As previously noted part of the inspiration for my exploration into the political economy of viruses came from the Chinese collective Chuang’s exemplary piece, Social Contagion which, predominantly from a Chinese perspective, looked at many of the material circumstances surrounding the emergence of COVID-19. One particular fact that seemed particularly salient on first reading was how changes within the Chinese healthcare system formed a key part of the reaction to the pandemic. Prior to China becoming more fully enmeshed within the global capitalist system, healthcare in China was largely covered under the danwei system of enterprises, which offered, many different services including socialized nursery, medical care and pensions.
In recent times, healthcare spending has plummeted, amid privatizations and the increasing presence of marketization currently China spends $323 per capita on healthcare according to statistics taken from the WHO for comparison, this is around half that spent by Brazil, Belarus or Bulgaria. Whilst healthcare is, on paper, funded by a combination of employee and employer contributions, in practice the latter is often ignored leading to systemic under-funding and many subsequent bills being covered as out of pocket expenses. The situation is exacerbated when the circumstances of migrant workers are taken into account with the last national estimates suggested only 22% of migrant workers had access to basic medical insurance.
This however is not just simply a matter of neglect or maltreatment, the profit margins many of the industries operate on over time has become more squeezed allowing for less spending on social benefits. Work done by the Chuang collective reveal that providing a level of healthcare at a similar level as the danwei system would lead to such a severe reduction in profits that many firms would subsequently become unprofitable. In The Production Of Plagues I attempted to draw parallels between critiques of capital accumulation and the patterns observed in the spread of pandemics, here perhaps another one becomes visible, the tendency of the rate of profit to fall and the subsequent affects on labor and social spending.
Whilst the Chinese administration has attempted to cover these gaps with a basic level of medical insurance, the current provisions are relatively minimal paying out only a few hundred yen per person per year. Alongside the spread of COVID, this systemic healthcare under spending produces other issues. In a survey conducted by Dingxiang an, online platform for healthcare workers, 85% of healthcare workers reported experiencing violent incidents at their workplace, often perpetuated by those who believed their relatives or friends had received poor care.
Chinese doctors regularly see four times the number of patients as US doctors whilst being paid the equivalent of just $15,000 a year. Whilst recent news of strikes or civic unrest can often be hard to obtain, work done by the News Worth Knowing blog, tracked multiple instances of strikes by healthcare professionals every month. Examining this pattern further, via the Chinese Labour Bureau’s interactive tool the Strike Map, strikes also took place due to companies not paying out health insurance or wage “delays”.
Only examining the epicenter of the pandemic however would give us a poor picture of the importance of healthcare and looking at other examples can reveal a more complex but similar pattern. At this moment in time the UK has the highest level of excess deaths in Europe and one of the highest death tolls from virus. Whilst public health spending in the UK has risen against declining national incomes, the UK still spends less than many similar advanced economies and currently spends the second lowest in the G7, this is despite a rapidly aging population and recent reports highlighting how life expectancy in the UK has recently stalled. Meanwhile the differences in health outcomes based on socio-economic status has widened, with research conducted by Kings College suggesting this was partly due to poor health coverage in deprived areas, and the UK having several of the most deprived towns in Northern Europe. Meanwhile the elder care has also been exposed as unfit for purpose with several instances of older patients being discharged into care homes being reported throughout the crisis which were ill-suited to contain the virus.
The resultant spread lead to over 16,000 people, dying an amount which continues to rise due in part to the failure of the government to put in place measures to stem the virus. Care homes have been regularly featured in the governments privatization plans with huge numbers of care homes being taken into private ownership however this has been followed by sharp declines in standards among increased reports of rushed visits and elder abuse. A look into care home contracts reveals half of all care home staff are paid less than the living allowance, despite the fact that many of these workers played a pivotal role in trying to contain the spread of the infection during the crisis.
The US spends the most per capita on it’s citizens however by and large it’s mismanagement of COVID has lead to a situation where, travel for many of its citizens has been severely restricted. Partly this is structural, the inability to transfer information seamlessly between various state and federal institutions at one point lead to a situation referred to as a information disaster, but partly this is entirely systemic, the product of a steady degradation in workers rights leading to circumstances where many have had to face the choice between going to work and facing exposure to losing the ability to afford food and rent.
Whilst the physician ratio is not quite as dire as those reported by China, according to data reported by the world bank the ratio of US doctors per 100,000 of the population (2.6) still lags behind many advanced economies such as Denmark (4), Germany (4.2) and Greece (5.5). In terms of net salary doctors in the US can regularly earn considerably more that their European counterparts however the debt accrued by these doctors could be seen as off-putting with the average medical student in 2019 being left with $201,490 worth of debt. Considered in the light of previous years this represents a 2.5% increase in costs compared to a 1.0% increase in median wages within the same period. The well publicized struggles over medicare for all a universalized medical programme which was one of the key components of the Vermont senator and presidential candidate Bernie Sander’s campaign highlighted the fact that, depending on which methodology was being used, the number of uninsured American stood at around 12.7 to 15.5% of the population.
This masks, another problem however, the affordability of healthcare insurance itself with premiums for single workers costing around $3,700 and $10,000 for families. A similar pattern can be observed with China with some firms, particularly smaller firms, opting not to supply their workers with health insurance coverage when faced with the mounting costs and other firms offering limited coverage leaving a large portion of the costs to be covered by their employees. Even firms that offer coverage often exclude some workers, particularly new employees, seasonal employees and temporary staff. The impacts on workers particularly frontline workers has been noticeble with heightened numbers of infections and fatalities being seen in industries such as garment manufacturers and meat packing centers which employ a larger number of seasonal workers, who often come from insecure or transient backgrounds.
Efforts to streamline the US’s National Security Centre, appear to leave the resultant organization under-prepared for the advance of COVID, and in a similar fashion to the UK the delay in procuring the necessary equipment lead to the US initially being on the back foot regarding PPE with many staff relying on air lifted aid supplies from abroad. Meanwhile the particularities of the US healthcare system where care is largely based around doctors, informal medical staff and specific health centers, both hospitals and clinics also appeared ill suited to come with the virus, with little care being available at the point of need and often people needing assistance having to travel substantial distances to access care. The surge in requests for onsite care has seen hospitals either transformed into potential vectors for transmission or avoided entirely by those looking to avoid contagion occasionally leading to delays in responding to health complications wrought by the virus.
Whilst I have mainly focused on three countries similar stories of unaffordable costs, shrinking public services and unbalanced outcomes particularly among working class, disabled and black and minority ethnic groups continue to be a consistent underlying current of the pandemic. Rather than something to be considered as a separate matter to the private appropriation of socially derived wealth, these closer examinations of healthcare over time and during times of crisis can hopefully go someway to revealing how the two are intrinsically related.
Notes
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.3.887
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.26.1.w22
https://www.theatlantic.com/health/archive/2020/05/cdc-publishing-covid-19-test-data/611764
https://www.grin.com/document/153422https://data.worldbank.org/indicator/SH.MED.PHYS.ZS