U.S. Health Care Flunks Its Most Important Exam

Bloomberg Businessweek|June 15, 2020

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U.S. Health Care Flunks Its Most Important Exam
We spend $4 trillion a year, yet we were totally overwhelmed by Covid-19
By John Tozzi

The new coronavirus was a test of America’s ability to protect the health of its people, and the country failed. The U.S. has the greatest number of confirmed cases and deaths in the world. Months after arriving in the U.S., the virus that wrecked the economy with disorienting velocity continues to inflict an unfathomable human toll.

The U.S. isn’t alone in failing to stop the coronavirus. But it is unique in how much of the nation’s economic resources are devoted to health care—about 18% of gross domestic product, more than any other country. The spending, approaching $4 trillion a year from taxpayers, employers, and households, is what makes America’s vulnerability to Covid-19 striking. What are we spending $4 trillion for, if not to avert disease and death?

The virus exposed some of the structural weaknesses in America’s approach to health care and health. Diagnostic tests, delayed and in short supply, were inadequate to detect the virus’s early spread. Hospitals with billions of dollars in revenue couldn’t secure dollar masks to protect staff. Local health departments charged with containing communicable diseases were quickly overwhelmed. They’re now scrambling to hire epidemiologists and contact tracers to track the pathogen as the country reopens. Neglect of public health funding has left U.S. companies playing catch-up to build the infrastructure to develop and manufacture a vaccine.

Beyond those specific failures, underlying inequities make some Americans more vulnerable than others. The virus spreads quickly in settings where people have little power to avoid it: nursing homes, homeless shelters, meatpacking plants, and prisons and jails that detain the world’s largest incarcerated population. Covid-19 kills more people who live in denser cities and crowded homes and work in lower-paying “essential” jobs. Black Americans, who have higher rates of chronic illnesses such as diabetes and asthma, are disproportionately harmed and killed by the virus.

None of this is an accident. It’s the accumulated result of policy and market decisions, choices about how we allocate resources that affect Americans’ health. Once the virus was on the loose, the damage it inflicted was amplified by decisions decades in the making, from how we fund local health departments to which workers get paid sick leave to who can afford proper housing. “A lot of the population has inadequate housing and inadequate nutrition, inadequate free space to get outside,” says Elizabeth Bradley, a longtime health policy researcher who now serves as president of Vassar College. “It’s just watching our system express itself in the extreme, because we’re under duress from this virus.”

Although the U.S. leads the world in Covid deaths, the pandemic has been more lethal elsewhere. France, Italy, Spain, and the U.K. all reported higher per capita death rates. Australia, China, New Zealand, South Korea, and Taiwan have largely contained their epidemics so far and limited deaths.

Clearly, there’s nothing magical about a publicly run medical system or a European-style welfare state when it comes to protecting a population from a novel infectious disease. In the months ahead, every country will debate how to prepare for further waves of Covid-19 and unknown future threats.

America stands out in the amount of money it’s already spending on health care, long a drain on governments, employers, and households. All those sectors now must cope with financial stress. So must health-care providers, who face lost revenue and new costs to adapt their operations for Covid-19.

“Once we come out of this pandemic, there is going to have to be some kind of an evaluation around, Do we need to be spending more on public health? Because the health-care system alone can’t come in and solve these problems,” says Ashish Jha, director of the Harvard Global Health Institute.


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June 15, 2020