As Spanish schools and universities went online, my students made a mad dash for their home countries and towns and while it might be comforting to be with family at a time like this, I realized that I would be a fool to leave Spain for the my home country, the U.S. This is in part because I am covered by Spain’s world-class public health system and currently have no health insurance in the U.S. But it is also because Spain is in a much better position to respond to the coronavirus pandemic. While Americans are doing voluntary self-isolation, still freaking out over buying toilet paper and apparently purchasing guns (only in America), the people of Spain are doing the only thing that can stop the spread of this deadly virus, staying at home.
Why is Trump’s newly great-again America doing such a terrible job against the coronavirus? To be fair, he inherited this system, if you can even call it one, but he has also done things to make it worse. We’ll start with healthcare in the U.S., which is a fragmented, for-profit mess that doesn’t cover everyone, which is the first and most important point.
While Spain has moved to centralize the coronavirus response, Trump’s words on a phone conference to governors throughout the country on Monday morning are illustrative of the disjointed patchwork of chaos in the U.S. He told them that they are basically on their own and shouldn’t wait for the federal government to help them get more respirators and other equipment that is in demand. The New York Times had access to a recording of this call in which he said, “Respirators, ventilators, all of the equipment — try getting it yourselves. We will be backing you but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
During the first one-to-one Democratic debate on March 15, Senator Bernie Sanders summed up the problem when he said, "This coronavirus pandemic exposes the incredible weakness and dysfunctionality of our current health care system.” And while all Democrats can agree on that, not all agree on his prescription which is “we need Medicare for All." Former Vice President Joe Biden pushed back, saying “With all due respect to Medicare for All, you have a single-payer system now in Italy. It doesn’t work there.”
While Biden’s comment was grossly unfair to Italy, it shows the division, even among Democrats about how to fix healthcare in the U.S. In fact, Medicare for All still wouldn’t be anything like the single payer healthcare system we know in Europe. Medicare is a public program that covers people over 65, but it still works mostly like private insurance coverage rather than a system of government run doctor’s offices and hospitals. Patients must still find doctors and hospitals that accept Medicare, which is difficult since the coverage is so sparse. People with enough means buy supplemental insurance to cover the rest. That’s right—Medicare on its own really isn’t enough.
Managing this byzantine system of supplemental insurance is pretty much a full-time job for my 73-year old mother. I asked her what happens with people who just can’t keep up with it anymore and she tells me that there are volunteer centers that will help people choose the right supplemental insurance. Yet, at least people over 65 have some sort of coverage. The rest in the U.S., even with Obamacare are mostly left to their own devices.
Less and less employers actually pay for health insurance, but it still remains largely tied to one’s job. Companies are able to get better prices for their employees by offering group insurance rates that employees mostly pay for on their own. What Obamacare did was open up health insurance marketplaces or exchanges to help make insurance more affordable for those who don’t have access to group coverage.
But again, this is a private system and as of January, 2019, Trump ended the individual mandate to buy health insurance that had been a critical part of Obamacare. According to the Census Bureau, 10.4% of Americans were uninsured in 2018 and that number has certainly gone up since the individual mandate went away. But even when there was one, people unable to pay for robust insurance would buy plans with astronomical “deductibles.” A deductible is the amount of medical expenses that you pay for yourself before the insurance starts paying. For example, a few years ago, my brother and his wife were on a plan with a $6,200 deductible—so on top of paying $400 per month for insurance, they had to pay for all of their medical expenses each year until it got to $6,200. As you can imagine, they just never went to the doctor. And while my brother’s situation was extreme, it’s not much better for most people, the average deductible is $2000.
This is an enormous challenge in terms of fighting the coronavirus because if people can’t or won’t go to the doctor to get tested if they are showing symptoms, then, even if there are enough tests, there is no way to know how many people have contracted the virus. Also, more people will die because, again, they will stay home to avoid astronomical emergency room costs. Federal officials have advised people to stay out of the emergency rooms and contact their primary care doctors if they are showing symptoms, but again the problem is that many people don’t even have a regular primary care doctor, in part because there are so few of them in the U.S. According to a recent report on CNN, the U.S. has about 3 primary care doctors for every 10,000 people. This compares to 7.5 in the United Kingdom, 9 in France and 13 in Canada. Why the shortage? Because the system rewards specialty doctors with higher pay and prestige.
Further complicating matters is that there is no federal law that requires employers to offer paid sick leave and about a quarter of U.S. workers don’t get any at all. Those without sick leave tend to be people who work part-time or by the hour and often in the service industry which have heavy contact with the public. This means that for many families, taking time off can be an enormous financial burden.
It’s easy to see why all of this poses a serious threat to combatting the spread of the coronavirus. If only people with money and generous sick leave can take time off and see a doctor, then the entire U.S. is in trouble.
And Trump has made matters worse. The first and most glaring issue has been the sluggishness in rolling out testing. Instead of relying on the test developed by the World Health Organization, the Centers of Disease Control (CDC) decided to make their own but it didn’t always work and there was government red tape slowing down academic labs from making their own tests. According to Axios, no one is sure why the CDC made this decision, but it is having disastrous results because they just don’t know how many cases there are in the U.S., which is slowing response.
It also doesn’t help that Trump himself hasn’t taken the threat seriously. When asked on January 22 about whether there were worries about a pandemic, he responded, “No. Not at all. And we have it totally under control. It’s one person coming in from China, and we have it under control. It’s going to be just fine.” At a campaign rally in early February he said “Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away.” On February 26, he tweeted “Low Ratings Fake News MSDNC (Comcast) & @CNN are doing everything possible to make the Caronavirus [sic] look as bad as possible, including panicking markets, if possible. Likewise their incompetent Do Nothing Democrat comrades are all talk, no action. USA in great shape! @CDCgov…..” While touring the CDC on March 6 he said “I like this stuff. I really get it. People are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”
Perhaps the most serious thing Trump has done to undermine a solid response to the coronavirus is something he did two years ago when he closed the White House National Security Council's entire global health security unit, reportedly in an effort to downsize national security staff. According to his answers in this article, he found it frustrating to have a team of people at the ready who might not be needed. Of course, that’s the whole point, you never know when a pandemic might arise, but they do from time to time and good governments should want to be prepared.
Needless to say, any roll-out of mandatory social distancing and isolation has been a patchwork of city and state mandates without any national leadership or coordination. And while Trump himself is not taking this seriously enough, other Republicans aren’t either. Republican Representative from California Devin Nunes told Fox News that “It’s a great time to go out [. . . ] so don’t run to the grocery store and buy, you know, $4,000 of food — go to your local pub.”
This might prove to be lethal to Trump’s re-election campaign, or not. In an NBC News/Wall Street Journal poll, 45% percent of respondents approve of Trump’s handling of the coronavirus pandemic while 51% disapprove. This nearly matches with his current approval ratings of an average of 43.5% approval and 53.2% disapproval, which suggests that much like during the impeachment proceedings (remember those?), his supporters love him no matter what.
Pandemics like the coronavirus know no borders. Sure, many borders have been closed and some countries are making progress towards defeating the coronavirus by taking the extreme and difficult step of ordering everyone to stay home. But the U.S. is dithering, and this will eventually be an enormous liability to the rest of the world moving forward.
This article was published in Spanish in esglobal.