All over the world, governments are scrambling to defend their citizenry from COVID-19, the disease caused by the outbreak of novel coronavirus. So far it seems levels of success have varied; countries like Italy and Iran have struggled so far, while Vietnam and Taiwan have seemingly put forth an efficient and effective response.

The United States, where a major outbreak is clearly developing, however, is in a class by itself. America's atrociously inadequate welfare state makes it by far the most vulnerable rich country to a viral pandemic, and the vicious, right-wing ideology of the Republican Party has wrecked the government's ability to manage crises of any kind.

The national health care system is of course the most important tool for any country trying to fight off an epidemic — all citizens need to be able to get tested, receive treatment, or be quarantined if necessary. If and when a vaccine is developed, the system needs to distribute it to everyone as fast as possible. That means handing it out for free in locations across the country, and perhaps making it mandatory if uptake is insufficient.

The American health care system fails at every one of these tasks. Nearly 30 million Americans are uninsured, and a further 44 million are underinsured — meaning they will likely hesitate to go to the doctor if they start developing COVID-19 symptoms. This problem is seriously exacerbated by the rampant predatory profiteering that infects every corner of the health care system. Indeed, responsible citizens who have gone in for tests have already started getting slammed with multi-thousand dollar bills. A father and daughter who were evacuated from China and then forcibly quarantined for several days (luckily they were not infected) went home to find $3,918 in bills.

If you are working-class person with a $10,000 deductible (not at all uncommon), going to the doctor simply because you have flu-like symptoms (which is how most cases of COVID-19 are experienced) could very easily send you into bankruptcy. If infected, millions of Americans are likely going to take their chances — and keep spreading the virus.

Indeed, U.S. health care is not only by far the worst system among rich countries, it is much worse than that of many middle-income or poorer countries when it comes to confronting a fast-moving epidemic. Distributing a vaccine is not that difficult of a task — World Health Organization workers managed it with smallpox even in desperately poor African countries in the 1970s. You just round up everyone, and give out the shot. But that will be a heavy lift indeed with a health care system geared above all to price-gouge sick people out of as much money as possible. While in theory the government could stand up a one-time free (or cheap) vaccination program, the administration has already ruled that out. "We can’t control that price because we need the private sector to invest," said HHS Secretary Alex Azar. That very likely means an eyewateringly-expensive vaccine that tens of millions can't get — we've seen what rapacious pharma companies do with insulin. (Speaking of vaccines, as Ryan Grim points out at The Intercept, Joe Biden voted against a Bernie Sanders amendment to force drug companies to provide drugs funded by public research at a reasonable price.)

It's worth pointing out again that if we had Medicare-for-all, these concerns would vanish at a stroke. People experiencing symptoms would feel free to seek medical care without worrying about breaking the bank, and a vaccine could be distributed by the government through hospitals and clinics at no cost to patients.

But there are still further problems. The United States is one of only a handful of countries (almost all of them desperately poor) with no national sick leave program, which means many workers who come down with COVID-19 will be forced to choose between starving or spreading the disease. Food service workers are especially unlikely to have sick leave from their employers, and are generally not paid well either. So-called "gig economy" companies naturally provide no sick leave either. In China, food delivery services have been critical for feeding cities under lockdown, but in America they are likely to become just another vector of infection.

Finally, there is conservative ideology. As I have written, the Trump administration — under the influence of conservative fanatics like Mick "The Knife" Mulvaney — has deliberately devastated the government's pandemic response capacity. He's cut key personnel, slashed funding, and made sure thousands more Americans have been thrown off their insurance. And while Trump is certainly the most incompetent president in American history, his style of government is not at all out of keeping with typical Republican rule. As Thomas Frank writes in his book The Wrecking Crew, for decades GOP rule has meant rampant corruption and disastrous incompetence. When a Republican is in the White House, unqualified cronies end up in charge of federal emergency management, and American cities and towns end up ruined. Even today, the Trump regime is doing its level best to kick as many people off their health insurance as possible — the Supreme Court just announced it would hear the latest Republican attempt to destroy the Affordable Care Act through judicial rule-by-decree.

The conservative movement has served like a bath of hydrofluoric acid on the quality, competence, and basic decency of American institutions. Republicans have all but posted up signs everywhere saying "epidemics welcome here." So now they are resorting to the only thing they know how to do really well — lying, concocting conspiracy theories and blaming Democrats and the media for any bad news. It does not bode well.

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