The Coronavirus Crisis Is a Monster Fueled by Capitalism by Mike Davis, In These Times, 3-20-20

…A year from now we may look back in admiration at China’s success in containing the pandemic and in horror at the US failure. Since at least 2000 we’ve repeatedly seen breakdowns in frontline healthcare. Both the 2009 and 2018 flu seasons, for instance, overwhelmed hospitals across the country, exposing the shocking shortage of hospital beds after years of profit-driven cutbacks of in-patient capacity. According to the American Hospital Association, the number of in-patient hospital beds declined by an extraordinary 39% between 1981 and 1999. The purpose was to raise profits, but the goal of 90% occupancy meant that hospitals no longer had the capacity to absorb patient influx during epidemics and medical emergencies.

In the new century, emergency medicine has continued to be downsized in the private sector by the ‘shareholder value’ imperative of increasing short-term dividends and profits, and in the public sector by fiscal austerity and reductions in state and federal preparedness budgets. As a result, there are only 45,000 ICU beds available to deal with the projected flood of serious and critical Corona cases. (By comparison, South Koreans have more than three times more beds available per thousand people than Americans.) According to an investigation by USA Today “only eight states would have enough hospital beds to treat the 1 million Americans 60 and over who could become ill with COVID-19.”

Local and state health departments – the vital first line of defense – have 25% less staff today than they did twelve years ago. Over the last decade, moreover, the CDC’s budget has fallen 10% in real terms. These shortfalls have only been exacerbated under Trump, who also closed the White House pandemic office established by Obama after the 2014 Ebola outbreak to ensure a rapid and well-coordinated national response to new epidemics.

We are in the early stages of a medical version of Hurricane Katrina. After disinvesting in emergency medical preparedness at the same time that all expert opinion has recommended a major expansion of capacity, we lack basic low-tech supplies as well as respirators and emergency beds. National and regional stockpiles have been maintained at levels far below what is indicated by epidemic models. The test kit debacle has coincided with a critical shortage of protective equipment for health workers. Militant nurses, our national social conscience, are making sure that we all understand the grave dangers created by inadequate stockpiles of protective supplies like N95 face masks. They also remind us that hospitals have become greenhouses for antibiotic-resistant superbugs such as S. aureus and C. difficile which may become major secondary killers in overcrowded hospital wards.

The outbreak has instantly exposed the stark class divide in our country. Those with good health plans who can also work or teach from home are comfortably isolated provided they follow prudent safeguards. Public employees and other groups of unionized workers with decent coverage will have to make difficult choices between income and protection. Meanwhile, millions of low-wage service workers, farm employees, the unemployed, and the homeless are being thrown to the wolves.

Universal coverage in any meaningful sense requires universal provision for paid sick days. A full 45% of the workforce is currently denied that right and virtually compelled to either transmit the infection or go hungry. Fourteen states have refused to enact the provision of the Affordable Care Act that expands Medicaid to the working poor, so nearly one in five Texans, for example, lacks coverage.

The deadly contradictions of private healthcare in a time of plague are most visible in the for-profit nursing home industry which warehouses 1.5 million elderly Americans, most of them on Medicare. It’s a highly competitive industry characterized by low wages, understaffing and illegal cost-cutting. Tens of thousands die every year from long-term care facilities’ neglect of basic infection control procedures and from government failure to hold management accountable. Many of these homes find it cheaper to pay fines for sanitary violations than to hire additional staff and provide them with proper training. So, it’s not surprising that the first epicenter of community transmission was the Life Care Center, a nursing home in the Seattle suburb of Kirkland. I spoke to Jim Straub, an old friend who’s a union organizer in Seattle area nursing homes. He characterized the facility as “one of the worst staffed in the state” and the entire Washington nursing home system “as the most underfunded in the country – an absurd oasis of austere suffering in a sea of tech money.” Straub pointed out that public health officials were overlooking the crucial factor that explains the rapid transmission of the disease from Life Care Center to nine other nearby nursing homes: “Nursing home workers in the priciest rental market in America universally work multiple jobs, usually at multiple nursing homes.” He says that authorities failed to find out the names and locations of these second jobs and thus lost all control over the spread of COVID-19. Across the country, many more nursing homes will become coronavirus hotspots. Many workers will eventually choose the food bank over working under such conditions and stay home. In this case, the system could collapse.

The pandemic illustrates the case for universal health coverage and paid leave with every step of its deadly advance. We must organize against evictions, layoffs, and employers who refuse compensation to workers on leave. But universal coverage and associated demands are only a first step. It’s disappointing that in the primary debates neither Sanders nor Warren highlighted Big Pharma’s abdication of the research and development of new antibiotics and antivirals. Of the 18 largest pharmaceutical companies, 15 have totally abandoned the field. Heart medicines, addictive tranquilizers, and treatments for male impotence are profit leaders, not the defenses against hospital infections, emergent diseases, and traditional tropical killers. A universal vaccine for influenza – that is to say, a vaccine that targets the immutable parts of the virus’s surface proteins – has been a possibility for decades, but has never deemed profitable enough to be a priority.

As the antibiotic revolution is rolled back, old diseases will reappear alongside novel infections and hospitals will become charnel houses. Even Trump can opportunistically rail against absurd prescription costs, but we need a bolder vision that looks to break up the drug monopolies and provide for the public production of lifeline medicines. As I wrote fifteen years ago in The Monster at Our Door: The Global Threat of Avian Flu, “Access to lifeline medicines, including vaccines, antibiotics, and antivirals, should be a human right, universally available at no cost.  If markets can’t provide incentives to cheaply produce such drugs, then governments and non-profits should take responsibility for their manufacture and distribution. The survival of the poor must at all times be accounted a higher priority than the profits of Big Pharma.”

The current pandemic expands the argument: capitalist globalization now appears biologically unsustainable in the absence of a truly international public health infrastructure. But such an infrastructure will never exist until peoples’ movements break the power of Big Pharma and for-profit healthcare. This requires an independent socialist design for human survival that includes, but goes beyond a Second New Deal. Since the days of Occupy, progressives have successfully placed the struggle against income and wealth inequality on page one – a great achievement. But now socialists must take the next step and, with the healthcare and pharmaceutical industries as immediate targets, advocate social ownership and the democratization of economic power.

We must also make an honest evaluation of our political and moral weaknesses. The leftward evolution of a new generation and the return of the word ‘socialism’ to political discourse cheers us all, but there’s a disturbing element of national solipsism in the progressive movement. In addressing the pandemic, socialists should find every occasion to remind others of the urgency of international solidarity. We need to demand a massive scaling up of the production of test kits, protective supplies, and lifeline drugs for free distribution to poor countries. Disease knows know boundaries, so evenr if you don’t believe in global solidarity, ensuring universal, high-quality global healthcare is in everyone’s interest.

Mike Davis is the author of several books, including Planet of Slums and City of Quartz.