Threadbare US Social Safety Net: The War on Science, Medicine, and Equality for All

The Covid-19 pandemic is a global health emergency that requires a coordinated and mobilized medical response, one based not only on public health expertise but also principles of social cooperation and solidarity. But in the United States cooperation and solidarity are almost alien values in a nation rent by growing political divisions and more substantively defined by extremes of wealth and class inequality.

In the hyper-capitalist United States, a threadbare social safety net is the norm and even people's health needs are commodified for financial profit.

In the hyper-capitalist United States, a threadbare social safety net is the norm and even people's health needs are commodified for financial profit. The culture of solidarity required to meet the challenges of a public health emergency is not exactly the default setting for a social system dominated by financial and political elites.

But it's worse than that. Today, the Republican Party operates as open saboteurs of public health. Across the nation, elected Republicans at every level of government display a callous disregard for the health and lives of the American people, sowing disinformation and resistance to public health efforts to contain and defeat the pandemic. In place of a united front of preventive community health action, Americans instead must contend with endless propaganda and nonsense from a far-right circus of liars and science deniers.

Far-Right Political Demagoguery

From the first days of the pandemic, when the spotlight of a public health emergency put President Trump's sociopathic misleadership on full display, the Republican Party was forcefully revealed as an entrenched lobby of billionaire lovers and public health defeatists. This is less a political party than a Trumpian cult of unabashed opportunists and far-right ideologues, willful traders in people's lives and health for whatever scraps of power and largesse they can hoard for themselves. Even basic public health measures to contain the spread of Covid-19, such as mask requirements for indoor settings, temporary restrictions on indoor gatherings, and more recently encouraging use of effective vaccines, have been demagogically politicized and resisted by Republicans.

To the extent his public health pronouncements run counter to the Republican agenda, even Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has had to endure slanders and threats from the malodorous swamps of the Trump milieu. In fact, harassment and abuse of scientists who give media interviews or otherwise comment on the pandemic is now common, according to a survey by Nature. This is actually a global phenomenon, thanks to the rise of far-right extremism in multiple countries.

Indeed, inspired by former President Trump's contempt for science, many among his base of supporters have come to view the scientific community as just another interest group out to promote its own self-serving agendas. The scientific consensus of the threat posed by anthropogenic climate change, for example, is viewed by many right-wing climate change skeptics as just one opinion among many. And since everyone is entitled to their opinion, take your pick which one you like!

The public health Covid-19 vaccination campaign is now under assault by many Republicans, motivated less by reasonable health concerns than just politically charged scare tactics and propaganda. Its source is the same far-right political milieu that perpetuates the lie that Donald Trump won the last presidential election. It's no wonder this same political milieu considers it a priority to force women to give birth against their will, promoting highly restrictive abortion bans in Texas and other states regardless of their harmful impact on women's health. These dissemblers of knowledge and justice have become the norm in the Republican Party.

The hypocrisy in all this reaches particularly stunning heights at Fox News, where masks, vaccines, and science expertise are regularly impugned by right-wing hosts out to discredit the current public health campaign. The hypocritical rot at the core of Fox News is evident in the fact that the media company actually requires all of its employees to be vaccinated against Covid-19, or undergo daily testing. While many among Trump's base of supporters express a kind of casual skepticism on social media and elsewhere toward use of face masks to reduce the spread of Covid-19, indoor masking in the Fox News offices is strictly enforced. Of course, this doesn't stop media propagandists like FoxNews host Tucker Carlson from ridiculing the "cult of mask-wearing" as pointless. You just have to wonder if these posturing media cynics think medical masks are used in surgical settings just for dramatic affect?

What's next? Will Fox News eventually come up with an expose of Ignaz Semmelweis, the 19th Century German-Hungarian physician who in the 1840s championed hand-washing to prevent the spread of infectious disease, as a secret communist friend of Karl Marx? Dr. Semmelweis originally developed his ideas about hand-washing based on clinical practice and observation, before the germ-theory of disease could clearly establish the value of preventative hygiene measures.

Understanding Vaccine Hesitancy

Certainly not everyone who avoids Covid-19 vaccination is an "anti-vaxxer" opposed in principle to all vaccines. Nor are they necessarily right-wing malcontents who reflexively oppose any public health measures supported by liberals or Democrats. There are actually many reasons why so-called vaccine hesitancy influences a segment of the U.S. population. First, as has long been true, some people worry about the safety or side effects of vaccines. These legitimate concerns deserve to be addressed, not ridiculed. In fact, there's research to suggest large numbers of the currently unvaccinated are more "confused and concerned" than "absolutely opposed" to vaccines," as New York Times columnist Zeynep Tufekci notes in a recent commentary.

Interestingly, Tufekci cites research from the Kaiser Family Foundation (KFF) that shows lack of health insurance is the single most powerful predictor for who remains unvaccinated. But Covid-19 vaccines are provided free to the public, so why would that be? For one, lack of insurance is also a likely indicator of a more tenuous social relationship to the health care system. The uninsured are more likely to be among the 25% of the U.S. population who lack a primary health care provider to turn to for advice or information.

This shouldn't come as much of a surprise. The United States is one of the few modern nations that does not have some type of non-profit single-payer or national health care system. As a result, an everyday lack of access to affordable health care, especially in poor and minority communities, is a familiar aspect of American life.

The lack of access to affordable care is indeed a major failing of the U.S. health care system, experts note. "Some 30 million Americans are uninsured, and mostly shunned by doctors and hospitals," write physicians David Himmelstein, Steffi Woolhandler, and Adam Gaffney in a recent British Medical Journal (BMJ) commentary on vaccine hesitancy. "Even those with insurance encounter ever-larger out-of-pocket costs. Having disciplined patients for decades to expect financial roadblocks, we now expect them to suddenly understand that covid-19 vaccination is different--a fact many apparently doubt." Indeed, they observe, vaccination rates are lowest in the states with the highest uninsurance rates and among those most excluded from access to care.

Vaccine hesitancy may also express historic distrust among racial and ethnic minorities who have experienced a legacy of discriminatory treatment in the health system. Some people may be concerned, despite reassurance from public health authorities, that Covid-19 vaccines, initially approved for emergency use, were developed so quickly. Tufeckci also reminds us that there exists a surprisingly large sector of the population who have a fear of needles.

To be clear, people have the right to ask questions and seek assurances about vaccine safety and policies. The antidote to "anti-vaxxer" opposition isn't just blind faith in vaccine science. Medicine doesn't need uncritical "pro-science" sycophants constantly shouting its praises any more than it needs its imprudent deniers. Actually, it is in society's interest for the general public to be as informed and educated as possible--to think critically--about the science behind public health guidelines and recommendations. In turn, medicine also works best when health care practitioners value and respect their patients' input and perspectives.

At this juncture, the consistent right-wing Republican opposition in the United States to public health measures is less absurd than it is just deeply tragic. In the United States, the Johns Hopkins Coronavirus Resource Center reports 751,349 Covid-related deaths as of November 4. Worldwide, 5,027,964 deaths have been reported. Notably, the United States fares poorly in global comparisons of Covid-19 morbidity and mortality rates.

Nor is the Democratic Party establishment without blame in all this. For decades, neo-liberal austerity policies supported by both major political parties have taken their toll on the public health infrastructure. In fact, pre-pandemic spending on public health has been in decline for years, reports the BMJ, more recently constituting only 2.6% of total health spending. Driven by corporate profit, hospital bed capacity and stockpiles of available medical resources have been gradually reduced over the past four decades.

What does a fractured public health infrastructure look like in practice? Here's one example: the Centers for Disease Control and Prevention (CDC) currently reports only "breakthrough" cases of infection among vaccinated populations that involve hospitalization, according to Johns Hopkins. The more complete data reporting necessary to track the virus is left to state health departments, many of which fail to report all the data necessary to track surges, variants, and vaccine effectiveness. In fact, 14 states do not report any data on breakthrough infections.

A Vision for Social Justice and Health

Rich in technology and wealth, but poor in leadership, equality, and justice, the United States is a dysfunctional outlier compared to other rich nations when it comes to providing basic social infrastructure and a robust social safety net for its citizens.

None of the public health shortcomings or current political divisiveness over even the most basic public health measures should come as a surprise. Rich in technology and wealth, but poor in leadership, equality, and justice, the United States is a dysfunctional outlier compared to other rich nations when it comes to providing basic social infrastructure and a robust social safety net for its citizens. This is a society that expects to spend $8 trillion on military spending over the next 10 years, but somehow can't manage to pass a $1.75 trillion social spending bill that would mandate even modest expansions in Medicare or establish for the first time national policy on paid family and medical leave for working families, without a contentious and likely losing political battle in Congress.

"The covid-19 pandemic casts a harsh light on America's lethal inequalities, but also illuminates a path forward," conclude single-payer advocates Himmelstein, Woolhandler, and Gaffney in their BMJ commentary. "Contending with tomorrow's health emergencies will require reversing austerity and adequately funding public health agencies. We must go further to democratize care: implement universal coverage and abolish out-of-pocket costs; equalize the distribution of health infrastructure; and reverse the privatization and commodification of medical services."

These are dangerous times. In the United States, millions of Americans are under the sway of a megalomanic ex-president Trump, a corrupt, inveterate right-wing liar described by his own niece as an "instinctive fascist." While many Republican leaders continue to bow down to this malignant anti-democratic menace, a majority of Republican voters in their political stupor continue to deny this scourge of a leader even lost the election.

These are the agitated know-nothings who want to ban mask mandates, criminalize abortions, ban teaching in schools on the history of racism, and undermine the democratic right to vote. They are crawling in a muddy trench with their dystopian visions of authoritarian repression and ever harsher specter of social and class injustice. The expectation that the cautious elites of the Democratic Party, with their penchant for moderation in all things, can prevent this irrational base of aspiring neo-fascist Republicans from destroying what remains of democracy is not an optimistic one.

If there is a public health lesson here, it is that no one is safe until everyone is safe. The dangerous dynamic of the pandemic is that the longer it lasts, the more likely even more dangerous variants of Covid-19 will emerge. Worldwide equality in access to affordable medical care, including vaccine equity, is in the interest of the whole planet. Worldwide solidarity, scientific internationalism, democracy in everything and social and climate justice for everyone, including mass resistance to the growing far-right threats to our future, has never been more urgently needed.