On Contact: Covid-19 & America’s health care crisis

CH: President-elect Joe Biden has promised to prioritize the nation's response to the COVID-19 pandemic in his new administration but at the same time he has said he would veto any proposal to create a system of universal and free national healthcare.  The problem we face many medical experts say is that our for-profit driven healthcare system is not designed to handle a pandemic which single-payer advocates have long warned.  The United States does not invest sufficient resources in public health, there is no national coordination, the complex and multi-faceted system is impossible to coordinate because the private corporations do not cooperate, they compete.  The American healthcare system is not built to provide health services to the public but to make money.  Healthcare services and hospital beds have been reduced and in many communities eliminated through consolidation and mergers to maximize revenue.  States and hospitals compete to purchase basic supplies leading manufacturers to jack up prices, the United States rather than import the German manufactured tests approved by the WHO, to test for the virus chose to make its own test kits delaying the ability to begin to locate and track the spread of COVID-19.  Those without health insurance or those unable to pay the high premiums charged by insurance companies often do not get tested or even treated.  The mercenary nature of the for-profit healthcare system also means that many Americans are distrustful of health guidelines and refuse to follow them.  These Americans are at the same time unlikely to get a vaccine when one becomes available, joining me to discuss the nature of our profit driven healthcare system and why even in a Biden administration it is ill-equipped to cope with our national health crisis is Dr. Margaret Flowers.  So Margaret, I have an article you wrote earlier, I'm just going to let you begin Norwegian University of Science and Technology, what it said to its own students.

MF: Well, basically at the beginning of the pandemic around the same time that it was taking off here, they asked their students who were abroad to come back home particularly if they lived in countries with poor health infrastructure and they singled out the United States as an example of that.

CH: And yet we pay more for health services than I think any other industrialized country, is that correct?

MF: Far more.  We spend twice as much per person per year on healthcare as the average wealthy nation, the average nation that's in the organization for economic and cooperation, cooperation and development.

CH: And where does the money go?

MH: Well, about a third of our healthcare dollars actually just goes into paperwork.  We have, you know, thousands of different health insurance plans, we have private hospitals, public hospitals, all these different sets of rules, we have administrators that have to sell the plans and then people that have to decide you know where can you get your care and then how much do you pay.  So all of that interface eats up about a third of our healthcare dollars and then our prices are extremely high because we don't have any system for, you know, determining what the prices of goods and services should be in our healthcare system, it's a completely open, you know, extortionist type of market.

CH: When President Trump announced a few months ago that COVID-19 would be covered without requiring co-pays, the insurance companies reacted immediately by saying that this would only apply to testing not to treatment.  You saw this idea that which President Trump pushed that chloroquine might be used and since been discredited as a treatment and the response of rising pharmaceuticals was to raise the price of the drug by nearly a hundred--a hundred percent.  So even in the midst of the pandemic, you're watching these healthcare corporations which are making record profits, use the pandemic to increase their revenues.

MF: Oh, absolutely.  And so, you know, as you said and especially since the Affordable Care Act was passed in 2010, the profits of the health insurance corporations, the pharmaceutical corporations have just skyrocketed and in fact private health insurance corporations are receiving hundreds of billions of dollars a year in subsidies from the federal government and they're taking over our public insurances, Medicaid and Medicare.  So now for many of them, over half of their revenue comes from the government but they're still for-profit corporations and so they can't be operating for the public good because they have to perform for their stockholders.  So if there's any opportunity to raise prices to, you know, to gouge people, to play people off of each other, that's what's best for their shareholders.  They just aren't capable of acting in the public good.

CH: And you've made the point that in fact over the last few decades in order to increase revenue, they've actually disemboweled much of the healthcare system, the United States, this is from an article you wrote ranks 175th out of 195 countries for access to healthcare since 1975 while the US population has risen from 216 million people to 331 million.  The total number of hospital beds has declined from 1.5 million to 925,000.  So it's not just that they're making money, it's that they've carried out an assault against the healthcare system further weakening it, and making it far more difficult to deal with a national health emergency.  Can you talk about what that assault consisted of?

MF: Right.  Well you have to, again, understand that these corporations are there to make money.  So if they're operating a hospital and that hospital is not making money for them, they'll just loot it as much as they can and let it go bankrupt.   We see this over and over, we see hospitals particularly in rural parts of the country or in parts of cities where there are low, you know, people that--impoverished people, they end up--those health systems getting turned over many times to different private corporations as they just kind of come in and use them as money-making ventures, again, not really caring about whether they're providing services for those populations in fact we're seeing a lot of hospitals that are even shutting down their essential services and just so they can focus on the money-making services like orthopedics and cardiovascular.  So this is, you know, again it's a model--there's no, like national coordination, there's no way of saying like these are the parts of the country that don't have hospitals or clinics and we need to build them there and make sure they're open.  No, a hospital will close in a poor community and move 30 miles away to a wealthier community just so that they can make money.

CH: And so this, as you point out, is disproportionately hit rural residents and people who live in impoverished urban areas, is that correct?

MF: Right.  Areas where we're seeing gentrification.  So this is, you know, and a lot of long-standing hospitals, ones that have served Black communities, you know, for over a hundred years in Philadelphia, New York, in Los Angeles, as these you know communities start to get gentrified those buildings are much more profitable as luxury condominiums or a retail space than they are as a hospital.  And so, you know, we're seeing cities in some cases try to fight to stop that but, you know, developers have a lot of control in our cities.

CH: And the numbers of potential closures, a hundred and twenty rural hospitals have closed since 2010.  Report that you quote "Found that another 453 of the 1844 that remain are at risk of closing."

MF: Well we've done--not done anything to actually stop the trend that we see and so, you know, these rural hospitals often are in communities that have a lot of health problems, they may not--particularly we're seeing it happen in the States, along the South, that refused to expand Medicaid under the Affordable Care Act.  And so they have a patient population that is poor, that needs a lot of care, and can't pay for it, and there's no safety net for these hospitals to make sure that they stay open, and they are just kind of prime for these, you know, corporations to come from out of state often and buy up these hospitals and then run them into the ground.

CH: So what is this type of infrastructure, how has it exacerbated the pandemic?  We have figures and estimates of 300,000 potentially American dead from the pandemic by December, 400,000 by January, and I think there was a new study that estimated 500,000 in February.  One in your opinion as a doctor have we lost control of the pandemic and number two within this for-profit driven healthcare system, is it possible that we can regain control?

MF: Right, I think it is fair to say that, you know, we have lost control of the virus and that our healthcare system has left us completely unprepared not you know just in the lack of infrastructure but the lack of national coordination, the fact that states are--and even counties within states are given the flexibility to do what they want to do.  And so you're seeing this as instead of focusing on public health and, you know, what should--what measures should actually be taken it's become an ideological battle where you see you know counties and states that are refusing to put in place strong public health measures and so this lack of coordination, the virus doesn't know the difference between one county and the next or one state and the next, and people do travel and so there's no real control to contain it, our public health system has been really decimated and even trying to, you know, hire more people and train them, you know, which is not something you want to be doing during a pandemic, ideally you do that before the pandemic, you know, has been inadequate.  So some states like Wisconsin are just kind of throwing up their hands and saying to people, oh, well if you test positive please call all the people you think you've been around and let them know, and then just this whole, you know, competition between the various states and different hospitals.  We have private hospitals and public hospitals, and they can't coordinate and they're all trying to buy the same supplies, and fighting over it, and using their connections to try to sneakily, you know, get what they can get, and then just not even taking care of our health professionals, some states are starting to warn like Ohio that they're not going to have enough health staff to provide care for the patients.  In countries like China and other places, they actually rotate their health staff in and out so they don't, you know, have to work for very long that lowers their burden of exposure to the virus, and then they're able to isolate them in between so they're not infecting other people or their family members.  These are the types of measures that other countries have taken, that our health system doesn't allow us to take and as long as it's based on profit, it won't allow us to take those steps.

CH: It was a huge issue in the election, many observers feel that if President Trump had handled the pandemic more astutely whether that was possible or not, I don't know under our system, he would've been re-elected.  Forty-one percent of the electorate said that the COVID-19 health crisis was the number one priority they voted for Biden three to one, what is your response to the reaction of the Biden transition team?  He is--he--President-elect Biden has certainly held it up as the number one issue certainly when he takes office.

MF: Well, I think, you know, he's trying to show people that he's doing something by bringing in these various experts to help advise him but at the bottom line his messaging is we're going to do our best to reopen schools and reopen businesses again, focusing on kind of the economy which has been a big problem under the Trump administration of, you know, pushing to reopen things too soon without putting in place the steps that we needed to take in order to make sure that people could get the healthcare that they need, that they were housed, that they wouldn't lose their houses, that they had financial security so that they didn't have to go out and work if that was a dangerous thing for them to do.  So, you know, none of these things were done and that's why, you know, we're in a situation where we just haven't been able to handle this but that's not what the conversation is about you don't hear Joe Biden saying, "Oh, let's do a universal basic income, you know, like Canada is doing, $2000 a month for every adult as long as the pandemic is going on."  You don't hear him saying let's, you know, quickly change to a national improved Medicare for all systems, something that we can do in this country, you know, instead he's putting forward a health proposal that's really nothing different not--substantially than what we have right now and is not going to get at the roots of the problems with our healthcare system.

CH: Great.  When we come back we'll continue our conversation about the US profit-driven healthcare system and the pandemic with Dr. Margaret Flowers.  Welcome back to On Contact.  We continue our conversation about the US for-profit healthcare system and the COVID-19 pandemic with Dr. Margaret Flowers.  So a lot of people have said, medical experts have said that if we had dealt with the pandemic early and quickly we could've gotten it under control.  What would that have taken?  What should we have done?

MF: Right.  And there are countries around the world including, you know, capitalist countries like Australia, New Zealand that have had much more success but particularly we see countries that have socialized healthcare systems like China, and Vietnam, and some Latin American countries that are doing much better than we are.  You know, if we had gotten the tests from the WHO, from the World Health Organization early and made those available and started testing anybody who was potentially infected, and then had a public cell--health structure in place that that person's contacts could be identified, that anybody who had come in contact could then be isolated, you know, in China they were even giving people hotel rooms to stay in so they wouldn't infect other family members when they realized that a lot of the spread was happening within families, of course, if that's who people are around when they're locked down that's who they're going to infect.  You know, if we had made sure that healthcare was free for people even if they had just said anything related you suspect that you have COVID-19 it's going to be free.  But of course the insurance companies as you said very quickly said, you know, no we wouldn't do that.  Well, maybe we'll offer some free tests but they aren't able to offer free care despite the vast profits that they make and the fact that their CEOs are making tens of millions of dollars.  So if we had put in place a structure so that--and also, I mean, another key feature, I guess, of these other countries is that they've used online applications so that people could get information and could notify the system but we don't have a system to notify, you know, so we can't really--we can't really do that in this country.  And plus people are so distrustful of the government here especially of giving information with the amount of, you know, surveillance that's going on and lack of privacy.  People just don't trust it.  So we just also didn't have the environment in this country, you know, to deal with it.

CH: You also have some states opening, some states closing.  You don't have a uniform policy.  And if there isn't a nationally coordinated policy is there any hope of containing the pandemic at all?

MF: No.  This is a time and you see countries around the world doing this and saying this.  This is a time for cooperation not just among the various states in the country to make sure that we're, you know, controlling this but also cooperation with the countries in our region.  And so now you see Canada has just basically said, no we don't want you here, you know, because you can't control it in your country and we're doing our best to do that.  There's no cooperation or collaboration.

CH: This second wave how do you see it playing out?  I think--was it the University of Washington who estimated 500,000 dead by February?  I mean these are really catastrophic figures both in terms of infections and death.  And the question is if and we don't have it under control if it--if it remains, you know, uncontrollable what happens?

MF: Right, well, you know, it continues to circulate in the population.  We do not know yet how long, you know, if somebody has COVID-19.  How long does their immunity last?  We do know that some people are not forming an immune response to it. And so, you know, are they more vulnerable?  We're starting to see around the world that people are being re-infected, you know, infected a second time.  And we know that viruses mutate so the more chances that it has to spread the more likely we're going to see mutations in the virus.  And it can mutate in either way, it can become more lethal or it can become less lethal.  But we are definitely now starting to see people who are getting infected a second time.  So without containment measures, without an effective vaccine we don't really have a way to control this.  And what's very sad about this is that the communities that are being disproportionately impacted are Black and Brown communities, and poor communities.  Communities that live in places where there's environmental degradation.  And so, you know, this is just having this--it's just kind of broadening the health disparities that we already have in this country.  And so this is a lunacy of thinking that you can reopen schools and reopen businesses.  This type of, you know, deaths and sickness, this is going to really hurt our economy significantly.  And we're in a recession that's likely to be very long and result in a depression because that's typical of what you see in a recession during a pandemic.  So I think we have, you know, very difficult years ahead.

CH: You have a bifurcation where the professional classes can often work from home and isolate themselves but frontline workers almost 50% of whom don't have sick pay or health insurance are forced to go out and work in the pandemic.

MF: Right.  And a lot of that, you know, is our young people.  I mean, look at what this is doing to our young people and how even the, you know, the colleges are not, you know, taking steps to take care of them to make sure, you know, a lot of young people had--were able to work through their universities and be able to support themselves during school.  That's not happening.  We're seeing a large proportion of students not returning to college because they need to try to find work to help support their families, yeah.

CH: It's been argued that the real policy of the Trump administration is what they call herd immunity.  Can you talk about that?

MF: Sure.  Well, herd immunity is the concept that once enough people in the population have immunity to an infectious agent that it's less likely to be spread.  Now that is typically a high percentage of people so 70%, 80% of people that have immunity.  And the best way to achieve that is to use a vaccine, I mean, that's why we have the various vaccines, measles, and mumps, and those kinds of things is to keep these diseases from spreading in the community.  What we're hearing though is people actually advancing the idea of allowing the virus to just run rampant until enough people have it and develop immunity and then it will slow down.  Well, that carries and we're seeing that in Sweden one country that decided to take that approach.  When you compare Sweden to the countries around it the number of cases, the numbers of deaths are multiple times higher than those other countries.  And this is a new virus, we still don't know the full impacts of it.  What we're starting to see is that even people with mild disease have long-term consequences as this virus is actually--it's less of what you think of as like a lung disease or pneumonia-type of virus.  It's actually an attack on the vascular system and so it's causing heart disease, liver disease, kidney disease, impacts on the brain and people's ability to function cognitively.  And so what does this mean for our children?  We're seeing a higher proportion of cases in children now at eleven percent where it was two percent earlier in the pandemic.  What is this going to mean for their development and their cognitive functioning going forward, we don't know.

CH: So let's talk about the Biden administration.  From what you've seen, from the measures that they plan to implement and of course their collaboration with the for-profit healthcare industry, what's your biggest concern?

MF: Well, what I see coming from the Biden administration is just nothing different really from what we have.  And it's interesting how he's pushing this idea of a public option.  And that was something that the Obama-Biden administration pushed in 2009 during the health reform process.  They said, "Oh we're going to create this public insurance and it's going to be less expensive and people will be able to have that."  And then what we found out as that process went on was that was a whole ruse to get people that supported public health insurance on board with their plan, but in reality when the Senate started to move in the direction of including it in their bill the White House whipped against the Senate and said "No, don't put that in there."  They wanted to make sure it wouldn't be in the final piece of legislation.  So is Joe Biden doing the same thing now?  We don't know, but even if he did develop a public option it doesn't change anything, it's just one more insurance, there's no way--there's no proof that it can lower costs of care, it has to compete with these other big insurance companies.  It has to market itself.  So we're just not--we're seeing again him using the same kind of language we saw in 2009, offering non-solutions and we don't have any trust that in the end that's what they're really going to do.  One other thing I see them doing which was done in 2009 is there's a lot of talk about abortion rights and reproductive healthcare rights.  And of course that's important, that's something that we need to have in this country.  But they did this with Women's Health in 2009.  It's a way to kind of--they put out a piece of legislation that's completely inadequate but they'll say, "Oh, but look how it's going to help this group."  And you can't get rid of it because, you know, we need to help this group.  And so, oh we'll throw all of the rest of the population under the bus but, you know, we can't sacrifice, you know, we have to do this because it's doing this one good thing.  So people fall for that and we're not, you know, we need to be demanding more.

CH: Well, you still have a significant part of the American population that are--that is uninsured.

MF: Well, and that's growing, I mean, through this recession as, you know, tens of millions of people have lost their jobs, we're seeing--we don't know yet I've seen a recent estimate of 14 million people losing their health insurance when you count the family members that were dependents.  What's that number going to be like at the end of the year?  What's next year going to be like?  We're not seeing any real steps by this Congress or even--or the Biden administration's rhetoric to actually put in the types of social supports that we need to build this economy from the bottom up.  70% of our economy is based on consumer spending and people are hurting right now because they just don't have money.  So I think we're going to continue to see millions of people becoming uninsured and even those who are insured as you know because of the high out of pocket costs are not, you know, are not able to afford the healthcare that they need.

CH: Do you think that given the nature and the structure of our healthcare system we can actually contain and push back against the pandemic?

MF: Not in the current structure but remember that the United States has a variety of different healthcare, you know, systems within it, so we have the Veterans Health Administration which is a completely socialized system the government owns and operates those hospitals.  We have Medicare, traditional Medicare which is public insurance, the public, you know, is paid for through public dollars but people can use any doctor.  If we just expanded on one of those systems and we could do that very quickly because every health professional in the country has a provider number with the government.  If we just got rid of the private insurance industry and move everything into the public realm then we would be able to have that level of coordination.  Short of that, you know, what we're talking about is a nationwide quarantine, you know, for weeks in order to try to stop the spread.  And again that requires social support so that people are able to do that and not lose their house or be able to have food and those kinds of things.  It takes that kind of massive coordination to stop the spread of the virus, but with all the various states and counties and there, you know, the way this has been made in an ideological situation I'm not sure that's possible.

CH: Great.  Thank you, that was Dr. Margaret Flowers head of Popular Resistance and public health advocate on the COVID-19 crisis.