A Bipartisan Catastrophe

And yet this isn’t the whole story. The breathtaking failure of the wealthiest, most technologically advanced empire in human history to deal with this pandemic is the result of a perfect storm of decades of bipartisan decision-making.

Perhaps the clearest factor is the continued lack of any form of universal health care in the United States. Opposition to this essential reform has been the official position of the leadership of both major parties since at least 2016. With anywhere between 25 and 54 percent of Americans delaying their search for health care for fear of what it would cost, the reluctance of countless people to get tested or treated certainly assisted the spread of the virus.

Those that did seek testing or treatment suffered the consequences, hit with thousands of dollars in medical bills — nearly $35,000 for one woman. This problem has only gotten worse since millions began losing their employer-provided insurance due to the dizzying number of job losses that accompanied weeks of lockdown.

But universal coverage is only part of the sorry picture. The US for-profit health care “system” has brought about a spate of closures of hospitals that had ceased being profitable, including at least thirty that went bankrupt in 2019. Things have been particularly severe in rural areas, with 120 rural hospitals closing over the last decade, reaching a high with nineteen closures last year.

Not only do such closures push patients to seek treatment outside of their insurance network, meaning more sky-high medical bills. For some people, particularly in isolated rural areas, it leaves them with nowhere to go in the middle of a pandemic.

Public Squalor

These closures aren’t just the product of a system built around profit. Rural hospital closures have been happening at a steady tick since the 1980s, when Ronald Reagan’s savage cuts to Medicaid and other public health programs led to hundreds of hospital closures, both urban and rural, by the end of the decade.

This pattern continued through the 1990s, fueled in part by the Medicare cuts in Bill Clinton’s Balanced Budget Act, and has kept going to this day because US lawmakers have continued to hack away at entitlement programs.

Washington’s war on government spending hamstrung the response in other ways. Tea Party Republicans rejected the Obama administration’s 2010 request to refill the federal stockpile of medical equipment that had been used up by swine flu. The automatic, across-the-board “sequestration” cuts that were cooked up in the administration’s budget negotiations further cut funding for disaster preparedness.

Although the Affordable Care Act put $15 billion into the Prevention and Public Health Fund, a 2012 deficit reduction package cut this by more than a third, the first of a number of cuts to come for the fund.

Obama was by no means innocent in this. It was his White House that had dreamt up sequestration in the first place, as a crude way to force tough budget-cutting decisions, and Obama personally approved it. And in 2013, he took nearly half of the $1 billion allocated to the fund that year and diverted it to the federal health insurance exchange, the confusing boondoggle meant to give consumers the joyous experience of spending hours making the wrong choice out of a dozen different insurance options.

Overall, Obama presided over a significant reduction in public health spending: while it had gone up as a share of overall health spending from 1.36 to 3.18 percent between 1960 and 2002, by 2014, it had dropped to 2.65 percent.

It’s Called Outsourcing, Larry

Decades of neoliberal trade policy have left the United States incapable of a wartime response to this equipment shortage. Its manufacturing base has been hollowed out and shifted overseas. The Trump administration now finds itself scrambling to import medical equipment instead, at a time when sixty-eight countries are restricting exports of medicine and personal protective equipment (PPE), including China.

Of total US imports of antibiotics, PPE, and medical devices, China is responsible for 35, 30, and 8.6 percent, respectively, including 42 percent of face shields, 45 percent of protective garments, and 70 percent of mouth-nose-protection equipment.

“Why can’t the greatest economy in the history of the world produce swabs, face masks and ventilators in adequate supply?” Larry Summers, Obama’s chief economist, asked on Twitter. As furious Twitter users pointed out to him, he only needed to consult his own words at a 2011 business conference: “We should not oppose offshoring or outsourcing.”

Corporate concentration played a role, too. The government had inked a deal in 2009 with the small California-based manufacturer Newport Medical Instruments to make thousands of affordable ventilators, for around $7,000 less than their typical cost. The plan was foiled when the fittingly named Covidien, a much larger manufacturer, bought Newport and five other medical device companies, as part of a trend sweeping the industry at the time.

After first demanding more public money for the project and a higher sale price, Covidien canceled the contract altogether two years later, without having produced a single ventilator. According to the New York Times, rival executives suspected the whole affair had been a move to stop Newport from undercutting Covidien’s own ventilator sales.

Cruel and Unusual Punishment

Meanwhile, the festering income and wealth inequality that the US political class has either permitted or actively worked to widen has worsened the spread and impact of the virus, particularly among people of color. African Americans have accounted for a staggering 70 and 81 percent of coronavirus deaths in Chicago and Milwaukee, respectively, and their contribution to the death toll far outpaces their share of the population in states in every region of the country.

Circumstances born of historical and existing injustices have conspired to produce these grisly numbers. Virtually every aspect of being black in America has made African Americans uniquely exposed to this pandemic: they tend to live in densely populated cities, have higher rates of chronic health problems, disproportionately rely on public transport, and often work in jobs that are especially at-risk for spreading the virus.

And decades of draconian anti-drug-and-crime laws also mean they’re overrepresented in prisons. With their cramped, unsanitary conditions and a population containing many older and less healthy inmates, jails are like a primordial soup for sickness. We’ve already seen this in Rikers Island prison, whose estimated infection rate of 9.29 percent is nearly six times the rate in New York City, and which is fast becoming the epicenter of the whole crisis.

Horrifying in its own right, this situation is also a ticking time bomb for wider public health: not only might it put further strain on the wheezing US health infrastructure, but the virus can be spread to the outside community through staff, visitors, and prison transfers and releases. With millions belonging to what is still the world’s largest prison population, the US carceral system could well become one more calamity to add to the growing swirl of debris that surrounds this virus.

Centers of Infection

While the pandemic has had some positive effects on the criminal justice system, leading to early releases, fewer arrests, and delayed trials, this approach has not been applied across the board by any stretch of the imagination. In many parts of the United States, even as the pandemic crescendos, you can still be arrested for a petty crime and placed for more than twenty-four hours in a holding cell with a dozen other people, as happened to one woman in New York arrested, grotesquely, for allegedly not following social distancing rules.

There’s little doubt these practices helped the virus spread in the first place. In some cases, officials are choosing to actually worsen the crisis by moving in the opposite direction on criminal justice. This includes Democratic media darling and New York governor Andrew Cuomo, who rolled back the bail reform that was enacted in his state last year.

All of these concerns apply equally to the inhumane, overcrowded immigrant detention centers, another product of Washington’s storied history of bipartisanship. Already, four migrant children have tested positive for COVID-19, and conditions are so dangerous, detainees are actually pleading and hunger-striking to be deported. If immigrant detention centers become the new hotbeds of coronavirus infection, you can thank the aggressive campaign of mass arrests and overcrowded immigration hearings that continued well into March 2020.

Quarantine for Those Who Can Afford It

As the virus spreads, it is the massive and growing US underclass of the poor and the just-barely-getting-by that are bearing the brunt of its effects. Every factor that has made African Americans particularly vulnerable applies to the poor more generally, including lack of access to health care — unsurprising, given the racialized nature of poverty in the United States.

Already data from New York and Michigan suggests that, as in the rest of the world, it’s the poorest neighborhoods that are being the hardest hit. This is a moral atrocity that will also make the task of containing the pandemic harder.

US economic inequality, primitive guarantees for workers’ rights, and a vanishing welfare safety net mean that staying quarantined or locked down was never an option for millions of Americans. Sixty percent of Americans don’t have the savings to cover an unexpected $1,000 expense, and nearly 40 percent can’t even cover a $400 one. By mid-March, thirty-three million didn’t have paid sick leave, a right overwhelmingly reserved for the country’s top earners.

Unable to claim unemployment benefits if they quit, and with welfare decimated in the wake of Democratic “welfare reform,” low-wage workers are locked into defying stay-at-home orders and venturing out to work, often using public transport. Phone location data analyzed by the New York Times reveals those who are most likely to stay at home are those with the means to do so.

A Failed State

The better-off might be spared for now, but that should be little comfort to them. It is these low-wage workers who do the vital work they rely on to stay quarantined, from picking fruit and packing meat, to transporting products, manning grocery stores, and delivering items to their doors. This means that an outbreak can only stay confined to the poor for a finite period of time, as it will disrupt vital supply chains that are needed to keep people safe at home.

Strategies to prevent this from happening, such as sick leave and workplace measures to protect workers from infection, could and should have been in place from the beginning. Instead, decades of attacks on union rights have meant that American workers were forced to come to work sick for fear of retaliation. They’ve had to fight tooth and nail for what should be common sense.

As we’ve seen in countries like India, it’s the people on the margins who are most likely to relocate in the midst of a lockdown, potentially spreading the virus to communities well beyond the places where infections were originally concentrated. America’s antiquated state bureaucracy makes that outcome more likely. Millions of people who don’t have direct deposit information logged with the IRS will have to wait months to receive their paltry, onetime $1,200 check.

State unemployment agencies are buckling under the weight of unprecedented numbers of applicants, their websites crashing while people make hundreds, even thousands, of calls to get through. This is a far cry from countries like Germany, where getting state help is a matter of filling out a short form and waiting a few days for money to appear in your account.

If you had consciously tried to engineer a massive public health disaster, you couldn’t hope to match the ways in which the whole American system has been calibrated to transform this crisis into a catastrophe. Decades of racist, anti-worker, and plutocratic government policy has created the ideal conditions for a pandemic to turn the United States into a failed state.

In order to resolve this crisis, and future ones like it, extra resources and fiery rhetoric about “waging war” on the virus won’t be sufficient. It will require us to completely overhaul the unequal structure of American society.