Has the Trump administration responded well to COVID-19?

Encyclopedia of Opinion

Question: Has the Trump administration responded well to COVID-19?
Position‹3 of 3: The flawed US health and social system is to blame for bad preparation for COVID-19
Argument‹4 of 4: The health system is hospital focused

The argument

Health care in the United States is the world’s most expensive, yet America’s health outcomes are poor with the highest rate of deaths amenable to health care per 100,000 population of 19 countries studied, with a rate not quite twice that of France, even though France spends roughly half of what the US does on health care. Unlike Britain and many Commonwealth countries, there has never been a focus on primary care and there is a major gap between the number of primary care providers and the number that would be needed to deliver primary care to the full population. The World Health Organization’s recommendation for pandemic response is based upon a strong public health and primary care response. Delaying disease spread is the only way a country’s health system won’t be overwhelmed. Americans with insurance are used to a high-tech health care response rather than a public health measure like washing hands. This meant that the Washington State long term care facility where the first cluster of cases occurred, responded by admitting the people to hospital which ensured the virus was spread amongst sick and vulnerable people as quickly as possible.

Premises

[P1]The US health system focuses on expensive hospital care rather than primary and public health, lacking enough primary-care providers. [P2] The WHO's pandemic response relies on strong public health and primary care to delay spread and avoid overwhelming hospitals. [P3] Lacking this, the first US cluster was sent to hospital, spreading the virus among the sick and vulnerable. [C] Therefore, because the health system is hospital-focused, the flawed US system is to blame for poor COVID-19 preparation.

Counter-arguments

America has some of the best hospitals in the world and is rightly proud of them

Rejecting the premises

[Rejecting P1] The comparison is doing less work than it appears. 'Deaths amenable to health care' is a constructed measure sensitive to which causes are counted and to differences in coding, obesity, firearm mortality and road deaths — none of which are attributable to the balance between primary and hospital care. High spending with poor aggregate outcomes is also consistent with explanations the premise does not consider, including administrative cost and unequal access. [Rejecting P2] The WHO guidance concerns detection, contact tracing, isolation and communication, which are functions of public health agencies rather than of primary care physicians. Countries with strong primary care and no pandemic capacity fared badly, and some with weak primary care but effective testing and tracing fared well — so the premise identifies the wrong variable. [Rejecting P3] The Washington case does not show what is claimed. Transferring severely ill residents of a long-term care facility to hospital is the clinically indicated response, and the outbreak had already spread within the facility before any transfer; the failure there concerned infection control, staff moving between sites and the absence of testing, not an excess of hospital orientation. [Rejecting C] The argument also does not answer the question asked. Structural features decades in the making are common to every recent administration, so they cannot by themselves establish that the system rather than the response is to blame — which is what the rival positions dispute. (The counter on record does not engage the argument at all and is a candidate for replacement.)

The argument

Premises

Counter-arguments

Rejecting the premises

Further reading