Tag Archives: health policy

Some Lessons Learned from the Pandemic

In listening to another press briefing by New York’s Governor Andrew Cuomo, I have noticed that he has consistently emphasized that much of what is being experienced, and governments’ responses, has never been faced in modern times. His related point is that if we want to avoid repeating the results of the past few months, we must learn from these experiences and change the way we do things going forward. We should not, he argues, just seek to restore everything from the past but build a new and better future based on the lessons learned during the pandemic. The possibilities are probably limitless but a few of them leap out at me.

Reliance on Foreign Supply

One big one is that as a society, we have come to rely on foreign sources, often but not solely from China, for many critical supplies, including medical supplies that are essential to addressing pandemic-driven illness. Cuomo correctly notes that the United States was ill-prepared to face an emergency of this nature, even though health experts have been predicting for years that a serious pandemic was virtually certain to occur.

How did we come to this situation? At the root of it, I suggest, is the “consumer mentality” of our evolved culture. Recognizing how broadly I am generalizing, it seems true that Americans generally lust for more and more “stuff” and the cheaper the price, the better. To accommodate this demand, our “free market” system of commerce turns to markets where labor and other factors permit the mass production of almost everything we lust for at prices below what they could be produced for domestically, remarkably even after the cost of transportation is accounted for. If you examine the origin labels on most of what you buy, you will see that most of it comes from China, South Korea, Vietnam and other countries in the Far East that are as far from here as you can physically get (except possibly for Australia).

Faced with these challenges from “foreign competition,” many American companies have closed their U.S. facilities and “shipped production overseas.” These decisions are supported, and sometimes even promoted, by the U.S. tax code, with the result that domestic jobs in hundreds of industries have been decimated and entire communities and even whole cities have been laid to waste. Youngstown, Ohio is one I am familiar with but there are many others all over the country.

These outcomes have not changed the demand for ever cheaper goods and have permitted companies like Amazon to dominate the supply chain for an astounding array of goods and services. If we are to believe the “reviews” on Amazon and elsewhere, much of what is produced in China and delivered in the U.S. is of low quality, but it’s “cheap” and it sells. What doesn’t sell is down-streamed through a largely invisible chain of distribution and re-distribution that sees a lot of this “stuff” for sale in so-called “dollar stores” and even second-hand shops.

If the only products we were considering were consumer electronics and such, the American lust for more and cheaper stuff would be somewhat less concerning, unless you ask someone who lives in a community devastated by the “foreign competition” that sucked local jobs dry and left the workers with nothing productive or remunerative to do.

Now comes the pandemic and we discover to our deep sorrow that we don’t have enough medical supplies to provide care of the swelling numbers of patients, many more of whom are going to die without it. Getting more supplies is now a global issue, as competition for scarce supplies erupts among countries and, we now learn, even between the states and our own federal government. The result is higher prices for everyone and still there is often a shortage requiring ordinary citizens to, for example, sew masks to try to protect healthcare workers on the front lines of patient care. If you’ve tried to buy your own masks from a foreign supplier, you may have learned, as I did, that much of the foreign supply is poorly made and often useless. And, of course, mask prices are now through the roof because government health policies are rigorously promoting/requiring mask use.

Another issue is that the federal government has allowed more than 100 coronavirus tests into the marketplace without full review. Many of these tests are sub-standard or worse. https://wapo.st/3c7V4TC

The lesson is clear, although the solutions are complicated and will, as with all major changes, take time. The United States should never again allow itself to be dependent on any foreign country for critical medical supplies. There will, of course, be a price to be paid for achieving this. Some things likely will cost more to produce here than in the “labor mills” of China. Americans will not willingly submit to the mass-production practices, and attendant low wages and poor working conditions, that dominate Chinese and other Far East manufacturing processes. So be it. Related to this is the question of foreign ownership of American companies, a readily available backdoor to foreign control of American business. We have to learn and change or face these problems all over again.

Tying Access to Health Insurance to Employment

Most Americans of working age buy health insurance provided/purchased through their employer. Putting aside ongoing issues of price/quality and coverage of options, not to mention extraordinary complexity of what is and is not covered, the real problem with this system is that when you lose your job, you lose your insurance as well. In normal circumstances, you have the option of paying for interim coverage through the COBRA program but there is no employer contribution, so the premiums are extremely high. There is also a time limit. COBRA can be a life-saver but it is economically challenging to put it mildly and highly disruptive.

The root problem is the connection between employment and insurance. There is no reason I know that this connection is immutable. Other systems exist in developed countries and seem to produce adequate or even superior protection for insureds. I am not an expert in all this, but it seems clear from the public dialogue about this that many people are invested in the current system, including the insurance companies. Many people are also opposed to greater direct government involvement on the grounds that it is “socialism.” The result is that the public discussion has partisan and irrational components that prevent a rational consideration of alternatives.

Of course, there is the issue of Obamacare that was intended to, among other things, give people the option of obtaining healthcare independent of an employer. In the gig economy that’s vital because so many people are independent contractors. When everyone’s health is tied together, as it is in a pandemic, we should be very concerned about people without health insurance and sick leave, but the Trump administration is working very hard to destroy Obamacare without proposing a replacement. Trump has, of course, denied that he is trying to end Obamacare and in particular has denied that he wants to eliminate insurance coverage of pre-existing conditions. Trump is lying about that. The Department of Justice is actively pressing litigation that would do precisely what Trump says he is not trying to do.

It is, however, clear that viable alternatives to the present system, whether it is Obamacare or something else, do exist and should be evaluated in a calmer, more rational way. I don’t know how to get there, but our society as a whole is paying a dear price for its failure to address this issue. The pandemic that has, as of this writing, led to nearly 40 million unemployed persons, has pushed evaluation of this issue to the top of the list of “must do” tasks as the United States tries to figure out what its future will be.