Category Archives: public health

COVID-19 and America’s Social Safety Net

Friday’s HuffPost published an article by Emily Peck on the Coronavirus (COVID-19) and its impact on the country’s broken social safety net.

The article indicates that millions of working Americans do not get paid sick days. It also states that a stunning 70% of low-wage workers and one of three workers in the private sector, have no access to paid sick time.

According to Ms. Peck, the US is one of the few countries in the world without a national paid sick leave policy. In addition, she adds, millions of Americans do not have health insurance, or their policies are designed to keep them away from doctors with high co-payments and deductibles.

Both these issues, Ms. Peck writes, highlights how coronavirus, or COVID-19, could test the US’ uniquely weak social safety net.

Kristin Rowe-Finkbeiner, the executive director of MomsRising, a nonprofit advocating for paid leave is quoted in the article, “Right now we’re looking at a situation where we have a lack of policies that most other countries take for granted that protect their public health.”

This isn’t just a “coronavirus” problem, Ms. Peck says. Even though the CDC warned Americans earlier in the week, so far there have been very few case reported in the US. (Note: As of this writing,  there have been 74 reported cases in the US, and two men have died in Washington State, and one case was recently reported in Rhode Island, and one in Manhattan)

Yet, fears of an outbreak has put a spotlight on the public health system. With cuts to many agencies by Trump, many experts fear that we will be unable to deal with the crisis, especially since the Trump called it a hoax at a recent political rally.

He also appointed his evolution-denying Vice President, Mike Pence to coordinate the Administration’s response after gagging several Administration personnel from appearing on the Sunday talk shows. It was mentioned after the announcement that Pence did not believe that smoking causes cancer when he was Governor of Indiana.

For the Democrats, says Ms. Peck, coronavirus makes the case for policies like universal health care and paid sick and family leave.

Some key points to consider:

First, flu rates are higher without sick leave. What about coronavirus?

In the US, the article reports, just 10 states, 20 cities and three counties have some kind of paid sick leave. This is compared with the rest of the world, where more than 145 countries have this benefit. People who live in those places, research shows, are less likely to get sick, Ms. Peck reports.

And lack of paid sick leave is certainly a “risk factor”, according to Nicolas Ziebarth, associate professor in health economics at Cornell. Professor Ziebarth’s 2019 paper in the Journal of Public Economics, looked at Google data on flu rates, compared cities with leave policies with those without, and found that flu rates were 5% lower in places with sick leave.

An upcoming paper of Professor Ziebarth’s, based on CDC data, has found that the rates are actually 11% lower.

For those workers in low-wage jobs, if they get sick, they cannot afford to take time off of work because they are barely getting by. So, they end up going to work, and they get their co-workers sick.

Working from home isn’t an option.

Many companies are telling employees to work from home with the threat from coronavirus. However, for low-wage hourly workers, says Ms. Peck, this just isn’t an option. Many work in industries that have contact with the community — such as food servers, people who care for children, clean offices and homes.

As stated above, it is not just sick leave, The US also lacks any kind of comprehensive paid family leave policy, according to Ms. Peck, which would enable workers to take time off to care for a close family member’s health issues. This issue first came to light in 1993 when Bill Clinton signed into law, the Family and Medical Leave Act, which required covered employers to provide employees with job-protected and unpaid leave for qualified medical and family reasons.

An example of just how needed is paid family leave, comes from the experience of Ericka Farrell, a mother of three in Maryland, who lost her temp job in the early 2000s because she had to take so much time off to care for her young son. She did not regret staying home, but now works with MomsRising to advocate for paid leave herself, writes Ms. Peck.

Millions are uninsured. Many more have terrible insurance.

According to Ms. Peck, even if you take time off when you are sick, you might not be able to afford to see the doctor. Slightly more than 10% of Americans. she mentions, or about 30 million people, don’t have health insurance. This is because their employers do not offer it, or it is too expensive.

Things to consider regarding the uninsured:

  • Far less likely to go to the doctor
  • Americans with insurance face obstacles to getting care due to high co-payments
  • Then there are the deductibles, which have been going up for decades
  • Most people haven’t come near clearing those deductibles at the beginning of the year

John Graves, associate professor of health policy at Vanderbilt University Medical Center was quoted as saying, “If we as a society are going to face a spreading infectious disease, the worse time of the year is the beginning of the year.”

Graves added that the US health care system is simply not designed to deal with a potential pandemic.

First, he says, the US relies on employment-based insurance. If people are thrown out of work due to an economic downturn, they lose coverage.

Second, insurance is designed to encourage people not to see the doctor through so-called “cost-sharing.”  Co-payments and deductibles exist to discourage people from visiting the doctor or going to the hospital for every “cough and sniffle.” Graves said.

Lastly, in 2018, the Administration made it easier for people to buy insurance plans with less generous coverage, and don’t always cover expenses stemming from preexisting conditions, the article says. Experts have said that these plans they consider junk policies, have even higher out-of-pocket costs.

So what does this all mean?

It means that cuts to the social safety net guarantees that should the coronavirus get out of hand, the US is not prepared to deal with it effectively, and many more people will probably die who shouldn’t because of politics and ideology.

Hospital closings in rural areas, the firing of hundreds of health care personnel at the federal level, silencing the experts in infectious diseases, and the appointment of a man who rejects evolution and says smoking does not cause cancer to coordinate the Administration’s response, is a recipe for a catastrophe of unimanigable proportions. Calling it a hoax in front of your ardent supporters who believe everything you say, will only lead to more confusion and more deaths.

But this crisis also proves that it is high time those on social media sites like LinkedIn who are part of the health care industry, whether they are physicians, in the pharmaceutical industry, work in hospitals, are device manufacturers, or are consultants and researchers, accept the fact that single payer, universal health care (Medicare for All) is not just an economic necessity, but a public health necessity as well.

Is your big, fat five or six figure incomes more important than human health? It’s your call.

Universal Health Care in Reach? Not So Fast

The magazine, The Economist, published a ten-page special report in their April 28th edition on universal health care worldwide.

The report, which one social media commenter said was a perfect example of title and context differentiation, and gave no data or reason why health care was closer to being universal, is an example of a neoliberal publication going out on a limb with an issue vital to all human beings, and giving it short-shrift.

Throughout the report, The Economist mentions the World Bank and the World Health Organization (WHO), as well as the Gates Foundation as international organizations involved with public health in developing countries. The report contains statistics on the percentage of people in certain countries who do not have insurance, and other statistics to paint a bleak picture of health care in developing countries.

What the report fails to do is mention that it is exactly the World Bank, the IMF, international financial organizations, philanthropies like the Gates and other foundations, and the WHO, that have been responsible for preventing these countries from improving their health care systems.

Chapter Nine of the Waitzkin, et al., book previously reviewed in this blog, discusses in detail how these institutions influenced health care around the world for the benefit of multinational corporations in the developed world, and to the detriment of the health care in the Global South.

In particular, the WHO, which began in 1948 as a sub-organization of the United Nations, lost considerable funding due to ideological opposition to several programs operated by sub-organizations of the UN, and because the Reagan administration withheld annual dues. The UN began experiencing increasing budgetary shortfalls, which was passed onto organizations like the WHO.

But to the rescue, came the World Bank, and with this influx of private funds, the agenda of WHO changed to match that of the World Bank, international financial institutions and trade agreements. It was in the interest of these entities that health care be carried out in a vertical, top-down approach that left out key parts of the health care services needed in developing countries, namely surgery and concentrated on addressing infectious diseases like AIDS, malaria, and tuberculosis.

But there is another reason why public health in developing countries is in such a dismal state, and it has to do with the debt crisis these nations and others were subjected to by the nations of the Global North and the World Bank, IMF and international financial institutions.

According to the blog, One.org, “Developing countries spent years repaying billions of dollars in loans, many of which had been accumulated during the Cold War under corrupt regimes. Years later, these debts became a serious barrier to poverty reduction and economic development in many poor countries. Governments began taking on new loans to repay old ones and many countries ended up spending more each year to service debt payments than they did on health and education combined.

After many years of activism on the part of advocates for the poor and other activists, the nations of the Global North, through such organizations as the G8, the IMF and World Bank, decide to abolish debts worth billions of dollars owed by developing countries. Yet, despite this action, data in the World Bank’s global development finance 2012 report shows total external debt stocks owed by developing countries increased by $437 billion over 12 months to stand at $4 trillion at the end of 2010, the latest period of available data, according to the Guardian.

Third world debt was a serious issue when I was in college studying international relations and foreign policy, and I was aware of the efforts to reduce or eliminate this debt, so when I read in The Economist that the World Bank and WHO are engaged in public health issues around the world, I have to ask myself how is it possible that the very institutions responsible for the state of affairs experienced in developing countries as pertains to health care, are the very same institutions undoing the wreckage they created. Or at least not in ways that are advantageous to the citizens of those countries.

Instead of the vertical, top-down orientation these institutions are engaged in, a broad, horizontal orientation needs to be implemented that will radically alter the health care systems of these countries and provide all of their people with truly universal health care.

Lastly, The Economist looks at the US, and rightly points to our stubborn adherence to individualism and even quotes Republican congressman, Jason Chaffetz, who said, “Americans have choices.And they’ve got to make a choice. And so maybe, rather than getting that new iPhone that they just love, and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”

Many Republicans, like Rep. Chaffetz, says The Economist, believe health care is not a right but something people choose to buy (or not) in a marketplace.  I can tell you, dear readers, I did not choose to have End-Stage Renal Disease, nor did I choose to be long-term unemployed (that is due to neoliberal economic policies and to the financial meltdown caused by the very institutions that have a negative impact on universal health care), so Rep. Chaffetz and his Republican colleagues are wrong. And besides, you can’t buy health, as we all get sick and we all die. What you buy is a policy, but policies are not the same as care.

One other reason The Economist cites for the US being an outlier in providing universal care is resistance to reform by powerful interest groups.

I don’t believe this report did anything to move the debate forward towards universal health care, either here in the US, or around the world. It really did not cover any new ground, and its prediction for health care universally achieved is either wishful thinking or a delusion. Either way, until the economic order changes, nothing in health care will.