2020 San Pedro California April 30: Federal Correctional Institution Terminal Island prison. Half the inmates there were infected with coronavirus.

Carceral Health Care Is Designed to Fail

By Andrea C. Armstrong

COVID-19 is not the first pandemic within prisons. Modern history is littered with examples of disease outbreaks in carceral spaces, including tuberculosis, influenza, and MRSA. Like these earlier carceral pandemics, the over 620,000 COVID-19 infections and 3,100 related deaths among incarcerated individuals to date simply expose how U.S. health law and policy fails to protect people in custody.

Only incarcerated people have a constitutional right to healthcare in the United States. That right, however, is rendered toothless when supplied through a punitive system that lacks meaningful standards and robust oversight.

Here is what we know — despite the secrecy that shields penal institutions — about carceral health care.

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Bill of Health - A worker gives directions as motorists wait in lines to get the coronavirus (COVID-19) vaccine in a parking lot at Dodger Stadium, Friday, Jan. 15, 2021, in Los Angeles, covid vaccine distribution

Countercyclical Aid Is Not Enough to Fix the Broken US Approach to Public Health Financing

By Philip Rocco

In the last month, the U.S. Centers for Disease Control and Prevention’s failed responses to COVID-19, ranging from “testing to data to communications,” have prompted a call to reorganize the agency.

Yet restructuring the CDC will have little effect on pandemic preparedness if the decentralized American approach to health finance remains in place. This structure was already stripped bare by decades of state and local austerity even before the first cases of COVID-19 were identified, and has been further worn down since 2020.

If the pandemic has taught us anything about public policy, it is that the model of countercyclical federal aid — which expands at the onset of an economic crisis but abates as that crisis is resolved — is fundamentally inadequate when applied to the realm of public health.

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The White House, Washington, DC.

The Years of Magical Thinking: Pandemic Necrosecurity Under Trump and Biden

By Martha Lincoln

From spring 2020 through the present day, Americans have endured levels of sickness and death that are outliers among not only wealthy democracies, but around the world. No other country has recorded as many total COVID-19 casualties as the United States — indeed, no other country comes close.

This situation is not happenstance. From early moments in 2020, the concept of a right to health — and indeed, even a right to life — has been discounted in American policy, discourse, and practice. Quite mainstream and influential individuals and institutions — physicians, economists, and think tanks — have urged leaders to shed public health protections — particularly masking — and “move away” from the pandemic. Over the past two years in the United States, leaders in both political parties have capitulated to — if not embraced — the doxa that a certain amount of death and suffering is inevitable in our efforts to overcome (or “live with”) the pandemic. In a piece written during the first months of COVID under Trump, I called this dangerous yet influential outlook necrosecurity: “the cultural idea that mass death among less grievable subjects plays an essential role in maintaining social welfare and public order.”

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Washington DC 09 20 2021. More than 600,000 white flags honor lives lost to COVID, on the National Mall. The art installation " In America: Remember" was created by Suzanne Brennan Firstenberg.

Introduction to the Symposium: Health Law and Policy in an Era of Mass Suffering

By Chloe Reichel and Benjamin A. Barsky

Last spring, the United States crossed the bleak and preventable 1,000,000-death mark for lives lost during the COVID-19 pandemic. In this symposium, our hope is to acknowledge — and mourn — this current era of mass suffering and death.

In particular, we want to reckon with the role of health law and policy in shaping, and at times catalyzing, the impact that the pandemic has had on our loved ones and communities.

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Motherboard, Reverse Detail: This is a green motherboard, photographed with red-gelled flashes.

The Future of Race-Based Clinical Algorithms

By Jenna Becker

Race-based clinical algorithms are widely used. Yet many race-based adjustments lack evidence and worsen racism in health care. 

Prominent politicians have called for research into the use of race-based algorithms in clinical care as part of a larger effort to understand the public health impacts of structural racism. Physicians and researchers have called for an urgent reconsideration of the use of race in these algorithms. 

Efforts to remove race-based algorithms from practice have thus far been piecemeal. Medical associations, health systems, and policymakers must work in tandem to rapidly identify and remove racist algorithms from clinical practice.

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a crowd of people shuffling through a sidewalk

The SSTAR Initiative: A Policy Proposal for a Full, Equitable Recovery from COVID-19

By Sara E. Abiola and Zohn Rosen

Full recovery from the COVID-19 pandemic in the U.S. will require new policy that promotes equity and streamlines access to social services while supporting small businesses

Unprecedented job loss due to COVID-19 has led to an economic crisis for families of all backgrounds and income levels.

Current health and social services programs are ill-equipped to handle this need. Moreover, long-standing racial health inequities and the stigma associated with using social services will persist in the absence of significant systems-level change.

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A male pharmacist is examining a drug from a pharmacy inventory.

How Policies Enacted During COVID-19 Might Reduce Future Drug Spending

By Beatrice Brown

The COVID-19 pandemic has prompted several states to take steps to temporarily authorize therapeutic substitution of drugs experiencing sudden shortages, whether due to spikes in demand or supply chain disruptions.

Although these instances of replacing patients’ typical prescription drugs with different drugs intended to have the same therapeutic effects have been prompted by necessity, therapeutic substitution more generally might reduce drug spending in the United States.

In a recent piece in the BMJ, Jonathan Darrow, Jessica Chong, and Aaron Kesselheim explore using state laws to expand the authority of pharmacists to substitute clinically similar alternatives in order to help cut spending. Actions taken by states to temporarily allow therapeutic substitution can help them gain experience with this strategy and potentially lead to broader and more permanent drug substitution policies that could help decrease drug spending.

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WASHINGTON MAY 21: Pro-choice activists rally to stop states’ abortion bans in front of the Supreme Court in Washington, DC on May 21, 2019.

The Harms of Abortion Restrictions During the COVID-19 Pandemic

By Beatrice Brown

Several states, including Texas, Ohio, and Alabama, have dangerously and incorrectly deemed abortions a non-essential or elective procedure during the COVID-19 pandemic. The stated reason for these orders is to conserve personal protective equipment (PPE), a scarce, important resource for protecting health care workers treating COVID-19 patients.

However, these policies restricting abortion are unlikely to conserve PPE, and more importantly, they mischaracterize the nature and importance of abortions.

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