Since the eruption of the Covid-19 (Coronavirus) outbreak in the countries of the West (EU, UK, USA, etc.) which are severely affected and the adoption of restrictive measures on the movement of citizens and a general lockdown on their economies, the governments of all these countries that are taking these measures constantly say that in order to stop the Covid-19 pandemic, the most essential and crucial role will be played by the individual responsibility of each citizen and that is why citizens should stay at their home.
by T.C.
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The suspicion that governments create among citizens
The fact that the governments of the countries are constantly insisting on these phrases about individual responsibility of citizens for dealing with the Covid-19 pandemic and in many cases imposing fines on quarantine offenders raises legitimate questions:
1. In the event of major future losses in human lives, the governments of these countries aim to pass on the responsibilities above them and to attribute them in advance to the society they serve and to their citizens.
2. The governments of the countries, repeating the phrases on individual responsibility of citizens and that they should stay in their homes, they show that as governments they do not trust the Healthcare System of their countries which due to saturation of large masses of patients from Covid-19 who need hospitalization in Intensive Care Units, cannot respond.
3. Perhaps in the future the governments of these countries will seek, if not to undermine, the National Health Systems of their countries at least in its obsolescence to turn their citizens to private insurance and private healthcare systems.
This may be especially true for EU member countries and the UK that have National Health Systems, while in the US the situation shows that uninsured people and generally those who do not have a job to pay private insurance are at the mercy of God in case they become ill in general.
In any case, the U.S. Healthcare System will treat them in case they get covid-19 disease, but then they will send them the bill of hospitalization and treatment costs that they will not be able to pay.
Political liberalism is linked to a settled set of rights and civic responsibilities. In other words, individual freedom means both autonomy over all forms of coercion and individual responsibility. The relationship between the citizen and the Liberal Republic means rights and responsibilities.
The fact that governments insist on constantly referring to the individual responsibility of citizens is trying to disorient public opinion about their own timeless responsibilities towards their own Healthcare Systems, which in many cases seem with no fortification in the face of any type of pandemic.
By saying with no fortification, we refer to the chronic deficiencies both in the necessary protective medical equipment and in the available number of Intensive Care Units as well as the under-staffing of the necessary medical and nursing personnel.
The Healthcare Systems and whether the governments of their countries trust them
When we talk about whether the governments of the countries trust the National Health Systems of their countries, we can see this by checking whether the National Health Systems are adequately funded from their countries’ annual state budgets, so that they can achieve their mission in the most effective way.
In the table below we present the annual funding of healthcare systems of each country in Europe as a percentage of their annual GDP. The healthcare system that we consider in this table for each of the following countries concerns the annual expenditure for the period (2010-2019) and includes annual expenditures related to healthcare providers including Hospitals, General Hospitals, Mental Health Hospitals, Specialized Hospitals (other than mental health hospitals).
For the years 2018, 2019 the Source of our data, Eurostat has not provided data. While for years that are empty (no entrance) there is no evidence. Data from Eurostat data base was used to create the following table. More specifically, for annual costs related to Healthcare providers https://appsso.ec.eurostat.ec.europa.eu/nui/show.do?dataset=hlth shall_hp&long=en , 07/04/2020, whereas for the data relating to the corresponding annual GDP, https://appsso. eurostat.ec.europa.eu/ nui/show.do? dataset=nama_10_gdp&lang=en , 07/04/2020.
| 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | |
| European Union – 27 countries (from 2020) | 10,46% | 10,53% | 10,60% | |||||
| European Union – 28 countries (2013-2020) | 10,55% | 10,79% | 10,67% | |||||
| European Union – 15 countries (1995-2004) | 10,89% | 11,16% | 11,03% | 10,97% | ||||
| Euro area (EA11-1999, EA12-2001, etc.) | ||||||||
| Euro area – 19 countries (from 2015) | 10,74% | 10,83% | 10,92% | 10,96% | ||||
| Euro area – 12 countries (2001-2006) | 10,81% | 10,91% | 10,99% | 11,04% | ||||
| Belgium | 10,03% | 10,41% | 10,69% | 10,89% | 10,98% | 10,91% | 11,13% | 11,33% |
| Bulgaria | 7,57% | 8,15% | 8,40% | 9,11% | 8,94% | 9,18% | 9,37% | |
| Czechia | 7,82% | 7,41% | 7,16% | 7,23% | 7,61% | |||
| Denmark | 10,33% | 10,21% | 10,56% | 10,56% | 10,67% | 10,77% | 10,73% | 10,84% |
| Germany | 11,07% | 10,87% | 11,11% | 11,50% | 11,72% | 12,09% | 12,31% | 12,59% |
| Estonia | 6,27% | 6,08% | 6,35% | 6,82% | 7,14% | 7,54% | 7,85% | 7,99% |
| Ireland | 10,87% | 11,09% | 10,82% | 10,16% | 8,29% | 8,38% | 8,11% | |
| Greece | 9,56% | 9,17% | 8,92% | 8,25% | 7,65% | 7,76% | 7,93% | 7,74% |
| Spain | 9,08% | 9,13% | 9,14% | 9,09% | 9,08% | 9,19% | 9,09% | 9,11% |
| France | 11,24% | 11,31% | 11,56% | 11,77% | 11,98% | 12,00% | 12,08% | 11,96% |
| Croatia | 6,53% | 6,66% | 6,77% | 6,88% | 6,96% | |||
| Italy | 9,18% | 9,30% | 9,46% | 9,54% | 9,51% | 9,52% | ||
| Cyprus | 6,24% | 6,67% | 6,93% | 7,12% | 6,92% | 6,77% | 6,59% | 6,61% |
| Latvia | 6,11% | 6,28% | 6,54% | 7,20% | 7,18% | |||
| Lithuania | 6,83% | 6,85% | 6,81% | 6,74% | 6,87% | 7,20% | 7,48% | 7,57% |
| Luxembourg | 6,40% | 7,06% | 6,20% | 6,24% | 6,10% | 6,02% | 6,15% | |
| Hungary | 7,51% | 7,58% | 7,48% | 7,30% | 7,10% | 7,06% | 7,26% | 7,31% |
| Malta | 10,14% | 10,23% | 10,27% | 10,75% | ||||
| Netherlands | 10,16% | 10,25% | 10,71% | 10,90% | 10,91% | 10,74% | 10,76% | 10,67% |
| Austria | 10,22% | 10,21% | 10,60% | 10,86% | 11,19% | 11,45% | 11,66% | 11,79% |
| Poland | 6,43% | 6,35% | 6,50% | 6,41% | ||||
| Portugal | 9,84% | 9,51% | 9,29% | 9,22% | 9,23% | 9,37% | 9,59% | 9,60% |
| Romania | 4,85% | 4,81% | 5,52% | 5,41% | 5,46% | 5,59% | 5,93% | |
| Slovenia | 8,81% | 8,91% | 8,96% | 8,77% | ||||
| Slovakia | 7,78% | 7,77% | 7,12% | 7,00% | 7,17% | 7,03% | ||
| Finland | 8,83% | 9,14% | 9,77% | 10,25% | 10,38% | 10,79% | 10,50% | 10,31% |
| Sweden | 11,21% | 12,08% | 12,48% | 12,11% | 11,89% | 11,94% | 12,01% | |
| United Kingdom | 10,31% | 11,07% | 12,26% | 11,08% | 10,51% | |||
| Iceland | 8,54% | 8,81% | 8,93% | 9,78% | 10,74% | 12,03% | ||
| Liechtenstein | ||||||||
| Norway | 9,63% | 10,37% | 10,36% | 10,16% | 9,98% | 9,91% | 10,15% | |
| Switzerland | 10,70% | 12,10% | 12,68% | 12,71% | 13,01% | 15,20% | 15,19% | 14,97% |
What is observed in the above table is that the country that has the highest funding to its healthcare System over time is Switzerland, which from 2011 until 2017 maintains the highest funding as % of its GDP. In the EU, the country that spends the most of funding on its National Health System is Germany with 12.59% of GDP in 2017, followed by Sweden, which is followed by France and Austria.
In the battle against the Covid-19 (Coronavirus) pandemic, both Switzerland and Sweden did not take drastic measures of social isolation and lockdown of their economies, resulting in a relatively small number of deaths and susceptible cases respectively (and always compared to their population).
Germany, on the other hand, despite applying social isolation measures in conjunction with the application of a screening test for this virus (Covid-19) to an increasing number of its citizens, also manages to have a low number of deaths and susceptible cases.
The data show us that these governments of the specific countries which also have the highest annual expenditure (funding) for the healthcare sector, in fact show that they have a very high confidence both in the relevant National Health System and in the respective healthcare services of their countries.
The exception to this rule is Greece, which has the lowest expenditure as % of its GDP for its National Health System and healthcare system in the EU. Given this fact, which shows that over time the Greek governments do not trust the Greek National Health System, the oddity is since Greece manages to have the lowest number of deaths and susceptible cases caused by Covid-19.
This Greek paradox is because the current Greek government, knowing in practice the weaknesses of the Greek National Health System due to its chronic under-funding, has implemented the only policy at its disposal to bring the expected successful results.
The rapid implementation of preventive measures that included social isolation, lockdown and quarantine of many weeks. Of course, Greece denies applying massive number of tests for Covid-19 in more and more citizens. For these reasons many believe that the real susceptible cases are nine times more than the official numbers, which in that case there is no reason to implement lockdown and social isolation measures. The fact that the Greek economy will be plunged into a terrible recession in the distant future because of these excessive measures is a matter of another analysis.
Lessons learned and conclusions to date from how to deal with the Covid-19 pandemic
What we conclude so far about the Covid-19 pandemic is that humanity should learn to live with epidemics and pandemics because it is part of our lives. What we need to do as humanity is to learn from this pandemic but also from other more recent epidemics such as SARS, H1N1 etc. and better prepare for the next pandemic that will appear.
As the development of technology has shortened the time travel gaps between the countries of the world, it should be understood by all that all kinds of viruses know no borders, countries and social classes.
National Healthcare Systems are extremely necessary for the treatment of pandemics in order to protect populations. The Pandemic of Covid-19 has shown that, both developed economies (USA, EU, UK, China, Japan, etc.) and the developing economies of Asia and Africa, and especially those of Africa that are accustomed to epidemics while having weak Healthcare Systems unlike developed countries, no healthcare system no matter how strong it is can cope in a short period of time with accumulated masses of patients in need of intensive care units treatment.
So, all countries independent of the power of their healthcare systems are vulnerable to external shocks that pandemics can cause. External shocks on both the demand and supply side of the economies since the measures to deal with them are social isolation and the lockdown in economies.
Given all these conclusions on better treatment of pandemics, we should:
- As regards National Healthcare Systems:
While emphasis should be placed on increasing the funding of resources (funds, staff, etc.) of national healthcare systems, this funding should exceed an annual 10% of a country’s GDP per year (e.g. common floor level for all EU member countries) but above all emphasis should be placed on the efficient use of these resources.
Apart from an annual floor level of expenditures and medical/nursing staff necessary to maintain citizens’ right of access to public healthcare services, the resources effectiveness in terms of the health of the population is of great importance.
Certainly, at critical times such as the Covid-19 pandemic, if annual resources for national healthcare systems have been reduced, the negative consequences will be multiple than they would have been compared to a normal period.
- As regards the organisational structure for dealing with a pandemic
The crisis caused by the Covid-19 pandemic in the EU is clearly being dealt at member country level and not by central European coordination. Therefore, in other EU member-countries there are a small number of deaths and susceptible cases respectively (Greece, Germany, etc.) while in other member-countries a very large number respectively (Italy, Spain, France, etc.).
The first and main reason for the rapid transmission of the virus in Italy was the Chinese community living in Northern Italy who unknowingly travelled to China and for the time when China together with WHO kept secret the evolution of the pandemic on Chinese territory from the rest of the world and then in Spain from Italy from the football match between the Italian and Spanish team.
The second reason is that both Italy, France and Spain did not cooperate among themselves despite maintaining an open border between thousands of travellers (this also applies to all euro area member countries applying the Schengen Treaty).
The apparent absence of a European Coordinator has led to weaknesses-difficulties that member countries alone have had enormous difficulties in dealing with, for example, Italy.
The choice to appoint a Single European Coordinator (correspondingly in US, a Single US Coordinator) would achieve:
1. The continuous communication and coordination of the respective responsible healthcare ministers of the EU member countries (in correspondence for US states).
2. The strengthening of care units directly with mobile laboratories and hospitals that could carry out ongoing checks for outbreaks while available shopping malls could be converted directly into hospitals only for patients with this virus.
3. The accelerated creation of dedicated care units only for Covid-19 patients, to keep the intensive care units of normal hospitals available for the rest of the population and not to bottle up existing ICUs.
4. Creation of a reserve for medical and nursing staff so that medical and nursing staff treated with patients with Covid-19 can rest and in case of their illness to be replaced without shortages. Transfer of medical and nursing staff from other member-countries to affected member-countries e.g. Italy for the smooth treatment of the patients Covid-19.
5. The creation of specially equipped planes which will have an intensive care unit and could transport to another member country the medical and nursing staff who were ill.
6. Funding decisions to speed up research into the Covid-19 vaccine.
7. Direct funding and creation of appropriate medical and protective equipment for tackling the pandemic (e.g. rescEU).
8. As much USA as EU and generally all the countries of the world they must have on their disposal a Continuity of Operations Planning (COOP) to implement in the case of any kind of disaster and of course for any kind of pandemic.
The same problems of lack of coordination occurred in the US and between their states, which did not take the same measures to tackle the pandemic at the same time. But the big problem that arises in the US is the fact that the absence of some form of centralised healthcare system creates waves of uncertainty for uninsured US citizens, who, in the event of their illness from Covid-19 and their care in ICU, the cost will be unrealistic for them.
In such a case, low-income citizens will be given huge debts to hospitals, thus losing any future access to them. The debts that will be created will be of enormous proportions like student debts that cannot be repaid, creating a serious social problem in US. So, it is time for the US to create a National Healthcare System worthy of their brilliant history.
