Learning From Decades of Public Health Failure

One glaring revelation of the Covid-19 crisis is how ill-prepared the United States turned out to be for an unexpected national medical emergency. There are deep historical reasons for why our welfare state proved incapable of dealing with the unprecedented challenges of the pandemic—reasons that predate the Trump administration’s mismanagement. Decades of economic decision-making that prioritized a market-driven system ignored the kind of welfare distribution necessary to deal with the potential challenges of a large-scale crisis like Covid-19.

As is so often the case, the long-term consequences of this deprioritizing of care fell disproportionately on Black Americans and other minorities whose health and finances were most affected by the pandemic. Consider, for example, a recent study by the University of Pennsylvania, which demonstrates that roughly half of low-income communities in the United States have no ICU beds. Indeed, the United States has fewer ICU beds per 1,000 people than China, Japan, or Italy.

The research of George Aumoithe, a historian of global health at Stony Brook University, shows that the lack of ICU beds in low-income communities is the result of federal and state spending cuts dating back to the 1970s. At that time, Aumoithe argues, an inflationary crisis, combined with urban flight to the suburbs, compelled politicians and health care experts to cut costs by closing down hospitals in urban areas and moving ICU-focused speciality care to hospitals in the suburbs. It was this policy of economizing—starting in the 1970s and continuing through the AIDS epidemic and today’s Covid-19 pandemic—that explains why half of low-income communities in the United States have no ICU beds.

The Nation spoke with Aumoithe about his work on the history of Medicare and Medicaid, the economics of disease prevention, the downsizing of inner-city hospitals, and the racial dynamics at play in health care during the pandemic. This conversation has been edited for length and clarity.

—Daniel Steinmetz-Jenkins

Daniel Steinmetz-Jenkins: As a historian of US health care and the welfare state, a major aspect of your work is examining how the political economy of health care after the implementation of Medicare and Medicaid shaped the nation’s capacity to cope with the challenge of disease prevention. One might think that, given this groundbreaking legislation, policies would have been in place to more adequately meet this challenge, but your work calls this assumption into question. Why is that?


Leave a Comment