（Photo source: Xinhua）
The “pandemic tsunami” has once again swept across US. This has been the fourth COVID-19 wave in the US since March 2020. The US pandemic curve has never been “flattened” in the past more than a year, with over 38 million infections and 640,000 deaths in total. To the disappointment of American people and the shock of the international community, the US, which boasts the world’s strongest health care system, most cutting-edge medical technologies, best-trained public health professionals and the most efficient emergency management system, has failed to contain the pandemic.
It is noteworthy that health expenditures in the US have been on constant rise in the past decade, accounting for 18% in its GDP in 2020.Johnson & Johnson, Pfizer, Merck, Regeneron and Stryker among other prominent pharmaceutical enterprises in the US have seen surging gains and record-high share prices during the pandemic. The stark contrast between the miserable failure of the US in its anti-pandemic fight and the fact that American pharmaceutical firms make good money therein has infuriated Americans and calls the health care system into question. People are wondering whether the health care system was designed to serve capital or save human lives.
US health care system: advanced but also backward
Political, economic and social factors of a country determine its commitment of resources to health care. For quite a long time, the US has led the world in health care input, featuring the highest per capita health care cost among Organization for Economic Cooperation and Development (OECD) members. However, in the past decades, particularly since the global financial crisis in 2008, the US has fell far behind in public health infrastructure and provided extremely limited basic medical services to a broader population in the middle and lower classes. The COVID-19 pandemic has fully exposed the distorted nature of the US health care system, which is advanced but also backward.
Thanks to heavy investment, the US excels in medical resources. OECD statistics demonstrate that during 2010–2020, US health expenditures as a share of GDP doubled the average of OECD countries, and US per capita health care cost was even more than twice the OECD average.
With such enormous investment, the US leads the world in medical resources and medical technologies in terms of market performance. The US is the world’s biggest pharmaceuticals market, accounting for 1/3 of the global market. According to data published by the Pharmaceutical Research and Manufacturers of US (PhRMA),American firms are responsible for over half of the pharmaceutical R&D across the world and claim intellectual property to most new drugs. In 2018, the Center for Drug Evaluation and Research, a part of the US Food and Drug Administration, approved a record-high 59 new pharmaceutical products, most of which were targeted at rare diseases. The US also boasts the world’s leading medical talents. Among the three winners of the Nobel Prize in Physiology or Medicine in 2020, two were from the US. Moreover, the US is also the world’s biggest medical equipment market. According to the US Department of Commerce, the US medical equipment market was worth $156 billion in 2017 (40% of the global medical equipment market), which is expected to reach $208 billion US by 2023.
Capital monopoly keeps US health expenditures high. Health expenditures in the US are basically equal to those of other OECD countries, with the excess part being mainly ascribed to private health expenditures. In other words, the US health care system creates a paradise for the rich. The US doubles OECD countries’ average per capita cost of hospitalization, and prices are the main reason for such difference.
The exorbitant health expenditures in the US can be mainly attributed to the monopoly of large capital groups over the health care industry. The highly monopolized health care industry in the US excludes free competition. By such means as mergers and acquisitions, large capital groups have firmly controlled the pricing power over in-patient services and pharmaceutical products. Labor costs, service charges and prices of medical products of hospitals are continually driven up to maximize benefits. Interest groups including the US Medical Association, the US Hospital Association and the Pharmaceutical Research and Manufacturers of US will make larger political donations each year to canvass political figures to act as their mouthpieces and to formulate policies favoring health care providers, so as to strengthen their market presence.
US public health infrastructure has long been backward. The average per capita administrative cost in US health care quadruples that of other OECD countries, and far exceeds its expenditures on disease prevention and long-term health care. As a result, despite high health care expenditures, the US lags behind many OECD countries in terms of people’s health conditions when measured against such frequently used indicators as life expectancy and infant mortality rate.
Public health infrastructure assists governments at various levels in effectively preventing diseases and preparing for emergencies and ongoing challenges, but it is unprofitable. In stark contrast to the US’ leading medical talents, cutting-edge medical facilities and abundant medical resources, the US public health infrastructure has lagged behind in recent years. Apart from the underfunded public health departments of various states in the US, public health funds at the federal level have also been slashed. Since the financial crisis in 2008,around 40,000 jobs in public health agencies at state and local levels have been cut, and the federal funds for emergency preparedness and response programs under the supervision of the Centers for Disease Control and Prevention have been reduced by half. The anti-epidemic system of the US depends on the coordinated efforts of health authorities at the state level for testing and medical record tracking and the CDC for sorting out information, giving guidance and making arrangement. In consequence, the long backward public health infrastructure has led to a severe manpower shortage in the health authorities of various states, resulting in inefficient testing, medical record tracking, treatment arrangement, and unsatisfactory anti-epidemic results. This can also partly explain why the expensive US health care system is ineffective in responding to the pandemic.
Capital interests led to inevitable failure of US health care system
The capital-dominated US health care system has resulted in high health care costs, while the underfunded public health infrastructure has greatly limited American people’s access to basic health care. This is a major cause of the high mortality rate in the US during the COVID-19 outbreak. Major medical capital groups in the US have profited greatly from the pandemic, while the poorest Americans are suffering from unaffordable medical cost. It is unavoidable that the capital interests-dominated US health care system will fail to contain the pandemic.
Major medical capital groups in the US have accumulated a huge amount of wealth from the COVID pandemic. Capital is never meant to solve a crisis, but to rake in enormous profits from it. During the COVID-19 outbreak, American hospitals and pharmaceutical firms have never tried to lower service charges—in fact, various COVID-19 vaccines in the US are more expensive than those in Europe. These large medical capital groups in the US have made good money from the pandemic through vaccine R&D and patent application, as well as a run on hospital resources.
Take the performance of several well-known pharmaceutical firms and medical equipment manufacturers in the US as an example. Since March 2020, Johnson & Johnson, Pfizer, Stryker and Regeneron among other major pharmaceutical firms have seen record-high share prices, wherein the reported operating incomes of Pfizer and Regeneron by mid-2021 have increased by 68.24% and 102.83% respectively compared with the same period a year ago.
In stark contrast, most Americans, represented by blue-collar workers and the declining middle class, are struggling and falling victim to the pandemic and the great economic recession. Moreover, though being beset with difficulties in acquiring food, holding on to jobs and having access to basic health care, a large number of low-income individuals have put all their money into the stock market, leading to a drastic inflow of money into US stocks, and an explosion of wealth of major capital groups in the US.
The US government rolls out policies of relief to save capital rather than human lives. Capital monopolizes not only the market, but also policy-making. Interest groups in the US, through powerful lobbying, hold sway over the policy decisions of the US government. During the COVID-19 outbreak, US politicians from both parties have put forward anti-pandemic measures to maximize the interests of the capital groups behind them and to curry favor with their constituencies so as to expand their political base. The US government, which follows a principle of “putting capital first”, has neither the will nor the ability to address the high cost of health care long existing in American society—instead of reducing health care cost to contain the pandemic, it has turned to safeguard the interests of large capital groups and blindly pursue an economic rebound at the expense of American people’s right to survival.
The rescue plans of both the Trump and Biden administrations have clearly demonstrated that the relief policies formulated by the US government tend to safeguard capital interests. The “Coronavirus Aid, Relief, and Economic Security” signed by President Trump earmarked a total of $2 trillion to deliver relief to people affected by the COVID-19 crisis. However, only $180 billion (9% of the sum) was used on hospitals, medical insurance, and other health care-related expenditures. In contrast, the loan funds for large and small enterprises have reached $510 billion and $377 billion respectively, accounting for 44.35%. The US Rescue Plan signed by the Biden Administration in March pledged to provide $1.9 trillion in pandemic relief, wherein 34.5% or as much as $656.18 billion was offered as direct financial aid, whereas only $86.24 billion went to health care, taking up 4.5%. The US health care system serves big monopoly capital groups, in the meantime, monopoly capital holds sway over US health care policies, which, in return, constantly intensifies the monopoly of capital. Such a system “valuing capital over human life” deprives governments at different levels, various social organizations and individuals in the US of the will and ability to form a united front against the pandemic, and makes US response to the COVID-19 outbreak an inevitable failure.
Contributed by Yu Feng, a contract research fellow with the Research Center for Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, Chinese Academy of Social Sciences, and assistant research fellow with the Institute of US Studies, Chinese Academy of Social Sciences; Wei Nanzhi ,a contract research fellow with the Research Center for Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, Chinese Academy of Social Sciences, and assistant research fellow with the Institute of US Studies, Chinese Academy of Social Sciences
Translated by Wu You