Why did the pandemic hit the U.S. harder than any other county in the world? A country that boasts of its exceptionalism has one more notch carved on its belt —more COVID cases (67.7 million) and more COVID deaths (854 thousand) than any other country in the world. Being only 4% of the world’s population, a lot of things have to go haywire to have 20% of the world’s COVID cases and 15% of the world’s COVID deaths.
Let’s start with the basics. Unlike its high-income peers, U.S. healthcare. Is mainly reserved for rich folks. If you’re not at the top of the economic food chain you’re in a world of hurt when you need medical care. Even before the pandemic, one-third of Americans (100 million) did not feel they could afford medical treatment. Figures since at least eighty-nine million of them were either uninsured or underinsured.
No doubt about it, study after study confirms that Americans are the unhealthiest people in the developed world. Cardiovascular disease, diabetes, cancer and respiratory diseases like asthma stalk the land and uproot and kill Americans in numbers unseen in any other developed country. Take the scourge of asthma, a killer co-morbidity for COVID. The U.S. has more than double the number of hospitalizations, 90 hospitalizations per 100,000 compared to an average of 42 per 100,000 people in comparable countries. And let’s not forget that 41.4 million Americans over the age of 18 have at least one and often more underlying medical condition(s) that put them at high risk of serious illness or death if they contract COVID. The U.S. also occupies the top spot among wealthy countries with the highest rate of infant mortality and the lowest life expectancy at age 60.
Looking at these dismal stats, you might understand why the underperforming U.S. healthcare system was out of its league when it came to coping with a national health emergency like the pandemic. Why is the U.S. in this sinking ship while twenty-five other wealthy countries are not? Could it be connected to the lack of a single payer national healthcare system? Correlation or causation?
According to Public Citizen, the evidence for causation is overwhelming: “The pandemic has shown how wide the gaps in our health care system remain and how easy it is for families to fall through them…We already spend far more than any comparably wealthy country on health care while achieving far less and were left wholly unprepared for the COVID-19 pandemic.” [Eagan Kemp, Public Citizen’s health care policy advocate]
The absence of a well-organized national health care system has been responsible for a complete breakdown in public health. Although the U.S. privatized, for-profit system has been on life support for many decades, the onset of the pandemic has left what was barely functioning in shambles. To the everlasting shame of the most richly endowed country in the world, the U.S. has occupied last place among eleven of its peer countries on almost all metrics of health care performance in seven reports the Commonwealth Fund has issued since 2004.
The U.S. failure to address the health needs of its people before the pandemic had catastrophic consequences once the pandemic hit. Most notable has been the breakdown of three major pieces of the social safety net — for-profit health insurers, hospitals and an economic system that ministers to the needs of people according to their financial statement.
As the most unequal society among peer nations, the U.S. performance during the pandemic suggests that the greatest predictor of COVID death may not be race, age, or ethnicity, but economics. In several studies that have appeared in leading journals like the Lancet the chasm between the outcomes of low-income individuals compared to those in higher income brackets is stunning. One study concluded that low-income COVID victims were 5 times more likely to die than their richer cohorts. [Study appeared in the Lancet 11/10/2021] Overall Black Americans have died of COVID at 1.7 times that of White Americans [Kaiser Family Foundation, December, 2021] Another study concluded that lower-income people were in the pandemic crosshairs because of their disproportionate number of co-morbidities, their presence in frontline jobs and their inability to afford health insurance.
The failure of the U.S. to guarantee its citizens health insurance has catastrophic consequence. Over one-third of COVID-19 deaths and forty percent of COVID infections are tied to the lack of a national healthcare system. [“The Catastrophic Cost of Uninsurance, Families, USA]
The business model of the for-profit health insurance industry puts profits above people .During the pandemic, profits above people took on a whole new meaning. While the vast majority of Americans were in economic distress, health insurance companies were capitalizing on their misery. As many people delayed seeking medical help and in many parts of the country elective surgeries were cancelled, premiums still came due and insurance company profits ballooned as payouts declined. But as profits boomed the predators running insurance companies and their investors sought other more heinous and illegal ways to drain the last drop of income from people in dire straits. It got so bad that the Centers for Medicare and Medicaid Services (CMS) had to intervene to stop insurers from denying claims for COVID-19 testing, and force compliance with COVID-19 relief legislation that required plans to cover testing without cost sharing.
What happened to the millions of Americans insured though their jobs? The prospect of utter ruin for the twenty million who lost both their jobs and their health insurance during the pandemic.
Which brings us to the public health component of this profiteering, dysfunctional system that U.S. political leaders past and present claim is the embodiment of Barack Obama’s boast that Obamacare (aka Affordable Care Act) guaranteed that — “in America healthcare is not a privilege for a few but a right for everybody. A characterization so absurd that only the bought and paid mainstream media and the oligarch community agree. In any nationwide healthcare system, in an emergency like the pandemic public health agencies spearhead the government response. In the U.S. at first there was no response at all.. In fact, the public health system has been in tatters as a succession of myopic past residents of 1600 Pennsylvania Avenue have deliberately underfunded it to the tune of $4.5 billion. It wasn’t all Republican presidents who participated in the massacre. How about President “American healthcare is a right for everyone” Obama who cut the public health budget to help pay for the misnamed Affordable Care Act, his phony health care reform scheme. His butchery didn’t end there. In 2012, Obama robbed the Prevention and Public Health fund he had set up under the ACA to support state public health agencies. Having promised to finance the fund with $15 billion, in 2014 he cut the appropriation by more than $6 billion to mollify conservative members of his own party yammering about a “balanced budget.” A year later in 2015, he swiped another $450 million to set up the federal health insurance marketplaces. His successor, President Trump competed the rout. His 2017 massive giveaway to the uber wealthy (AKA the Trump tax cuts) robbed the fund of another $750 million in order to continue funding the Children’s Health Insurance Program, too politically popular to abolish. The 2018 budget stripped an additional $1.35 billion from the PPHF over 10 years.
Pinning the blame for the catastrophic trail of serious illness and death the pandemic has left in its wake in the U.S., we are led to the undeniable conclusion that America’s plight has its antecedents in decades of private, profiteering health care that has produced a sick society with skyrocketing rates of comorbidities like obesity, diabetes, and asthma, a fertile environment for the rapid spread of COVID.
One of the main actors in this tragedy of virulent economic inequality in a privatized health care world: hospitals whose profiteering takes the form of $15 for a single Tylenol, $8 for a box of tissue (often referred as a “mucous recovery system)” and $53 for one pair of non-sterile gloves. Cutting costs has become the gold standard in both for-profit and non-profit hospitals. At the height of the pandemic, hospitals were filled to the overflowing. Don’t for one moment believe that the pandemic was solely or even principally responsible for hospital overcrowding.
The real culprit is remarkable transformation of what a hospital is. First, private equity bought out non-profit hospitals and turned them into profitable investments. The hospitals that remained non-profit aped their profiteering ways . Easiest way to do it —cut costs and bump up revenue. Cutting capacity was at the top of the list. In 1971, the United States had 1.5 million hospital beds., In 2017, there were only 931,000, a decrease of 62%. During the same period, the US population grew from 207 million to 327 million. Instead of one hospital bed for every 138 patients, the U.S. was left with one hospital bed for every 351 patients.
Cutting staff was another way to increase profitability and enrich executives and investors. The twin plagues of bed and staff shortages increased the pandemic fall out. In 2020 the Kaiser Family Foundation reported that 10,000 patients in the hospital for conditions other than COVID and testing negative prior to their stay caught COVID in the hospital and 2,000 (20%) ultimately perished.
By no means are these the only drivers for rampaging COVID. In a privatized healthcare system with little government oversight and even less regulation, where healthcare big wigs call the shots, shit happens. “Just in time ordering” of personal protection equipment and other supplies has left both hospitals and nursing homes with vulnerable populations a veritable killing field. Inaction on climate and unchallenged environmental degradation have led to out-of-control respiratory disease especially among children — 6.1million children, 1 in every 12 below age 18, suffer from asthma. An unregulated pharmaceutical industry, recipients of the Oscar for unrivaled greed and double dealing, play a major role in the tsunami of cases and deaths that stalk the U.S. The bottom line is what you would expect in a declining empire —a failing healthcare system, the most expensive in the world gobbling up 20% of GDP or $12,530 per person in 2020 but the least effective. And tragically, a beaten down public resigned to the nationwide healthcare death spiral with nary a pitchfork in sight.
