Doctor’s Orders
finding the right coronavirus prescription for America
Hello America. You’re looking worse for wear.
I see that you’re experiencing symptoms of a pandemic. Please hop up on the exam table.
I’ll tell it to you straight. You’ve got it. You’re sick as a dog with this bug that’s been going around. Like every other country in the world, you are in crisis mode, and the actions you take in the coming months, weeks, days, and even hours will have a tremendous impact on the future of your nation and its people.
I understand that your primary care physician, the U.S. government, has started you on a specific treatment plan and that you’re interested in a second opinion.
For this visit, let’s leave aside discussion of therapies for your healthcare system, small businesses, large corporations, and local governments. Those types of targeted, systems-level actions will of course play a very important role in your treatment and recovery. However, my specialization is more holistic and fundamental, dealing first and foremost with the immediate resilience of your population, which is your first and most crucial line of defense.
Diagnosis
The SARS-CoV-2 virus, commonly known as coronavirus, is devastatingly well-equipped to spread quickly, to kill in mass numbers, and to grind economies to a halt. It first appeared in China’s Wuhan Province in December, and by mid-March it resided in hundreds of thousands of lungs in over 200 countries around the globe, bringing even the strongest world powers to a standstill.
I’m afraid you have a particularly severe case, America.
Prognosis if Untreated
Coronavirus presents an exponential growth dynamic, and the numbers are stark. There would be heavy implications both for human lives and for the national economy if your government and people were to take no action and try to continue daily life as normal.
Likely Public Health outcomes
- Healthcare system collapse — beds, staff, and equipment become quickly overwhelmed, leading to triage decisions and an increased mortality rate, both for those afflicted with the virus and for those in need of medical care for other ailments
- Insufficient health coverage — millions who take ill or suffer an emergency and lack health insurance and/or income to pay associated costs will go without treatment. This will be amplified by mass job loss, as both income and health coverage are commonly tied to those jobs.
- Maximum casualties — over a hundred million Americans infected, tens of millions hospitalized, and over a million dead in worst-case predictions.
Likely Economic Outcomes
- Heavy reduction in consumer spending — a rapidly-increasing number of people stay home and cling to whatever savings they might have
- Workforce depleted — as employees take ill, get laid off, or quit to stay safe or care for family
- Widespread businesses closures — either temporarily or permanently, depending on the financial solvency of each business
- Massive unemployment — further escalating inequality and insecurity
- Widespread default — on rent, bills, debt, and other financial obligations
- Stock market panic — possibly a prolonged recession or depression
Because you’ve already begun to implement a fair amount of social distancing and other actions, your worst-case scenario is showing signs of starting to soften a little, although it still remains potentially quite severe, especially if you don’t stay the course on the actions you’re taking. The question to ask now is what else can and should be done to reduce the pain much further?
Analysis
The fundamental course of action I suggest is rooted in two main objectives:
- Keeping everyone in nonessential roles in isolation from each other
- Keeping the entirety of your economy solvent, from individual and household budgets to small businesses and major industries
You need most of your population to stay home for an extended period of time, likely on a recurring basis as appropriate over the next 18 months or so until a viable treatment or vaccine for the virus can be developed.
But people must have financial security in order to survive. You cannot ask them to stay home from work without directly providing, at minimum:
- income for basic needs like food, rent, and utility bills
- coverage for additional costs incurred (especially healthcare)
Current Treatment Plan
In an attempt to provide this financial security, your government has so far prescribed:
Health coverage
- All coronavirus testing to be free of cost
- All private insurance policies required to cover coronavirus-related treatment
Financial support
- Citizens—$300B to fund a one-time cash payment to individuals ($1200/adult + $500/child), phasing out for income brackets between $75K and $90K (double those numbers for couples who file taxes jointly)
- Workers — $260B to fund an Unemployment Insurance enhancement, most notably adding an extra $600/week to existing unemployment benefits for 4 months
- Students — $44B for temporary student loan deferral plus an assortment of other small programs
- Welfare recipients — $26B to supplement various food programs for the needy
Prognosis under Current Treatment Plan
Here is what you should expect if the current treatment plan is left as is:
Individual Health
- The fact that private insurance must cover COVID-related treatment is inadequate. Millions were uninsured to begin with, millions are losing their employer-provided insurance as they lose their jobs, and millions of those who manage to keep their insurance will not be able to afford the co-pays and deductibles of either their COVID- or non-COVID-related medical needs without a source of income. Millions with sickness or injury will go untreated.
Individual Finances
- The direct cash support to citizens is grossly insufficient. People cannot safely quarantine for an extended duration on a one-time infusion of $1,200 per adult and $500 per child.
- The Unemployment Insurance boost introduces a significant level of moral dilemma and injustice. Those who are laid off from low-wage jobs will make far more from their unemployment benefit plus the additional $600/wk subsidy than they would if they kept working. You should expect to see a crumbling of the workforce performing essential work, enormous resentment from those still risking their lives while being underpaid, and an Unemployment Insurance program drowning under an avalanche of submissions.
- The student loan deferrals and additional welfare funding will provide some temporary relief from some percentage of insecurity for some Americans in need, but will not alter outcomes significantly.
Additional Societal Symptoms
- Due to the need to earn income, many people will not cooperate with stay-at-home directives, further accelerating the spread of the virus.
- Your healthcare system will still be overwhelmed in short order and to spectacular degree.
- You’ll still experience severe damage to your economy and societal stability.
Proposed Treatment Plan
There’s no sense in undoing the treatment that’s already been prescribed. There is much benefit to it, and it was hard to procure. What follows is what should be added onto and adjusted within your current treatment regimen:
Booster Shots— Guaranteed Security to All
- Emergency Universal Single Payer Healthcare — the government must cover all medical expenses for the duration of the crisis.
- Emergency Universal Basic Income (UBI) — the government must provide an ongoing income floor, unconditionally to all individuals (whether they are students, workers, seniors, welfare recipients, etc.), sufficient to meet basic needs for the duration of the crisis. As a bare minimum, the $1200/adult and $500/child stimulus checks must be made a monthly occurrence.
Adjustments to Current Treatment
- Reduce the unemployment benefit expansion to mitigate the unjust moral dilemma mentioned above and to lessen the administrative burden on your Unemployment Insurance program. Unemployed workers would now be receiving a supplement to their unemployment insurance benefit through their Emergency UBIs instead.
- For all essential employees who cannot work from home, mandate and subsidize a $15/hr minimum wage floor, paid sick leave while workers are forced to self-isolate, and, crucially, hazard pay for all hours worked.
The Bad News — Prognosis Remains Grim
Now comes the part I hate. How can I say this?
The truth is, America, we caught this too late to avoid major trauma and a slow, painful recovery. You’re going to be out of commission for months and in rehab for years. You will carry scars for generations. The toll in human lives — and on your way of life — will be dramatic.
Why? Let me put it this way. Your nation is a body, and every person in it is one of its few hundred million cells, each performing various functions.
And I might as well cut the doctor act. I’m obviously not really your doctor. I’m just another one of those cells, a microscopic participant in our American body politic, a speck of a freckle screaming from the tip of our nose what should by now be in plain view to us all. I’m not prescribing to you. I’m pleading with us.
(Note: this anatomical metaphor only goes so far. Please resist the urge to assign different functions of the body to different people, classes, or groups. If you are already imagining yourself to be the “brain” then I assure you that you’re the ass.)
So yeah, think of us all as cells. Through poor lifestyle choices, we’ve made our body extra susceptible to this pandemic.
For one, we’re immunocompromised. Our population is too weakened by financial insecurity to fight off hardship at the cellular level. And when one of us falls into decay, we can become a burden on or a danger to those around us. This occurs millions of times across the nation on a normal day. Now multiply that effect at least tenfold in the face of coronavirus.
The other problem is that we have horrible circulation. We have plenty of resources, but their initial distribution is wildly unjust to begin with, and our redistributive system is ill-equipped to deliver the necessary medicines, antibodies, and nutrients to each of our cells quickly and effectively. Even if we inject a sufficient level of cash into our national blood stream, it won’t get everywhere it needs to go at anywhere near the speed required. We’re just not set up for it, and we don’t have enough time to build out our circulatory system to have the blood vessels we need to do this well during this crisis. We will fumble, and people will suffer. There’s no avoiding that. We’ve already failed to a large degree.
The best we can strive for is partial success in reducing the pain of this pandemic and the duration of our recovery as much as possible for as many people as we can manage.
It will hurt badly, and the trauma will be most acutely felt by those already struggling and disadvantaged.
The Good News — Recovery and Prevention
This pandemic isn’t going to end us. America will survive.
It will be an arduous slog, and it will test us like nothing we’ve experienced in generations, but this could be just the kick in the ass we need to get our health in order.
For too long, we’ve been complacent, drunk on comforting placebos like the stock market, unemployment number, and GDP, ignoring the moral and financial decay creeping down into our very DNA in the form of insecurity and inequality. But as we each sit helplessly in our homes, witnessing the virus wreaking havoc on our frail national anatomy, it is nothing if not sobering.
What we need to realize here and now is that America has always been in a pandemic. On any given day, millions of Americans are unemployed or underemployed, uninsured or underinsured, disadvantaged, homeless, abused, hungry, neglected, or teetering on the edge of desperation, each one experiencing their own private disaster.
It may have taken a shared catastrophe for us to see it, but we’re as weak as our most vulnerable members. It’s why the coronavirus has so thoroughly walloped us.
Fortunately, the long-term preventive strategy to building up our strength and immunity is very similar to the short-term emergency tactics prescribed above.
Primarily, there are two things we must do as soon as possible:
1. Implement a permanent universal healthcare system
However we get there, we need to guarantee coverage for all, thereby ensuring that nobody can be taken advantage of or fall into desperation on account of their medical needs. This is how we fortify our immune system.
2. Implement a permanent universal basic income
This suggests first creating a utility like a federal bank to serve as a uniform place to deposit the cash distributions in simple accounts tied to each individual (as a glorious side effect, our people would be fully banked for the first time). If politically necessary, we can even start with a smaller universal income and build on it as opportunity allows. The most crucial step is getting the framework in place, getting some money flowing, and letting the healing begin. This is how we upgrade our circulatory system.
Convalescence and a Healthy Lifestyle
Universal Healthcare and UBI can become the two pillars of our national health. If we motivate ourselves to make these changes now, we will become vastly more prepared to deal with the next national crisis, be it a pandemic, hurricane, wildfire, or flood. With a mechanism to swiftly support every individual on day one of a disaster, we’ll be able to focus our political energy instead on the macro-level institutional and logistical tasks that will also need addressing.
And in more normal times, each of us will be far more resilient at the cellular level in the face of each of our millions of daily tragedies, from a downsizing to a divorce to a bad diagnosis. When that occurs across society and each of our people can walk confidently into their respective roles, we will experience a communal strength like we’ve never known.
If there’s a silver lining in all this, let it be the incredible opportunity we’ve been granted to whip America into shape.
Want to read more? Here’s a handy list of links to all my Medium pieces on basic income.
