It Took the World Getting Sick for America to Realize What a Lot of Us Already Knew

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Countries like New Zealand (1939), the United Kingdom (1948), Sweden (1955) and Norway (1956) began putting together national health systems many decades ago. Yet, the U.S. has remained steadfastly determined to stick to its for-profit health care model. But at what cost?

COVID-19, the new coronavirus, has revealed the terrible inadequacy of America’s for-profit health system. The U.S. has several public institutions which are committed to public health and the public good. Unfortunately, the actual gatekeepers for health care — insurance companies — don’t always behave in the interest of the public good.

There were gaping holes in the United States’ health care system long before coronavirus. Failing to address them now, with New York City’s morgues overflowing with the dead, would be a crime against humanity.

But how did we get here?

America’s Health Care Problems Didn’t Begin with Coronavirus

America was extremely poorly equipped to deal with the everyday health concerns of its citizens — to say nothing of a global pandemic — long before COVID-19 started making headlines.

Compared to other wealthy and developed nations, the U.S. has far fewer doctors and hospital beds per capita. With just 2.6 physicians for every 1,000 citizens, America doesn’t even crack the top 10.

And thanks to the uniquely high cost of seeking medical care in the U.S., many Americans are already accustomed to avoiding the doctor. Between the lack of actual health care infrastructure, being deathly afraid of accruing financially ruinous medical bills, and millions losing health coverage due to layoffs, many symptomatic Americans may simply ignore or try to work through their condition until it’s too late. Or until they infect others.

This type of health care “rationing” has been business as usual for a long time in the U.S. This is just the way it is when citizens are stuck with high-premium, employer-provided health care plans or a lack of coverage altogether thanks to the gig economy model. Tying health care coverage to employment isn’t just ethically wrong. It is, as we are now seeing, a recipe for catastrophe.

The U.S. treats health care like a luxury for the affluent, and so America is now a place where doctors often find themselves in the emotional quandary of having to console patients who need help but cannot afford it. These professionals know that your treatment should be determined by you and your doctor — not your level of coverage or your employment status.

The “design” of the American health care system results in substantial numbers of unnecessary hospitalizations for conditions that, if treated in a timely fashion, wouldn’t require a hospital stay at all. This means our hospitals were congested with sick patients even before the influx of coronavirus patients.

Health care in the U.S. has been a house of cards for a long while. COVID-19 is just the first thing in a while to have the potential to bring the entire system crashing down around us.

Map of the COVID-19 outbreak per capita as of 3 April 2020. the darker the red, the more cases there is. Be aware that since this is a rapidly evolving situation, new cases may not be immediately represented visually. Photo from Wiki Commons

How the U.S. Became the Epicenter of a Global Pandemic

As of April 1, 2020, 11 states plus Washington, D.C., have reopened their “Obamacare” health care exchanges to make it easier for the uninsured to purchase coverage. The Trump administration has refused to implement extended enrollment periods nationwide, which fits with the president’s promise to dismantle the Affordable Care Act altogether.

Such a move would have delivered some short-term peace of mind for many American families. But it wouldn’t remove the proximate cause of America’s failed health care system: the profit motive. The ACA helped millions of American families insure themselves for the first time, but it also consolidated health care decision-making power into the hands of a small number of terrifically profitable insurance cabals.

The profit motive lies at the heart of America’s tragic and embarrassing rate for coronavirus testing. As of March 11, the U.S. had tested 23 people for every million citizens. By that time, Japan had tested 66 people per million, the U.K. had tested 347, Italy had tested 828, and South Korea had administered 3,692 tests for every million people.

America began falling behind early in the outbreak for a very simple reason: making a push for the large-scale “commercialization” of testing protocols simply wasn’t a profitable enough investment to make.

And speaking of public health investments: it shouldn’t be forgotten that the Trump administration called for a $9.5 billion funding cut to Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Rapid Response Reserve Fund and the National Institute of Allergy and Infectious Diseases (NIAID).

After intense criticism, the administration announced in mid-March that it had reconsidered some of these funding cuts. Unfortunately, White House Budget Chief Russ Vought, in a letter to Congress, indicated that the CDC wouldn’t have the resources it needs until October 1, 2020.

Meanwhile, we are seeing what leadership looks like in several other somewhat unlikely places.

Since America cannot provide for its own health care necessities, Russia has been flying critical medical equipment, including personal protective gear, into the United States.

Cuba is exporting hundreds of trained physicians to countries all over the world during the epidemic, continuing a long tradition of what they call “medical internationalism.” It goes back decades to Fidel Castro’s tenure as Prime Minister, when he flew medics to Chile to help the nation recover from an earthquake. Their response now, amid the coronavirus epidemic, according to Cuba’s health minister Jose Angel Portal Miranda, has “no precedent.”

An Indictment of Rugged Individualism

Thanks to its lack of preparation and investments in public health systems, America is now the epicenter of the pandemic. It was inevitable that the U.S. would find itself in this position. From the lack of attention to public health in general, to the shortsighted defunding of emergency preparedness programs, to the utter callousness of the administration’s response so far, all of this is typical of America’s “you’re on your own” doctrines. If you’re unemployed, you’re not trying hard enough. And if you don’t have health coverage, you’re not working hard enough.

Laissez-faire capitalism, socialism for the rich and austerity for the poor, and the fetishization of rugged individualism all helped get us into this mess. It’s the overarching idea of I don’t give a damn about you until there’s something in it for me.

Now there’s something in it for you. There’s something in it for all of us. COVID-19 makes the most compelling and urgent case yet for a radical change in how health care is handled in the United States. Things didn’t have to get to this point. But if we pay attention to cause and effect and learn something from this horrible ordeal, it may not have to get this bad ever again.

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