The COVID-19 Pandemic and Ethical Challenges Posed by Neoliberal Healthcare

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School of Medicine, University of California, San Francisco, San Francisco, CA, USA; 2California Institute of Integral Studies, San Francisco, CA, USA; Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA; 4Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.

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J Gen Intern Med DOI: 10.1007/s11606-020-06316-w © Society of General Internal Medicine 2020

continues to ravage the world, the pandemA sicCOVID-19 has revealed the stark inadequacies of the United States’ beleaguered social safety net and health care system, which have predisposed us to a poor emergency response. In addition to the 27.9 million uninsured Americans prior to the pandemic, the economic spillover added 36 million and counting newly unemployed Americans.1 COVID-19 has revealed and exacerbated inequalities in US health outcomes and healthcare access which are characteristic of a neoliberal system. Neoliberalism holds that laissez-faire economics result in an optimally organized social system. However, we argue that neoliberal healthcare is fundamentally unethical as healthcare is a human right and not a commodity. Though much thought and research has examined the ways in which the failures of our healthcare system are unethical, the role of neoliberalism has been rarely acknowledged. This gap in scrutiny is worth addressing, as neoliberal economic forces influence if not dictate many dangerous inadequacies with US healthcare, especially in this time of COVID-19. The term “neoliberalism” refers to a political and economic philosophy of unbridled capitalism popularized in the 1970s and 1980s that favors corporate deregulation, privatization, and austerity (i.e., reducing government spending for social services), and is the dominant economic system in the USA.2 In the context of US healthcare, neoliberal policies promote corporate profit through the privatization of systems of healthcare delivery and payment models which transformed a social service into a business. The interests of the private sector (e.g., profit) are prioritized, while the interests of the public (e.g., healthcare and health), whose labor enables that profit, remain secondary.

Received August 11, 2020 Revised September 4, 2020 Accepted October 12, 2020

As evidenced by the rapid and effective COVID-19 response seen in countries with socialized healthcare delivery systems such as New Zealand, we can better meet the needs of our patients and improve public health by decoupling our care models from corporate interests. The magnitude of social disruption due to the pandemic offers a rare opportunity to reflect on the ubiquity of neoliberalism, and proactively design a more ethical system. Despite the labor of health workers trying to meet their patients’ needs during these unprecedented times, our system is flailing. The neoliberal trade-off of capital for corporations and austerity for the working poor is unethical and ill-suited to the achievement of