Covid-19 poses great risks to humanity and human life. Given the right conditions, these risks could be greatly ameliorated and the epidemic contained. These conditions include a society that puts human welfare first, that has a high quality medical system with free access for all, together with a capable, determined and competent leadership to organise the fight against the virus. None of these conditions prevail in the US. Quite apart from the fact that it is a capitalist country where people’s health is not a priority, the US has a commercialised medical system where people get medical care only if there is a profit to be made. It also has an incompetent, anti-science president and administration whose every step has made the situation worse. STEVE PALMER reports.
Commercialised health excludes the poor
The overriding characteristic of commercialised medicine is the need to yield a profit. For-profit health ‘care’ diverts resources away from health care into investors’ pockets; requires bureaucratic overheads to manage complex insurance billing (8% for the US compared to 3% in other OECD countries); demands widespread performance of medically unnecessary treatment and operations to maximise profit and massively over-prices drugs. The result is that an excessive share of GDP goes to health care (about 17.8 per cent of GDP compared to 9-11% in other OECD countries) while creating vast inequalities in access to health care with poor outcomes (the US is 37th in ranking of quality of health care).
With regard to Covid-19, there are a number of specific obstacles created by for-profit medicine. The first and most obvious problem is simply having to pay for testing. Frank Wucinski faced medical bills of $3,918 after spending two weeks in government-mandated quarantine. Osmel Martinez Azcue visited a Miami hospital on his return from a work trip to China after feeling unwell. He tested positive for flu, was discharged, and billed $3,270. There are an estimated 27 million uninsured workers who will be deterred from seeking any medical assistance until the last possible opportunity. They typically work in low paid service jobs such as fast food outlets, cleaning etc. Many of them are undocumented workers who want to minimise their visibility to avoid the racist Immigration and Customs Enforcement which is out to deport them. Meanwhile they could be infectious and be spreading the disease to customers and fellow workers. A for-profit health care system ensures that epidemics spread wider, faster and quicker than a socialised health care system.
Trump: Covid-19 ‘fake’ news
Trump’s administration, contemptuous of science, has fought any concessions to common-sense, to science or public health expertise in its headlong ideological crusade against ‘big government’. Its initial response was to dismiss Covid-19 as ‘fake’ news, then accuse the Democrats of exaggerating the epidemic’s significance. The next step was to reluctantly recognise Covid-19’s existence – and then stigmatise the disease as ‘the Chinese virus’. When Trump was forced to acknowledge the reality of the epidemic, it appeared a corner had been turned and the primacy of public health science would be accepted. But on 19 March he tweeted that two drugs used to treat malaria, arthritis and lupus would be effective in treating Covid-19. The result was panic buying and the drugs disappeared from pharmacies, threatening supplies to patients who actually require them. Forced onto the offensive, Trump had to agree a $2.2 trillion stimulus on 27 March. Since then, Trump has said that social distancing and other measures to enforce isolation threaten to undermine the US economy and that people should return to work after Easter.
Killer Mike Pence
When Trump appointed vice-president Mike Pence to head the fight against the virus, a shocked public health official remarked that this was like putting an arsonist in charge of the Fire Department. In Austin, Indiana, when Pence was State Governor, he managed to convert an HIV outbreak in November 2014 into an epidemic. The only nearby testing facility had been a Planned Parenthood office, which Pence shut because of its support for the right to choose. He delayed approval of a needle-exchange programme, reluctantly signing one into law six months after it was needed. At the same time, however, he also approved a law that increased jail sentences for anyone found carrying needles. By 2017, 215 HIV cases had been attributed to the outbreak, of which more than half could have been averted. Now this killer has been unleashed on the US people.
The international Global Health Security index ranks the US first internationally in pandemic preparedness. Yet the Trump Administration has worked energetically to destroy that capability. In 2018, the National Security Council’s pandemic preparedness office was dissolved. Testing has been a dismal failure. The first test kits distributed by the Centres for Disease Control (CDC) had numerous failures which took weeks to correct. Bureaucratic procedures effectively prevented labs apart from the CDC’s own Atlanta lab from testing any samples, creating a bottleneck which slowed testing to a crawl. It took several weeks before the CDC’s test kit was fixed, non-CDC labs licensed to test results, and production of kits increased.
South Korea and the United States both reported their confirmed cases on the same day. South Korea moved fast and developed an extensive test program; by 26 March, it had tested 1 in 143 of the population, and reported 104 new cases on that day. In comparison, the US had tested 1 per 568 persons, by which time the daily spread of cases had reached 20,000. Many people who clearly should be tested are turned down for failing to meet the formal requirements. There are not enough testing kits to satisfy the demand from those who do qualify which means that the number of confirmed cases is likely to be lower than the true number. Now the US has more cases – over 100,000 as we go to press – than any other country in the world, including China whose population is four times larger, and whose decisive anti-virus measures were derided by the Trump administration.
It has fallen to state and local governments to take on the responsibility of protecting the population. California, for example, a Democrat-controlled state, has mandated sick-pay (not a Federal policy), banned all gatherings, shuttered non-essential businesses and taken other serious suppression measures. Even so, these measures offer little or no protection to the poorest workers who will be forced to continue in work, undermining even the most serious social isolation measures. Other states have implemented such measures only partially or even rejected them. In Mississippi, the Governor has issued an executive order overriding most social restrictions, even those recommended by his own Department of Health, declaring that ‘Mississippi’s never going to be China’. States can’t control the movement of people across state borders, so even the most draconian measures will be undermined unless all states adopt the same policy. It is a disaster in the making.
Fight Racism! Fight Imperialism! No 275, March/April 2020
