Death by Austerity

Nobody can blame the outbreak of a never-before-seen super-contagious virus raging all over the world on politicians. Few nations were adequately prepared for this contagion. You can blame political leaders for preparedness and response, however. The last great outbreak that overwhelmed healthcare systems was hardly the SARS epidemic of 2003; only 8,000 people worldwide contract that disease. Or the H1N1 outbreak in 2009. Ebola in 2014. That last truly overwhelming pandemic dates back to 1918-20 when the so-called Spanish Flu wreaked havoc that the world has not seen since the Bubonic Plague.

The Spanish Flu may also have had its roots in China, but no one is really sure. “From January 1918 to December 1920, a deadly influenza outbreak infected 500 million people across the world. Estimates suggest between 50 and 100 million people died from the virus, in other words, up to 5% of the planet’s population. It killed more people than any other illness in recorded history, more even than the total number of deaths in WWI.” RareHistoricalPhotos.com (which also presented the above picture of a treatment center). Clearly, medical care was not remotely up to the quality we have today, so the casualties were simply not provided with care that would have kept a lot of the fatalities from happening. Unlike COVID-19, which targets the elderly, the Spanish Flu targeted the immune systems of younger people.

“In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 675,000 died (0.48 to 0.64 percent of the population). Native American tribes were particularly hard hit. In the Four Corners area, there were 3,293 registered deaths among Native Americans. Entire Inuit and Alaskan Native village communities died in Alaska.” Wikipedia. Nobody had universal healthcare in that post-World War I era; it wasn’t even a political issue then. But there is no question that if such systems had been in place, the survival rate would have been much higher. Whether to have universal health care is a decision that has been faced by every developed nation in the world, starting primarily in the 1960s, with a resounding “yes” in every such country… except the United States.

Access to healthcare in this country has split heavily along party lines. Democrats think it should be a right; Republicans believe that healthcare should be an individual right without government imposition. Funny if you polled GOP elected officials, if they could do it, they just might approve a Medicare for all bill… that would only cover COVID-19. Donald Trump promised a better and less expensive healthcare plan that the Obama-era Affordable Care Act, but no plan emerged, and the Trump administration joined 20 GOP-dominated states in litigation aimed at killing the Affordable Care once and for all.

The 2018 mid-terms suggested that healthcare was going to be the ultimate political focus from then on. And that was before the dramatic mishandling, the utter politicization, of this coronavirus outbreak by the Trump administration. Healthcare is skyrocketing to the fore in this election time, and oddly, for those who correctly remind us that “It’s the economy, stupid,” the desire to live seems to rise above economic mandates when the threat levels are high enough… oh, and the economy is tanking over this healthcare issue too. We seem to be narrowing the issues to “what kind of universal healthcare” and “when.” Not whether we should have it.

But tax cuts have been the delight of conservatives all over the United States. They’ve even embraced critically disproven “trickledown economics” to justify slashing taxes for the rich. Not one of those policies produced a measurable trickle down to the rest of us, but they sure helped widen the wealth gap and sear economic inequality as the “New America,” where upward social mobility has now been rendered to the history books. Simple and obvious statement: if you do not prepare for something, if you reallocate resources away from necessary preparation, when the horribles you ignored actually happen – and they always do – the damage is so much greater… and generally those on the lower rungs of the economic ladder pay the biggest price.

We know the federal government was not and is still not prepared to deal with the COVID-19 crisis. As my March 12^th Fix the Coronavirus Crisis with a Tax Cut? blog points out, we went from weeks of “it’s a hoax” and “the Democrats are blowing it out of proportion,” to shutting down travel between the United States and the European Union. Test kits have still not found their way to the necessary dispensaries, the time to analyze the tests is way too long, and the President and his CDC experts are still contradicting themselves in public. Trump had cut the CDC budget by 16% and disbanded their pandemic group early in his administration as well. Saved a couple of bucks. Then. Does the burden fall therefore fall on the states?

Unfortunately, austerity programs even at the state level have taken their toll. Most states are woefully unprepared, but those with solid GOP legislatures and governors are the worst prepared in the land. Noam N. Levey and Jenny Jarvie, writing for the March 12^th Los Angeles Times, bring us up to speed on that aspect of our healthcare system: “Nationwide, spending on public health varies dramatically between those states and local governments that have invested and others that have allowed public health departments to wither in recent years.

“In Florida, for example, where a large population of seniors makes the state particularly vulnerable to the coronavirus, state funding for county health departments is below what it was a decade ago… The cuts have forced some counties to shutter clinics, threatening to worsen the state’s problems with access to healthcare, said Anne Swerlick, senior health policy analyst at the nonprofit Florida Policy Institute. ‘There used to be a lot more capacity to provide more primary care services,’ she said.

“California, too, has seen a steady erosion in public health investment, forcing counties to cut epidemiologists, public health nurses, lab technicians and others, said Michelle Gibbons, executive director of the County Health Executives Assn. of California… ‘One of the challenges is that there is a lot of investigation that’s needed right now, and that puts a huge strain on existing staffing,’ she said…

“In addition to the variations in the public health systems, there are huge disparities between states in insurance coverage, as many conservative-leaning states restrict access to the Medicaid safety net. That leaves several million low-income Americans without health insurance, a major hurdle during an infectious-disease outbreak…

“For example, Washington state and King County, which includes Seattle, have long been considered national models, but the scope of the outbreak there, the most severe in the nation, is seriously straining local leadership and resources.

“‘When you see such a potential onslaught of virus in your community, it’s quite overwhelming,’ said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. ‘The problem is we’re going to very likely have a number of King Counties emerge over the days ahead, all at the same time.’

“As troubling, Washington state has additional advantages that other states do not, including strong insurance coverage… The state took full advantage of the 2010 Affordable Care Act and has expanded Medicaid eligibility to low-income adults. Just 9% of working-age adults in the state lacked coverage in 2017, according to federal data analyzed by the nonprofit Commonwealth Fund.

“In California, 10% of working-age adults lack coverage, down from nearly a quarter before the healthcare law was enacted. That reduction has not only improved access to care for millions of Californians, but also allowed a historic expansion of medical services across the state.

“But 14 states — all with Republican governors or legislatures hostile to the healthcare law — have not expanded Medicaid… These include several large states such as Texas, where nearly a quarter of working-age adults lack insurance, and Florida, where 21% of these adults are uninsured… The huge coverage gaps worry many health advocates… ‘We know that people will avoid care,’ said Jodi Ray, project director for Florida Covering Kids & Families, which has worked to expand coverage in the state.

“Exacerbating the challenge are wide variations in workers’ access to paid time off, which is considered increasingly critical as public health authorities nationwide work to slow the spread of the virus… Nationwide, 55% of workers had access last year to paid time off, according to a 2020 state-by-state tally by the Trust for America’s Health… But while about 64% of workers in Connecticut and 68% of workers in Texas had paid time off, only 44% of workers had such benefits in South Dakota and 45% in Arkansas, South Carolina and Utah. In California, 56% of workers have the benefit.”

For the bulk of Republicans surveyed, who believe that the coronavirus is hugely exaggerated, there is some truth in that view. Fear is what is causing most of the damage now. But the erratic behavior of the President himself just might be the reason the fear factor is so high. In short, even if fear is currently overblown, you still have risks everywhere, exacerbated by crowding in larger cities. Few actually trust the federal government to tell the truth after Trump’s politization of a medical issue. But if you actually need treatment and are left to the vagaries of local state healthcare options, if you live in a truly red state, you are… er… screwed. Will this reality settle on the always-Trumpers who fit that description but have a terrible habit of being manipulated to vote against their own best interests? Will it take a devastating disease to turn that tide… or is even that enough? How about the recession that has already begun?

            I’m Peter Dekom, and why is the obvious so elusive?