Quick: What’s the biggest debate happening right now that touches on pharmaceutical greed and the US health care system?

There’s a good chance you said vaccines, their efficacy, and whether we should be made to get them. For the past few years, the blue-red food fight that for many constitutes US politics has often been centered on vaccines and whether or not one “believes” enough in science to voluntarily get the jab — or to support mandates for others. Look at the way that Florida governor Ron DeSantis catapulted to prominence in Republican politics by rolling back the “medical authoritarianism” of pandemic mandates while surrounding himself with anti-vaccine cranks.

Meanwhile, President Joe Biden’s stiffest primary challenge has so far come from a longtime anti-vaccine Kennedy family member who points to the past few years of immunization policy as a nefarious product of pharmaceutical greed. The past few weeks alone have been dominated, ironically, by debate about the effectiveness of debate in responding to anti-vaccine commentators who share Kennedy’s sentiments, who have grown in prominence in recent years.

The core argument of these figures can be summarized like this: the danger of the coronavirus pandemic was overblown, and the vaccines that were produced were ineffective to combat it, if not outright dangerous for the alleged secondary side effects they carry. The panic over COVID-19, the rapid development of the vaccine and massive government purchases of doses to combat it, the society-wide push to get vaccinated, the implementation of mandates to nudge those less willing into doing so — all of it was driven by Big Pharma as part of its insatiable hunger for profits, working with notoriously corrupt government institutions.

Stop and think about it for a few seconds, and you’ll marvel at just how remarkable a sleight of hand this has been. You don’t have to think back very far to recall that the worst, most greed-inflected COVID-related injustice wasn’t the fact that people got vaccinated against a deadly illness, but that billions who needed to couldn’t.

For nearly two years, wealthy Western governments, including that of the United States, dragged their feet on approving a patent waiver that would have allowed cheaper, generic versions of vaccines, therapeutics, and tests to be developed locally by countries that couldn’t afford to buy up enormous quantities of the stuff. Big Pharma companies fought fiercely against the waiver, preferring that fewer of the world’s people get immunized against or cheaply treated for the virus if it meant bigger profits for themselves. They ultimately got their way, with a substantially watered-down version of the waiver approved last year.

In this effort, pharmaceutical companies were joined by billionaire Bill Gates, cast by the Right as one of the big villains of the pandemic. Gates does deserve this label — but not, as Kennedy and others might argue, because he foisted vaccines on the rest of us, but because he did the opposite. The influential and absurdly wealthy Gates was one of the leading voices against the waiver even as the virus spread and wreaked havoc through the poorest parts of the world. Once again, it would be surprising if financial incentives didn’t play at least some role, since Gates’s wealth is partly based on rigid intellectual property (IP) protections.

But this goes beyond IP. Until recently, the federal government’s mass buy-up of COVID vaccines, tests, and treatments had been core to US efforts to combat the pandemic, guaranteeing that cost and insurance status weren’t barriers for anyone to get medical help for an infection, and ensuring that American society’s most vulnerable — and those who might be hit hardest by the virus — would be protected.

Then late last year, just as today’s right-wing vaccine skeptics demanded, the Biden administration announced that it would privatize the US pandemic response. As a result, the price of the Moderna and Pfizer vaccines shot up more than fourfold, a devastating financial barrier for the millions of uninsured Americans whose ranks are set to swell by fifteen million by the end of this month, thanks to the COVID emergency declaration’s end — spelling the end of Medicaid expansion, another result of Biden bowing to COVID skeptics. (The end of that emergency also meant the end of a federal provision letting state Medicaid programs cover vaccine-related costs). We’ve already gotten a taste of the chaos that this pandemic privatization has meant for the uninsured, who have been unwittingly charged hundreds, even thousands of dollars for tests.

Though the administration put forth a $1.1 billion bridge program on vaccines, its modest size coupled with the failure to create a more permanent vaccine safety-net program for adults means that it won’t be enough to cover the shortfall. The insured, meanwhile, can look forward to higher premiums as a result, or even paying this full, exorbitant cost if they go out of network.

It’s astounding that in the face of all this, the Right — long hostile to a publicly funded and controlled health system — has somehow been able to make the idea of the corporate health care system conspiring with politicians to make it harder to get treatment for the pandemic a virtue, instead of the scandal that it is.

The pandemic should’ve provided a leg up to efforts to expand the United States’s patchy public health system. Americans were instead given a brief taste of what a sensical health care system could look like, only to have it ripped away for the sake of private profits and government penny-pinching that’s never applied to the Pentagon — and for billions of others around the world who were denied the most basic bit of COVID protection in the form of vaccines, thanks to pharmaceutical greed.

That’s the real scandal of the pandemic. And the fact that the public health debate has lurched like it has to the preferred terrain of vaccine skeptics more or less ensures for the foreseeable future that we’ll only be talking about what other forms of health care big business and neoliberal politicians can deprive you of next.