"(America will need) a new army to hunt down the coronavirus."

This paragraph hints at the fundamental problem.

The erosion of the public-health workforce has taken place even as the U.S. health-industry workforce swells. In addition to medical staff doing heroic work right now, untold numbers of workers spend their days adjudicating zero-sum disputes over medical bills that add complexity and cost without healing anyone. One analysis found 10 administrative workers for every physician.

Why do we tolerate a system that doesn't work for us?

The following appeared on Friday at Bloomberg's Bloomberg Prognosis, a daily coronavirus newsletter.

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Without a trace

As the U.S. begins to consider how to lift measures to slow the spread of Covid-19, it’s going to need a new army to hunt down the coronavirus.

As many as 100,000 contact tracers will be needed to track down people exposed to the virus and prevent them from spreading it, according to a new estimate this week from the Johns Hopkins Center for Health Security.

How big a lift is that? Across the U.S., about 130,000 people work for local health departments full-time, according to the National Association of County and City Health Officials. About 91,000 more work in state health agencies, down 15% in the past decade as a consequence of government belt-tightening.

“Clearly over time that capacity has eroded,” John Wiesman, Washington State Secretary of Health, said on a call with reporters Wednesday.

Public-health departments will have to train thousands of people to do the rigorous work of retracing the steps of coronavirus patients, reaching out to others they may have encountered, and ensuring they can safely isolate to interrupt chains of transmission. Students of medicine and public health may be good candidates, along with retired medical staff or others who simply need jobs – as millions do now.

The erosion of the public-health workforce has taken place even as the U.S. health-industry workforce swells. In addition to medical staff doing heroic work right now, untold numbers of workers spend their days adjudicating zero-sum disputes over medical bills that add complexity and cost without healing anyone. One analysis found 10 administrative workers for every physician.

It’s a cliché to say the U.S. doesn’t have a health-care system, it has a sick-care system. Covid-19 has exposed some of the risks of skimping on prevention and public health, even as we spare few expenses on costly treatments. The core operations of local health departments can keep cases from becoming clusters, and keep clusters from exploding into uncontrolled spread.

In one sense, they constitute the country’s immune system. That was weakened when coronavirus arrived in the U.S. As the virus runs its course, can the system’s strength be renewed?—John Tozzi

Moore's "Sicko" another must-watch. Be prepared to examine your premises.

(Gone bikin': I'm taking a personal day with full pay --that's $0.00 -- on Sunday. See you Monday morning. Keep those lovely cards and letters coming.)

The last time I attended a public screening of a Michael Moore movie, it was in 2004 for Fahrenheit 9-11. The crowd was feisty, the derision palpable, and undisguised contempt for George W. Bush heavy in the air-conditioned confines of the theater.

I loved it.

Tonight we viewed Sicko, Moore’s latest polemic, and although the demographic in attendance was much the same as for documentary filmmaker’s previous effort, the atmosphere was quite different. Ostensibly, Sicko makes the case for publicly funded, universal health care, citing models in Canada, Great Britain, France and Cuba as examples. The crowd expressed indignation when challenged and laughed when prompted -- like Moore's other films, there are ample moments of mirth -- but the overall reaction was muted and somewhat somber, perhaps because the root questions inevitably run deeper than the film's broad topic.

Is the profit motive compatible with considerations of health – of life and death? Why do we permit health care to be controlled by for-profit insurance companies and pharmaceuticals manufacturers? How is this “better” than control by much loathed government bureaucrats? Moreover, what does it say about Americans as a people when so many are uninsured or underinsured, and even those who are fully insured are subject to degradation and humiliation at the whim of corporate shareholders who reward their own bureaucrats to enhance return by withholding care?

Wikipedia offers a balanced overview of the film’s themes and includes links to opinions on all sides of the critical spectrum, and you may consult it for a more expansive look at the film.

But when you watch the movie, pay close attention to the testimony submitted to Moore by Tony Benn, the legendary left-wing British Labour politician, and later, to comments made by one of the American expatriates in France. Benn muses that historically oppressed Americans are too frightened, ignorant and demoralized to vote, when voting (“the ballet”) is in the end more powerful than money (“the wallet”).

Conversely, the American expatriate suggests that life is good in France precisely because of fear, in this case the government’s healthy fear of the French people, who’ve not forgotten what it means to take to the streets to seek redress for slights. Of course, Moore’s film was completed before the recent French presidential election and the victory of conservative Nicolas Sarkozy, who vows that there’ll be less fun and more work, although it is likely that Benn is correct when he predicts revolution as the likely outcome of any attempt to do away with current European health care systems.

Can it really be that Americans, seemingly the world’s most macho patriots, are too afraid to demand necessary fixes? Too depressed and demoralized? It’s not something that we’re accustomed to discussing or admitting, and in broaching this topic, I find Moore at his most controversial in Sicko – even more so than in staging the “9-11 workers go to Cuba” stunt that so far has attracted the most media attention.

Perhaps there is another explanation for why the United States is the way it is when it comes to health care, insurance and related issues. In a brief examination of the failed health care program early in the first Clinton administration, the list of contributors to lobbying efforts against Hillary’s reform brief scrolls past, and while it is no surprise to see the names of insurance and pharmaceutical giants, sizeable monies donated by the Christian Coalition surely elicits a double take.

Have I missed something? Is there something about being Christian that argues against a concept like universal, publicly funded health care, and in favor of the contemporary approach? If so, then why do I dread that the answer is almost certain to have far more to do with capitalism than with Christianity?

In essence, are we the only western democracy without some form of national health insurance because too many of us continue to embrace the superstition of “God’s will” as applied to ultimate fate, and to a sort of “the ill must be guilty of something” Calvinism? The people from Canada, the UK and France interviewed by Moore appear to a diverse lot, all of whom seem to share an attitude of secular commitment on the part of haves to help have-nots, sans religious sanction, which a French doctor summarizes as (gasp) “from each according to his means, to each according to his needs.”

Yes, I understand fully that a mere two hours of agitprop isn’t enough to explicate the many sides of the story. I know it isn’t that simple.

So, why am I feeling sick?