University at Buffalo School of Management

12 Buffalo Business Autumn 2020 The COVID-19 pandemic has already turned our fragile, dysfunctional health care system on its head. While the next year will likely bring relief, expect these six mega-trends to become permanent developments. Investment in public health The United States health care spend exceeds $3.6 trillion annually, or 18% of our total GDP. Only 2.5% of that total is spent on public health, a decline of 20% since 2002. COVID-19 brought our underfunded public health system to its knees. America paid with a death toll far greater than it should have been. Just as 9/11 spawned increased spending in security measures, we can expect a surge in public health-related spending, regardless of who wins the election in November. A new infectious disease business model In the first half of the last century, the major killers were infectious diseases like tuberculosis, measles and smallpox. All have been virtually elim- inated through widespread precise diagnosis and effective drug treatments. Over the last several decades, pharmaceutical companies were rewarded through the development of "blockbuster" drugs—products that treat life- time, chronic diseases on a continuous basis. Drugs cost billions to develop, and the blockbuster model supported the industry. Le behind were new infectious disease treat- ments, which cost just as much to develop but are taken for a very short period. When a needed service is not sustainable for private enterprise, it requires government intervention—in this case, a new version of an old pharma model would have the government helping to fund basic research into promising therapeutics, and then engaging private companies to bring them to market. On the diagnostic side, private companies need a national government strategy to scale quickly. Patents and future profits need to be shared. And while all of us have benefitted from the globalization of supply chains, the pandemic showed that health care—like national defense—is a market that needs to be nationalized, at least for critical items. The impact of health disparities State aer state has reported much higher COVID-19 fatality rates among African Americans. Health disparities are nothing new—Black Americans have higher incidences of disease in nearly all the leading causes of death in America. People with underlying conditions are much more susceptible to fatal outcomes in the pandemic. But what is killing African Americans in this country goes well beyond the health care system and into the social determinants of health: economic stability, good education, healthy food access, afford- able housing and safe neighborhoods. Government spending without addressing these underlying social determinants is doomed to fail. Enlightened health care systems like Johns Hopkins are pursuing an "Anchor Mission" promoted by the Democracy Collaborative, which includes active local hiring, local sourcing and investment in the commu- nities they serve. Health systems could be joined by other major employers. If policymakers can create an economic founda- tion, at-risk populations may finally get the health care every American deserves. CORONAVIRUS AND THE AMERICAN HEALTH CARE SYSTEM By Larry Zielinski 1 3 2 6 TRENDS FOR THE FUTURE O V E R C O M I N G A D V E R S I T Y W I T H R E S I L I E N C E A N D D E T E R M I N A T I O N

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