As I watch the COVID-19 virus boil up in hotspots scattered around the globe, I look around at the US and realize that 40 years of presidential economic decisions that favour profit over people have set us up to struggle as a nation. From lack of affordable health care, to lack of major factories we can repurpose to fit current needs, we have set ourselves up to see people avoid doctors and spread disease while our health systems are crippled by lack of basic goods and equipment. These issues have their source in Reagan’s deregulation of healthcare and the economics of Clinton. To get through the coming COVID-19 outbreaks, we must do more than just wash our hands; we must prepared to help one another when social systems fail us.

A hand washing station in an abandoned building.
credit Tama66

Back when I started college in 1992, I was an international relations major in James Madison College at Michigan State University. As part of our election-year course work we read the latest books by Paul Krugman and Robert Reich, respectively Bush & Clinton’s economic advisors. This had 3 out-of-the-classroom effects on me. The first impact was perhaps silly. I was so impressed by Paul Krugman’s book that the next time I was in Boston visiting my boyfriend at MIT, I emailed Krugman to ask to meet. He was heading off on a trip himself, but we overlapped at Boston Logan airport. We met in the terminal, he signed my book & we talked econ. The second impact was life changing. I discovered I hated understanding economics — understanding that what is best for the rich also destroys the working class — that I switched to astrophysics. Yes folks, the fact that it is beneficial for a factory to kill rather than maim drove me to astronomy. The third impact is the one that is actually relevant here. In reading these books, I decided that my 18 year old, Massachusetts democrat, socialism-loving self was going to vote for Bush because I wanted to live in Paul Krugman’s economy instead of Reich’s. We didn’t get to see Paul Krugman’s 2nd-term future. Clinton won.

The thing that terrified me about Reich’s book, “The Work of Nations,” was a call to offshore industry to other nations and transform our nation into what would today be called a nation of thought-leaders. In his vision, we would innovate, lead, and industry would go elsewhere. His argument was, we needed to increase the education of our population & if we are well-educated we can take that population doing industrial work at good union salaries & get them doing other jobs. This would benefit US companies that would benefit from lower production costs (Hi, Mexican factories) & focus our people on more lucrative innovation. I was living in Michigan when I read this, and surrounded by students whose parents worked in the auto industry. I have a family of truck drivers and skilled crafts people. Looking at these well-paid, technically skilled people, I saw first hand that not everyone wants to be educated into being a thought-leader & not everyone can be. We need industry jobs.

I remember hearing in class that there would always be the need for service industry jobs for those who can’t be educated Into the white collar workforce. Thing is, your McDonald’s employee isn’t unionised, & has no hope of healthcare, retirement, or other benefits. There is a cruelty in this “well, they can work in service” only option.

Put simply, it was and is my opinion that a healthy nation needs a diversity of jobs that provide insurance and a living wage that allow people of all educational attainments to flourish. The rust belt once built our economy by making a large middle class possible.

The rust belt was just starting to oxidise when I was in college. I lived in Michigan when GM left Lansing and Ford started opening plants in Mexico. I saw the fear it put in people who had been buying cars regularly, using vacation time to travel, & who pumped money into the economy as they lived the American dream.

Today, more than 20 years since I left Michigan State University with an Astrophysics degree, we are seeing the results of Clinton-era economics. Our supply chains rely on cheap offshore labor, and the majority of non-“thought-leader” jobs are now in the service economy and the new gig economy. From the 1990s through to the numbers of uninsured people steadily increased until Obamacare began to kick in. While things are better, there is a difference between better and good. Service industry workers can’t afford time off. They don’t get insurance through their job, and they may not be able to afford rent (let alone insurance!) if they miss a shift or two. If they are sick, they will still serve. These are the people we will see collapsing on US streets and transit in coming weeks, just like we’ve seen in photos from Asia. (There may have been the first such case in NYC today).

Hell, I’m a PhD Astronomer now, & I’ve only had health care as an option for 3 of the last 14 years. Currently, because I’m not full-time on a grant, I’m an hourly employee with no benefits. This is reality for so many adjuncts and research scientists. If we don’t work, we don’t get paid, and we will work when sick. (I am lucky — My husband has insurance through his job.)

Many of us end up waiting until we’re unable to function before we go to the doctor because we hope to get better on our own. Why? Because of the cost. I have insurance, but the few $100 that blood tests & X-Rays will cost me in co-pays in more than I sometimes have. Combine those bills with the impact of lost wages and sometimes gambling on free versus pneumonia seems the better option.

Right now, we have a nation filled with pockets of people (like me) who just can’t afford time off and struggle when we have medical bills. In the face of coronavirus, I can decide to simply just work from home and not leave the house. Most don’t have that option.

The economics of this isn’t going to just hit at the personal level. It is also hitting companies large and small.

Our nation relies on foreign manufacturing of medicine, machinery, and most everything else. Our former factories, the ones that defined the assembly lines perfected by Japan, are literally rusting apart. If international travel to the US is cut off, supplies are cut off.

We’re watching in the news as country after country is cut off to stop the spread of coronavirus. Flights to and from China, Iran, Italy… What if that happens to the US? We have what’s called “Just in time inventory” in most stores and what few factories we do have.

Did I mention I hate economics? That hate doesn’t mean I don’t try to understand economics. OK, so we don’t have massively stocked backrooms of goods. The US doesn’t have massive industrial capacity. We’re a lean mean economy with no excess — goods ideally arrive just in time to be used without ever sitting in inventory. If supply lines are cut, we have only the national reserves.

So let’s look at COVID-19. We aren’t testing efficiently. This means we have unchecked person-to-person spread of unknown degree. Why? Funding to teams developing tests had previously been cut by Trump, so we’re running on skelton crew of tired researchers who make mistakes and have a slow response.

As a consequence, we can’t know who is sick at the moment. But does that matter? Sick people can’t afford to stay home and often really sick people can’t afford to go to the doctors. People are going to hide their illness, which will spread one service transaction at a time. Hospitals will only see people after illness takes hold, when denial of sickness is impossible.

Honest talk here: I’ve twice had pneumonia because I said “it’s just allergies” until I was so sick my admin demanded I go to the doctors.

Beyond the issues of cost, this is also an engrained response. In graduate school I was yelled at for not being back on my campus working immediately after a major surgery, and decades later I was dropped from a collaboration after I told the primary PI I was having a substantial health issue. We are trained that sickness is unacceptable.

This isn’t a poor people issue. This isn’t an uneducated people issue. This is an American issue.

In recent years, it’s become normalized to treat people poorly at work if they have a health issue; calling them unreliable or otherwise marginalising them if they get sick.

If people only go to the doctor when they have hit the severely ill stage (as I’m guilty of doing), what is the result? Instead of heading off the disease (any disease) while it is treatable or manageable, doctors have to start in crisis mode. This is a lot more expensive.

For Coronavirus, crisis treatment appears to mean ventilators. Most hospitals have just enough to get through a normal flu season with some extra units in national reserves and storage.

I’m hearing on the news that we don’t have factories to make respirators in the US. We will have a shortage. This could mean that people will die due to the one-two punch not going to the doctor early enough to have their symptoms treated before lung damage takes hold, and a lack of ventilators. (These two aren’t necessarily coupled. There will be people who seek timely care and still die due to a lack of ventilators).

The lack of supplies goes beyond ventilators. We also don’t have enough protection equipment for health care workers. This could mean fewer health care workers caring for more people, more sick/dead HCWs.

But what if you survive and don’t get sick?

Most Americans are 4 paycheques from homelessness.

Most Americans don’t get paid sick leave.

If a business shuts down, you don’t get paid. If you get sick, you don’t get paid.

People will, as they always do, stop making non-essential purchases. This will hurt small business, construction, major manufacturing, and the service industry first. No new cars, no new stoves, no new Easter dresses, no vacations, no replacing the roof, no extra anything.

When families get hit with hospital bills, they’ll end up selling their homes, tanking the housing industry. Rents will get driven-up as people stop owning. This will lead to overcrowding. Also homelessness.

The same will play out when businesses shut for weeks or months.

So how do we stop this?

1) Test wildly — find everyone who is sick

2) Make tests free

3) Offer emergency bailout measures to pay all medical bills associated with cold / flu / bronchial illness so no one fears the doctor.

That is the medical side of things — and some places like New York are trying to implement this.

But we also have to look at treating economics.

1) Offer immediate unemployment benefits to anyone out of work due to coronavirus related business closures

2) We need to put into effect emergency policies preventing price gouging in all sectors. Freeze rents.

And we’re going to need a bailout plan in place so that people know that when this is over, America will be here to help them rebuild.

We can do this. We can come out stronger like we did with the great public roads programs of the New Deal.

I’ll pay more taxes gladly.

But right now, frankly, we are fucked. Because none of this is going to happen with the Trump administration.

And I’m scared.

So how do we make it through?

We have to take care of each other and be prepared to be our own community safety net. If you have extra, stock up extra food — dried beans, canned goods, and be ready to share. If you have an extra room, imagine saying “I have space” to the friend who becomes jobless. Give.

We are going to have to take care of each other. Plant a garden, share a meal, make your extra someone else’s only.

Pray / hope / work to make this never happen. Employers enact paid sick leave now. Researchers, make those COVID-19 tests CDC authorised.

We’re on our own, but we’re not alone.

We have each other (and you really should wash your hands).