Behold a country littered with profiteering health care and drug industry executives free to haul away billions of dollars while the pandemic exacts its deadly toll on the poorest and sickest. Yup it’s the U.S.A. which finds itself in this sticky situation— spending more on healthcare than any other country, yet on the ropes as the pandemic takes a deep bite out of the lives and livelihoods of millions of Americans.
Only 4% of the world’s population, the U.S. has almost 20% of the world’s coronavirus cases and 15% of its deaths. How is it possible that a country spending more than any other nation on healthcare, that never stops bragging about its preeminent place as the number one provider of excellent health care has sickened and killed a greater percentage of its citizens than any other high-income country?
The Commonwealth Fund has the answer. According to their August 4th report (“Mirror, Mirror 2021—Reflecting Poorly”]“The United States trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes. To be clear, of the eleven high-income countries in the study, the U.S. brought up the rear in almost every metric. To make matters worse, “the U.S. consistently demonstrated the largest disparity between income groups [in obtaining healthcare services]. One example speaks volumes. In the United Kingdom, 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting needed health care. In the U.S., 44 percent of lower income and 26 percent of higher income people found their access to care blocked by the cost of healthcare services. Which goes to show that in the topsy-turvy U.S. healthcare world, a high-income American is more likely to report financial barriers than a low-income person in the U.K.
Is it so hard to believe the ravages of the pandemic in a country that has the highest rate of infant and maternal mortality, the lowest life expectancy rate at age 60 and saw historic declines in overall life expectancy from 78.9 years in 2014 to 77.3 years in 2020? This is the dismal picture painted by the facts. Remember we are talking about the biggest healthcare spender on the planet.
How did the pernicious effects of the pandemic cast such a dark shadow on so many Americans? As is the case in societies with huge wealth disparities like the U.S., the victims were in large measure low-income Americans and minorities.” Not surprisingly the report identified income inequality as the cause of much of the U.S. poor performance. Think about it — how effectively can a healthcare system provide for the well-being of its citizens when it’s controlled by powerful insurance companies, private for-profit (even if they are designated non-profit) hospitals and doctors’ groups (47% are now employees of for-profit hospitals or private investor groups).
It’s time to face the music. America is flunking the COVID stress test. The catastrophically high U.S. COVID death toll is no outlier but an outgrowth of a population that long before the pandemic started its deadly march through the country was already in poor health unable to afford the U.S. brand of overpriced primary and preventive care. “The U.S. health system delivers too little of the care that’s most needed — and often delivers it too late — especially for people with complex chronic illness, mental health problems, or substance use disorders, many of whom have faced a lifetime of inequitable access to care.” [Conclusion of the Commonwealth Fund report].
A barely-functioning public health system contributed to America’s failed response to the pandemic. Overwhelmed state and local health departments folded under the weight of the demand for services. Most were critically understaffed to begin with having lost around 40,000 public health jobs since the 2008 recession. When it comes to funding priorities, two-thirds of Americans live in counties that spend twice as much on the police as on all non-hospital health care including public health. In 2018, Boston spent five times as much on its police department as on its public health department.
Even the healthcare lobbyists that wrote Obama’s Affordable Care Act (ACA) recognized the critical need for a robust public health system. Almost dwarfed by ACA’s giveaways to the private insurance industry, big pharma, hospitals and doctors was a Prevention and Public Health Fund “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care costs.” Sounds good right? Unfortunately, the devil is in the details. The billions of dollars to finance the fund became instead a piggy bank for Obama and Congress to raid for other priorities including a payroll tax cut. [Kaiser Health News 7/1/2020] If the fund had remained intact, billions would have been available to state and local health departments as the pandemic was raging.
Also suffering the same fate were two large funds — the Public Health Emergency Preparedness Program and the Hospital Preparedness Program created after 9/11. Both were decimated to pay for priorities more pleasing to the President’s and Congress’ main constituency: major donors.
Making a bad situation deplorable, as the pandemic was taking its toll on residents, fourteen states cut their health department budgets. Michigan cut its state health workers by 20%. Pennsylvania put 65 of its 1,200 public health workers on temporary leave and laid off others.
Considering the urgent need to upgrade state and local public health departments, a massive, sustained plan of action is called for. Unbelievably, public health doesn’t even appear on the wish list of most politicians. As the 2022 midterm election approaches, uppermost on the minds of both party’s elected officials is keeping their jobs, and in the case of democrats their slim majorities in both Houses. What better way to succeed than satisfying the big kahunas who dole out the money? You can imagine how concerned billionaires like Bezos and Bloomberg and even the pretentious Gates are about the health and welfare of the American public. The politicians’ solution? Allocate temporary funds to beef up health departments for as long as the pandemic lasts. What about the next health emergency? The next pandemic? Mãnana.
