Many Americans bemoan the normalcy before the lockdown prompted by the COVID-19 pandemic. Until we can get back to normalcy, however, we can do all the things that make America America by using technology.
Even liberal Democrats are unwilling to provide real relief to distressed homeowners and renters. All they want to offer is a temporary moratorium on evictions and foreclosures. In that respect, they are exactly the same as the Republicans. After all, they have a common class interest.
The coronavirus pandemic has laid bare two fundamental flaws in the American healthcare system.
Number one: There’s a reason that other rich countries treat healthcare as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford to buy private healthcare.
The second inherent flaw in the U.S. approach is that it’s for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.
When your insurance company issues a denial, they don’t merely pocket that payment. They also add to future profits. Even if you’re insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. “Visits to primary care providers made by adults under the age of 65…dropped by nearly 25% from 2008 to 2016” due to routine denials by insurers, reports NPR.
Denials also create a societal effect: news stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.
There’s another, third structural problem exposed by the pandemic—but it’s not receiving attention from public policy experts or the media. I’m talking about America’s lack of a centralized healthcare system.
A centralized healthcare system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for-profit. In such a scheme all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you’re on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.
The current system is primitive. Data is not transferable between doctors or medical systems without a patient’s directive, which inexplicably is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that’s it’s not a weekend or national holiday or a Wednesday, when some doctors like to golf.
Unless a patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether an unconscious victim is allergic to a drug, has a chronic illness or that there’s a treatment regimen proven to be more effective for them. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter one-size-fits-all treatment.
A few months ago I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in LA. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. “We do not treat viral infections with antibiotics,” the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.
This would not have been a issue back home in New York, where both my general practitioner and my pulmonologist know my medical history. Either doctor would have prescribed a strong antibiotic and a codeine-based cough syrup.
Because I happened to be in LA, I left CVS empty-handed.
It got to the point that I couldn’t walk 100 feet without pausing to catch my breath. I felt like I was going to die.
I called my doctor back in New York. She called in a prescription to the same CVS. It helped arrest my decline. But I wasn’t getting better.
I visited a different walk-in clinic, in West Hollywood. It was a better experience. They tested me for flu (negative), X-rayed me (diagnosis was early stage- pneumonia) and put me on a nebulizer. I began a slow recovery.
A centralized system would have been more efficient. The CVS nurse would have seen my history of non-response to treatment devoid of strong antibiotics. He also might have taken note of my pulmonologist’s effective use of a nebulizer to treat previous bouts of bronchitis and pneumonia. I might have been prescribed the proper medication and treatment as much as a week sooner.
COVID-19 almost certainly would have been detected in the United States sooner if we had a centralized medical system. “One example of a persistent challenge in the early detection of health security threats is the lack of national, web-based databases that link suspected cases of illness with laboratory confirmation. This leaves countries vulnerable, as they cannot accurately and quickly identify the presence of pathogens to minimize the spread of disease,” according to the U.S. Centers for Disease Control. Algorithms can automatically scan massive volumes of information for signs of novel infectious diseases, help identify potential problems and focus responses where they are needed most.
How many people’s lives could have been saved if lockdown procedures had begun earlier? If public health officials had seen the coronavirus coming back in December—or November—they might have been able to protect vulnerable populations and avoid a devastating economic shutdown.
There are substantial privacy considerations. No one wants a hacker to find out that they had an STD or an employer to learn about documented evidence of substance abuse. Keeping a centralized healthcare system secure would have to be a top priority. On the other hand, there is no inherent shame in any kind of illness. In a nightmare scenario in which medical records were to somehow become public, no one would have anything to hide or any reason to look down on anyone else.
We can’t pretend to be a first world country until we join the rest of the world by abolishing corporate for-profit healthcare and decouple insurance benefits from employment. But reform without centralization would be incomplete.
(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie,” updated and expanded for 2020. You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)
We can save the economy.
We have to throw the landlords under the bus to do it.
At this writing, 26.5 million Americans have lost their jobs to the national lockdown necessitated by the COVID-19 pandemic. Added to those who were unemployed before the coronavirus crisis, we will soon face jobless numbers equivalent to or greater than those at the height of the Great Depression. What’s going to happen to them? More specifically, where will they live?
Drawing from the experience of the collapse of the USSR in 1991, the droll writer Dmitri Orlov mused on what would happen here in a similar scenario. Surviving the fall of the Soviet Union, he concluded, would be easier than it would be to make it through the then-future implosion of the United States of America.
“In the United States,” Orlov wrote in 2011, “very few people own their place of residence free and clear, and even they need an income to pay real estate taxes. The real owners of real estate in the U.S. are banks and corporations. People without an income face homelessness. When the economy collapses, very few people will continue to have an income, so homelessness will become rampant. Most people in the U.S., once their savings are depleted, will in due course be forced to live in their car, in some secluded stretch of woods, in a tent or under a tarp. There is currently no mechanism by which landlords can be made not to evict deadbeat tenants, or banks prevailed upon not to foreclose on non-performing loans.” Residents of apartments in the former Soviet Union faced hardships, but no one evicted them for nonpayment of rent. Private property rights were valued less than human lives.
Avoiding a mass-eviction scenario must be the top priority of American political leaders.
Aside from mass human misery, the downsides of allowing banks and municipalities and landlords to evict large numbers of people became evident after the evictions and foreclosures of millions of homes following the 2008-09 housing crisis. Every foreclosure drags down the property value of neighboring homes. Abandoned houses become meth labs.
But let’s not forget about mass human misery. Even if you’re rich and not a humanitarian, the thought of tens of millions of homeless people wandering streets and highways, desperate and hungry, can’t possibly make you sleep soundly. Property crimes and violence designed to separate people from their possessions will soar unless we keep people in their homes, safe, fed and warm. And don’t forget about the coronavirus. Even after two years from now, when there may or may not be a vaccine, many of the poor will be uninsured and won’t be able to afford medical care. Kicking them out of their homes will spread the virus.
America needs a rent and mortgage holiday, not a lame moratorium that kicks the can of mass evictions down the road for a few months. That includes commercial rent. Empty storefronts become targets for burglary and squatters. Some become drug dens. Arson fires consume them and neighboring homes. Until COVID-19 is in our rearview mirror, we need everyone and everything to stay put for health reasons. Afterward we want to give the economy a chance to recover. We don’t need blight. We want restaurants and other businesses to reopen. We want individuals to return to work, not starve in the streets. Individuals and businesses who can’t afford it should withhold rent from landlords and mortgage payments from banks, without penalty, until both the public health and the economic crises are over.
What about the banks and landlords? I’m not suggesting that they should be stuck with the whole tab for COVID-19. Municipalities should waive real estate taxes. They should receive relief to cover their utility and maintenance expenses. Lobbying organizations for property owners point out that their members often have underlying mortgages themselves; those mortgages too should be subject to the payment holiday. Banks should receive infusions of interest-free cash from the Fed. But the U.S. can no longer afford to let these entities continue to collect real estate profits as usual.
Landlords should take the biggest bath for the simple reason that they are social and economic parasites. Value is added via the production process; landlords add no value whatsoever. If a revolution were to turn renters into homeowners by transferring titles, and abolish bank liens and property taxes and so turn homeowners into full owners, no one would miss landlords. Former renters and mortgage borrowers could easily assume the cost of maintenance that they currently pay to landlords and banks for pennies on the dollar.
You probably know a nice landlord. My father-in-law was one. I used to sublet a room in my apartment so I could make the rent, which made me a sub-landlord. But part of the reason my rent was too high was that I could sublet that room. Landlords are unnecessary at best, pernicious at worst.
In part, eviction is a remedy: it allows a property owner to try again with a new tenant. In a broader sense, it is a threat to remaining renters: unless you pay me, I will throw you out. That threat is the ultimate expression of the enclosure of the commons. I own this. You do not. Therefore I can force you to leave.
A depressionary spiral during a pandemic is no time to prioritize property rights. Eviction is a national suicide pact.
In 2014 a boy broke into what he thought was an abandoned house in my hometown of Dayton, Ohio. In a closet he found the mummified body of the homeowner, who committed suicide five years earlier out of despair that his $10,000 house had been foreclosed upon. He needn’t have bothered. The bank was so overwhelmed with newly acquired properties due to mass foreclosures that it never bothered to send anyone to investigate or take possession.
The guy died for nothing.
The last thing we need now is a million more like him.
(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie.” You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)