elanah uretsky Neoliberalism Pandemic

The U.S. Was Not Prepared for a Pandemic – Free Market Capitalism and Government Deregulation May Be to Blame

Public health cuts left the U.S with a skeletal workforce to manage the pandemic. Because of this, responsibility fell to individuals.

Elanah Uretsky / The Conversation

By Viacheslav Lopatin on Shutterstock

It’s unclear when the pandemic will come to an end. What may be an even more important question is whether the U.S. will be prepared for the next one. The past year and a half suggests that the answer may be no.

As a medical anthropologist who has spent the past 20 years studying how the Chinese government reacts to infectious disease, my research can provide insight into how countries, including the U.S., can better prepare for disease outbreaks.

Researchers agree that a good response starts with a strong public health system. But this is something that has been sidelined by the United States’ neoliberal system, which places more value on free markets and deregulation than public welfare.

Neoliberalism promotes a free market accessible to the wealthy few, making essential services less free for everyone else.

As US neoliberalism evolved, public health devolved

Neoliberal economic policies became popular in the 1980s during the Reagan and Thatcher eras. This new approach aimed to make government leaner and more efficient through measures like market deregulation, privatization and reduction of government provision of public services like health and education – resources that do not necessarily lend themselves to market production.

While neoliberal governments still work to promote the health, welfare and security of their citizens, they place the responsibility of providing those services in the hands of private entities like health insurance companies and nongovernmental organizations. This gives the government space to focus on economic performance.

But placing responsibility for a public good into the hands of a private corporation turns that good into a commodity that people need to buy, rather than a service publicly available to all.

Spending on health care in the U.S., including on hospitals, medications and private insurance, has more than tripled in the past 60 years. But the public health system that helps the nation prepare for the unexpected has been neglected. 

U.S. spending on the local health departments that help to avert epidemic outbreaks and protect the health of populations fell by 18% between 2010 and 2021. Two and a half cents of every medical dollar goes toward public health, a figure that has fallen from 1930 levels of 3.3 cents of every dollar. This has allowed the U.S. to manage health risks like chronic diseases that threaten individual’s health. But it leaves the nation inadequately prepared for population-level major health threats that have a much bigger effect on the economy and society.

Public health cuts left the U.S with a skeletal workforce to manage the pandemic. Because of this, responsibility fell to individuals. For example, without mandatory workplace COVID-19 safety guidelines, essential workers faced daily exposure to the coronavirus with insufficient to no protective gear and sanitizing supplies. They had to protect both their own health and the health of their families when they returned home, a difficult task without proper resources and support.

And this was not unique to the U.S. There were similar COVID-19 outcomes in other neoliberal countries like the U.K. and India that had shifted priorities away from public health.

How Asian nations learned their lessons

The story was different in many Asian nations where people enjoy the same types of individual liberties as those who live in neoliberal societies. The difference is a collectivist type of mindset that guides these societies and encourages people and government to take responsibility for one another. In her book Flexible Citizenship, anthropologist Aihwa Ong argues that this leads to a societal model where citizens can be independent and self-reliant while also able to rely on a state that supports the collective. Countries like Taiwan and South Korea may have been better prepared to respond to the pandemic because most people are accustomed to protecting themselves and their communities. 

Like China, these countries also learned from their recent experience with a pandemic. In 2003, China and much of Asia were caught off guard with the emergence of SARS. Like the U.S., China’s public health system had taken a backseat to investment in market reforms for over 20 years. As a result, it couldn’t accurately track individual cases of infections.

Following the end of the SARS outbreak, however, the Chinese government improved training for public health professionals and developed one of the most sophisticated disease surveillance systems in the world. This allowed China to respond more quickly to the 2009 H1N1 pandemic and late 2019 COVID-19 outbreaks, once it was able to get past the initial bureaucratic and political hurdles that prevented local doctors and government officials from sounding the alarm. 

Some have attributed this swift action to China’s authoritarianform of government that allows for greater control over individual lives. But prioritizing public health is not new to China. This became official practice as early as 1910 when it adopted the methods of quarantine, surveillance and masking to respond to an outbreak of pneumonic plague.

Could this work in the US?

Much like SARS did with China, COVID-19 has exposed huge holes in the American public health infrastructure. 

Take for example contact tracing. SARS taught China and other affected countries the importance of a robust system to identify and track people who may have been exposed to the COVID-19 virus. The Chinese government sent more than 1,800 teams of scientific investigators to Wuhan to trace the virus, which helped their efforts to quickly bring the virus under control.

In the U.S., on the other hand, poorly funded and thinly staffed public health departments struggled to test and notify peoplewho had been in direct contact with infected individuals. This crippled the U.S.‘s ability to prevent the spread of COVID-19.

In my home state of Massachusetts, the local government teamed up with the global health organization Partners in Healthto start a contact tracing operation. But even then, people were left to fend for themselves. This became all the more evident as people scrambled for vaccines after their initial approval, through Facebook groups and informal volunteer networks that worked to help people secure appointments. Those who had resources learned how to take advantage of the system while others were overlooked.

This is typical of a U.S. health care system that is consumer-oriented and market-based. Americans are often convinced that the solution to a health problem must be technical and costly. The focus was placed on developing vaccines and therapeutics, which are essential for ending the pandemic, while ignoring lower-cost solutions.

But masking and social distancing – non-pharmaceutical interventions that have long been known to save lives during disease outbreaks – fell by the wayside. Uptake of these simple interventions is dependent on strong and coordinated public health messaging. 

As seen in several Asian nations like Taiwan and South Korea, a well-thought-out plan for public health communication is key to a unified response. Without clear, coordinated directions from a public health system, it becomes difficult to prevent the spread of an outbreak.

What it takes to be prepared

Anthropologist Andrew Lakoff describes preparedness as more than just having the tools. It’s also about knowing how and when to use them, and keeping the public properly informed. 

Such preparedness can only happen in a coordinated fashion organized by national leadership. But the U.S. has seen little of this over the past year and a half, leaving pandemic response up to individuals. In an era where emergent viruses are an increasing threat to health and welfare, the individualism of neoliberal policies is not enough. While neoliberalism can be good for an economy, it’s not so good for health.

Elanah Uretsky
Elanah Uretsky

Elanah Uretsky is an Associate Professor of International and Global Studies at  Brandeis University.


  1. It’s not possible to comprehensively address a pandemic while simply ignoring an entire chunk of the population – the very poor, homeless. That’s several million Americans today, and there has been no government response to this portion of the population. This is a complex issue that, this long into the pandemic, govt. and media have chosen to keep sweeping under the carpet.

  2. “May”? Seriously? There’s credible doubt?
    Facts prove we’re a failed state and has been since, at the absolute least, the 1990s (open to arguments that it goes further back).

  3. Those who really rule the US — the wealthy, corporations, and top executives — do not care about the welfare of Americans outside of their elite social class. That the majority may die or live difficult lives is of no consequence. For proof, just listen to anything emanating from Elon Musk’s mouth.

  4. Wow, this is just as propagandistic as anything from corporate media. Talk about being so blinded by your ideologies that you can’t see reality!

    Zoonotic diseases like COVID are caused by humans destroying ecosystems, which causes non-human animals to come into closer contact with humans, and by confining animals and having unnaturally close contact with them. Economic concerns regarding this pandemic are totally secondary. How about addressing unnatural and thus very harmful human lifestyles and gross human overpopulation? Those are the real problems, the rest are just symptoms.

      1. I mainly stated facts, not raised points. The fact that this rant wasn’t about the real causes of the current pandemic was my point. This essay claims that economic reasons are why the pandemic harmed and killed a lot of people, but the real reason for the pandemic is unnatural human lifestyles.

  5. Cui bono? The apparent inefficiencies and breakdowns of the system may be suffered by us proles, but they can be positively beneficial for ruling class interests. In this sense, the US was more than prepared for pandemic, or rather the 2020+ pseudo-event that has served as cover for a global coup.

    Even before the live exercise of SARS-CoV-1 in 2003, R&D of gain-of-function weaponization of disease (problem) and mRNA biotechnology (solution) was underway. False flag bioterrorism, aka Dark Winter, with the anthrax attacks in conjunction with the 9/11 false flag shock event, erased from propaganda coverage when traced to bioweapons labs like Ft. Detrick, MD, set the stage over the next twenty years for a series of largely if not entirely fraudulent states of emergency designed to further implement states of siege upon general populations governed by collective panic and authoritarian control; very much in line with the later Lock Step plan more openly articulated in the 2010 Rockefeller Foundation’s “Scenarios for the Future of Technology and International Development.”

    These public health pysops were in conjunction with pandemic preparedness simulations (e.g., Clade-X, Crimson Contagion, Event 201 just before Covid-19) almost every year during this period, sponsored by deep state agencies and actors chiefly interested in surveillance and security agenda, including medical martial law, all of course for people’s welfare. Mass media messaging ratcheted up conditioning for the inevitability of pandemics, while the meaning of pandemic was redefined to fit any cross-border phenomena, no matter the actual threat, which might meet the demand. Gates launched his Decade of Vaccines in 2010, and the many major media under his financial control did their parts to advance anti-vax agitprop.

    The steady war of attrition upon public resources waged by neoliberalism was only enhanced with the disaster capitalism of the virus crisis. Continuing shutdowns of medical facilities and layoffs of staff past 2020 helped manufacture mythology of overrun hospitals incentivized to admit only covid cases while turning away less worthy patients, even as cash cow emergency units lay empty and unused.

    Perception management of the failures of capitalism is meant to steer us into a Great Reset of social systems along the ‘collectivist’ or totalitarian lines promoted here by this propagandist. Plandemic is the means by which capitalist crisis creates the opportunity for neoliberalism to reinvent itself as the end of history’s class struggle in the New Normal World Order of the war on/of bioterror. Resist or die a slave.

  6. Oh, the failed liberals on this site. For another perspective, or many other perspectives, read:

    In the first phase of the pandemic — the lockdowns phase — it was those leaning towards the cultural and economic right who were more likely to emphasize the social, economic and psychological damage resulting from lockdowns. Meanwhile, Donald Trump’s initial lockdown skepticism made this position untenable for most of those leaning towards the cultural and economic Left. Social media algorithms then further fueled this polarization. Very quickly, therefore, Western leftists embraced lockdown, seen as a “pro-life” and “pro-collective” choice — a policy that, in theory, championed public health or the collective right to health. Meanwhile any criticism of the lockdowns was excoriated as a “right-wing”, “pro-economy” and “pro-individual” approach, accused of prioritizing “profit” and “business as usual” over people’s lives.

    In sum, decades of political polarization instantly politicized a public health issue, without allowing any discussion as to what a coherent Left response would be. At the same time, the Left’s position distanced it from any kind of working-class base, since low-income workers were the most severely affected by the socio-economic impacts of continued lockdown policies, and were also those most likely to be out working while the laptop class benefitted from Zoom. These same political fault lines emerged during the vaccine roll-out, and now during the Covid passports phase. Resistance associates with the Right, while those on the mainstream Left are generally supportive of both measures. Opposition is demonized as a confused mixture of anti-science irrationalism and individualistic libertarianism.


    1. “the Left’s position distanced it from any kind of working-class base”

      The “Left” as you describe it is not the actual left, which in the U.S. is tiny (10% at most). If you don’t advocate for the poor and the working class, you’re not “left” by definition. The U.S. has two right wing parties and virtually no left.

      1. No left at all. None. Just a couple people like you and me….living in the Matrix.

    2. USA “left” advocates gun control; European/S American left opposes gun control
      USA “left” obsessed w climate change/cocktail party environmentalism; not European left—the so called “greens” right wing in Europe…environmentalism described by the French Marxist Alain Badiou: “crude counter-revolutionary”
      European feminists regard “intersectionality” described by Black agenda report as “counter-revolutionary” as opposed to feminism

  7. public health? free enterprise is a religion in USA…assembly line health care for everyone except rich and celebrities…no universal health care, no mandatory state paid maternity leave, no state paid university education…the everybody for them selves society thrives on envy, obsequiousness, violence, distraction—communism for the rich, feudalism for the remainder–without the benefits of feudal freedoms

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