The private market is not a place for Covid-19 countermeasures

Tthroughout the Covid-19 Pandemic, the US federal government has overseen the purchase and distribution of vaccines, tests and treatments. Many Americans saw for the first time what publicly funded health care could do, as citizens had access to prevention and treatment without for-profit restrictions.

But a few weeks ago, Dawn O’Connell, the US Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, announced that Covid-19 “countermeasures” — meaning vaccines, testing and treatment — are going commercial would be on the market faster than previously planned, as the program funds will expire in January 2023.

O’Connell noted that “the federal government was happy to take on this role, but we always knew we wouldn’t be in this business forever”. She stressed the government’s goal of “continued equal access” for all Americans.

Their statement expresses a stunning demonstration of unfounded faith in the idea that the private sector will do the right thing – like hand over chicken coop security to a fox and expect higher egg production in return. Given the longstanding inequalities inherent in our country’s commercialized healthcare system — inequalities that predate Covid-19 decades — the failings of that system should be obvious to everyone, especially health policymakers. Why would anyone believe that Covid care will be any different if you just leave it to the empirically obvious ailments of the American healthcare market?

A striking example of the devastation caused by our hyper-commercialized healthcare is the insulin business. Left to the predatory impulses of the private sector, insulin — a drug without which many diabetic patients would die — has a wholesale price that has tripled in 10 years. A vial priced at $8 in peer nations is $119 in the United States. On average, an American with diabetes spends over $9,000 out of pocket each year, spurring some to buy their insulin in Canada or Mexico. Because of the high cost, one in four American diabetics reports skipping or rationing doses — a potentially deadly gamble. Does this evidence of how American commercial healthcare works in practice mean that O’Connell’s reliance on “continued equitable access” is in any way justified?

Society has a responsibility to protect all of its citizens, and public health is clearly one of those necessary safeguards.

The damage of this your-money-or-your-life healthcare market mentality has gotten so bad that the state of California felt compelled to step in and committed $100 million to bait out the predatory private sector actors by manufacturing its own affordable insulin take care of. Gov. Gavin Newsom, who announced the plan in July, said, “Nothing epitomizes market failure more than the cost of insulin.”

Unfortunately, these blackmail practices are not limited to insulin. Americans, for example, pay more than double for prescription drugs and triple for brand-name drugs compared to citizens of their peer nation. And according to a Gallup poll conducted in June 2021, 18 million people did not get a prescription in the past three months because of cost concerns.

Our profit-above-all healthcare system still left 30 million citizens uninsured and 43 percent of adults underinsured in 2020. This is disproportionately true for communities of color, which are burdened by a slew of healthcare inequalities. (Covid was no exception: The pandemic’s impact on life expectancy was 75 percent worse for Black Americans than for white populations and 140 percent greater for American Indians and Alaska Natives.)

Although almost 20 percent of the country’s gross domestic product is spent on healthcare – twice the rich world average – life expectancy in the US today ranks 50th in the world. This is the empirical track record of our for-profit healthcare system: higher costs and worse outcomes. It has been estimated that by emulating the practices and efficiencies of less market-driven systems in other affluent countries, the American economy could save about $2 trillion a year in wasted healthcare costs. The GDP of 187 nations is less than this annual health care overspending. If it were a country our healthcare system would waste the ninth largest economy in the world.

What could we do with that extra $2 trillion a year? To help you understand the scale of the waste, that’s 54 times the annual price of Biden’s supposedly huge climate-energy bill, or 2.6 times our gargantuan annual Pentagon budget. And that’s the real flaw embedded in O’Connell’s announcement. It expresses data-resistant dogma about commercial healthcare and makes perhaps one of the biggest belief-based financial mistakes of all time. This unfounded confidence in the markets is feeding a $2 trillion tumor that is rifling through our economy.

She stressed the administration’s goal of making the transition “to the commercial market in a thoughtful, well-coordinated manner that leaves no one behind”, adding that her department has met with over 100 relevant parties – including insurers and pharmaceutical companies – to discuss these plans. However, it remains unclear what steps they would take to actually ensure equitable access, and there is simply no reason to believe that shifting Covid-19 responses to commercial markets will not simply repeat the life-shortening mistakes of the past .

Society has a responsibility to protect all of its citizens, and public health is clearly one of those necessary safeguards. Rather than abandoning the underserved to predatory markets, we should step up public sector efforts to better protect everyone’s health. Finally, public health practitioners must work to prevent or minimize disease in entire populations. By creating – and even accepting – conditions that ensure many citizens are left behind, we are actively choosing to further fuel a longstanding crisis.

This is especially true when dealing with a pandemic like Covid-19. The rich will never be safe from a rapidly spreading contagion until the poor are safe from it too. And if there’s one lesson to be learned from decades of dismal American health data, it’s this: The poor will never be safe under for-profit healthcare.


Jag Bhalla is a writer and entrepreneur.

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