The value of life. The agony of health systems in times of crisis.

Today uncertainty seizes each of the inhabitants of the globe. A silent but deadly enemy has broken the daily routine of life in society. Forcing us to seclude ourselves in the "safety" of our homes, without an exact date that will put an end to this apocalyptic dystopia. SARS-CoV-2, originating in the province of Wuhan, China, has already crossed any border between countries. It has not distinguished social strata, gender or age. It has been inserted into the depths of bodies and minds and has called into question the prompt action of governments worldwide.

Despite the fact that the mortality rate of the virus is relatively low compared to other existing diseases, to date it has claimed more than 50,000 lives worldwide. What really worries health authorities is its ability to spread, which is known to be three times greater than that of the common flu. Measures such as social isolation and intensive hand washing are practices that governments recommend to stop the spread of the virus.

The Coronavirus, as it is colloquially known, not only demonstrated the fragility of human beings in the face of a pandemic, but also the existing deficiencies in health systems. Just four months after the first registered case, the capacity of the health system in countries like Spain, the United States and Italy, to name a few, has collapsed. Today, with more than a million infected worldwide, various experts reconsider the credibility of a universal health system for their respective countries.

It's panic. The decline of the Italian healthcare system.

The virus broke into the daily life of Italians at the end of January. Weeks later, various international media replicated over and over again what for many represented an imminent danger to the rest of Europe. The regions of Lombardy and Emilia Romagna were facing an emergency situation. The virus had withdrawn, and what seemed to be a local problem for China had quickly become the start of a bloody battle for all of Italy. Prevention and confinement measures were slow in coming. The number of infections was growing exponentially daily, as was the number of deaths. Eight days after the first cases of COVID-19 in the country were confirmed, the number of infected in northern Italy rose from 20 to 1,128.

As expected, the public health system began to hang by a thread. Day by day the number of infected people increased and, with this, the number of people who needed immediate medical attention. The days for health personnel began to be exhaustive. The supplies began to be scarce and Italy exceeded the total number of deaths every day. Soon, the epicenter of the pandemic ceased to be that Chinese region and was transported deep into the lungs of the Tiber country.

The collapse of the health system in Italy surprised many. According to the Bloomberg report, the Mediterranean country is ranked fourth in the world in terms of sanitary efficiency. However, the real problem lay in the overload to which it was subjected. Intensive care units exceeded their capacity for timely reaction, so much so that there was already talk of the possibility of choosing between patients who could be cured and those who could not. Like any problem, there is an answer that explains what happened.

Since the end of 2010 the Public Health System in Italy suffered a cut of approximately 37 billion euros. This was reflected in the decrease in Intensive Care Units (ICU) as well as the number of general practitioners throughout the country. The cut also affected emergency departments, which were reduced by 14% from the aforementioned date. Ambulances and medical equipment suffered a worse setback, type A were reduced by 4%, while type B did so by just over 50%. In total figures, in seven years there was a reduction of 32,777 beds in the public sector. By comparison, the private sector suffered a cut of just 4,335 beds during the same period.

"We don't have free beds in intensive care units" Lorenzo Casani, Time.

Old age has been one of the fundamental factors for the death toll in Italy to rise abruptly. The country concentrates the second oldest population in the world, only surpassed by Japan. To this must be added another fundamental factor that has prevented the decrease in the number of deaths: poverty. Despite being the number 10 economy worldwide, 6% of Italians live in conditions of extreme poverty, to this we must add that about 32% of immigrants settled in the country live under the same conditions.

The coronavirus does not distinguish between social strata, access to health and basic medical care, yes. For an average citizen, the cost of medical attention is around 1,900 euros, taking into account that there is a basic monthly income. For older people and immigrants this "right" is practically non-existent. The control of bodies, in the purest style of Foucault, does not cease to be present even in times of crisis.

The sunset of the generation of pain.

In Spain mourning increases day by day. The generation of pain, the one born in the middle of a war, loses the fight against an invisible enemy and part of this world in the middle of a pandemic. Some 600,000 health professionals fight daily against a virus that seems not to give up. This war has already claimed the lives of more than 9,000 people and has occupied the bodies of just over 100,000 in the Iberian country.

The figures are staggering, the lack of tests has left a large number of deaths out of the count, and public hospitals are overwhelmed with capacity. The Spanish Health System ranks third in efficiency worldwide, only surpassed by Hong Kong and Singapore. Despite this, frontline healthcare workers are forced to improvise protective gowns from surgical sheets or reuse masks that were originally disposable.

To be honest, no country in the world was prepared to face a pandemic of this magnitude. However, some experts associate this crisis with the health cuts made in recent years. According to data from the OECD, Spain is the fourth country that has cut the most in its health system since 2009. This has caused a great impact that, to this day, is more clearly visualized.

In capitalism profit is a constant. Health is paramount, large companies know it and for this reason they have placed an intrinsic value on it. In Madrid, for example, public hospitals have been sold to multinationals. These impose their conditions and distinguish between those who can or cannot pay. Today, the private sector is in control of Madrid's healthcare, while thousands struggle to access basic healthcare.

"It's a crisis!" the local news broadcasts day and night. People are confined because they are afraid. Not from the virus, some say, but from the indebtedness that getting sick from it would mean. Since the start of the epidemic, 900,000 jobs have been lost and a few thousand more are hanging by a thread. Confinement turns out to be an unlikely option for those who lack sufficient resources. Getting sick from the new virus is a luxury in a Spain that is going through dark days.

Medicare for all (a few). The US hospital crisis

In recent weeks, American morale has fallen completely. This is supported solely by the thousands of workers in the health sector who fight an unstoppable enemy every day. To this day, the United States has become the epicenter of the pandemic, and what was thought to be impossible has happened. The North American country already concentrates almost 1/4 of the total number of infected worldwide. To date, more than 300,000 people have contracted the virus and approximately 9,550 have lost their lives due to it. Despite the tragedy, the political elite is absent. The highly acclaimed re-election of Donald Trump hangs by a thread and every day it is more noticeable that the hospital crisis in the United States is an uncomfortable and painful truth.

While it is true that the current situation has revealed various problems in health systems around the world, what has happened in the United States is not something new. For years, many experts have exposed the need for a universal health system to which all citizens have access. The consensus for the creation of a concrete health policy does not arrive. Opponents proclaim the unsustainability of the model, while thousands of Americans find themselves helpless.

The curious thing about all this is that, globally, the United States is the country that invests the most in health. It allocates about 17% of its GDP to this item, much more than Sweden, Switzerland and France. However, the State only contributes 48% of all that is invested in health, thus positioning the North American country in position 117 worldwide. As a consequence, health is an enormous luxury in a country where just over 30 million poor people live.

The key point of this problem is that health services are largely provided by the private sector. Commercial insurers play an important role in financing health care and very few citizens have efficient health insurance. Per capita health spending in the United States exceeds $9,000 per year. For many citizens, going to a specialized consultation or treating a degenerative disease entails an unsustainable debt.

"44% of workers in the US (more than 53 million) receive low wages, an average of just under $18,000 a year, which is not enough to provide economic security." Brookings Institution.

Job insecurity has been a constant during the current administration. The vast majority of workers do not have "sick leave", that is, if they get sick and are absent from their job, they do not receive any salary or sickness benefits. These conditions have caused a large number of carriers of COVID-19 to continue working, while the contagion curve increases exponentially.

Few have been public policies implemented to combat this problem. The most renowned is undoubtedly the Affordable Care Act, or Obamacare, as it is colloquially known. Its application marked a milestone for various sectors of the population to access health services; however, despite its wide promotion, it was not enough to counteract the structural problems of the US health system. Obamacare only contemplated that citizens could access financial coverage via health insurance provided, mostly, by a private company. With the only difference of reducing costs in access to this service. In simpler terms, citizens continued to pay for a right that would be supposed to be fundamental.

Currently, about 30% of US citizens do not have access to health services and another 27 million have insufficient coverage. The figures seem alarming, and in reality they are, however, these figures do not show the reality that millions of undocumented immigrants living in the country live. For them, the possibility of dealing with a health emergency, such as the one currently being experienced, is practically impossible.

Two things characterize Donald Trump; disbelief and the fervent desire to demonstrate to the world the warlike strength of the United States. This was to such an extent that, during his administration, the Federal Programs for Infectious Emergencies were cut by 20%, the pandemic unit within the National Security Council was eliminated and more funds were invested in the army. Today, that the virus has gained strength, the US president resorts to the old rhetoric of deception. He is lying when he says he is concerned about the situation of the 30% of citizens who do not have access to healthcare. He claims that he will expand Medicare to citizens without health insurance. A hardly credible proposal for an individual who has exposed his desire to eliminate Obamacare to the maximum, regardless of the effects that this entails for his population. Political strategy to secure re-election?

Medical care is a "universal right", it should be prioritized above the interests of large private companies. However, as I have already remarked, in capitalism profit predominates before well-being. The creation of a universal health system would mean the death of the big insurers. It would imply millions in losses for the big pharmaceutical companies and it would get in the way of a business chain where big politicians participate. Despite the difficulties and obstacles that this entails, there are those who continue to defend this possibility at all costs.

Bernie Sanders, an electoral contender for the Presidency, has advocated throughout his campaign for the creation of a free health system for all. Under the slogan of "Medicare for all", Sanders opened the possibility of imagining a fairer society where the rights of each individual prevail over money. A society where medical attention is not denied just because it does not have the means to finance it. Such an idea of solidarity each time remains framed only in a kind of utopia difficult to put into practice.

The electoral elections are just around the corner. Sanders loses more and more the opportunity to contend for the Presidency of the country, with him, the possibility of carrying out the socialist imaginary in the United States is also lost. It may be Biden or again Trump who will manage the country for the next four years, however, in times of crisis, the American citizenry should reconsider again whether the established system is enough. However, in the face of one of the worst health crises in the country, little is thought about the political future. After the storm. The future of the post-crisis world reconfiguration.

Many theorists speculate about how the post-crisis world will be reconfigured. Some assume that the pandemic will mark the end of the prevailing economic system, others, on the contrary, affirm that it will be strengthened. Being honest the chances of the latter turn out to be higher. In the words of Franco "Bifo" Berardi:

“The new coronavirus has already affected the global economy, but it will not stop the circulation and accumulation of capital. In any case, a more dangerous form of capitalism will soon be born, which will have greater control and greater purification of populations. Chronicle of psychodeflation, March 19, 2020

The adaptability of big capital in the face of crises is immense. Today, no matter how much there is speculation and advocacy for the creation of a new economic model of solidarity, the conditions for this to happen are non-existent. Every individual around the globe is immersed in this system. Millions of jobs, services and others are associated with the functioning of capitalism. As Berardi points out, it is possible that after this crisis a hyper-capitalism dependent on the State will develop. Political discourses will advocate segregation and confinement as permanent protection measures. The number of unemployed will continue to grow and the fear of new pandemics will keep us in a constant state of alarm. If there is a change, we may not want to know about it.

Today it is difficult to think about when and how the pandemic will end. The stress and fear generated by visualizing future repercussions is immense, however, if there is one thing we can be sure of, it is that everything, absolutely everything, has an end. According to WHO data, between 70% and 80% of the world's population will contract the virus at some point of the year, there will be more outbreaks in various seasons and, later, when the virus cannot spread further, it will be immersed in everyday life Life, for many, will return to normal. For those who have lost a loved one to the virus, it will be marked forever.

If there is something positive that can be rescued from all this, it is the possibility that the world society becomes more supportive. That he rethink his privileges, his needs, his shortcomings and begin to practice a system of greater equity. That forms responsible consumption chains and that advocates the distribution of wealth among each individual. Only in this way, when society has understood the fundamental concept of solidarity, will it be possible to give way to the creation of new inclusive and sustainable economic systems.

While this happens, or not, it remains to keep hope active. Continue with our social responsibility by not leaving home and value the constant struggle that medical personnel carry out on a daily basis. In the same way, think of those who cannot stay in their homes as a consequence of our structural conditions of life and continue working so that they are eradicated.