In the Atlantic and the New York Times this week, there are long and thorough analyses of why the coronavirus pandemic has hit the United States so badly. Neither, of course, explicitly states “the socialists were right about the systemic problems facing the country.” Yet when we actually list out the causes of the failures, many of them are exactly the problems that the left has long identified as causes of dysfunction and misery. This is important to point out not because the pandemic is an “I told you so” moment—there is no satisfaction to be found amid tragedy—but because we need to understand how the problems exposed by the articles can actually be fixed.
Ed Yong, in “How The Pandemic Defeated America,” relates his findings from over 100 interviews with experts. Let’s look at a number of the factors he notes in trying to understand why the number of deaths, and the amount of general misery, has been so much higher in the United States than anywhere else.
- Austerity in Services for the Vulnerable — Yong cites “Chronic underfunding of public health,” and a “bloated, inefficient health-care system.” He notes that “today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health…. Since the last recession, in 2009, chronically strapped local health departments have lost 55,000 jobs—a quarter of their workforce. When COVID‑19 arrived, the economic downturn forced overstretched departments to furlough more employees.” Yong also says that before the pandemic “three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control,” so it wasn’t surprising that COVID-19 ripped through so many nursing homes.
- Racism — Yong cites: “Racist policies that… left Indigenous and Black Americans especially vulnerable to COVID‑19…” Yong says that over a century-long period the white leaders of former slave states “built hospitals away from Black communities, segregated Black patients into separate wings, and blocked Black students from medical school. In the 20th century, they helped construct America’s system of private, employer-based insurance, which has kept many Black people from receiving adequate medical treatment.”
- Market Approach to Health — Capitalism has screwed up the incentives for hospitals: our “profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.” The PPE bidding war was a clear example of a free market disaster: “The federal government could have mitigated [the problem of PPE shortages] by buying supplies at economies of scale and distributing them according to need. Instead, in March, Trump told America’s governors to “try getting it yourselves.” As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.”
- Workers Facing A Choice Between Risking Health and Poverty — Yong: “The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood.”
- Environmental Destruction — Yong: “The biggest factors behind spillovers [of viruses from animals to humans] are land-use change and climate change, both of which are hard to control.”
- Self-Interested Behavior By Nations — Yong: “To avert a pandemic, affected nations must alert their neighbors quickly… The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans… The World Health Organization initially parroted China’s line…”
- Trump Prioritizing Border Controls Over Testing Infrastructure, and Failing to Wield the Power of the State to Direct Production — Yong: “Trump could have spent [the] crucial early weeks mass-producing tests to detect the virus, asking companies to manufacture protective equipment and ventilators, and otherwise steeling the nation for the worst. Instead, he focused on the border.”
- Having The Government Run By People Who Hate Government — Yong: “It is no coincidence that other powerful nations that elected populist leaders—Brazil, Russia, India, and the United Kingdom—also fumbled their response to COVID‑19. [NOTE: My personal opinion is that Yong’s definition of populism is a mistake.] “When you have people elected based on undermining trust in the government, what happens when trust is what you need the most?” says Sarah Dalglish of the Johns Hopkins Bloomberg School of Public Health, who studies the political determinants of health.”
- Mass Incarceration — Yong: “The hardest-hit buildings were those that had been jammed with people for decades: prisons… Many American prisons are packed beyond capacity, making social distancing impossible.”
- The Link Between Employment and Healthcare — Yong: “More than 26 million people lost their jobs, a catastrophe in a country that—uniquely and absurdly—ties health care to employment. Some COVID‑19 survivors have been hit with seven-figure medical bills. In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves disconnected from medical care and impoverished.”
Yong says that there was ample warning about the possibility of a pandemic; he himself had written an article pointing out the risks. Yong is not a radical, but he concludes that “normal” led to this, and that we need a “full accounting” not just of “every recent misstep” but of every “foundational sin.” He says that COVID-19 is a “teacher” as well as a “tragedy” and should be a “referendum on the ideas that animate [American] culture.” We must have “radical introspection.” His particular recommendations are:
- “America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies.”
- “It should strive to prevent sickness instead of profiting from it.”
- “It should build a health-care system that prizes resilience over brittle efficiency…”
- “It should rebuild its international alliances, its social safety net, and its trust in empiricism.”
- “It should address the health inequities that flow from its history.”
- “Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.”
The New York Times analysis by David Leonhardt covers much of the same ground. Some additional observations include from it. It also talks about mixed messages on masks, Republican governors thinking they could save their economies without controlling the virus, and the failure to test sufficiently or quickly enough. It also cites the fact that while Trump supposedly imposed a ban on travel from China, he didn’t really, because American citizens, permanent residents, and their families escaped it. What Trump did was more like a ban on Chinese people, but because the virus isn’t racist, and does not care whether it infects an American in China or a Chinese person in China, allowing nationality-based exemptions to the ban made no sense.
I’d like to also note one passage on the relationship between charging for healthcare and the spread of infections:
“By the time the virus became a problem in Germany, labs around the country had thousands of test kits ready to use. From the beginning, the [German] government covered the cost of the tests. American laboratories often charge patients about $100 for a test. Without free tests, Dr. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, said at the time, “a young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people.”
What then, should we conclude? Yong’s advice on radical introspection is good, but I want to spell it all out a little more clearly. Look at what caused problems. Take austerity, for example. Contact tracing was stymied by a lack of staff, and that’s because public health departments have been hollowed out. Abdul El-Sayed writes in his great book Healing Politics about his efforts to rebuild the Detroit Health Department, which had been almost completely destroyed when he arrived. Because the office had been privatized thanks to budget cuts, it could do almost nothing to serve the people of Detroit long before the pandemic hit. Or look at the way profit-driven healthcare disincentivized pandemic preparedness. Even the Wall Street Journal admits that “the hospital industry, in a bid to increase profit, slashed inventory of all supplies.”
A huge problem here is that markets cannot deal with pandemics, because pandemics are a collective problem requiring collective solutions, and it’s not profitable to stop them. If a bunch of unhoused, uninsured people are sick, there is no money to be made in treating them. Left to the “free market,” not only will they suffer, but the infection will not be controlled. The private sector will not, and did not, step up, because when something requires the coordination of a bunch of different interests and institutions, the orders have to come from government. In the United States, however, both Democrats and Republicans have embraced neoliberalism, the philosophy that the government is best that governs least, and private business can sort most things out. Unfortunately, the government that governs least is failing to do its basic job. The government is best that governs well, not least.
Look at Cuba and Vietnam (officially socialist countries, though there is significant debate about the extent to which the term applies). Here’s a Guardian report on what Cuba did:
The state has commanded tens of thousands of family doctors, nurses and medical students to “actively screen” all homes on the island for cases [of] Covid-19—every single day. That means that from Monday to Sunday, Dr Caballero and her medical students must walk for miles, monitoring the 328 families on her beat. “There’s no other country in the hemisphere that does anything approaching this,” said William Leogrande, professor of government at American University in Washington DC. “The whole organization of their healthcare system is to be in close touch with the population, identify health problems as they emerge, and deal with them immediately. We know scientifically that quick identification of cases, contact tracing and quarantine are the only way to contain the virus in the absence of a vaccine—and because it begins with prevention, the Cuban health system is perfectly suited to carry out that containment strategy.”
Cuba has long had a strong public commitment to healthcare—it has the highest doctor-to-patient ratio in the world and sends doctors around the world to help other countries in crisis—and as such, it has dealt well with COVID-19. You may, of course, point out that Cuba, being an island, is easier to seal off. But Vietnam, with a tourist economy and proximity to China, has had only ten deaths so far from COVID-19, which experts affiliated with the Bill and Melinda Gates Foundation (not exactly known for radicalism) attribute to “several key factors, including a well-developed public health system, a strong central government, and a proactive containment strategy based on comprehensive testing, tracing, and quarantining.” (Vietnam has recently seen a spike in cases, but still nothing on the scale of the United States.)
The COVID-19 pandemic has, as Yong pointed out, exposed and exacerbated all the social dysfunction that was already present in the United States. We shunt old people off into facilities where they are neglected, because money is not spent to ensure that there are adequate staff to care for them. We pile people into prisons by the millions. We disincentivize people from seeking medical care because they know it will be costly.
This is fixable. Yong and Leonhardt don’t say it, but it’s obvious what the United States needs: a universal national healthcare system that is free at the point of use. Then nobody would lose their insurance (and thus their access to care) because they’ve lost their job, and nobody would have to make the decision about whether or not to get tested for a disease based on whether they’ve got a spare $100. Profit doesn’t belong in healthcare, because profit creates terrible incentives to cut costs and corners.
Of course, just because you have socialized medicine does not guarantee your healthcare system will function perfectly. The National Health Service in Britain is one of the most effective systems in the world, but a Guardian investigation shows how privatization under Conservative and “New Labour” governments has damaged its functioning:
The government’s reliance on private contractors during the public health emergency comes after a decade of public sector reorganisation, marketisation and deep cuts to services and local government in England. The Guardian has interviewed dozens of public health directors, politicians, experts in infectious disease control, government scientific and political advisers, NHS leaders and emergency planners about the years leading up to the pandemic. They described how an infrastructure that was once in place to respond to public health crises was fractured, and in some places demolished, by policies introduced by recent Conservative governments, with some changes going as far back as Labour’s years in power. “The undermining of our responsiveness to a pandemic was one of my major concerns,” said Gabriel Scally, a professor of public health at the University of Bristol and a former regional director of public health in the NHS for almost 20 years. “There has been a destruction of the infrastructure that stops England coping with major emergencies. It absolutely explains why you’re now seeing private companies being brought into these functions.”
How are we going to reverse all of this? Who is going to seriously cut the prison population in the United States? Who is going to stay committed to healthcare that is free at the point of use? Who rejects “personal responsibility” and “bootstraps rhetoric” in favor of a renewed commitment to the public good? Who has a sufficiently collective-focused philosophy? (Yong cites as a problem “a national temperament that views health as a matter of personal responsibility rather than a collective good” and Leonhardt quotes Dr. Jared Baeten, University of Washington epidemiologist,” saying that while “there is a lot of good to be said about our libertarian tradition” it means “we don’t succeed as well as a collective.”) Who talks about caring for those you don’t know, decoupling insurance from employment, ending the kind of mutually suspicious nationalism that means countries are “competing” to produce a vaccine rather than cooperating? Who believes that the rich should not be able to buy their way to the front of the line while everyone else is neglected? Who talks about how working people of all lands must unite because their problems are ones they face together rather than apart?
The problems that have made this crisis so severe in this country are easy enough to identify. As former CDC and New York City official Dr. Thomas Frieden told the Times “this isn’t actually rocket science… We know what to do, and we’re not doing it.” The question is why we’re not doing it, and this is more complicated. Because as Yong documents, it’s not just a matter of Donald Trump being the president. The rot is far deeper, and few of the problems Yong describes can be solved simply by changing the occupant of the White House. We can come up with “road maps to reopening,” but unless we actually have a functional and efficient government, it’s never going to be implemented well. Preventing healthcare from being distributed according to the profit motive is a mammoth task. So is ensuring racial equality in health services provision. So is overhauling the way we treat old people and those convicted of crimes so that they are not warehoused in neglected, cramped facilities. The hardest talk of all might be creating international solidarity, so that U.S.-China tensions decrease, rather than increase, when a problem affects us both. It is very clear though that the current leaders of the Democratic and Republican party are incapable of pulling anything like this off—they can’t even provide the most basic relief to get people through the economic crisis, and both parties are stoking tensions with China. Without an organized left and a powerful, radical social democratic agenda, everything that has elevated the levels of suffering and death during this crisis will still be here when the next one hits.
Photo of Medicare for All rally, 2017, by Molly Adams.