Later this week, President Joe Biden is expected to declare the nation's COVID pandemic emergency over, even as the nation's healthcare system is in a deepening access and affordability crisis Washington is in active denial about because the medical industrial complex is paying them to look the other way.
The awful truth is that America's politics have been so corrupted by corporations that the Supreme Court, Congress, and the White House are all captive to varying degrees to those interests that are steering the 2024 conversation AWAY from healthcare which is actually the central most important labor issue of our time whether the AFL-CIO has the courage to say so or not.
There's little room for this real-world reality to break through on broadcast or cable-TV where ads for big pharma and Medicare Advantage dominate the messaging.
New York State Senator Jessica Ramos, D, who chairs the Senate's Labor Committee, told Work-Bites that she's committed to winning passage of the single payer New York Health Act, precisely because doing so "would certainly leave a lot more money on the bargaining table for wages."
"Healthcare is becoming increasingly more expensive because we continue to think we are going to have a system that is commodifying healthcare when it's not a commodity at all" but a human right, Ramos said. "It's something coming out of the pandemic — that more than ever before — we should understand that it matters that the person next to us on the bus that's sneezing and coughing that they can regularly see the appropriate doctor."
While in the first wave of COVID, New York City was the epicenter of the pandemic, as of March of this year New York State's 77,500 COVID deaths, at 397 deaths per 100,000, ranked it 15th in the nation for mortality. Back in December, an industry survey found that the state's hospital sector was uniformly plagued by staffing shortages and significant fiscal challenges.
And the budget that came out of Albany recently most likely will fall far short of addressing either issue as the federal government is speeding toward the debt ceiling cliff.
Even now, as the tabloids feature an update on the horrific death of an emotionally disturbed homeless man in the subway at the hands of a civilian who felt he had to subdue him, the city's FDNY EMS, whose job it is to respond to such scenarios, is woefully understaffed, according to DC 37 Locals 2507 and 3621 that represent that workforce.
Whether it be the wave of mass shootings, suicides, drug overdoses, or the mental health crisis playing out for the growing ranks of undomiciled, things are very much NOT right in America no matter what they say from the White House Rose Garden. And the one strand linking all of these seemingly disparate acute problems is the lack of universal healthcare.
The national public health dashboard is blinking hazards ahead and there's no more essential gauge of the success or failure of a healthcare system than life expectancy.
THIS S—T IS KILLING US
Last August, the CDC reported the back to back annual decline in life expectancy in 2020 and 2021 "was the biggest two-year decline in life expectancy since 1921-1923" with a "0.9 year drop in life expectancy in 2021, along with a 1.8 year drop in 2020."
As President Biden attempts to shift our attention away from the ravages of the pandemic, we still have no idea how many healthcare personnel, first responders, transport employees and other essential workers died as a consequence of their workplace exposure though it's likely in the tens of thousands.
We certainly have not fully processed the significance of this once in a century mass death event that has killed almost twice the number of Americans that died in the so-called Spanish Flu pandemic that started in 1918.
In New York City, a place that once took great pride in its improving life expectancy, the Department of Health and Mental Hygiene recently reported that in 2020 the COVID death toll caused life expectancy to drop from 82.6 years in 2019 to 78 years in 2020, a drop of more than four and a half years.
As the New York Times recently reported, the last time New York City had that sort of "seismic" shock was in 1834 when it "was just expanding its first railroad line. The penny press was flourishing. Cholera had struck. And smallpox was resurgent."
"It would be nearly 200 years before another shock that seismic, when the coronavirus pandemic in 2020 caused the death rate in New York City to once again climb about 50 percent over the previous year, according to new data released Friday by the city's health department," reported the newspaper.
While the U.S. is four percent of the world's population it was 12 percent of the planet's COVID death toll. Let's call that the profit premium our society pays for the most expensive healthcare system in the world with the most miserable outcomes in terms of premature death as well as declining life expectancy.
And that delta between those two data points is related to the unique role that predatory capitalism plays in our healthcare system which is fueled by scarcity because that's what produces the obscene profits for big pharma, the health insurance companies and Wall Street which increasingly calls the shots in that sector.
Throughout the pandemic, the American response was defined by scarcity, scarcity of masks, tests, hospital beds and staffing. Even now, as President Biden immorally declares this once in a century public health crisis over, healthcare staffing is critically short across the country even within the CDC complex itself where several key posts are vacant.
As long as we insist on coupling healthcare coverage to our employment, Americans will never see another raise even as our life expectancy continues to decline. At the same time the lack of healthcare coverage kills tens of thousands every year while potentially exposing all of society to another deadly infectious disease because we lack universal care and access.
So far, Congress has been resistant to an objective after action examination of the healthcare system's response to the pandemic precisely because it's the unique role of profiteering in the American healthcare system that makes us such a tragic outlier among other wealthy nation.
HEALING US
This point is brilliantly made in a new "must see" documentary Healing Us from filmmaker Kenny Ballentine and narrated by Susan Sarandon. The film tracks the organic growth of the Red Beret, Medicare for All movement inspired by real life American tragedies like the suicide of 23-year-old Danny Desnoyers who was denied his essential prescription because he missed a $20 monthly premium payment on his Medicaid health plan.
As Gretchen Morgenson and Joshua Rosner document in their seminal work How Private Equity Runs and Wrecks America private equity, enabled by our corrupt tax code, has bought up hospitals, medical practices, emergency rooms and nursing homes.
"By way of example, they look into the private-equity acquisition of nursing homes, a favorite target. In those cases, equity ownership equates to a far higher death rate, more visits to emergency rooms, and increased Medicare costs," Kirkus recounts in a review of the book. "Private equity has also absorbed huge chunks of the medical sector, laying off doctors and cutting out essential services even at the height of the coronavirus pandemic. On that note, the authors observe, private owners took great pains to use the cheapest possible ventilators for Covid-19 patients in critical care, which finally resulted in a federal fine of $40.5 million, a fraction of what they made."
Kirkus continues. "As Morgenson and Rosner clearly show, the pirates are flourishing; while there were but three 'debt-fueled billionaires' in 2005, there were 22 in 2020. Much of this wealth comes from self-dealing, for apart from owning medical providers, private equity is also heavily invested in insurance, ripe with the possibilities of conflict of interest."
But as we saw with the tens of millions of dollars in campaign donations invested by the crypto currency industry, it's possible to induce a certain level of willful blindness on either end of Pennsylvania Avenue when the price is right even as banks linked to it collapse and taxpayers are left holding the bag.
THE ROBBER BARONS HAVE RETURNED
Even before the pandemic, the United States was seeing a level of wealth inequality and concentration not seen since the Gilded Age of the Robber Barons. Now, with companies like Aetna using Medicare Advantage to raid Medicare in broad daylight, we see the aging baby boom generation's healthcare up for auction.
Pre-pandemic, American life expectancy data showed troubling signs of pronounced racial and economic disparities which only became more pronounced during the pandemic.
"Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. They also have worse health outcomes for certain conditions," wrote Martha Hostetter and Sarah Klein for the Commonwealth Fund in September 2018.
Scroll forward to April 2022, when researchers Steven Woolf, Ryan Masters and Laudan Aron reported in JAMA how U.S. life expectancy changed between 2019 and 2020, in the first wave of COVID, compared to what was happening in 21 other high-income nations.
"In this cross-sectional study, calculations of life expectancy based on official death counts revealed that US life expectancy decreased by 1.87 years overall, and by 3.70 years in Hispanic populations and 3.22 years in non-Hispanic Black populations," the researchers reported. "The decrease in life expectancy in peer countries was a mean of 0.58 years, with no country experiencing a decrease rivaling that of the US."
"The large and highly racialized decreases in US life expectancy underscore the growing US health disadvantage relative to peer countries and the need for policies that prioritize health and equity," wrote Woolf, Masters, and Aron.
IN A NEW YORK STATE OF MADNESS
Last year, Wallet Hub ranked New York's healthcare 20th overall getting dinged for cost (33) and health outcomes (26) with access (11) a bright spot which is likely to dim with the federal government's rolling back pandemic supports, according to Kaiser Family Foundation.
"Between February 2020 and March 2023, Medicaid enrollment grew by an estimated 20 million people, contributing to declines in the uninsured rate, which dropped to the lowest level on record in early 2022," KFF reported. "As states unwind the continuous enrollment provision, we estimate, based on a recent KFF survey, that 17 million people could lose Medicaid coverage – including some who are no longer eligible and others who are still eligible but face administrative barriers to renewal. Decreases in Medicaid enrollment could reverse the recent gains in insurance coverage overall."
In a note to Albany lawmakers, George Grisham, president of 1199SEIU, the state's largest healthcare union, warned that Gov. Hochul's healthcare budget as approved was "a major misstep that will have significant consequences for the safety-net hospitals and other Medicaid-reliant providers."
Grisham faulted Hochul for proposing "devastating cuts and refused to truly address the crisis in budget negotiations". He predicted that the state budget included Medicaid rates "far below the cost of care" that would lead to hospital closures, layoffs, and the "limiting of services in underserved communities."
The 1199SEIU leader credited Speaker Carl Heastie and Majority Leader Andrea Stewart-Cousins for "staving off the truly draconian cuts contained in the Governor's initial proposal."
"As a result of circumstances beyond their control, hospitals statewide need urgent help to sustain their services," the NYS Health Care Association reported back in December. "According to a fall 2022 survey by New York's state and allied regional hospital associations, New Yorkers are losing access to healthcare services amid escalating care delivery costs and persistent workforce shortages — and providers expect access to medical services to further deteriorate."
Compounding their fiscal challenges, 100 percent of the state's hospitals reported nursing shortages they could not fill with 75 percent unable to fill essential radiology/ medical imaging roles, lab staff, respiratory therapists, physicians, and environmental services personnel.
According to NYS HCA, 49 percent of New York's hospitals reported "reducing and/or eliminating services to mitigate staffing challenges while ensuring their most critical services remain available" while "77 percent report delaying or canceling building and improvement projects as a result of fiscal challenges — actions that erode the accessibility of healthcare services."
Twenty-seven percent of the hospitals surveyed reported "being at risk of defaulting on existing loans, which can decrease financial resources available for patient care," NYS HCA found.
POVERTY KILLS
As the U.S. shuts down the COVID emergency, we are still losing close to 160 Americans every day to the infectious disease. Evidently, this data point will become just a number that our nation's leadership ignores like the estimated 183,000 deaths in the US in 2019 before the COVID pandemic that were directly linked to poverty, according to a University of California, Riverside, (UCR) paper published last month in Journal of the American Medical Association.
"The analysis found that only heart disease, cancer, and smoking were associated with a greater number of deaths than poverty. Obesity, diabetes, drug overdoses, suicides, firearms, and homicides, among other common causes of death, were less lethal than poverty," wrote David Danelski for UC Riverside News.
Danelski continues. "Another finding is that people living in poverty – those with incomes less than 50 percent of the U.S. median income -- have roughly the same survival rates until they hit their 40s, after which they die at significantly higher rates than people with more adequate incomes and resources."
"Poverty kills as much as dementia, accidents, stroke, Alzheimer's, and diabetes," David Brady, the study's lead author and a UCR professor of public policy told Danelski. "Poverty silently killed 10 times as many people as all the homicides in 2019. And yet, homicide firearms and suicide get vastly more attention. If we had less poverty, there'd be a lot better health and well-being, people could work more, and they could be more productive. All of those are benefits of investing in people through social policies."
