Sick at Heart: A Fundamental Reason the United States Was Unprepared for the COVID-19 Emergency

Abstract

This article explicates a fundamental reason the United States was unprepared for the COVID-19 pandemic, which is that we have systematically institutionalized and created a culture of selfishness in our system for financing and delivering health care. After a brief introduction, the article proceeds in six steps. In Part One, I describe the origins of the novel coronavirus in China, the actions taken there, the fact that while the ban on domestic travel from Wuhan limited the degree of spread within China to cities like Beijing and Shanghai, it failed to prevent the virus’s spread across the world and its march across the United States in the midst of denial, obfuscation, refusals to act and delay. In Part Two, I explicate the various ways in which the United States was unprepared for the pandemic, focusing particularly on the lack of public health infrastructure, including the ability to mobilize supply lines, but also the breakdowns in hospitals and nursing homes and, importantly, the manner in which our continuing lack of a national health care system is part of our lack of preparedness. In Part Three, I describe how some other nations have had much greater success in staunching the outbreak, focusing particularly on Germany, as a liberal democracy in which civil liberty is respected. In Part Four, I take note of some of the complicated social, political and cultural features that steer a pandemic, which is as much a biological as a social and cultural phenomenon: leadership; disparate interests, regional rivalries and political structures; globalization; the role of the 24/7 news cycle; and finally, the importance of communal embrace of public health to minimize the need for coercive measures. In Part Five, I turn to the institutionalization and embodiment in culture of selfishness in our system for financing and delivering health care, giving rise to a fragmented system of payment and delivery, along with massive concentration of economic power and separate, siloed networks, all reflected in and created by legal doctrine that itself is fragmented. Finally, in Part Six, I offer a brief reflection on the possibility of change, given the crisis. This reflection is rather gloomy, as is, frankly, what is written in the entire article.

Keywords: Coronavirus, COVID-19, Epidemic, Global Pandemic, Health Care, Health Care System, Health Insurance, Health Law, Health Policy, Health Politics, Pandemic, Public Health, Public Health Emergency, Public Health Emergency Preparedness, Public Health Infrastructure, United States Health Care System

JEL Classification: I10, I11, I13, I18