By Gordon Hull
I argued a few days ago that late capitalism, with its fetishization of efficiency, leaves us unprepared for a pandemic because of vulnerabilities in the supply chain. In a recent blogpost, Frank Pasquale adds some healthcare-specific texture to the point, noting how our healthcare system is almost designed to fail in a pandemic. He cites one of his own papers from 2014:
“The reduction in hospital facilities and other resources, although “efficient” in normal times, may prove disastrous if there is an epidemic. For example, one national-preparedness plan for pandemic flu estimated that, in a worst-case scenario, the United States would be short over 600,000 ventilators. “To some experts, the ventilator shortage is the most glaring example of the country’s lack of readiness for a pandemic,” one journalist noted. The lack of “surge capacity” throughout the health care industry is a major infrastructural shortcoming, likely to cause tremendous, avoidable suffering if a pandemic emerges” (179).
The quotes are from… 2006 and 2007, and refer to warnings coming after the SARS epidemic. In other words, we’ve been as unprepared as possible for 14 years, despite a near-miss epidemic and constant warnings from epidemiologists. So Trump is an idiot and an imposter, and his son-in-law supply czar is a feckless idiot who understands nothing about supply, but, as Pasquale underscores, there is another, longer timeline to our pandemic preparation failure.
In Pasquale’s paper, he notes that part of the problem is how we frame healthcare in terms of aggregate costs (and the need to keep costs down), a construction that makes it impossible to notice that some things are over-funded and others under-funded. In particular, not only can mantras of cost-cutting shield wasteful allocations of resources like those to hedge-fund managers from scrutiny, but it can also hide the fact that some aspects of healthcare (let’s see, hmm. Pandemic prevention!) are radically under-funded. Worse, there is absolutely no way to guarantee that money saved here will actually be reallocated to something more socially useful:
“If the health care cost-cutters had a plan for reallocating excess health sector spending to pay for care that is now undercompensated or absent, they would merit the influence they have now achieved. But in reality, money freed up by cost-cutting is much more likely to be retained as profit or claimed by capital and rentiers in some other way” (191)
We see at least three versions of these problems playing out now.
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