Jacobin - March 20, 2020

Medicare for All would not have saved us from this disaster, but it would’ve softened the blow. The global public health crisis ushered in by the COVID-19 pandemic reminds us that single payer is a vital necessity but not a magical solution to our health care problems.

COVID-19 has revealed the long-standing fragmentation of our public health infrastructure. It has also confirmed how much of it, beyond direct clinical care, is controlled by the private sector (no coincidence Trump had corporate executives at the helm of this week’s Coronavirus Task Force press conference). Calls to reform and rebuild our public health infrastructure and liberate it from the shackles of capitalism need to be as resounding now as calls for Medicare for All.

As opposed to clinical care which centers treatment in the singular clinician-patient interaction, public health focuses on prevention and tracking of disease and provision of care in a broader sense. We should seize that difference. In the throes of this pandemic, usual protocols of care can become quickly obsolete, and this uncertainty opens up the opportunity to reexamine the undergirding (data, hospitals, health care providers, safety nets, housing) that make population health possible and in many cases, impossible.

When Biden cynically invoked Italy’s predicament (having lost three thousand lives, “despite” single payer), he was asking voters to pause on a health care revolution because now was the time to deal with “the crisis,” not worry about structures he claims take longer to reform. Never mind that Italy spends $8,000 USD less per capita on health than the United States yet outranks it in life expectancy and almost every measure of health care quality, affordability, and equity, Biden’s remarks ignore what the current crisis reveals: systems and structures either do not exist or are in crisis and can’t simply be resurrected or mobilized at a moment’s notice.

Our public health system is uncoordinated, if not chaotic. Disease surveillance is disjointed at every level of government: local, city, state, and federal.

Take our data architecture. Why, in the age of “big data,” do we not have access to data unified across private and public payers, readily enabling epidemiologists the opportunity to study emergent patterns of infectious and chronic disease and identify risk factors disaggregated by important parameters like age, race, sex, employment, and geographic location? Aside from publicly available data from the Centers for Disease Control and Prevention (CDC) and other government agencies and data from the Centers for Medicare and Medicaid Services (CMS) — Medicare and Medicaid claims data are also costly for researchers — the vast majority of our health care claims data are now owned by private corporations.

It’s a multibillion-dollar industry that trades in our sickness and health. This data needs to be nationalized and protected. We need it, across the board, to forecast, understand, and mitigate the adverse effects of a public health crisis.

But this is a pandemic. What must be done now? COVID-19 has been a masterclass in emergency unpreparedness revealing little cross-training or capacity-building at hospitals, now holding on to their last masks, with ventilator scarcity and ICU bed rationing. Emergency room physicians, nurses, and technicians are frontline providers and there simply isn’t enough of them to safely manage this situation.

We’ve long known there was a shortage of ER and primary care physicians in this country, as medical school students (often burdened by medical debt) have been disincentivized into entering these comparatively lower-wage specialties. Advocacy movements like Beyond Flexner and the Campaign Against Racism have been at the forefront of demanding changes that address these political determinants that ultimately limit access to care for already at-risk communities. We need to support their efforts now.

Testing must be our first emergency demand. Public health prioritizes access and effective systems of delivery. If and when the COVID-19 test is approved by the Food and Drug Administration, there need to be guarantees to ensure tests will make it to those who need it most. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is right: unlike South Korea, we do not have a cohesive structure in place to implement broad-based testing. ...
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