The outbreak of the novel coronavirus has highlighted the massive health care access inequalities that continue to plague the richest country in the world. The coronavirus is attacking both rich and poor, but it is most destructive among the poor who lack access to a healthy living environment. It’s difficult to think that the current health care status quo is going to survive the pandemic and its aftermath. Moreover, the pandemic has made it abundantly clear that the growth of the economy is tied to the health of its people at a depth and breadth that was generally unappreciated prior to the outbreak of the disease.
A rural-urban divide also exists. While rural hospitals are closing, people living in the metropolitan New York region can take for granted an abundance of hospitals. Whether it’s Columbia Presbyterian in Washington Heights or the HHS/Weill Cornell complex on the East Side, many New Yorkers are within walking distance or a short drive to a massive medical center. The same goes for Boston, Philadelphia, Pittsburgh, Cleveland, and other cities.
Our society has chosen a private hospital system that relies on quantities of patients to thrive. The absence or paucity of health care in low-density or low-income regions suggests that a pay-for-service health care system is simply not an efficient solution for every region in the United States. That divide creates impediments to growth in the country and in some ways prevents those who live in rural areas from having the same opportunities as those who live in richer urban and suburban ecosystems.
The debate over health care continues, just as the debate and attacks on Social Security have remained part of the policy landscape since 1945. But there is no reason why policy cannot be designed to bridge ideological divides via public-private solutions. For instance, to solve the problem of poor seniors, we’ve designed a system in which you can have private savings for retirement, but there are also mandatory payments into the publicly sponsored Social Security retirement fund.
In rural areas, if there is a local hospital, it is often the main economic engine and employer. In light of that, lawmakers could create a policy through which taxpayers could sponsor an infrastructure program to build hospitals or other types of health care centers in rural areas that lack sufficient health care. Such projects would create short-term construction jobs and long-term careers in health care, therefore supporting the businesses and schools that sustain community life.
So what’s in it for the rest of us who can live comfortably with or without addressing rural or urban decline? A modern economy can grow only as fast as the labor force increases its intellectual capital and productivity, resulting in increased household consumption. If a large percentage of households were to remain unhealthy, members of those households may not be able to be productive, and the economy’s potential growth would remain lower than it could have been.
The pandemic has shown need to attack not just this virus, but the conditions in which disease can thrive. This includes knowledge of practices for well-being, and the acknowledgment of unequal treatment because of race and/or social status.
We’ve attacked the number of car accidents by mandating seat belts, and we’ve addressed a cause of cancer by taxing cigarettes and disallowing smoking in buildings. Such policy steps have lessened the indirect costs of injury and disease, which serve to increase costs on the rest of us who otherwise observe the steps taken for healthier outcomes. We can decrease the social costs of comorbid conditions by helping everyone get access to health care, and providing the education and infrastructure needed to provide healthier outcomes; e.g., school lunches, grocery stores in food deserts, etc.
Taking stock of what could have been
In recent weeks, the virus has been surging in Texas counties along the border. A physician at one of the county hospitals reported being overwhelmed, both by the shortage of doctors relative to the population and by the shortage of equipment and facilities needed to treat the influx of cases. The Texas report was in many ways a repeat of the situation doctors in New York City hospitals faced earlier this year, though the most serious of infections at the Texas hospital had to be moved to larger hospital centers and out-of-state facilities that were capable of treatment.
More encouraging numbers in some parts of the country may have led some to believe we were winning the fight against the pandemic. New York, which suffered the horrors of the initial outbreak of COVID-19 infections from March to May, closed down normal activities and kept them closed. By May 1, New York was still reporting 5,800 cases per day, but daily infections have since dropped to 650 in the first week of August. In tiny Vermont, where social distancing practices and masks are still the norm — whether in town or along the Long Trail — infections are occurring at an average of only four per day.
Compare those improvements to the soaring number of infections in the South and Southwest as restrictions were lifted in May. As the figure below shows, Florida, which had less than 600 cases per day on May 1 now reports 6,600 cases per day – that’s 11 times higher. Texas, which had less than 900 cases per day on May 1 is now reporting 7,500 cases per day – more than eight times higher.
There is still much work to be done to reduce the 650 cases per day in New York, and a frightening amount of work to be done to reduce the thousands of daily cases in Florida and Texas. Given the reluctance of the authorities to reinstate stay-at-home orders, we anticipate a dragged out recovery and long-term damage to the labor force and potential economic growth.
Assessing the status of the pandemic
Lawmakers should use a common sense reading of data to make policy decisions. First, it’s important to acknowledge that virus is still here and that the risk of infection increases as individuals widen their circle of personal contacts. As the first figure shows, there are 63,000 new cases of COVID-19 infections reported nationally each day, which is about double the April peak of 32,000 per day. As we showed above, the experience of New York suggests it could take months for new cases to dissipate.
And given the enormous number of infected persons across the Sun Belt and into the interior of the country, the spread is likely to continue in alarming numbers no matter how severe the rate of infection. We have already passed 5 million cumulative coronavirus cases the United States in less than six months. As we show in the second figure below, that number could approach 5.5 million in the second week of August given the current rate of spread. The third figure below shows that a thousand people are dying in the United States each day as a result of COVID-19.
Of the six states with major metropolitan areas that were hit hardest in the initial outbreak of the virus (New York, New Jersey, Massachusetts, Pennsylvania, Illinois, and California), only California is reporting an increasing number of cases, growing at an average weekly rate of 11.7% since Memorial Day. Cases in New York and New Jersey are decreasing at weekly rates of 8% to 9% on average.
Nationally, 38 states are reporting increasing average weekly growth rates of infection since the Memorial Day weekend, as listed in the table below.