Now, with the Democratic presidential primary field winnowed down, the two candidates really need to demonstrate some agility for the significant challenges at hand.
This article first appeared in Salon.
We have to hear stump speeches and debate exchanges that relate to the rapidly deteriorating facts on the ground in this country — and not get hung up on the histrionics of how we got here.The hour is too late, and the stakes get higher by the day.Joe Biden's stutter, or what Bernie Sanders said about Fidel Castro, are all distractions from the very perilous 2020 American circumstance.
What the novel coronavirus has revealed in stark relief is the decrepit state of the nation's healthcare system decades in the making at the community level, where epidemics are either contained or left to decimate the local population.
By every measure, this most essential system upon which our biological well-being rests has been permitted to fall into the same state of ruin and disrepair that we see in our water systems, bridges, tunnels, rail networks, airports and schools.
That in itself is distressing enough. Yet sadly, there's more.
This hollowing out — of all of the most critical infrastructure upon which our day to day life rests— was done as we squandered trillions on a further notice global war on terror that only proliferated terror and set off the worst global refugee crisis since World War II.
This would not be histrionics, because right now we are spending several hundred billion dollars a year just to service the debt we racked up subsidizing multinational defense contractors who show their gratitude with tax avoidance.
And while our decades of disinvestment in public health has us now scrambling to improvise an effective coronavirus response, the Trump and the GOP tax cuts for corporations and the wealthiest Americans accelerated wealth concentration and sunk the government deeper into debt.
Meanwhile, America's rural and urban hospitals were being decimated, thanks to the predations of a profit driven health care system and the refusal of Republican governors to act on the 2014 opportunity under the Affordable Health Care Act to expand Medicaid for millions of low-income households.
Talk about rationing care.
As Oliver Millman recently reported in the Guardian, "hospital closures in rural areas of the US hit their highest point in the past decade last year, with 19 rural hospitals shutting down" with "34 facilities shuttering in the past 24 months."
Since 2010, 120 hospitals in rural states like Texas (20), Tennessee (17), Oklahoma (7), and Georgia (7) have fared the worst.
What Millman's analysis found was that hospitals were much more likely to face closure in states with spiteful GOP governors, driven by Tea Party ideology, who refused to expand Medicaid the hospitals.
"Using a model that shows risk factors for hospitals, the report found that 453 rural hospitals across the US are vulnerable to closure," the Guardian reported. "Being in a state that has accepted expanded Medicaid help decreases the likelihood of closure by 62 percent on average, according to the analysis."
But rural America is not the only place where the backlash against Obamacare and Wall Street driven predators are closing hospitals and leaving poorer communities vulnerable to something like the novel coronavirus.
According to the Health Care Financial Management Association, in 2017, the first year of Trump's presidency, 16 hospitals closed. Last year, that number reached 47. This system is in free fall, and it is not in the interest of corporate media to tell us just how marginal the whole system has become.
In a vivid piece last summer for US News & World Report entitled "Code Red: The Grim State of Urban Hospitals", Joseph Williams chronicled the efforts on labor and community activists to try and keep Hahnemann University Hospital in downtown Philadelphia open.
He wrote the 178-year-old hospital, that serves primarily people of color, "has a mandate that's rarely advertised but widely understood, especially in poor neighborhoods: Treat everyone who walks through its doors, the indigent as well as the insured."
He continued: "That egalitarian mission led to some 150 patients treated in its emergency room per day – including many who don't have a medical emergency, but lack insurance and can't afford a primary care doctor. It also led to a financial balance sheet featuring $3 million a month in losses – brutal numbers that would make any executive reach for the antacids."
The Pennsylvania Association of Staff Nurses and Allied Professionals, along with community advocates and Sen. Bernie Sanders, described the closure as creating "a public health emergency triggered by corporate greed and a dysfunctional, profit-driven health care system."
In the process, the corporate bankruptcy created a health care desert, assuring that the rest of the city's crowded emergency departments "increasing wait times and putting patients hurt in a car crash or suffering from a stroke at greater risk of dying."
The essential community asset was also a teaching hospital for Drexel University of Medicine and St. Christopher's Hospital for Children.
In January 2018, American Academic Health LLC, an affiliate of Paladin Health Care, completed the transaction they had initiated the year before.
"We are thrilled and proud to be the new owners of these venerable Philadelphia hospitals and the outstanding clinical and academic programs for which they are recognized," said Joel Freedman, American Academic's Founder and Chief Executive Officer.
In a year and a half, American Academic Health's local Philadelphia affiliate filed for bankruptcy.
In the process, the health care profit vulture's bankruptcy upended the career of 570 medical students, including 55 medical residents in the U.S. reliant on J-1 cultural exchange visas who faced potential deportation.
Hopefully these aspiring physicians hung on and landed on their feet and in their lab coat.
We are going to need every one of them.
As we see with the global coronavirus scramble for surgical masks, capitalism is all about feeding off scarcity.
We know that we spend more on health care than the other 35 nations that make up the Organization for Economic Co-operation and Development with not much to show for it in terms of health care outcomes.
"The United States spends more on healthcare than any other OECD country, both as a proportion of GDP (16.9 percent) and per person (USD 10 586). Spending is expected to increase with healthcare as a proportion of GDP forecast to reach 20 percent by 2030," according to the OECD. "High levels of spending have not translated into people leading longer lives. Life expectancy at birth is two years below the OECD average, and actually declined by over two months between 2012 and 2017."
So far, the debate facilitated by the corporate news media on health care has been framed as a question of whether or not Americans were in favor of universal health care or wanted to hold on to their private plan, assuming they have one.
What the coronavirus crisis has revealed is just how delusional this debate has been. The reality is the whole architecture is inadequate to face the public health challenges upon us.
Hence, universal health care is no longer a talking point. It is a national security imperative.