Stopping COVID-19: Healthcare Reform, Incident Command, & the False Promise of Libertarianism

2020.08.23.v2 ICS org PPT slide

This post will argue that healthcare reform would be sufficient, but not necessary, to stop COVID-19. Even without total system reform, just activating the Incident Command System could stop COVID-19. But this post will claim that COVID-19 in the U.S. is a reflection of, and metaphor for, a societal “infection” with libertarian hyper-individualism. Healthcare reform alone would not cure that.

Healthcare Reform and COVID-19

This blog has envisioned that healthcare reform would entail the following elements:

  • Increasing the federal share of healthcare finance enough to give the federal government leverage over the entire healthcare sector.
  • Deployment of that market power to bust anti-competitive pricing, thus constraining rampant cost increases
  • Use of hard (regulatory) and soft (incentive-based) measures to root out waste, to set uniform standards for efficient operations, and to reprioritize goals (public health).

It is the third point that would be render reform sufficient to stop COVID-19. The COVID-19 pandemic has laid bare the excessive commodification of healthcare in the U.S. currently.  In facing high demand for their services to fight the virus, the healthcare industry should have reaped a bonanza. Instead, many hospitals actually lost money or went bankrupt. This happened because our commercialized healthcare enterprises consider public health and emergency preparedness to be “externalities” that give no return-on-investment. Disaster planning was largely brushed aside, leaving systems unable to withstand the virus. Healthcare reform would fix that.

In a reformed healthcare system, hospitals would be paid to support public health infrastructure, emergency preparedness, and surge capacity. They would have uniform standards for interoperable information systems, disaster planning, and coordination.

This kind of integration and public health orientation would be effective to stop COVID-19.

Stopping COVID-19 without Healthcare Reform: Incident Command System

Healthcare reform would indeed prepare us better to handle pandemics, and that is a good argument in favor of reform. On the other hand, reform skeptics will counter-argue that, while sufficient, complete healthcare reform is not necessary.

The skeptics are correct. The pandemic could be stopped, even without full-blown reform, by simply activating the existing emergency response system. This is called the Incident Command System.

The Incident Command System (ICS) was created in the 1970s after a series of catastrophic wildfires in California. ICS is supported within the federal government by the Federal Emergency Management Agency (FEMA), but it is designed as a partnership among jurisdictions at all levels, non-governmental agencies like the Red Cross, and the private sector. Every professional emergency responder as well as volunteers (like myself) are trained to follow ICS. Organizations adhere to its structure, and by doing so can qualify for federal grants.

ICS is now successfully used for natural disasters, mass casualties, environmental incidents, as well as public health emergencies. ICS can also be used for large-scale planned events like the Olympics.

Key characteristics of ICS are unified chain of command, modular organization structure, and comprehensive resource management. 

Unified chain of command means that every individual has one, and only one, supervisor.  Each supervisor is limited to a span of control of no more than five subordinates. The buck stops with the top Incident Commander.

Modular structure means that the emergency response can expand and contract according to the size and complexity of the incident.  Small incidents might require only one commander and a few subordinates, say, to rescue an accident victim. As incident complexity increases, the incident organization expands from the top down by delegating functional responsibilities to sub-modules.

Large incidents are handled by a set of defined teams.  These are:  Operations, Planning, Logistics, and Finance/Administration. The Planning function often includes an Intelligence Officer responsible for investigating the incident. Each team is led by an Officer who reports directly to the Incident Commander. The Commander’s staff can also include a Public Information Officer, Liaison Officer (to coordinate with others affected by the incident), and Safety Officer.

Comprehensive Resource Management describes standard procedures to handle personnel, teams, facilities, equipment and supplies. This is the responsibility of the Logistics Officer. The Logistics Officer identifies resource requirements, then orders and acquires resources, mobilizes, tracks and reports, demobilizes, and reimburses and restocks them. At the highest federal level, the Defense Production Act and the military’s Defense Logistics Agency can be activated when necessary.

From this description, one can understand how the Incident Command System, with its military-like structure and operation, could control a pandemic. It also highlights the regrettable failure of the President’s administration fully to activate the Incident Command System, especially to organize testing and to procure personal protective equipment and ventilators. The White House Coronavirus Task Force could have followed the ICS manual to tackle the public health crisis, but instead seemed to engage primarily in tackling public relations for the President.

Stopping COVID-19 Is Not Enough – Stop Libertarianism, Too

We conclude in this post that COVID-19 could be stopped either by comprehensive healthcare reform or by full activation of the Incident Command System.

But now many are asking, Is just stopping this virus enough?  Social commentators like Ed Yong in The Atlantic, are saying no, and are asking a bigger question:  How did it come to this?

As Yong put it:

Water running along a pavement will readily seep into every crack; so, too, did the unchecked coronavirus seep into every fault line in the modern world.

Those fault lines include:

  • COVID-19 is disproportionately causing infection and deaths among Black, Latino and indigenous persons.
  • These disparities are largely explained by social and economic determinants: crowded living, occupational exposures, lack of access to healthcare. A Federal Reserve Board survey in April drove home this point. It showed that 57 percent of college-educated workers could work remotely compared with only 27 percent without a degree, thus leaving them unable to protect themselves with social distancing.
  • COVID-19 is also having a disproportionate impact economically on working class and minorities. Opportunity Insights project reports that while employment rates have rebounded to pre-COVID-19 levels for high-wage workers, they remain significantly lower for low-wage workers – still 20 percent unemployment for workers earning less than $14 an hour. This is being described as a K-shaped economic recovery, bifurcated between the rich and poor.
  • Many of the newly unemployed are losing employment-based health insurance.
  • A Census Bureau survey in July showed that almost half of Black and Hispanic renters reported low confidence for paying their August rents, while homeowners have seen their real estate values rise.
  • The tattered American social safety net is not adequately responding to the needs of the moment:  unemployment payments, medical leave, child care, as well as health insurance.
  • All of these factors shine the light on political, social, educational, and economic discrimination, namely on structural racism that has gone ignored and largely unaddressed for decades.
  • Leadership is incompetent, disorganized, sabotaged, or untrusted.
  • COVID-19 has broken out in vulnerable nursing homes, packing plants, and prisons, and now increasingly in schools and colleges
  • Even some affluent parents are unable to return to work, either remotely or in-person, because schools and daycare are closed.

In summary, the libertarian hyper-individualistic ideology underlying America’s laissez-faire pandemic response is roundly debunked by this coronavirus. The virus exposes libertarianism’s flawed theoretical foundation. It calls attention to libertarianism’s misunderstanding of American history. And most strikingly it has proven libertarian government to be unworkable for stopping this pandemic.

Today’s libertarians base their “limited government” philosophy on a concept of humanity that the virus shows to be incomplete. They see human individuals to be like dust particles bouncing freely with no social limits. But the virus now demonstrates this idea to be false: We are social creatures. The isolation wrought by the pandemic has awakened us to our profound need for relationships. Within those relationships we thrive most in interconnected communities whose institutions mold us and give structure to our lives. How interconnected are we?  Let the virus count the ways! Technology is now expanding those interconnections even more widely to cover the whole planet through trade, communication, and culture, and is ushering in a still-evolving era of virtual meta-social life.

The central question posed by political philosophy was up to now framed simply as the relation between individuals and their societies. Now that question has morphed into the more complex question about relations among individuals, multi-layered institutions, and complex global structures.

The libertarian stock slogan of “less government and more liberty” is no longer an adequate answer for human thriving in the 21st century.

Today’s libertarians also have a false understanding of the founding of our nation. The libertarian 1777 Articles of Confederation failed because they gave Americans too much freedom and not enough government.  The replacement 1789 Constitution strengthened government, and it limited the freedoms of citizens in the governing majority by affording rights to the governed minority. That U.S. Constitution has been among the most successful in history, and has withstood even a Civil War.

Today’s libertarians quote John Locke and Adam Smith, but fail to appreciate that these Enlightenment philosophers subscribed to the social contract between the individual and the state. Citizens all contribute to the state, and they all stake a claim to its benefits in return. These theorists also understood that political freedom and market freedom should serve the common good, not merely serve as a rationalization for selfish enrichment or racial injustice. And they understood that freedoms existed within an invisible social milieu.

Thus, healthcare reform does not go far enough if it only provides universal access. Likewise, this post claims further that reform is not enough, even if it also allows Americans to fix U.S. healthcare by acting through government to constrain costs, to eliminate non-costworthy care, and to promote public health, as advocated by this blog.

The COVID-19 pandemic shows us that our health and our health system is inextricably linked to our economy, our society, and our world. Healthcare will truly be reformed only if it is part of a larger movement to fulfill the American aspiration for life, liberty, and pursuit of happiness in a more perfect union and a more peaceful, verdant world.

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Image Credit

By: Federal Emergency Management Agency


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