Capitalism Left Us Vulnerable

At Washington Monthly, Shannon Brownlee and Jeanne Lenzer explain How Mistreating Nursing Home Staff Helped Spread Covid-19.

By the end of May 2020, half of all cases among the elderly were brought in by “direct care workers,” such as nurses, nursing assistants, physical therapists, maintenance and kitchen staff. These people are among the most essential workers—and some of the worst paid. In 2019, their median hourly wage was just $12.80. Nearly half live in low-income households. More than half receive public assistance. The vast majority are women and three in five are people of color.

Add poor pay to no sick leave or health insurance, and many direct care workers can’t afford to stay home when they are sick. Jen Hurst is a critical care speech pathologist in Kansas City, Missouri. For 15 years, she’s worked for the same long-term care company, which has never given her a full-time job or benefits. She can’t afford to take time off when she’s sick. When she developed symptoms that seemed like Covid-19, she briefly thought about going into work before deciding to stay home—and that required tapping her family’s modest savings.

Note that there are a wide variety of nurses. A registered nurses has had anywhere from two or three years of classroom study in medical science to a Ph.D. in nursing. LPNs, licensed practical nurses, generally have a year or so of classrom study and clinical experience before getting licensed. But a “nurse” might also be a CNA, a certified nursing assistant, who has a high school diploma and four to twelve weeks of training, mostly to do things like giving baths and helping patients transfer from a bed to a wheelchair. I suspect these are the nurses the article is talking about.

Nursing home staff qualify as “health care workers” but are often on the periphery of medicine. They are not paid well, and some employers limit their hours in order to limit their benefits. The article explains that a lot of infections happened because people work for multiple facilities in order to make a living. One study showed that roughly half of all covid deaths in nursing homes could be traced to staff moving between facilities.

There is a direct link between low pay and benefits for nusing home staff and high rates of covid infection and death. Unsurprisingly, the for-profit nursing homes had higher rates of death than those run by nonprofit organizations. A google search brought up all kinds of articles and studies (example) saying that for-profit nursing homes tend to have lower quality of care, lower staff-to-patient ratios, are more likely to overbill Medicare, etc.

It’s also the case that there are much lower vaccination rates among nursing home staff than hospital staff. Harvard Medical School reported in February that a high percentage of nursing home staff had no plans to get a vaccine, even though their employers offered it to them. Remember, many of these workers have little to no classroom instruction in science, in spite of being classified as “health care workers,” and many don’t trust their employers.

But the bottom line here is that there is a direct link between the way nursing home staff are considered nothing but cost who must be denied sick days and a living wage for the sake of profits, and a whole lot of death. And this ought to tell us that you can’t protect a population during a pandemic if you’re not protecting all of the population during a pandemic. That includes low-wage workers stocking shelves or cleaning bedpans; this includes undocumented immigrants who may have no access to vaccines. The virus doesn’t care what documents you have or how much money you make.

This is just one way our stubborn insistence on for-profit health care got in the way of the pandemic response. See Elizabeth Rosenthal at the New York Times, We Knew the Coronavirus Was Coming, Yet We Failed, May 6, 2020.

… our system failed in its response. Heroic health care providers were left to jury-rig last-minute solutions to ensure that the toll wasn’t even worse.

But the saddest part is that most of the failings and vulnerabilities that the pandemic has revealed were predictable — a direct outgrowth of the kind of market-based system that Americans generally rely on for health care.

Our system requires every player — from insurers to hospitals to the pharmaceutical industry to doctors — be financially self-sustaining, to have a profitable business model. As such it excels at expensive specialty care. But there’s no return on investment in being primed and positioned for the possibility of a once-in-a-lifetime pandemic.

Combine that with an administration unwilling to intervene to force businesses to act en masse to resolve a public health crisis like this, and you get what we got: a messy, uncoordinated under-response, defined by shortages and finger-pointing.

The prevailing faith in the Free Market to provide for all left us vulnerable. Free markets don’t fix infrastructure (see: Texas). Free markets go where the profit is, but not everything people really need can be made profitable.

4 thoughts on “Capitalism Left Us Vulnerable

  1. Similar theme, but more broadly applied to the workforce at large, in an article about economics and politics, in Shifting Balance of Power?

    A massive shift is occurring in the labor market today, one that has been misinterpreted by economists of all stripes: On the right, there is the false meme that lazy workers are staying home because the massive CARES Act. Unemployment bennies are so generous, it’s leisure + easy living. This rehash of Reagan era dog whistle of welfare cheats driving Cadillacs, has been long on random anecdotes, short on supporting data…

    …Over the past decade, this system has being challenged. Companies like McDonald’s and Walmart game the system so they were subsidized by anti-poverty programs. Their employees were so underpaid they still qualified for government assistance. Recall the McResource help line that assisted McEmployees in getting food stamps and other aid. Often, large profitable public companies were the biggest beneficiary of welfare in many states in America. If for no other reason, minimum wages should be raised so that Welfare Queens like McDonalds and Walmart would be forced off their abusive suckling at the public teat…

    ..The recovery from the financial crisis and an adherence to an older cost-cutting approach led to a shortage of qualified staff at many companies. My favorite examples manifest itself in Walmart stores – they looked rundown, and understocked, with empty shelves. “Underinvestment in labor” was part of the reason Wal-Mart’s employee turnover was as high as 70%. Middle class consumers decided to patronize instead the more modern stores where companies paid their employees a decent wage: CostCo, Trader Joe’s, Target, and Starbucks. They all demonstrated you didn’t need to impoverish your staff in order to be profitable.

  2. For now, I'm still in my assisted dyin… living… assisted living facility- and not a nursing home.

    Our staff here is grossly underpaid.  And a lot of them have other jobs – often in hospitals, or nursing homes, or other assisted living places.  I feel for them.  Being an aide is a very hard job.  It's physically and mentally exhausting.  Physically, because you have to help lift residents, or give them baths – and then there are things to carry.  Mentally, because we old folks aren't the charming, bubbky, cute and witty seniors you see on TV sit-coms.  Some of us are mean, and/or nasty.  Some belong in an actual nursing home.  And some belong psychiatric institutions.  Not me, of course.  I'm an angel!

    We were lucky until this January, with no resident getting Covid.  But then, because one of the aides caught Covid and didn't know it, a lot of residents here got it – including my beloved Mother.  She died, as did 7 other residents.  An aide also died – so, 8 people overall.

    I'd been reading about the potential for another Spanish Flu pandemic since I was a kid, so I wasn't surprised by this pandemic.  

    And the US wasn't taken by complete surprise, since we had prepared for another pandemic over the decades. 

    It was tRUMP who was surprised.  "How dare a bug ruin my beautiful presiDUNCEY!!!"

    Never mind how well Obama, Bill, or Hillary, could have handled Covid-19.  Even George W Bush would have done a much better. 

    TRUMP mucked-up pretty much every thing that could get mucked-up.

    "It didn't have to be THIS bad!" Truer words were never spoken.

    PS: I may look for a little apartment for myself later this year- or next year.

  3. So true, the big lie was the Regan lie.  A cold snap in Texas and a virus showed that profit motive has weaknesses.  No, in many areas government is not the problem.  Nor is capitalism the solution or so called privatization.  Just because they have brainwashed near half of the population does not change fiction to truth.  

    So what do they do when those who are "right" are wrong.  Only Alan Greenspan did it with dignity.  We all have at a certain point in our lives a personal reality and a philosophy.   We may not even know the name of a philosopher but we have a philosophy.  (personal communication credit Cam Perry)  Greenspan admitted publicly the same, and in the big financial meltdown of the end of the Bush era admitted his was in error.  No, he said in essence, capitalism cannot regulate itself. We need a power that is not greed motivated that can see the big picture and regulate it properly.  For an old geezer like me to say those words was wisdom we should revere. Greenspan was a hero, but like humans not infallible.



  4. As I see it, there are three types of "corporations" that should exist.

    1) Essential services. These are things like utilities upon which individuals and our civilization depend. These corporate entities may be part of the government or simply non-profits administered by the government. I think hospitals and roads fit in this classification.

    2) Corporations that can easily be predatory. Everything in the energy sector.  Home owner's insurance is a classic example. Corporate organizations of doctors could be predatory. Fine line here. An MD should not become a slave to the state by virtue of his/her profession, nor should a gang of doctors be able to extort using lives and pain as leverage.

    3) Corporations that offer goods and services that aren't essential in a competitive market. Cars, refrigerators, furniture, clothing, travel… Tax on the basis of declared earnings. 

    I would tax churches UNLESS they can prove that 90% of revenues are applied to services for the people. In other words, food, clothing, medical, outreach to prisons, education… 'Money for places of  worship would not qualify as exempt.





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