What could we have done better?
While I was writing The Rich Flee and the Poor Take the Bus conversations about the book with friends and colleagues always turned to Covid-19. When it did, some version of this question was always asked: “What should we have done differently?”
The question was well-meaning. There were no outspoken Covid-deniers in my social circle. Everyone agreed that too many people suffered and too many people died. They recognized the catastrophe and wanted to know how we could have done better.
Most expected me to suggest an intervention or policy that we could have implemented or changed at the pandemic onset in spring 2020. However, very little of my answer had to do with the direct response early in the pandemic. Sure, we could have had better testing and contact tracing protocols. We could have allocated more medical resources to underprivileged groups and made sure that vials of vaccine arrived to the most disadvantaged neighborhoods sooner. We could have better communicated the effectiveness of indoor masking and extended required mask use longer into the pandemic. We could have guaranteed wages or extended financial aid for unemployed workers and small businesses more broadly. All of these things and more assuredly would have helped to save lives and lower the levels of physical and financial suffering. However, none of these things were atop my list of suggestions.
Instead, the most important part of my answer involved the years and decades of pre-pandemic neglect for the most socially vulnerable among our society. The years when we allowed health disparities and income equality to grow. The years when we allowed millions of hard-working people to live without health insurance, the lack of which denied them access to high quality preventative care. The years when we gutted public health funding and allowed millions in cities and rural towns across the country to live without nearby access to physicians, health clinics, and pharmacies. The years when we allowed the creation of barren food deserts. The lack of serious attempts to address issues of affordable housing that resulted in overcrowded homes and housing insecurity. The trend to steadily turn our health care infrastructure over to large corporate enterprises that measured success mostly by profits and rarely by the health of those they served. These issues compounded into health conditions like diabetes, heart disease, and asthma that all made a pandemic infection worse. They compounded into decreasing rates of life expectancy for the working poor and the lower middle class even before the Covid-19 pandemic began. Then Covid-19 exploded upon us and exacerbated every negative aspect of social inequality that we faced.
When placing blame for the Covid catastrophe, economic and financial inequality was nearly as responsible as the virus. As one example of how badly we suffered due to inequality, a study published in the Proceedings of the National Academy of Sciences estimated that over 330,000 American lives would have been saved in just the first two years of the pandemic if the United States had adopted universal health care prior to the pandemic. The majority of these saved lives would have come from lowering pre-pandemic health conditions and risk factors. Let that sink in for a moment. 330,000 people would have been saved by simply guaranteeing healthcare coverage for everyone.
The cruelest irony of this: The study estimates that providing universal health care would have saved the U.S. economy “$105.6 billion in health-care costs associated with hospitalizations from the disease” during this same time period. We would have saved lives and saved billions of dollars at the same time. These savings extend into non-pandemic times too. In a non-pandemic year over $400 billion dollars would be saved from the move to universal health care. Other programs to combat poverty, to provide mandatory paid sick leave, and to provide options for child and elder care can generate a more robust and resilient society and economy too.
The differences between the haves and the have-nots are a series of choices that we have made as a society. We have decided to accept stark inequality in economics and healthcare that carry forward to inequality in morbidity and mortality. Too many have come to accept these disparities as normal. When I’m asked what we could have done better to fight Covid-19, this is my answer. We should work to create a more equal and just world in normal times. Without that we are guaranteed to return to the abysmally unequal outcomes of Covid-19 when the next epidemic arrives. We need to do the hard work now otherwise we are guaranteed to suffer similar atrocities and to fail again the next time we face an epidemic crisis.
Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.