Grassroots/Hank Kalet

We Are All Vulnerable

The poor health of American capitalism is being exposed by a virus that no one expected and no one seems prepared to address. As the COVID-19 virus, also known as the Coronavirus, spreads in the United States, it’s growing increasingly clear that the economic and health-care deficiencies we have in this country will limit our ability to combat it.

As the economics writer Anand Giridharadas tweeted out in March, the “Coronavirus makes clear what has been true all along. Your health is as safe as that of the worst-insured, worst-cared-for person in your society. It will be decided by the height of the floor, not the ceiling.”

Let’s be clear, the floor in the United States is low and barely existent. We are reliant on a drug industry that historically has chased profits without concern for whether the drug they manufacture and sell are those most needed or whether they are cheap enough for everyone to purchase. We lack universal health care, even after the Obama-era expansion. And a full quarter of our workers do not get paid if they must call out sick, which leaves them with a dangerous choice.

During normal moments, this can be tragic for the uninsured. These, however, are not normal times. As I write this on March 3, the US death toll has hit nine, but was expected to continue increasing. There had been 115 confirmed cases of the virus in more than a dozen states, according to the New York Times, while CNBC was reporting that the mortality rate internationally was almost four times that of the seasonal flu.

I don’t want to overstate the dangers. The numbers remain fairly low, and detection and treatment are not complicated. According to the Centers for Disease Control, those who believe they may be infected should stay home from work and call a doctor. The doctor would then work with public health officials to test those with symptoms and work to ensure against the spread into the community.

The problem, as I said at the outset, is threefold. too many areas in the country lack the facilities and resources to follow these guidelines. Too many people lack insurance or the ability to call out of work.

There are physician and hospital shortages in both rural and urban areas where there are higher instances of poverty. This undermines the first line of defense against the spread of COVID-19. A Pittsburgh Post-Gazette/Milwaukee Journal Sentinel analysis published in 2015 found that “people in poor neighborhoods are less healthy than their more affluent neighbors but more likely to live in areas with physician shortages and closed hospitals.” The report found that new hospitals were most likely to open in affluent, suburban areas even as the number of hospitals have been closing in the nation’s cities. There are similar shortages of physicians in these areas, which are relying more and more on small clinics and a core of committed but overworked doctors.

Similar issues exist in rural areas. According to the National Rural Health Association, there are about one and a half more physicians per patient in urban areas than rural areas, an “uneven distribution of physicians (that) has an impact on the health of the population.”

In rural areas, according to Gary Hart, director of the Center for Rural Health, University of North Dakota School of Medicine and Health Sciences, “Primary care doctors are stretched thin, and specialists, including mental health and substance abuse providers, are a rarity.”

This means that the the poor — whether in cities or rural areas — areas cannot easily seek out care, which in turn means that they are less likely to identify and treat a virus like COVID-19 were they to contract it.

This is compounded by a lack of health insurance, which puts the working poor in a bind. Many earn too much to qualify for Medicaid, but not nearly enough to purchase their own insurance. This leaves them in a precarious position. I’ve talked with dozens of low-income people for other stories who tell me the same thing: they often put off medical care or the purchase of needed medicines because of the cost. There are too many months, they tell me, when they have to choose between buying food for their kids or paying for their cholesterol drugs or blood pressure meds. It’s a Hobbesian Choice, because it’s not really a choice at all — and the damage to their health is all too real.

Imagine having to make this choice every day. Now, imagine adding in a contagious disease that presents itself as a bad cold or flu. Imagine that you have to make the choice of paying a doctor or paying for transportation to work, or buying dinner. And imagine that you, like a full 25 percent of the working population, will not get paid if you call out of work. What do you do?

We know the answer, because this is what plays out everyday in restaurants and retail establishments, in daycare facilities, among custodial workers and day laborers. The poor are forced everyday to ignore their own health and, by extension, the health of everyone else, to keep going, keep working, or suffer the consequences.

That’s what Giridharadas means when he says all of us have COVID-19 targets on our backs.

What has struck me about the news coverage about the COVID-19 outbreak is that it has ignored this component, that the breakdown of our public health system and the major flaws in our healthcare system are not a central part of the COVID-19 coverage, and that they are treated only as political chips for the presidential candidates to play with. We refuse to see the urgency of providing universal health care, of mandating that every worker get paid sick leave, that every area have both good doctors and a hospital.

My prescription would be to remove profit from the equation, create a single-payer model and establish a string of non-profit, government-run hospitals, but I am open to discussing an array of models that take into account the health needs of the urban and rural poor and that also make clear that there is a direct link between their health and the health of the rest of the population.

Hank Kalet is a poet and journalist in New Jersey. Email, hankkalet@gmail.com; Twitter, @newspoet41 and @kaletjournalism; Instagram, @kaletwrites; Facebook, facebook.com/hank.kalet; Patreon, https://www.patreon.com/Newspoet41.

From The Progressive Populist, April 1, 2020

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