My "net assessment" of the US response to covid19

In the Washington Post, columnist David Ignatius ("Where would the U.S. stand in a post-pandemic assessment?") discusses the "Net Assessment" process created by the Department of Defense to assess the comparative likelihood of the US and the USSR to survive nuclear war.

He opines about a net assessment comparing the response of China and the US to the coronavirus.

Here's my not particularly detailed response:

China has an authoritarian government that withheld information, endangering their citizens. But they did respond, eventually.  And their scientists communicated about the situation and the virus in scientific circles early, giving a leg up to creating tests and more quickly understanding the nature of the disease.

Photo: Rex Features.

Neoliberalism: the emphasis on the market at the expense of government.  Since the era of Thatcher and Reagan, neoliberalism has resulted in the denigration and defunding of government in the US ("Neoliberalism's 'trade not aid' approach to development ignored past lessons: Neoliberal development policy was radical and abstract, but its uncompromising approach proved dangerous in the real world" and ">Neoliberalism – the ideology at the root of all our problems," Guardian). From the first article:

At the heart of the new right project was a particular constellation of ideas and policies known as neoliberalism. Neoliberalism is often used today as shorthand for any idea that is pro-market and anti-government intervention, but it is actually more specific than this. Above all, it is the harnessing of such policies to support the interests of big business, transnational corporations and finance. It seeks not so much a free market, therefore, as a market free for powerful interests.

From the second article:

So pervasive has neoliberalism become that we seldom even recognise it as an ideology. We appear to accept the proposition that this utopian, millenarian faith describes a neutral force; a kind of biological law, like Darwin’s theory of evolution. But the philosophy arose as a conscious attempt to reshape human life and shift the locus of power.

Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency. It maintains that “the market” delivers benefits that could never be achieved by planning.

Attempts to limit competition are treated as inimical to liberty. Tax and regulation should be minimised, public services should be privatised. The organisation of labour and collective bargaining by trade unions are portrayed as market distortions that impede the formation of a natural hierarchy of winners and losers. Inequality is recast as virtuous: a reward for utility and a generator of wealth, which trickles down to enrich everyone. Efforts to create a more equal society are both counterproductive and morally corrosive. The market ensures that everyone gets what they deserve.

Extreme Republican ideology.  With the rise in extreme Republican ideology--dating to Newt Gingrich's Speakership if not before ("How Newt Gingrich Destroyed American Politics," The Atlantic), and the most recent Presidential election, the US has a viciously incompetent federal government that failed to maintain public health monitoring and surveillance systems, and through continued incompetence spreads misinformation through the President, even though somewhat crippled federal agencies are reacting, although local and state agencies are more in the lead because of the vacuum of leadership and competence.

Public health and health care is not an integrated system.  The US has adopted an approach generally and specifically in terms of health care to governance and funding that de-emphasizes the importance of surveillance and stocking slack resources to be able to respond to pandemics in a timely fashion.

I can't remember the article I read, but it made the point that "the US doesn't have a health care system, it has various disconnected marketplaces."

Rural areas have been particularly hard hit ("The Quiet Crisis Of Rural Hospital Closures, Kaiser Health) and because rural Republican states have declined to expand health care access to the poor.

But plenty of urban hospitals have closed ("Hahnemann University Hospital Closure: What Philly Is Losing," Philadelphia Magazine; "St. Vincent Medical Center closes after a century, shocking community," KCRW/NPR)sometimes because they are owned by for profit firms, or because the cost of uncompensated care is high and threatens the financial health of university parents.

These 2019 entries include links to past entries concerning health care matters in the DC area:

-- "Another example of a failure to do public capital planning in DC: Council votes to stop funding United Medical Center
-- "Community health improvement planning"

This has resulted in a continued reduction in the number of available hospital beds and usually a decline in the number of ICU beds as well.  Per capita numbers for the US lag countries with national health systems.

More recent efforts to tie public welfare health coverage and food assistance to employment, making it more difficult for immigrants to get citizenship status if they've received public benefits increase the likelihood of poor health outcomes.  Not to mention the difficulties of applying for benefits--most states haven't adopted best practice computerized systems, and have closed offices where people normally apply, etc.

Difficulty of responding extranormally when circumstances warrant.  Plus the bureaucratic nature of agencies tends to make it difficult to respond in innovative ways let alone with alacrity in extranormal situations (e.g., compare South Korea or Taiwan's response to that of the US, and the testing creation and approval process; cf. the debacle concerning expanding the Seattle Flu Study to test for coronavirus, etc.).

Need for a national health care system.  How the US health care system is set up disincentivizes people to get "wellness" care because of copayments, missed work and loss of income, lack of sick leave, etc.

Ideally, a net assessment would be like Britain's health services assessment during WW2 ("Want, disease, ignorance, squalor and idleness: are Beveridge’s five evils back?," Guardian) because in moving people from cities to the country, they realized that the country was underresourced in terms of health care systems and that people weren't very healthy.

That resulted in the creation of Britain's National Health Service in 1948.

(How health care is delivered in the US needs to be reorganized, in three tranches for normal care: (1) wellness care; (2) management of chronic disease; and (3) catastrophic care; alongside a more robust public health system.)

Globalization and the precariousness of work.  The problem with globalization isn't necessary globalization, that is the economic and social interconnectedness, although this can be simultaneously strengthening and weakening--but because it was paired with the adoption of neoliberal principles and the simultaneous disruption to and elimination of a social safety net.

The loss of the safety net has heightened effects because of the change of the nature of work and the organization of the economy away from large employers, who traditionally provided health insurance (and pensions) in the US system.

Globalization made work more competitive, led to the migration of large scale industry to countries with cheaper labor, putting many people out of work, especially in center cities where manufacturing had been concentrated.

Replacing labor with capital.  Plus alongside globalization you have an increased focus on capital and mechanization, the simultaneous upskilling of jobs while also eliminating or outsourcing jobs whenever possible.

For example, an auto plant probably has 25% or fewer workers than it did 30 years ago.  In Flint, which had a peak GM employment of over 80,000 people (+ the multiplier effect of 3.0 add on jobs at suppliers), today there are fewer than 9,000 GM jobs.

Although some of that is because GM spun off its part manufacturing into separate firms including Delphi--still the overall number of jobs has been reduced by more than 50%).

More recently, IT, telecommunications and software has led to the elimination of jobs (such as in human resources, accounting, etc.).

People out of work, low wages, and limited social safety provisions are vulnerable.  This creates a fragmented society and economy that is economically and socially vulnerable to exogeneous shocks--climate change; financialization; pandemic; etc.