Yes, America is suffering needlessly. That may save us.
by Nickolas Kristof - NYT - July 16, 2020
Just one in six Americans in a poll last month was “proud” of the
state of the country, and about two out of three were actually “fearful”
about it. So let me introduce a new thought: “hope.”
Yes, our
nation is a mess, but overlapping catastrophes have also created
conditions that may finally let us extricate ourselves from the mire.
The grim awareness of national failures — on the coronavirus, racism,
health care and jobs — may be a necessary prelude to fixing our country.
Nicholas Kristof Is Discussing Why He’s Hopeful
And
Michelle Tilley says, welcome back to Oregon. Great to be here. I’m
actually hoping to go hiking this weekend around the three sisters in
central Oregon backpacking with our dog owners and make the dog have a
cameo. The dog disappeared. You may hear her barking and so one news
June 4 says to pay for social programs. It’s obvious taxes will need to
raise Will this hurt Biden. So I think a lot will depend on how it’s
done. And I mean, I must say that I found few things more hypocritical
than the way the Republicans have responded on funding issues. The idea
that in January 2009 during the worst financial crisis since the Great
Depression. At that time every single house Republican voted against the
National Recovery act desperately needed stimulus to get people back to
work to save the economy. Every single Republican in the house of
Representatives voted against that act. And yet, you know when Trump was
in office, then they voted overwhelmingly for $1.5 trillion tax
giveaway to the wealthiest Americans. I just found that unconscionable.
Oh, let me know. Somebody is mowing the lawn wrecking here here, which
is not good. Stay tuned. Eric OK. That was silence. But it is true that
there are going to be you know. And so it also, if you look at polling
you find that more than 80% of the public says they are in favor of more
taxes on the wealthy to pay for addressing disadvantage. So I don’t
think that raising taxes on the top end is going to be particularly
painful. And you know if there were a financial transaction tax that
might raise say 70 billion a year. That’s real money. Larry Summers has
argued that if we enforced tax collection better and funded the IRS
better for audits we could raise maybe a trillion dollars a year. That’s
huge amounts of money that would go to social programs. You know right
now in the US the county that has the most number of audits is bigger
than anything, I think is a poor county in Mississippi or South Carolina
largely African-American. And it’s because people in that county have
they use the e ITC their earned income tax credit. And the IRS goes
after them when their income is 15, $20,000 a year, which I think is
just you know unconscionable. I’m interested in the idea of a wealth
tax. There are problems with accounting of it. There are problems could
be problems of evasion. But there are problems with all taxes and a
modest wealth tax in the range of 1% Seems to be worth pursuing. It’s
unclear if it would pass constitutional muster or the courts might throw
it out. But I think it’s worth pursuing. And wealth tax on people with
more than $5 or $10 million in assets. Polls very, very well. So I think
that Biden could pursue some of those kinds of tax increases not only
without denting his popularity, but possibly increasing it. And a
decline. Deborah says animals don’t have an afterlife. The reason is
that animals don’t have the capacity to worship a god. Well, I’m not
going to get into a theological argument. I must say somebody on Twitter
told me that dogs don’t have souls. Anybody who thinks that hasn’t
didn’t meet our old dog. Katie Katie was as so I interviewed a lot of
prime ministers and presidents. And Katie was much more soulful than
they were. And Dana’s Book offline. I think it’s your first day on
periscope. So welcome here. And there’s my screen is stuck here. Oh so
somebody is it. M.j. can’t Clint says where relations with China headed.
I’m I have such complicated mixed feelings about our relations with
China. You know, I think China did walk all over us on trade after
entering the World Trade Organization. I also think that it’s important
that the US stand up to Xi jinping the Chinese leader on everything from
what you’re doing. And toward Muslim leaders in shenyang region in the
far west, which is something like a cultural genocide. A million people
imprisoned in modern concentration camps essentially for being Muslims.
Widespread use of force contraception apparently to limit childbearing.
80 percent of IUDs insertions in China reportedly are in cian Jiang
which has just over 1% of the population. When Shane Chiang and men are
in these concentration camps then Chinese Han Chinese men from the Han
Chinese majority are sent to st. John to live in the houses and by one
account are told to sleep in the beds of the family bed with the wife is
left behind and something that is. I mean, whatever happens is
obviously humiliating and threatening and devastating to those families.
Children sent off to be brainwashed in boarding schools. You know, I
think Jiang deserves more attention. What China is doing now in Hong
Kong. And I worry about what it might do in Taiwan. I fear that that
Hong Kong may be a prelude to trying to putting pressure on Taiwan, it
away they’d be disastrous. I think there’s some risk of conflict in the
South China Sea between the US and China and that you might get a
headstrong captain of a US ship or a Chinese ship the bullets were fired
or missiles are fired. And I know I think things would go downhill
very, very badly very, very quickly. But that’s why it’s important to
have dialogue to have conversation. The US the Trump administration says
now that it is talking about banning all 92 million members of the
Chinese Communist Party from visiting the US we want to engage those
people if there is reform in China, then it’s going to come partly from
members of the Chinese Communist Party. And so my belief is we should
stand up to China on changing stand up China and Hong Kong on Taiwan on
the South China Sea but also engage with China and have as much dialogue
as we possibly can. And there are areas where we have common interests,
including climate change piracy. Obviously public health, we should be
talking about how to tackle that kind of virus together. And we’ve
failed to do that. And so I I’m kind of sad by the way, China US
relations are headed. I think Xi jinping there is a huge amount of
responsibility for what he’s doing and Xi in other places. But I think
the Trump administration is taking the wrong course, as well. And oh Lin
Siegel. So that Barry Weiss in the New York Times so feel like I’m
getting into a whirlpool here. So for those who don’t know, I have AI
had a colleague Barry Weiss who’s I think she describes herself as a
centrist. I think most people at the Times most of our readers thought
we thought of her as a conservative. And she was working on ads by
conservative writers brought in some very good ones and also did some
writing and is a wonderful provocative smart writer. So she resigned the
other day with a scathing letter to the times saying that the times was
no longer welcoming to conservative opinions effectively. And I was
sorry to see Barry go. I thought that her op Ed’s and her writing made
us a broader paper with more points of view and that on saris there’s a
truck or something behind me, that’s the danger of being on a farm, but
you know, I think and hope that the New York Times will indeed continue
to have a broad range of voices and we’ll prove her wrong. And today we
ran some tough letters to the editor denouncing us based on Darius
Leonard and you know, I think that’s important. I think we should
provide outlets to let people hold our feet to the fire. And so you know
they’re where I think that there a lot of debates not just with the
newspapers. But within the large community about what views are
appropriate. We see that in universities. We see that across the board.
My own take is that it’s important to engage with conservatives and with
social conservatives. Every morning, I go for a run. And I do that
because it is painful, but it makes me a better person. And in the same
spirit I go through the Wall Street Journal opinion pages because it’s
painful. But I think it makes me a better person. It’s a kind of mental
exercise. And so I. Oh, that was the garbage truck. It is an ass. I
think once every couple of weeks or so here on the farm. I want to you
know we’re sort of coming the time. But I want to see if I can show you a
little bit of the farm. OK So we I should explain a little bit. So we
used to have sheep and you will didn’t even enough lamb. We no longer
had the sheep. They were by then they were also kind of family, friends,
and we when we got rid of the others we saved two that really were dear
old family, friends. And I think a cougar got the last two. And then so
we no longer have livestock we do. We had a cherry orchard and we also
have timber but most of our land isn’t it. And isn’t forest. But we. But
we had a beloved cherry orchard making pie cherries rancid cherries.
And people weren’t eating an f cherry pies. Welcome e Allan h EMQQ oh
you first and periscope. And people were eating a cherry pies or a buyer
didn’t want to buy cherries so in the last couple of years, we pulled
out the cherries which was traumatic. This farm has had carries for 70
years. And we put in wine grapes and cider apples and so let me see if I
can show you. That’s the that’s the house behind me the farmhouse. And
this really is the most beautiful farm in the world. Can you see that.
That’s the grapes in the background there. Pino when chardonnay grapes
stay tuned for some wine and about three or four years, isn’t it
gorgeous though. I mean Oregon is always beautiful, but it’s surrounded
by fiery Kimber there. Douglas fir trees and then let’s see if I can
show you the those are the apples on either side. I don’t. It’s a little
far away. I don’t know if you can see that on the Hillside over there.
There are cider apples. So we hope to have some good cider in now
actually about a year from now will we should have some hard cider on
the market. You can follow us on Instagram the farm at Kristaps farms
does it at Instagram Chris, your farms. And I just want to actually get
the dogs into Connie I want introduce are our dogs Connie Chloe Connie
Chloe and let me remind you also about the upcoming upcoming chats by
opinion members. So tomorrow at 1 o’clock it’ll be Farhad Manjoo 1:00
eastern time Monday. Binyamin Appelbaum Tuesday Jameel Bouie Wednesday
Elizabeth Bernard Thursday Soledad O’Brien and Friday. David Brooks. And
Yeah. Thank you for staying the farm is gorgeous. And the dogs. Connie
Chloe oh, here’s Connie. OK Connie is a coup boss. We’ve always had
coupons is a Hungarian sheepdog. Come on Connie. Yeah Connie. Here we go
Connie. Here’s Connie. Oh, Yeah. And come on Connie. Yeah, you’re on.
Yeah say hi to everybody. Connie is a wonderful dog. Her we got our
first kudos as a guard dog to protect the sheep and a bit of a scandal
there. So we around here. If a dog kills a sheep. It’s thought that the
dog will always be a sheep killer and you’re supposed to. But your own
dog. Sleep well we had just paid $300 for our guard dog to protect the
sheep and we weren’t just about to execute her. And so who said we
covered up the dog. Her name was t said we covered up pieces of crime
and she never harmed another sheep. And in fact, the canvasses were
wonderful protectors of we’re wonderful protectors of the sheep after
that. And one actually killed the coyote right in the sheep barn. And so
I recommend us they do shed there. They really shed but just great
guard dogs wonderful personalities. Aren’t they the most beautiful dogs.
Yeah people are saying nice things about you Connie. OK Well, anyway
thanks so much for joining this. I was a little concerned about doing
one on the farm, but Connie. Say goodbye but it worked. Can we can hear
own byline. What else grows here. Timber a lot of timber kind. You’re
getting a lot of compliments. So thanks very much for joining us. You
didn’t meet our other dog Chloe acrylic good creeper will have to do
that. Another time. OK Take care. Thanks so much.
The last time our economy was this troubled, Herbert Hoover’s
failures led to Franklin D. Roosevelt’s election with a mandate to
revitalize the nation. The result was the New Deal, Social Security,
rural electrification, government jobs programs and a 35-year burst of
inclusive growth that built the modern middle class and arguably made
the United States the richest and most powerful country in the history
of the world.
History doesn’t repeat, but it does
rhyme. And when I reached out through the gloom to consult experts, I
was struck by how much hope I heard.
“On balance, I am very
hopeful and I’m very optimistic,” Darren Walker, the president of the
Ford Foundation, told me. “What we’re seeing today is a sort of national
convulsion over the recognition that racism in America is real and it’s
not a figment of the imagination of Black people in this country.”
Marian
Wright Edelman, the founder of the Children’s Defense Fund, who for six
decades has been battling for a more just society, told me, “I’m very
optimistic. I think we have a chance of getting something done.”
Like
others I spoke with, she said that one reason for hope is,
paradoxically, President Trump and the way he has become the avatar of
failed “let them eat cake” policies and narratives. “Mr. Trump is the
perfect opposition to have,” Edelman said. “He represents the implosion
of the American dream, and we can’t go down his road much farther.”
“If we can’t get something done now,” she added, “then shame on us.”
Betting markets like PredictIt expect
Joe Biden to sweep into the presidency in January with a Democratic
House and a Democratic Senate. By then we may have lost a quarter
million Americans to Covid-19 and remain mired in the worst economic
downturn of our lifetimes, with racial antagonisms inflamed by a
president whom a majority of Americans
regard as a racist. I’ve known Biden since he was a senator, and he’s
no radical — but that reassuring, boring mien may make it easier to win a
mandate and then use it to pivot the United States onto a new path.
So
perhaps today’s national pain, fear and loss can also be a source of
hope: We may be so desperate, our failures so manifest, our grief so
raw, that the United States can once more, as during the Great
Depression, embrace long-needed changes that would have been impossible
in cheerier times. *
The United States
faces at least three simultaneous crises: more coronavirus deaths than
any other country, the worst economic slump since the Great Depression
and overflowing outrage over racial inequity. Yet these crises are all
interlinked, all facets of the same core failure of our country, one
that has its roots in President Richard Nixon’s “Southern strategy” of
1968 and in the racialization of social safety net programs thereafter.
Why is the United States just about the only advanced country to lack universal health care? Without universal paid sick leave?
Many scholars, in particular the late Alberto Alesina, a Harvard economist, have argued
that one reason for America’s outlier status is race. Investing in
safety nets and human capital became stigmatized because of a perception
that African-Americans would benefit. So instead of investing in
children, we invested in a personal responsibility narrative holding
that Americans just need to lift themselves up by their bootstraps to get ahead.
This experiment proved catastrophic for all Americans,
especially the working class. Marginalized groups, including
African-Americans and Native Americans, suffered the worst, but the
underinvestment in health and the lack of safety nets meant that
American children today are 57 percent more likely to die by age 19 than European children are.
This boomerang effect of obdurate white racism — what Dr. Jonathan M. Metzl calls “dying of whiteness” — means that Americans now are less likely
to graduate from high school than children in many peer countries.
Meanwhile, people die in the United States from drug overdoses at a rate
of one every seven minutes.
This is deeply personal to me. As I’ve written in a recent book, “Tightrope,”
a quarter of the children on my old No. 6 school bus in rural Yamhill,
Ore., are dead from drugs, alcohol and suicide — deaths of despair.
Others are homeless or in prison. Although they were white, they
perished because of policy choices, partly rooted in racism, that the
United States has pursued for 50 years.
Gaps in safety nets left
us in turn particularly vulnerable to a pandemic, for underinsurance and
lack of paid sick leave helped spread the coronavirus. The pandemic
then caused people to lose their jobs, which in the United States meant
that they lost health insurance just when it was most needed. Trump
bungled the pandemic, as did some local leaders, but the failure was
also 50 years in the making. *
Do we now have a chance for a reset? Yes, I think we do.
It
may already have been in the works. Kansas Republicans rebelled against
tax cuts that had devastated schools. Texas helped lead the way in
reversing mass incarceration. Red states like Idaho, Utah and Oklahoma
expanded Medicaid.
To the extent that America’s 50 years of
failures had their roots in racism, it’s also striking that the new
possibilities arise in part from mass revulsion at a short video that
showed the undeniable truth of racism today.
In 1899, W.E.B. Du
Bois, writing about racial injustice, said there have “been few other
cases in the history of civilized people where human suffering has been
viewed with such peculiar indifference.” Yet maybe the video of George
Floyd’s life being snuffed out by police officers is dispelling that
indifference. The current Black Lives Matter protests, measured by the
number of participants (roughly 20 million), appear to constitute the largest movement in American history.
“There
was something about seeing a man’s knee on another man’s neck that woke
people up,” said Helene Gayle, the chief executive of the Chicago
Community Trust. “People think I’m crazy, but I have a sense of
possibility.”
The polling is striking. Sixty percent of Americans, including a majority of white people, said in a CBS News poll last month that they support ideas promoted by the Black Lives Matter movement. Almost as large a majority supports a national health care plan. An astonishing 89 percent favor higher taxes on the rich to reduce poverty in America.
The
sense of opportunity thus is emerging not solely from the wreckage of
past policies but also from new attitudes, particularly among young
people. Half a century ago, there was something to Nixon’s claim of a
“silent majority” that backed his racist dog whistles; today, polls
indicate, the silent majority want more spending to address racial inequity, moreeffort to address climate change and more input from scientists on how to handle Covid-19.
It’s
not clear, of course, that these views will translate into wiser
policies. Congress is often more responsive to wealthy donors than to
voter opinions. And while white Americans may chant “Black Lives
Matter,” they may not want to back policies to share the bounty that
they have been hogging; few are talking about fixing our unequal system
of local school funding built to transmit advantage from one generation
to the next.
Yet this inchoate movement is gaining ground, and
Trump is on the defensive. In the rural Oregon town where I grew up,
most people voted for Trump in 2016, and until early this year they
stuck with him because they liked his nominations of conservative judges
and his pro-gun stance, but most of all they liked the roaring economy.
Now the collapsing economy and Trump’s manifest failures in managing
the pandemic test that support.
In the 1930s the unequivocal
nature of Hoover’s failures helped win Roosevelt his mandate and made
the New Deal possible. Maybe national anguish can again be the midwife
of progress.
“It is possible that the best thing that could have
happened to make progressive change possible is the crass,
self-interested, ineffective politics of Donald Trump,” Lizabeth Cohen, a
Harvard historian, told me. *
But wait!
Even if Biden wins with both chambers of Congress — a huge if — this is
an age of toxic polarization. Republican senators will filibuster (if
the filibuster survives), conservative judges will overturn Biden
executive orders, and Tucker Carlson and Sean Hannity will spew venom.
Actually,
that sounds rather like the 1930s. Roosevelt was (initially) blocked by
the Supreme Court, and fervently denounced by Father Charles Coughlin
on the right and Senator Huey Long on the left. F.D.R. was regularly
accused of being a “warmonger” and a “fascist dictator,” or of taking
America on the road to Communism. He didn’t even have the full backing
of his wife, Eleanor (history vindicated her on most of their
disagreements, such as anti-lynching legislation that she supported and
the internment of Japanese-Americans that she opposed).
Skeptics
worry that Trump has permanently damaged American institutions and
norms, in ways that will impair future progress. Perhaps. But Nixon
likewise challenged institutions, norms and the rule of law, and the
result was that Americans came to value them more. One result was the
Democratic tidal wave of 1974.
Like Trump, Nixon took on
journalists — his vice president, Spiro Agnew, excoriated critics as
“nattering nabobs of negativism” — but ultimately Agnew was convicted of
a felony, and Bob Woodward and Carl Bernstein inspired a generation of
kids to become journalists. Me included.
I often hear Americans
say that our country has never been so divided. That doesn’t ring true.
Far more than today, households in the 1960s were riven by civil
warfare, with children denouncing parents as murderers for supporting
the Vietnam War and parents despairing of their offspring as immoral,
impractical good-for-nothings who lived in sin, smoked pot and
threatened the nation’s future. If we survived the chasms of the ’60s,
we can get through this.
“I know we will see a better future,”
President Jimmy Carter told me recently. “We have been through many
painful crises, some spanning years, but we have always gotten back on
our feet. Sometimes there must be a reckoning and course correction.”
I
reached out to Carter because his administration in the late 1970s
roughly marked the end of the postwar cycle of inclusive capitalism. At
age 95, he’s still guardedly optimistic, as is Walter Mondale, his vice
president, a classic liberal who at age 92 — “not too many more years,
and I’ll be getting old,” he told me — said he feels “a lot of hope.” *
History
does not unfold smoothly; policies do not “evolve” gradually. Rather,
they develop, like animal species, through what evolutionary biologists
call “punctuated equilibrium” — long periods of stasis and short bouts
of intense variation. The change is often driven by traumas, like the
American Revolution or the Great Depression.
Roosevelt
was a somewhat conventional, privileged figure who seized upon the
catastrophe of the Depression to transform America. Lyndon B. Johnson
was a corrupt and manipulative Southern politician who seized upon the
Kennedy assassination to pass civil rights legislation and the Great
Society programs.
“F.D.R. wasn’t by nature a revolutionary, but
out of the trauma of the Great Depression he helped unleash a revolution
that made America a richer, fairer and better country,” said Cohen.
“The same is possible again — if we get everything right.”
Covid-19
and the Black Lives Matter movement, along with a broad recognition
that America has taken a wrong path, create a similar opportunity for
Joe Biden. While Biden isn’t charismatic, he’s a reassuring veteran who
knows how the system works and doesn’t frighten voters — and who thus
has a chance, like F.D.R., to be elected with a mandate and make
history.
Some of Biden’s aides are telling him to think in such
grand terms, and he seems drawn to the idea. “I do think we’ve reached a
point, a real inflection in American history,” he told reporters a few days ago. “And I don’t believe it’s unlike what Roosevelt was met with.”
Biden
added that “we have an opportunity to make some really systemic
change,” but for now his policy positions don’t show much sign of that.
He is likely to favor a public option as a path to universal health
coverage, stronger moves on climate change, a higher federal minimum
wage, easier access to college, and jobs programs to reduce inequality.
If enacted, these would put America on a path more like that of Europe
and Canada, but they would be short of Rooseveltian.
Add a
universal child care/pre-K program modeled on the military’s, universal
dental coverage, Canada-style child allowances to cut child poverty in
half, major investments in K-12 education for disadvantaged children,
“baby bonds” to reduce wealth inequality, greater union protections and
“bandwidth for all” — then you are talking history.
Is that a pipe
dream? Perhaps. But a series of national crises may have exposed our
failings enough to give us a chance at a do-over.
This
hope is not Pollyannaish. It rests on a tragic toll of Covid-19 deaths,
and it requires a thousand caveats. Trump might win in November. If
Biden wins, a Republican Senate might stymie his proposals and block his
nominees. Deficits are now so enormous that politics may become a
dispiriting fight about which programs to cut, not which dreams to
finance. Veteran liberals are scarred by memories of unfulfilled hope
that followed Barack Obama’s election in 2008, Bill Clinton’s in 1992,
Jimmy Carter’s in 1976: Hope is the engine oil of campaigns, but it
burns up in the heat of governing.
And yet.
“Hope right now
in America is bloodied and battered, but this is the kind of hope that
is successful,” said Senator Cory Booker, Democrat of New Jersey. “It’s
hope that has lost its naïveté.”
Besieged as we are by plague and
crisis, a dollop of this “calloused hope,” as Booker calls it, offers an
incentive to persevere. If in the depths of the Great Depression we
could claw a path out and forge a better country, “calloused hope” can
guide us once more to a better place. https://www.nytimes.com/2020/07/16/opinion/sunday/coronavirus-blm-america-hope.html?
The crisis that shocked the world: America’s response to the coronavirus
Dysfunctional politics, a lack of funding
for public health and a rush to reopen the economy ignited the
resurgence of the virus
Isabelle Papadimitriou devoted herself to
treating patients as a respiratory therapist in Dallas. She was stricken
with covid-19 as it surged in her state, and died on the Fourth of
July. (Family photo) “I feel like her
death was a hundred percent preventable. I’m angry at the Trump
administration. I’m angry with the state of our politics. I’m angry at
the people who even now refuse to wear masks,” she said.
Six months after the coronavirus
appeared in America, the nation has failed spectacularly to contain it.
The country’s ineffective response has shocked observers around the
planet.
Many countries have rigorously driven infection rates
nearly to zero. In the United States, coronavirus transmission is out of
control. The national response is fragmented, shot through with political rancor and culture-war divisiveness. Testing shortcomings that revealed themselves in March have become acute in July, with week-long waits for results leaving the country blind to real-time virus spread and rendering contact tracing nearly irrelevant.
The
United States may be heading toward a new spasm of wrenching economic
shutdowns or to another massive spike in preventable deaths from
covid-19 — or both.
How the world’s richest country got into this
dismal situation is a complicated tale that exposes the flaws and
fissures in a nation long proud of its ability to meet cataclysmic
challenges.
The fumbling of the virus was not a fluke: The American coronavirus fiasco has exposed the country’s incoherent leadership,
self-defeating political polarization, a lack of investment in public
health, and persistent socioeconomic and racial inequities that have
left millions of people vulnerable to disease and death.
In this
big, sprawling, demographically and culturally diverse nation, the
decentralized political structures gave birth to patchwork policies that
don’t make sense when applied to a virus that ignores state boundaries
and city limits.
While other countries endured some of the same
setbacks, few have suffered from all of them simultaneously and
catastrophically. If there was a mistake to be made in this pandemic,
America has made it.
The single biggest miscalculation was rushing
to reopen the economy while the virus was still spreading at high rates
through much of the country, experts say. The only way to reopen
safely, epidemiologists said as far back as early April, was to “crush the curve” — to drive down the rate of viral transmission to the point that new infections were few and far between.
Many countries did just that. The United States did not follow the expert advice. Now, the curve is crushing America.
“We
didn’t have the stick-to-itiveness, the determination, to carry through
what we started in March, April and May, and now the virus is taking
advantage of that,” National Institutes of Health Director Francis
Collins said.
“If we’d had really strong guidance from local,
state and national leaders, maybe we could have sustained the
determination to get the curve all the way down to zero,” he said. “Now,
we’re on the upswing, and I don’t quite see the top of the upswing
yet.”
America, the outlier
Other countries
have managed to avoid the kind of dramatic viral resurgence that is
happening in America. Spain, Italy, Germany and France — all devastated
by the virus months ago — drove coronavirus cases and deaths to
relatively low levels. The United Kingdom has been an outlier in Europe,
with one of the highest per capita death tolls in the world, but after
suppressing transmission, it has not seen a major rebound.
And in Asia, the picture is radically different. In Taiwan, baseball
fans sit in the stands and watch their teams play. Japan has had fewer
than 1,000 deaths from covid-19, the illness caused by the coronavirus.
South Korea has had fewer than 300. Vietnam has recorded no deaths from
the virus.
The death rate from covid-19 in the United States looks
like that of countries with vastly lower wealth, health-care resources
and technological infrastructure. By late June, the coronavirus was rampaging
through Houston. Here, medical staff remove a victim who had died in the
covid-19 intensive care unit at United Memorial Medical Center. (Go
Nakamura/Getty Images)America’s
mishandling of the pandemic has defied most experts’ predictions. In
October, not long before the novel coronavirus began sickening people in
China, a comprehensive review ranked the pandemic preparedness of 195
countries. The project — called the Global Health Security Index
and spearheaded by the Johns Hopkins Center for Health Security and the
Nuclear Threat Initiative — assigned scores to countries as a way to
warn them of the rising threat of infectious-disease outbreaks.
With a score of 83.5 out of 100, the United States ranked No. 1.
How
did the nation get caught so flat-footed? By not really trying, said
Beth Cameron, who helped lead the project for the Nuclear Threat
Initiative.
The federal government punted the coronavirus response
to the states, counties and cities, said Cameron, who was senior
director for global health security and biodefense on the White House
National Security Council and helped write a pandemic response plan
under President Barack Obama. The team Cameron led was disbanded after Donald Trump took office.
“I
just never expected that we would have such a lack of federal
leadership, and it’s been deliberate,” she said. “In a national
emergency that is a pandemic, spreading between states, federal
leadership is essential. And if there was any doubt about that, we ran
that experiment from March and April until now. It failed. So we have to
run a different experiment.”
A nation of individuals
Somehow,
this highly mobile virus keeps sneaking up on communities, seeding
itself extensively before people detect the breadth and intensity of the
attack. That happened catastrophically in New York City early in the
pandemic. The new outbreaks have been largely in the South and West.
This
month, Roy Ramos, a reporter for WPLG-TV in Miami, noticed he had a
cough. He and his wife, the station’s evening news anchor, Nicole Perez,
went to get tested for the coronavirus. Positive — both of them. Soon,
another anchor and the station’s chief meteorologist had tested
positive, too.
As of July 14, 10 station employees had tested
positive, including some who hadn’t even been in the office or in
contact with their co-workers. The virus was everywhere in South
Florida, which is now reeling from the pathogen’s assault.
“This
is not a political message, but a personal one,” Perez’s co-anchor,
Calvin Hughes, told viewers. “Please, please wear a mask.”
Local officials in Florida are calling on the Republican governor to
better convey the urgency of the health crisis as covid-19 cases surge.
(Reuters)
In the minds of many Americans, the
coronavirus crisis that was so alarming in March and April lost its
fearsomeness in May and June, when people tried to resume something
approximating a normal life. The shutdowns had been miserable, but
they’d been effective.
The success of the shutdowns meant that
many Americans didn’t know anyone personally sickened by the virus. In
places with low transmission, the crisis seemed far away.
“We just
let our guard down,” Ohio Gov. Mike DeWine (R) said in an interview
Friday. “Some people when they heard, ‘Hey, Ohio’s open,’ what they
mentally processed is, ‘It’s safe. We can go out and do whatever we want
to. It’s back to normal.’ ”
In the past two months, the virus has
been smoldering in his state, the governor said, and “now we start to
see some flames.” He fears Ohio could soon have the kind of runaway
transmission afflicting Florida.
“Florida a month ago is where
Ohio is today. If we don’t want to be Florida, we’ve got to change what
we’re doing. Everybody’s got to mask up,” the governor said.
He and others cite human nature as a problem with containing the
virus. Human brains simply aren’t wired to emphasize the importance of
doing things, like wearing masks, that protect others but offer no
immediate payoff, said Paul Slovic, a University of Oregon psychologist.
“You
don’t get rewarded for putting on a mask,” Slovic said. “You don’t see
who you’ve protected from harm, but you do feel an immediate
discomfort.”
Protecting one life — or even one small puppy —
generates a major emotional response that can prompt action, Slovic has
found. But as the number of individuals involved increases — say, to the
137,000-plus deaths caused by the coronavirus — people grow inured to
the loss, less prone to take action.
That makes public messaging
especially essential, experts say. But the messaging in the United
States has been all over the place. Even the scientists have struggled:
They were wobbly on the effectiveness of masks before eventually
embracing them.
Kristin Urquiza, 39, said she tried warning her
father, Mark — a lifelong Republican — against going out and risking
infection. In their home state of Arizona, as leaders including Gov.
Doug Ducey (R) sprinted to reopen in May and June, Urquiza could tell
she was losing the argument.
“When the president, the governor and people on cable news are all
saying one thing, how do you compete with that?” she said. “He would
push back. ‘I hear what you’re saying, but why would the governor say
it’s safe to go out if it’s not true?’ ”
Her father died of the virus June 30. In the obituary she wrote, she lashed out at government leaders.
“He
was a huge supporter of Trump and Arizona governor Ducey. He believed
what they said. And they betrayed him,” she said in an interview.
When there’s no cavalry to send
Even before the pandemic hit, local public health agencies had been decimated by years of staffing and budget cuts.
They
had lost almost a quarter of their overall workforce since 2008 — a cut
of almost 60,000 workers, according to national associations of health
officials. The agencies’ main source of federal funding — the Centers
for Disease Control and Prevention’s emergency preparedness budget — had
been cut 30 percent since 2003.
Public health is an enterprise with an intrinsic problem: People can’t see sicknesses avoided or deaths averted.
“You
don’t see the results. It’s a dog that doesn’t bark,” said David
Himmelstein, professor of public health and health policy at the CUNY
School of Public Health.
“The question is, does the water come out
of your tap clean? Are the sewer systems being inspected? Are
restaurants and food being inspected? Those things, you don’t notice
until they fail,” he said.
The country’s electronic disease
surveillance systems are “archaic and cumbersome,” said Cathy Slemp, who
was recently dismissed as West Virginia’s public health commissioner
after the governor blamed her for failing to reclassify certain
coronavirus cases as recovered.
“We’re driving a Pinto and want to have a Ferrari,” she said.
The
public health challenges are keenly felt in Malheur County, a vast
swath of mostly federal rangeland in rural eastern Oregon. About a
quarter of its 30,000 residents live in poverty. Teen pregnancy rates
are double the statewide rate. There’s one school nurse for 10,000
square miles. Drug use is high.
The first coronavirus case hit
March 30, and for more than a month, the county averaged just one to two
cases a week. There was resistance to a statewide shutdown in the
conservative area, but most people were willing to observe temporary
restrictions, said Sarah Poe, director of the county health department.
But
after a month or so, residents began to complain of government
overreach. Many felt they had to resume working to survive, she said.
“People’s
response has been to just take care of themselves, take care of your
own business, your own family,” Poe said. “That’s not how this virus
works.”
Now, the coronavirus is a full-blown crisis in Malheur
County. Cases began soaring three weeks ago, to 15 or 16 a day. As of
Friday, the county had 477 cases. The cumulative positive rate since the
first case is nearly 16 percent — quadruple the state’s rate.
On Wednesday, facing an accelerating caseload, Malheur County commissioners passed a resolution
that goes further than the state’s mask order. It recommends gatherings
of no more than 10 people indoors and 25 outdoors, and mask-wearing in
groups indoors and out.
But resistance in the county remains high. Poe said she regularly gets hate mail and phone calls accusing her of peddling a hoax.
“We’re
up against just a ton of misinformation,” she said. “What are we
fighting here? We are fighting a virus and our goal is to save lives.
Let’s not be distracted into fighting other people.”
A turning point
America, experts say, is approaching a
tipping point at which its public health systems could become so
overwhelmed they begin to collapse. Already, coronavirus test results
take so long to come back they are almost useless for anything except as
a historical record.
The delays have a cascading effect. Contact
tracing is rendered ineffectual. Containing the virus by isolation
becomes impossible. And as hospitals fill, the virus’s fatality rate
could inch upward because of overtaxed ICU nurses and doctors struggling
to care for so many.
But the most dangerous cascading effect
could be despair — a loss of hope, along with the resolve to fight the
virus, warned Michael T. Osterholm, director of the University of
Minnesota’s Center for Infectious Disease Research and Policy.
“When
that happens, you lose the ability to act rationally. You lose the
commitment to fight. You lose all chance of beating back the virus,” he
said.
As some states began to reopen in late April, New York doctors who
saw a decline in coronavirus patients said lifting social distancing
could reverse progress. (Joyce Koh/The Washington Post)
Adam Fleming Petty, a writer in Grand
Rapids, Mich., said he feels that demoralization acutely — as well as
“so much rage” at Trump and other political leaders whose measures did
not quell the virus enough to allow many schools to open.
“One
thing I told myself was, ‘Okay, as long as school starts back up in the
fall, I can do this. I can make it through the summer if I have that
goal waiting for me.’ Now, that goal isn’t there anymore,” said Petty,
38, who has been the primary supervisor of two daughters, ages 5 and 7,
while his wife works from home. For four months, the family has
socialized with only a handful of relatives just a few times.
“This
is far from the first time that governmental administrative
incompetence has been displayed. But I can’t remember the last time that
the consequences of that were so personal,” Petty said.
Governors
and local officials across the Sun Belt have announced incremental
measures in recent days to halt the viral resurgence. California
instituted a statewide mask requirement. Arkansas and Colorado did so
Thursday. Arizona allowed local jurisdictions to implement mask mandates
as they see fit.
Florida’s governor has resisted weeks of calls
to implement such a mandate. Georgia Gov. Brian Kemp (R) announced
Wednesday that all local mask mandates in his state are void.
Louisiana and Texas recently shut down bars all over again. Alabama
Gov. Kay Ivey (R) announced a statewide mask mandate in recent days as
an alternative to closing. West Virginia limited gatherings to 25 people
or fewer.
In New York, Gov. Andrew M. Cuomo (D) threatened to close restaurants if social distancing is not taken seriously.
“Closing
the bars is going to be the equivalent of fixing three of the five
screen doors in your submarine,” said Osterholm, who says that places
with high levels of transmission need to return to the kind of shutdowns
common in March and April.
In a telephone interview, Cuomo said
New York officials were caught off guard early in the year because
everyone assumed the virus was coming into the West Coast from China.
But it had already spread in Europe, and from there to New York.
“We
didn’t find out until after the fact. You don’t have the revelation by
the academics until mid-March that this was one of the great health
blunders of all time,” Cuomo said. “You actually got hit by a bus that
came from the other direction.”
He expressed dismay about the national failure to suppress the virus.
“If
you could have written a prescription four months ago, a manual — ‘This
is what you must do to deal with a virus’ — and if people could just
follow the manual, we would be over this, like other countries are over
it,” Cuomo said. “I think it exposed a fundamental weakness in this
country. We have a divided country.”
New York beat back the virus
by closely following the scientific data and being cautious about
reopening the economy, Cuomo said. Many places suffering high rates of
infections didn’t do that, he said.
“It was science denial meets government incompetence,” he said.
‘The exception and anomaly’
This crisis has been sucked inexorably into the vortex of political polarization.
Trump
repeatedly downplayed the viral threat. “You have 15 people, and the 15
within a couple of days is going to be down to close to zero,” he said
in late February. On Twitter, he cheered on citizen protests of
shutdowns that had been ordered by Democratic governors. He did not wear
a mask in public until July 11.
White House spokeswoman Sarah
Matthews in a statement defended the administration’s response to the
crisis, saying Trump “has led an historic, whole-of-America coronavirus
response — resulting in 100,000 ventilators procured, sourcing critical
PPE for our frontline heroes, and a robust testing regime resulting in
more than double the number of tests than any other country in the
world. … This strong leadership will continue as we safely reopen the
economy, expedite vaccine and therapeutics developments, and continue to
see an encouraging decline in the U.S. mortality rate.”
A White
House official on background defended the president’s support for
reopening the economy while the virus was still spreading, citing
Trump’s belief that the cure cannot be worse than the disease: “There
are consequences to staying closed, including but not limited to missed
doctors’ appointments, drug or alcohol misuse, and suicide as a result
of the pandemic.”
Future historians will not treat kindly Trump’s efforts to divide and
confuse, said James Grossman, executive director of the American
Historical Association.
“You look at the Great Depression and how
Roosevelt made a concerted effort to unite the country — the fireside
chats, the New Deal. That is the instinctive reaction of almost every
president in crisis. Even if you don’t succeed, you try to convince
people that they’re all in this together,” Grossman said. “This
presidency is the exception and anomaly.”
Many Americans now
believe the pandemic has been exaggerated, or even fabricated, by
scientists and the mainstream news media. The rejection of scientific
expertise has flowered into a conspiracy theory holding that the experts
are lying as part of a political agenda.
“The most outrageous
lies are the ones about Covid 19. Everyone is lying. The CDC, Media,
Democrats, our Doctors, not all but most, that we are told to trust,”
former “Wheel of Fortune” game show host Chuck Woolery tweeted July 12.
Trump
retweeted that. Days later, Woolery revealed his son was sick with the
virus, and he has since taken down his Twitter account.
To be an American
As she prepares for a three-day drive across the country — from New York to Texas — to bury her mother, Tulip said she has been thinking a lot about what it means to be American.
She
was raised like many Texans, unabashedly proud of her roots and her
patriotism. “I grew up a Dallas Cowboys fan. All about the stars and
stripes. You know that song ‘Proud to Be an American’? We would
literally sing that as kids in elementary school and mean every word.”
Now,
she said, she feels betrayed by her country and home state. For the
past two weeks, she and her husband have been calling funeral homes in
Brownsville, unable to get through because the town has been overwhelmed
by the virus.
“I desperately want to believe we as a country can
change, that we can recover from where we are now,” she said. “I want to
believe that America can get back to who we were, a proud country, one
where people can thrive and not suffer.” https://www.washingtonpost.com/health/2020/07/19/coronavirus-us-failure/?hpid=hp_hp-banner-main_virusfiiasco-415p%3Ahomepage%2Fstory-ans
Healthcare is Trump's Achilles heel. Republicans don't get it
Five million Americans have lost their health insurance in a pandemic - yet Republicans are still trying to end Obamacare
Like Moloch, the ancient pagan god,
Donald Trump is ever ready to demand that Americans sacrifice
themselves for his greater good. He commanded that states open up early,
and then this happened: Arizona, Florida, and Texas are looking like
Wuhan redux. Come this fall, the president also expects that parents
will put their children in harm’s way for the sake of his re-election
bid. In response, teachers have taken to drafting their wills, just in case.
But other moments, Trump acts like a man with a political death wish
of his own. His justice department is urging the US supreme court to
strike down the Affordable Care Act as unconstitutional. The fact that 5.4 million people have already lost their health insurance amid the pandemic does not even register as a blip on the administration’s radar.
Instead, last month the government filed its brief
with the high court in its endless endeavor to erase Barack Obama’s
legacy. Just think of Wile E Coyote chasing Road Runner and you get the
picture.
What the president could not accomplish when the Republicans controlled both houses of Congress, he now hopes to achieve in the courts. Regardless, his timing couldn’t be worse.
A legal gambit hatched when the world looked well and the economy was
thriving has morphed into another reminder that this administration
functions as an incompetent Death Star divorced from reality. A response
to the administration’s filing is due at the court late this month. By
the time the Republicans convene for their convention in Florida,
briefing will have just been completed.
Unfortunately, don’t expect Covid-19 to be done with America by then.
Already, more than 135,000 of its victims lie dead; the total could
reach 200,000 by election day. Once upon a time, the president predicted
that this plague would be quickly gone and Jared Kushner told the world
that everything would be awesome come July.
Instead, Americans are prisoners within their own borders. Large
swaths of Europe, Asia and Canada are denying entry to US citizens. Passport privilege is gone.
The amicus briefs filed in opposition to the government’s position
are bad news for the president. Portions of Trump’s base are actively
aligned against him. In simplest terms, older voters and Catholic
Americans don’t necessarily like what they are seeing. AARP and the Catholic Health Association have come out swinging to defend Obamacare. AARP speaks for America’s seniors, and older voters are walking away from Trump.
Looking at the map, Joe Biden leads in Florida. Grandma and grandpa
have no intention of going gently into that not so good night, not if
they have a say about things.
As for the Catholic Health Association, it is one more reminder that
organized Catholic interests go beyond contraception. Rather, the
Catholic health ministry is the largest group of nonprofit healthcare
providers in the US. Indeed, Biden’s call
for an updated New Deal is reminiscent of the “small-c” Catholic ethos
that marked FDR’s years. Rugged individualism has limited appeal when
death looms and collapse is all around.
From that vantage point, Trump’s stance appears to be more about
keeping the Republican donor-base happy than winning votes. When
rocked-ribbed Oklahomans recently backed Medicaid expansion, it is time
for Trump and his minions to rethink things.
In other words, conservative America is not exactly craving
Republican economic orthodoxy. But the Republican party’s big-ticket
contributors still do.
For example, the Cato Institute
is siding with the administration in this scrum. The Koch brothers were
early funders of Cato, and Nancy Pfotenhauer of the Koch-affiliated
Americans for Prosperity sits on Cato’s board. The message is clear.
Against this backdrop, Trump’s veneration of all things Confederate
appears to be misplaced recompense for his sticking it to his own
working-class core. Yet the wisdom of this strategy is doubtful. Some of
the economically hardest hit states may be ready to desert the
president. The latest weekly initial unemployment
statistics show the largest number of first-time unemployment claims
originating in places like Michigan and Texas. Biden’s lead in Michigan
is no longer a surprise but polls also show him ahead in Texas, a state
that last voted Democratic in 1976.
Texas’ hospitals are now being overwhelmed by Covid-19 yet the Lone Star State is the lead respondent
in the fight before the supreme court. In the words of Kyle Hawkins,
Texas’ solicitor general, “petitioners defend the ACA as good policy,
citing the current pandemic. Not only are those policy arguments
incorrect, but they miss the point.”
That is the sole mention of the disease in 49 pages of argument.
Arizona and Florida, among other states, are also on board with the
brief. Talk about a convergence of bad timing and worse luck.
In Too Much and Never Enough,
Mary Trump, the president’s niece, writes that if the president “can in
any way profit from your death, he’ll facilitate it, and then ignore
the fact that you died”. As her book dropped on Tuesday, the Grim
Reaper’s scythe is again unsheathed. Covid is going full-bore. The
prospects of Trump as a one-term president grow.
As proposals to ban surprise medical bills move through Congress and
state legislatures with rare bipartisan support, physician groups have
emerged as the loudest opponents.
Often led by doctors with the veneer of noble concern for patients,
physician-staffing firms — third-party companies that employ doctors and
assign them out to health care facilities — have opposed efforts to
limit the practice known as balance billing. They claim such bans would
rob doctors of their leverage in negotiating, drive down their payments
and push them out of insurance networks.
Opponents have been waging well-financed campaigns. Slick TV ads and
congressional lobbyists seek to stop legislation that had widespread
support from voters. Nearly 40% of patients said they were “very worried”
about surprise medical bills, which generally arise when an insured
individual inadvertently receives care from an out-of-network provider.
But as lobbyists purporting to represent doctors and hospitals fight
the proposals, it has become increasingly clear that the force behind
the multimillion-dollar crusade is not only medical professionals, but
also investors in private equity and venture capital firms.
In the past eight years, in such fields as emergency medicine and
anesthesia, investors have bought and now operate many large
physician-staffing companies. And key to their highly profitable
business strategy is to not participate in insurance networks, allowing
them to send surprise bills and charge patients a price they set — with
few limitations.
“We’ve started to realize it’s not us versus the hospitals or the
doctors, it’s us versus the hedge funds,” said James Gelfand, senior
vice president of health policy at ERIC, a group that represents large
employers.
“They have money to burn,” said a Democratic congressional aide with
knowledge of the lobbying efforts “They’re in take-the-bill-down mode.”
Private equity firms and the staffing companies they own have a lot
to lose, too. While doctors largely once worked for hospitals or had
individual contracts, many hospitals now rely on these huge staffing
businesses to provide doctors for various departments. Companies like
Envision Physician Services and TeamHealth provide doctors to dozens,
sometimes hundreds of hospitals. Private equity firms back these
ever-growing outsourced staffing companies.
Because patients have no effective way to protect themselves from
unexpected medical bills, even knowledgeable, proactive people with
comprehensive insurance can find themselves whisked away to an
out-of-network hospital in an emergency or treated by an out-of-network
anesthesiologist at the in-network hospital they selected.
Several lawmakers have adopted the issue, one seemingly ready-made
for campaign season: In fighting surprise bills, they are attacking a
practice both reviled by the public and easy to explain.
What’s harder to explain is where the money on the other side of the
campaign comes from. Coalitions like Physicians for Fair Coverage and
dark-money groups with innocuous names like Doctor Patient Unity have
flooded the airwaves with ads urging people to call their lawmakers and
voice opposition to ending surprise bills. And those lawmakers are
overwhelmingly senators facing difficult reelection fights next year,
who might be hesitant to vote for change — especially if it means more
expensive ad campaigns aimed at taking them down.
To understand the power and size of private equity in the U.S. health
care system, one must first understand physician-staffing firms.
Increasingly, hospitals have turned to third-party companies to fill
their facilities with doctors. Among driving factors: physician
shortages, a bigger insured population because of the Affordable Care
Act and an aging population, according to research from the investment firm Harris Williams & Co.
In some areas, doctors have few options but to contract with a
staffing service, which hires them out and helps with the billing and
other administrative headaches that occupy much of a doctor’s time.
Staffing companies often have profit-sharing agreements with hospitals,
so some of the money from billing patients is passed back to the
hospitals.
The two largest staffing firms, EmCare and TeamHealth, together make up about 30% of the physician-staffing market.
That’s where private equity comes in. A private equity firm buys
companies and passes on the profits they squeeze out of them to the
firm’s investors. Private equity deals in health care have doubled in the past 10 years. TeamHealth is owned by Blackstone, a private equity firm. Envision and EmCare are owned by KKR, another private equity firm.
With affiliates in every state, these privately owned, profit-driven
companies staff emergency rooms, own dialysis facilities and operate
physician practices. Research
from 2017 shows that when EmCare entered a market, out-of-network
billing rates went up between 81 and 90 percentage points. When
TeamHealth began working with a hospital, its rates increased by 33
percentage points.
A study by the Kaiser Family Foundation found that 1 in 6 Americans with insurance were surprised by a medical bill after treatment at a hospital in 2017.
That is no coincidence: In many states, balance billing — when a
provider charges a patient the difference between their fee and what
their insurance company paid — is legal, so physician-staffing services
have little incentive to contract with insurance companies and provide
in-network doctors.
“These physician-staffing companies are benefiting tremendously from
the ability to bill out-of-network,” said Zack Cooper, an associate
professor of public health at Yale, who has studied physician-staffing
firms and balance billing. “It’s a small but profitable sliver of the
health care system that these firms are using to make pretty significant
amounts of money.”
Cooper said the business models are built on the ability to get profits from balance billing.
“Private equity firms are buying up physician practices that allow
them to bill out-of-network, cloaking themselves in the halo that
physicians generally receive and then actively watering down any
legislation that would both protect patients but affect their bottom
line,” Cooper said.
The staffing firm Envision disputed this assessment of its business
model. An emailed statement said more than 90% of its business comes
from in-network agreements and that the company continues ”actively
advocating for a federal solution to surprise medical bills.”
The two possible solutions on the table in congressional legislation are arbitration and benchmarking.
Arbitration sends the insurers and health care providers through an
independent review to determine a fair price in the event of a balance
bill.
Under benchmarking, out-of-network physician charges are paid by the
patient’s health plan based on an average of what other in-network
doctors in the area are paid. Money is being spent on all sides of the
debate, but for the physicians and private equity firms, it’s weighted
most heavily on the side of arbitration.
Assorted groups have organized themselves into different coalitions
and mega-groups to pool resources for lobbying and ads. On the side of
benchmarking, there is the Coalition Against Surprise Medical Billing,
made up of employers and insurers like Blue Cross Blue Shield, the
Association of Health Insurance Plans and ERIC, which represents large
employers.
On the arbitration side, there is Out of the Middle, Physicians for
Fair Coverage, SOAR and Doctor Patient Unity, to name a few. Ostensibly,
these are composed of doctor and hospital groups.
“It’s important that federal legislation to end surprise billing also
incentivizes all providers and insurers to negotiate in good faith in
order to increase the number of in-network providers and ensure
patients’ continued access to high-quality medical care,” added Megan
Taylor, a spokeswoman for Physicians for Fair Coverage.
Yet these groups are dominated by private equity and
hedge-fund-backed organizations. Physicians for Fair Coverage is made up
of ApolloMD (a staffing firm owned in part by the investment firm ValorBridge), Radiology Partners (a staffing firm owned in part by the investment firm New Enterprise Associates)
and a trio of staffing firms called US Acute Care Solutions, US
Radiology Specialists and US Anesthesia partners (all partly owned by
the investment firm Welsh, Carson, Anderson and Stowe).
Among the groups listed as lobbying on surprise bills are hospital groups like Christus Health (which uses EmCare) and Wellstar Health Systems (which uses ApolloMD). In addition, HCA, a large hospital chain that has had a joint venture with EmCare, has also been active on these issues.
Even the groups that appear to represent independent doctors are tied
to private equity and staffing firms. Out of the Middle consists of
trade organizations for specialty doctors, like the American College of
Emergency Physicians (ACEP) and the American Society of
Anesthesiologists and many others. It’s mostly run by ACEP, whose
immediate past president, Dr. Rebecca Parker, was also a senior vice
president at Envision.
Spending on lobbying around this issue has been generous, according
to disclosures from the Center for Responsive Politics. The staffing
firm Mednax spent $180,000 on lobbying the House and Senate. TeamHealth and TeamHealth Inc. together spent $100,000. Physicians for Fair Coverage spent $145,000. US Physician Partners, an “informal lobbying group” that never lobbied before 2019, spent $130,000.
“There’s no way we can match them,” said Gelfand, from ERIC. “We’re
entering this debate knowing we’re being horrifically outspent.” https://khn.org/news/investors-deep-pocket-push-to-defend-surprise-medical-bills/
Wendell Potter on Why America’s Healthcare System Is to Blame for Our Poor Coronavirus Response
The former Cigna insurance executive
has been firing off righteous screeds against his old industry on
Twitter, outlining just how broken the system is amid the pandemic.
Wendell Potter used to lie for a living. He admits this fact readily:
Twenty years as an insurance executive at Cigna, during which time his
job was to peddle misinformation defending the American healthcare
system.
Eventually, Potter had an epiphany,
realizing his own public relations spins were not, in fact, true. He
quit. Ever since, Potter has been campaigning against the multi-billion-dollar
insurance industry that he once defended. He founded a nonprofit
healthcare publication, Tarbell, has gotten involved with two other
nonprofits advocating for Medicare expansion, and has been been firing
off pointed critiques at the insurance industry on Twitter. (His most
recent tweet thread, posted June 25th, was also his most viral: more
than 80,000 retweets and 11 million views.) “I often say what I’m
doing now is an attempt to make amends for the harm that I know that my
colleagues and I did during my career,” says Potter.
Potter’s
particular style of Twitter takedown — that of the incredulous, but
reformed, insider — makes for a compelling narrative. He almost always
prefaces his tweets with a bit of soul cleansing: As a former insurance exec, I must come clean…
The coronavirus pandemic has only raised the stakes and confirmed to
Potter what he already believed: that the insurance industry is rotten.
Potter, who’s been quarantining from his home in Queen Village, spoke
with Philly Mag about how America’s private insurance system has
worsened its COVID-19 outcomes, why insurer profits are rising even amid
a pandemic, and why he’s still not optimistic that this country will
create a Medicare for All system anytime soon. In one of your recent tweet threads
you suggested a correlation between the healthcare system of the
country and the quality of its coronavirus response. You noted that
Canada, which has a single-payer system, has a lower death rate per
capita than the U.S. As it relates to COVID-19, how does single-payer
improve not only infection rates but also the actual health outcomes at
the end of the road?
In the Canadian system and in
single-payer systems around the world, everyone living in the country
has access to healthcare. And while the Affordable Care Act did a great
deal of good, before this pandemic began we had about 30 million people
who didn’t have health insurance and as many as 80 million people who
are underinsured. That doesn’t happen in Canada and elsewhere. A lot of
people in this country are afraid to go to the doctor, they are afraid
to get tested for concern of how much it will cost them, how much they
will have to pay out of their own pockets — even if they have insurance.
So there is a lot of fear that’s holding people back. In Canada,
there’s no charge at the point of service. You don’t have to stop and
think, Can I afford this? before getting the care that you need. In the U.K., which has a nationalized health system, they have 66 deaths per 100,000 people,
compared to the U.S. rate of 39 deaths per 100,000 people. There are
lots of other variables that could affect that death rate, like age of
population or where the hot spot of a particular outbreak is happening.
But when you’re using death rate as a data point to suggest that
single-payer or nationalized systems are better, how do you reconcile
that with the U.K. example?
That’s true. Statistics do
show that the incidence of death in the U.K. is higher. I never was
suggesting that it was solely the structure of a healthcare system that
contributes to the success or failure of all that goes into how to deal
with a pandemic. The age of population absolutely is a factor, the
number of people who are in nursing homes is a factor. And in the U.K.
there have been concerns over the years that it has not been as
supported by conservative governments as it should be. Overall, though,
the U.K. system ranks pretty highly among developed countries. If
you’re thinking about how to grade a response to the pandemic, you
could focus on treatment results. But a lot of single-payer advocates
would probably say that regardless of what the outcome is, the fact
that, according to one study, the average cost for COVID treatment for an insured
person in the U.S. ranges from $9,000 to $20,000, is proof enough of
the egregiousness of that system. Whereas in other countries, it’s free.
It’s
free at the point of service, which is an important distinction. We all
know that healthcare is not free in single-payer systems. The system,
or access to care, is publicly funded. … We, in this country, ration
care on the ability to pay. And with our employer-based system, it’s
showing that it is probably the worst system in the world when it comes
to assuring that people can get the care that they need when they need
it. We have had more than 43 million people file for unemployment
compensation and an untold number of those people lost their health
insurance, not only for themselves, but for their families. When you’ve
lost your job and your health insurance and you’re trying to figure out
how you can continue to pay the mortgage and put food on the table,
you’re gonna be very cautious about getting the healthcare you need,
getting tested, for fear that you might incur bills you simply can’t
afford. … We’re killing people unnecessarily in this country because of
how we structure our healthcare system. Congress passed a law that would ostensibly have made coronavirus tests free, but you’ve outlined how that hasn’t happened. The New York Timesreported
that two friends in Texas got tested at the same emergency room: One
was billed $200, the other was billed $6,400. Explain to me how that
federal law is failing and people are still getting bills like this.
Well,
because it has no teeth. It disburses money, but there’s no mechanism
to actually make sure that Congressional intent is carried out. There is
no real oversight of private insurance companies at the federal level.
Aetna, for example, was claiming that they’re waiving out-of-pocket
costs for testing and treatment. But they then said that their
self-insured members or customers can opt out. Well, what they didn’t
tell you is that the vast majority of their customers are self-insured,
which means it is the employers’ decision. It is just the luck of the
draw as to whether or not you’re going to get your costs covered. One
might have expected that the pandemic would be a nightmare for the
insurance industry because they’d have to cover so much care for people,
and also, if people are losing their jobs, there would be fewer people
paying premiums. But in another set of tweets, you noted,
at least in the case of United Healthcare, the company earned $5
billion over the first three months of 2020, exceeding projections.
You’ve said there’s reason to believe that will continue into the next quarter. How are insurers accomplishing this?
There
are a number of factors, but one is that so many elective procedures,
so many other things that ordinarily would have been done, are just not
happening. The result is that people are still paying premiums, but
claims are not nearly as high as they otherwise would be. Now, yes,
obviously there are a lot of people who have been affected by COVID who
have had to have treatment. But when you look at the landscape and look
at demographics, you see that a high percentage of those people are 65
and older, so they’re on a government program. The government, Medicare
for the most part, is picking up the tab for a lot of the testing and
treatment of people who have been affected by this. Could
the pandemic prompt wholesale change in the U.S. healthcare system?
Given everything you’ve just outlined about the system’s problems, you
might think it could lead to some kind of galvanization of public
opinion. On the other hand, neither presidential candidate right now
supports a single-payer system, and insurance companies are making as
much, if not more, money than previously.
I think the
chances are pretty slim at this moment that Congress will pass — even if
they control both houses of Congress next year and we have a Democrat
in the White House — a single piece of legislation that will establish
an improved Medicare program to cover everybody. I do think there will
be enormous pressure on Congress, regardless of the outcome of the
election, to move forward with meaningful reform that goes far beyond
the Affordable Care Act. One area is high drug prices. Another is
ever-increasing deductibles — how much people are having to pay out of
their own pockets for care, even if they have insurance. I mean, people
in this country have family plans with deductibles of over $16,000. It’s
just absurd. Has your advocacy work on social media
gotten more traction in recent months? Are you detecting any sense of
change of opinion on this topic simply based on what you’ve been putting
out onto Twitter?
I do sense that, and not just through
social media. That’s one way of detecting public opinion, but we also
see it in the recent presidential primaries. Entrance and exit polling
showed that a majority of people who voted in the Democratic primaries,
in every state, including the southern states, supported moving toward Medicare for All,
even after being told that this would largely replace private insurance
companies. So there is a shift taking place, and I’m sure that my
former colleagues in the insurance business are monitoring this very
closely and are pretty alarmed at it. You can expect that they will
spend enormous amounts of money to try to stop that in its tracks and to
shift public opinion to scare people, as I used to do in my old job.
But I am seeing a shift. I think some of what has been exposed in this
pandemic is going to be lasting. The ability of the industry to block
meaningful change is diminished. It’s not going away, but it’s going to
be more and more difficult to hold back change that very possibly can
reduce their profitability. https://www.phillymag.com/news/2020/07/02/wendell-potter-coronavirus-american-health-insurance/
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