Covid-19: Developing countries must learn what not to do from the US

With the United States of America acquiring the dubious distinction of having the highest caseload of Covid-19 patients and deaths globally, there are some important lessons for developing countries as the US is often seen as the trendsetter in terms of corporate and organisational best practices.

The present crisis in the US has largely unfolded in and around New York city, which ironically has one of the best hospitals in the world. Coincidentally, the two most visible political faces nowadays in the context of crisis response were born and raised New Yorkers. Both President Donald Trump and New York state Governor Andrew Cuomo were born in Queens borough, arguably one of the most diverse pockets of the world. At the same time, the contrasts between the two men born in privilege could not have been more. In his typical Queens accent, Cuomo, born in an Italian-American household and son of former Governor Mario Cuomo, holds press conferences every day on the crisis. His words of hope, and yet caution, laced with facts, have helped his popularity soar across the world.

New York City may be the mecca of global capitalism, but the city is known for its progressive policies. As compared to other parts of the US, New York City has a strong safety net devised by the state for the low-income population. There is hardly a doubt that the viral spread of Covid-19 in New York city is primarily because of the huge daily inflow of people into the city. The city’s residents have linkages all over the world as around 37% of them are foreign-born. This makes the city diverse and colourful but also highly vulnerable to a pandemic.

However, there is another thing that is exacerbating the crisis. It is endemic to the US, and even a city like New York with all its uniqueness and strong safety net cannot escape from it. This is the infamous US medical system, which is perpetually hostage to the greed of the insurance companies. The system is structured so as to make maximum profits to pay for the huge unproductive administrative and marketing costs. Patients who have insurance go to the doctors regularly and also get preventive care. In some cases, even they are not immune to the absurdities of the system. The medical expenses are negotiated between the hospital and insurance companies. In 2014, I had made my nearly $17,000 bill from a New York city private hospital negotiated by an insurance company down to $8,000. That bill was for having a thumb cut stitched in an emergency unit.

In an environment where the bills are inflated, patients are hesitant to go to the doctor. This is common even among patients who have insurance but are worried about the high co-payments involved as the quality of insurance varies. In the absence of free testing for Covid-19 during the initial phase of its spread in the US, many patients avoided going to the doctor and thus became carriers of the virus. The empirical evidence is before us. The poorer and outer parts of the boroughs of Queens and Brooklyn have shown the highest numbers of Covid-19-positive cases. Elmhurst, a public hospital in Queens, is the epicentre of the Covid-19 explosion in New York city. Reportedly, more than two-thirds of the residents in the area around Elmhurst were born outside the US, and they belong to the low-income category.

Around 8.5% of the US population is uninsured even after the passage of the landmark Affordable Care Act during President Obama’s tenure. In January 2019, New York City had over 600,000 uninsured residents; about half of them are undocumented immigrants, the rest are eligible for coverage, but they’re not enrolled for one reason or the other.

A lack of proper health insurance and the presence of co-morbidities have proved to be the death knell during the pandemic. The uninsured depends on public and safety-net hospitals, which proved to be inadequate during the pandemic. A New York-based non-profit – the Association for Neighbourhood and Housing Development -- reports that “at least 18 hospitals have closed all of their in-patient services in New York City since 1998, leading to the loss of thousands of hospital beds -- with two-thirds of those closures occurring in the outer boroughs…A look at the data shows that the majority of these outer-borough hospital closures fell in lower-income communities of colour (non-White) that bear the brunt of the coronavirus crisis today.”

In the context of developing countries, the first priority is to control the spread of Covid-19. It is also an opportunity to draw adequate lessons from varied global experiences. Undue and unregulated privatisation of the medical system along with the presence of opaque practices of insurance companies is not a solution. Densely populated Asian countries like South Korea, Singapore and Taiwan flattened the curve early and these models need to be studied closely. For instance, the US has six times the population of South Korea but 174 times its Covid-19-related fatalities so far.

The elements of the public health system in developing countries, particularly accessed by the vast majority, that are working well should be continued, modernised and scaled up. At present, the private medical sector, which is accessible to only a few, lacks proper regulatory checks. There is an apprehension that at times the treatment prescribed is done to inflate costs. In a nutshell, the pandemic is for national health systems across the world a moment to act both short-term as well as long-term by learning from each other, by factoring in what has and what has not worked.

(The writer is a political analyst and has worked with the United Nations in various capacities)