has resisted the sharing of airwaves required for all types of emergency responders to be able to communicate with each other in a disaster.

Many of our nuclear power plants, chemical plants and other potentially dangerous industrial sites are still inadequately protected because those industries do not want to pay the security costs, and because the federal government has refused to knuckle them under. A plane flown into one of them will make 9-11 a good day by comparison. Our ports remain security sieves because making them safe slows commerce.

The American public has resisted too; it seems no more willing than American industry to suck it up for safety and disaster preparation. Many who stayed in New Orleans and along the Gulf Coast did so because they simply did not believe a disaster would really happen. Many of us will complain bitterly if our president has the courage to stand up and tell us that it is time for collective national sacrifice through higher taxes to pay for better emergency preparedness and the war in Iraq.

There is not enough discretionary spending left in the budget to cut our way out of the federal budget hole left by Katrina, previous Bush tax cuts and the Medicare prescription drug benefit. We must have the will to pay for all of that, which will mean tax increases or billing our children via a larger national debt.

Our leaders, in the Bush administration and others, have not simply failed to tell us what true emergency preparedness costs, what work must be done and what sacrifices must be made. They have also intermittently staffed the Federal Emergency Management Agency, the agency charged with leading us through disasters, with political hacks instead of professional disaster preparedness experts.

Five of FEMA’s current nine senior leaders are political appointees of the Bush administration, according to The Washington Post. That list includes recently fired FEMA head Michael Brown, whose previous management experience was in planning horse shows. It is no wonder then that Hurricane Katrina flattened FEMA like an old trailer. This dangerous approach to staffing FEMA reflects our national perspective that emergency preparedness and disaster management is not serious work. Some Americans in New Orleans and elsewhere along the Gulf Coast paid for that mistake with their lives.

We are not unwilling to do all of this work and pay all of this money for emergency preparedness simply because we want to watch reality TV while Rome burns, New Orleans floods and the terrorists plot, however. The real reason we are unwilling is that we are not afraid enough to really sacrifice. We don’t believe that the next Hurricane Katrina or Hurricane al-Qaida is really coming, or that the next disaster is going to catch us unprepared.

We still think this is Kansas, Toto, and don’t yet realize the tornado of a new time has plunked us down in a different world. We want our safety from the high tides of hurricanes and Islamic fundamentalism, but we do not want to move off our coast of collective comfort to the higher ground of national sacrifice.

Until we wake up to the demands of true emergency preparedness we are a nation of New Orleanians, living below sea level with an old, leaky roof over our heads, waiting, witless, hopeless and helpless.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.