Green stethoscope forming a dollar sign with the tube ( Atomic Imagery/Getty Images)

Dr. Jonathan Metzl: How coronavirus reveals America's extreme social inequality

Author of "Dying of Whiteness": Trump's response has been "exactly wrong" for America, but his base doesn't care


Chauncey DeVega
March 19, 2020 12:00PM (UTC)

The richest 1 percent Americans own 40 percent of the wealth. That same 1 percent also owns more than half the value in mutual funds and stocks, while the top 5 percent of Americans own two-thirds of the nation's wealth. The top 0.01 percent of Americans — the 16,000 or so richest families — saw their income increase at rates far higher than the much-discussed 1 percent.

Globally, the wealthiest 26 individuals hold about as much wealth as the poorest 50 percent of people on the planet.

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Income and wealth data are abstract. In practical terms, rich people do not live in the same world as everyone else. That fact becomes more even more obvious in times of trouble, tumult, danger, disaster, disease or plague.

As America and the world struggle to confront the deadly coronavirus pandemic, the rich are escaping to private islands and bunkers, using their vast resources to secure medicine and other assistance denied to the general public, flying on private jets with their own personal physicians and nurses, and leveraging the vast wealth they have inherited or otherwise accumulated to survive (and perhaps even prosper) during a worldwide health emergency that may take the lives of millions.

Human disaster is a business opportunity. The rich are taught from childhood to never let a good crisis go to waste.

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To wit: Donald Trump's son-in-law Jared Kushner and his family will likely make huge sums of money from the coronavirus pandemic and the need to test millions of people in the United States. DCReport explains:

The Kushner family is trying to cash in on the pandemic that could kill millions of us.

Oscar Health, the health insurance company co-founded by Jared Kushner's younger brother, announced Friday it has launched a testing center locator for COVID-19. It shows where more than 100 centers are in the United States. The company is also offering a risk assessment survey and means to talk to a doctor online.

The coronavirus is predicted to kill anywhere from almost 500,000 Americans in the next year to more than 5 million. At least 62 people in the United States had died by Sunday; 3,130 have tested positive ….

Joshua Kushner co-founded Oscar Health in 2012. His co-founders are Mario Schlosser, the company CEO, and Harvard Business School classmate Kevin Nazemi who left the company in 2015.

President Trump may also receive tens of millions of dollars — if not much more — from the American taxpayers as part of a proposed coronavirus relief bill to bail out the airlines, hospitality and entertainment industries.

Ultimately, the coronavirus will make the obscene levels of social inequality in America even more obvious. One person especially qualified to discuss this is Jonathan Metzl, the Frederick B. Rentschler II Professor of Sociology and Psychiatry, and director of the Center for Medicine, Health, and Society at Vanderbilt University. He is the author of several books, including "Prozac on the Couch" and "The Protest Psychosis." His new book is "Dying of Whiteness: How the Politics of Racial Resentment is Killing America's Heartland."

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I asked Metzl to explain how wealth and income inequality exacerbate the impact of the coronavirus and other diseases, and how Republican efforts to roll back the Affordable Care Act and Medicaid expansion are likely to worsen the impact of the coronavirus pandemic, especially among Trump's supporters in red-state America. Metzl also told me that his colleagues at the Centers for Disease Control are frustrated that the Trump regime appears more concerned with the president's electoral fortunes than in helping the American people survive the coronavirus pandemic. 

Based on his conversations with Trump supporters for his book "Dying of Whiteness," Metzl also has a dire warning for Democrats in this election year: Trump's followers will not turn on him, even as they are sickened or killed by the pandemic that he made dramatically worse.

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You can also listen to my conversation with Jonathan Metzl on my podcast The Truth Report or through the player embedded below.

Government exists to solve problems that are too big for any one person or group. A pandemic is a perfect example of why we need government. But in this moment which shows the need for robust government, many conservatives are complaining about "infringements" of their "rights." Is the American right's hatred of the very idea of government imperiling public health and safety?

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The states that have a better Medicaid infrastructure and that accepted the Affordance Care Act expansion are going to do better with the coronavirus than the states that didn't. The states that have Medicaid block grants are going to be in big trouble. As of several days ago, the Trump administration is not allowing states with functioning Medicaid infrastructures to be more flexible and expand to help more people. This is the exact opposite of how to confront a pandemic.

In a moment of terror, a society can go one of two ways. It can become more ideological. In Nazi Germany, for example, people became more irrational in a moment of crisis rather than coming together. That facilitated the rise of Hitler and the Nazis. Or people can rethink their ideologies and decide to come together with others in order to fix the problem.

With the coronavirus crisis, there are examples of the second option. I have colleagues in Israel who are starting new grassroots mobilizations between Arab, Hasidic and secular Israeli communities. The virus does not care about human social categories. We're all in this together. We also need true experts to be directing the response effort to the coronavirus here in the United States. Part of the crisis here, with the panic buying, the uncertainty and the public not having a true sense of what is happening, is a result of faulty national leadership under Donald Trump.  

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You have contacts at the Centers for Disease Control and Prevention. How are they feeling in this moment when the Trump administration has systematically purged the federal government of the expertise necessary to effectively confront a public health crisis such as the coronavirus pandemic?

I cannot even begin to describe the frustration among the people I've spoken with and that I know at the CDC. Part of the frustration is that people who have it as their responsibility, who have trained for many years to prevent and respond to diseases such as the novel coronavirus, are not being allowed to do their jobs by the Trump administration. The fact that the Trump administration has put inept people in charge, the incorrect messaging to the public, etc., all contributes to the frustration by the real professionals at the CDC, the National Institutes for Health and elsewhere.

Another source of frustration among the professionals at the CDC is that they all have colleagues who are in the World Health Organization. They have colleagues who are working in Korea. They have colleagues who are working in the Middle East. The entire rest of the world is mobilizing around public health expertise. This has resulted in lifesaving measures on a huge scale. Experts in other countries are being allowed to develop public health programs that are saving the lives of their citizens. In the United States this is not happening.

Stephen Miller and Jerad Kushner are now advising Donald Trump on the coronavirus pandemic. One is a white supremacist and the other is a plutocrat. When I heard that the two of them would have anything to do with the coronavirus response — never mind that neither of them is a scientist or a doctor or has any relevant expertise — I said to myself, "My God, what can go wrong?" What was your reaction?

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Trump cares about the stock market — and the stock market is being pretty honest with him about what they think about how the coronavirus pandemic is being managed. The stock market is rejecting the Trump administration's censorship and silencing of experts and the truth about what is really happening.

I was just waiting for Kushner to be put in charge of the response. It's not just about his and Miller's complete lack of qualifications. It's actually that their impulses are exactly wrong for what is happening in the United States with the coronavirus. There is a tendency among too many people to want to circle the wagons and announce that the virus is "an Asia thing" or "a foreign thing." Trump used basically that language during his very unsuccessful address to the nation about the coronavirus last Thursday.  In reality, the coronavirus does not care about human categories of race or ethnicity or geography. To fight the coronavirus effectively, the United States and the world need to share information and expertise openly. What you need to do is create open access.

Stephen Miller and the Trump administration's response to the virus is to call it "foreign" and to build walls and do other related things. That is literally going to get people killed. Those reactions are not just going to get people killed, they will also have profound health and economic consequences on the United States for a very long time. On so many levels, the Trump administration is doing literally and exactly the opposite of what should be done to stop the coronavirus and protect the United States.

What do diseases such as the novel coronavirus reveal about social inequality? What lessons are taught by a pandemic or other health crisis?

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In America, our responses to the coronavirus have been as individuals. For example, panic-buying toilet paper and food. The sense is, basically, you're in it for yourself. It's every man for himself. Such a response shows how any sense of community and cooperation has been really diminished in the United States. America is not exemplifying a spirit of cooperation to the extent necessary to stop a pandemic.

For example, young people need to wake up, because if they're carrying the coronavirus then they are going to be the ones who are killing older people. A sense of community would help to stop such behavior.

What of vulnerable populations, such as people in prisons or being held in Trump's detention camps? What of poor people more generally?

Incarcerated populations are at great risk. Not having Medicaid flexibility is going to literally kill low-income and minority populations in many parts of the country.

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Who's going to get the testing first? Who's going to get access to care? Denying the whole of the population proper health care is going to hurt everyone in the end.

Perhaps one or two people — and the extremely rich as a group — can lock themselves away in a bunker or on an island. But for the most part, nobody's safe until everybody's safe when the country and the world are being confronted by a pandemic such as the coronavirus.

If there is a high incidence of illness and related health care costs in one particular population, it is then a risk for everybody else. The notion held by too many people that "The coronavirus could be present in poor populations, but not in me," is completely false. Population-level health is the only way we're going to get through this crisis as a country.

Predictably, Donald Trump is blaming Barack Obama for his administration's failure to properly respond to the coronavirus. Of course, this is just another example of Trump's pathological racism, as manifested through his obsession with Barack Obama. But that is also connected to why so many white conservatives and their leaders rejected the Affordable Care Act. In your book "Dying of Whiteness," you write about white Trump supporters who would rather die than accept "Obamacare." How does that connect to the coronavirus?

Donald Trump, like so many other demagogues, is very good at focusing the blame on other people — especially groups that are marginalized, stigmatized and considered the other. In crisis, demagogues attack vulnerable people. That is related to Donald Trump not taking responsibility for his own actions. It is always someone else's fault. With the coronavirus, the temptation for Trump to use that strategy is going to be very great.

Donald Trump is also a very skilled manipulator of anxieties and the worst aspects of human behavior. People always ask me about my book "Dying of Whiteness": Did the white people profiled in it realize that Trump's policies were killing them? If so, why didn't they reject him?"

I would tell people, "No. The irony is that the people being hurt by Trump's policies actually supported him more."

Because of that, I worry that the same dynamic is going to take place with Donald Trump and the coronavirus. The more desperate that some Americans become, the more Trump will tell them that it's someone else's fault. Then the more that things get worse, the more Trump becomes popular and his ideology becomes entrenched among his followers.

It is a fantasy of liberals to believe that Trump supporters are going to wake up one day and turn on Donald Trump. It is not going to happen.  

When I was doing the research for "Dying of Whiteness" I would often be asked, "When are Trump supporters going to wake up? When are they going to see what is really going on?" I keep hoping that maybe there will be a moment when conservatives wake up and say, "Yeah, we're Trump supporters. Yeah, we're Republicans. But in exchange for our votes, we want to have better health care, better education, and better schools in exchange for our support."

Who knows? Maybe if that somehow happened there could be a moment when liberals and conservatives could find some type of common concern that would help the country create a better health care system.

If you were called to testify in future congressional hearings about the Trump administration's failed response to the coronavirus, what would you say?

First, that it is a fantasy to believe that a person can have a proper health care system that is going to work for them but that will punish those "undeserving" people. Likewise, that we can have a good educational system in this country where some people get to hoard resources and have charter schools but not "those people." An example from my book: Many white parents told me, "I'm not paying taxes for public schools because the black districts are using our money for luxury party buses." They recycled those urban myths and many others.

The United States is strongest when we have social and political systems that work best for everybody. The coronavirus is proving that to be true.


Chauncey DeVega

Chauncey DeVega is a politics staff writer for Salon. His essays can also be found at Chaunceydevega.com. He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.

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