Weekly Review – September 10, 2020

Published on September 10, 2020 / Leer en español

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Dear Readers:

The COVID-19 pandemic has put a spotlight on the stresses and weaknesses of our health care system, all of which existed prior to the pandemic but had remained mostly hidden until now. In this essay for the New York Review of Books (“NYRB”), Timothy Snyder, history professor at Yale, narrates how he barely survived his ordeal with the medical-industrial complex.

In late 2019 Snyder had surgery for appendicitis. But his appendectomy was not the average case, his appendix had burst, infecting his liver and eventually causing sepsis, which is fatal in many cases. However, no one noticed the condition until he had developed an abscess the size of a baseball in his liver.

In the meantime he spent a lot of time in the limbo of an emergency room, which was overflowing with patients and severely understaffed; was subject to two unnecessary spinal taps, and his sepsis was left untreated for so long that he almost died. After spending weeks in the hospital, he finally went home with “nine new holes” in him: “three from the appendectomy, three for liver drains, two from spinal taps, and one in [the] arm for the tube that channeled the antibiotics [he] inject[s]”.

Snyder, who specializes in the history of Eastern Europe during the Second World War, is remarkably evenhanded in his account. He doesn’t blame the doctors or nurses for what happened to him. Rather, he sees them as fellow victims of a system that is primarily driven by the pursuit of profits. As he put it in an interview with the editors of the NYRB, “our interactions with them are deeply false, because we do not recognize just how disempowered they are in commercial medicine”. And while “we would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care.”

So it is in Puerto Rico. I personally spent many hours in hospitals with my parents between 2016 and 2019. I can attest to the same chronic understaffing; the same overflowing emergency rooms with patients waiting for treatment in some dark hallway; the same system that treats sick people as a means to a monetary end.

It is difficult, I think, to expect anything else when the entire system is based on making big profits mostly from elective procedures; downplaying primary care and treatment; and churning patients through hospitals as fast as possible.

Snyder seems to believe that if we change the system we can change the results. But here I think he is mistaken. We could have the best-designed healthcare system, the brainchild of the best and the brightest minds and still, nothing would change. That is, until we all understand, as Snyder himself points put, that “the purpose of medicine is not to squeeze maximum profits from sick bodies during short lives but to enable health and freedom during long ones.”

Sergio M. Marxuach, Editor-in-Chief

Insights + Analysis from CNE

Update from Washington D.C.

By Rosanna Torres, Director – Washington, D.C. Office

With only 21 days left on the legislative calendar before elections, lawmakers still have several tasks ahead. Among the most important: funding the government for fiscal year 2021, legislating another round of a long-awaited coronavirus relief package, and potentially extending supplemental aid to the victims of this season’s natural disasters. But time is not on their side. As of today, the House has 14 working days left before a lame-duck session. The Senate has 20 days.

Yet the total amount of legislative days left is somewhat misleading. That’s because, for a bill to become law, the House and Senate must agree to the same legislative text. The House typically initiates the appropriation process and sends its approved version to the Senate for its consideration. If the Senate disagrees with any of its provisions, it sends its own version back to the House for reconsideration. That back and forth process is time-consuming and requires the House to recommence debates on the new funding amounts and program language. Taking that process into account, there are only 13 days for both chambers to work simultaneously and agree on all fronts.

According to several sources, House Speaker Nancy Pelosi has agreed with the White House’s representative, Treasury Secretary Steven Mnuchin, to a government funding bill prior to the elections. Separately, Vice President Mike Pence indicated that conversations about government funding will pressure Congressional negotiators to focus on all that remains to be done.

If past serves as prologue, though, it is unlikely that 13 days would be enough. The House sent to the Senate two minibus bills it approved in late July but conversations have stalled since then. Under normal circumstances, this is a difficult process with plenty of room for partisan sniping. Now, with the uncertainty surrounding the November elections and the prospect of another divided Congress, there is a chance Congressional leadership could opt to fund the government in the same amount appropriated for the previous fiscal year – known in Washington-speak as a continuing resolution – and punt negotiations to next year.

Also on our radar is the impact of this weekend’s petition for a writ of certiorari to the U.S. Supreme Court regarding the First Circuit Court of Appeals’ decision on the implementation of the Supplemental Security Income program in Puerto Rico. In a detailed petition citing a wide range of other rulings and programs that treat Puerto Rico differently, the Acting Solicitor General for the U.S. filed a request to the highest court to review “whether Congress violated the equal-protection component of the Due Process Clause of the Fifth Amendment by establishing Supplemental Security Income – a program that provides benefits to needy aged, blind, and disabled individuals – in the 50 States and the District of Columbia, and in the Northern Mariana Islands pursuant to a negotiated covenant, but not extending it to Puerto Rico.”

In a strongly-worded request, the Department of Justice asserts that “Congress has a legitimate interest in avoiding a one-sided fiscal relationship under which Puerto Rico shares the financial benefits but not the financial burdens of statehood, and declining to include Puerto Rico in the SSI program is a rational means of furthering that interest.” Furthermore, it states that “the cost of including Puerto Rico would be extremely great.” In their argument, federal officials allude to an estimate by the Social Security Administration that calculates the total cost of the program between $1.8 billion and $2.4 billion annually over the next ten years.

Democratic candidate for the Presidency Joe Biden took the opportunity to shed some light on what his Administration’s stance on federal programs for Puerto Rico would be through a tweet: “Time and again, the president has refused to provide Puerto Rico with much-needed resources. He’s repeatedly insulted Puerto Ricans and this latest action is another example of his disrespect for the island. This ends when I’m elected president.”

Alas, the endgame is far from certain.  We’ll keep you posted on any developments.

How Did U.S. Consumers Spend Their Stimulus Payments?

The CARES Act provided for the federal government to send checks of up to $1,200 per individual (plus $500 per dependent child) to persons earning up to $99,000 a year ($198,000 for couples). The idea was this money would be spent rapidly and prop-up the economy. However, a study cited by The Economist found “that Americans did not use the payments quite as Uncle Sam had hoped. Using data from a recent survey of 12,000 Americans conducted by Nielsen, a market-research firm, the authors found that just 42% of the money was spent. Another 27% was saved. The remaining 31% was used to repay debts.” There was, however “wide variation across households. The authors found that 30% of Americans spent their entire stimulus check, while 40% did not spend any at all. As you might expect, poorer households spent more of their payments, with the bulk going on food and other essentials (see chart); bigger households spent more, too.”

In sum, there is room for improvement should Congress approve a new round of stimulus spending.

On Our Radar...

COVID Trends – The Institute for Health Metrics and Evaluation (“IHME”) at the University of Washington recently updated its COVID-19 forecast for diagnosed cases, hospitalizations, and expected deaths, using three different scenarios: (1) a continuation of current trends; (2) an easing of social distancing and mask-use requirements; and (3) the “universal” adoption of mask use requirements. The IHME’s model forecast finds that should the current trend continue total expected deaths would exceed 410,000 by January 1, 2021, in contrast with approximately 190,000 recorded deaths so far. Under the “easing” scenario deaths would exceed 620,000, while under the “universal” mask use scenario deaths would total approximately 288,000, by New Year’s Day 2021.

Hunger in the United StatesAccording to the New York Times “a shadow of hunger looms over the United States. In the pandemic economy, nearly one in eight households doesn’t have enough to eat. The lockdown, with its epic lines at food banks, has revealed what was hidden in plain sight: that the struggle to make food last long enough, and to get food that’s healthful — what experts call ‘food insecurity’ — is a persistent one for millions of Americans.”

State Capacity and the Pandemic – A recent paper by Mariana Mazzucato and Rainer Kattel, “argues that to govern a pandemic, governments require dynamic capabilities and capacity—too often missing. These include capacity to adapt and learn; capacity to align public services and citizen needs; capacity to govern resilient production systems; and capacity to govern data and digital platforms.” Required reading for people in the White House and La Fortaleza.