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Because in the US, no amount of money could ever do what was done in China. Both Americans and Chinese have naïve assumptions about how the American health care system works. One of the most naïve assumptions is that the US has a robust system of public health. It doesn’t. It has a for-profit system of personal healthcare for individuals. Never the twain shall meet.More money put into a fundamentally dysfunctional system doesn’t necessarily lead to better outcomes. It can even be part of the process of worsening the problem.America’s private healthcare system doesn’t simply mean private doctors as opposed to state-owned clinics, hospitals, and provider services. It means that the mission of American health care is to tend to private individual’s personal emergencies and healthcare needs. In what may be called ordinary times, the medical difference between a personal emergency and a public health crisis may seem purely abstract, to some. Events like the pandemic of 2019/20 show that the distinction has a direct bearing on costs and outcomes, and even the functioning of society itself. America lacks a system of public health, and many Americans don’t even know that a system of public health and a system of personal health treatment are distinct things, let alone understanding their intersection.America’s private system is costly to the point of exclusion by design. Despite having a generalist to specialist ratio not very different from other industrialized countries, the US relies on more costly specialists for treatments far more often. The system is organized to serve providers, not the patients.American professionalization is based on complicating treatment for its own sake, as can be seen from comparing certification regimes on reiki and other remedies. Parallel with this, maximum profit comes from using the most expensive options to charge each patient the most, while providing limited services and service categories to individual patients. This also reduces costs to the provider and healthcare system, but not the costs of treatment.Less inclusive of the overall population, but requiring a greater part of national wealth.For instance, in pretty much any other country but the US, not only would a tooth crown be cheaper than in the US, but there would be a choice of materials and procedures from bare-bones cheap to very expensive, including shorter-term solutions. In the US, only the most expensive option is considered —which is usually more invasive and dangerous to boot. So, in this example of a tooth crown, given any excuse a crown will be discouraged. Instead, much more expensive implants will be preferred, and even the crown will only be available in the most expensive materials.This is pitched as saving the patient money by making a more long-term investment, but this also ignores that it is unaffordable for many. This forces many to forego otherwise accessible treatment altogether. Misleadingly, the health care industry will often justify lack of choice and access as a cost containment measure they are helpless to control, rather than the monopolistic practice to inflate prices that it is.Like the US, China’s pandemic response has been constrained and determined by the bureaucratic/ organizational processes and interests. For China, this means those who came to full hegemonic ascendancy in the suppression of the anarcho-communist uprising of 1989. Nothing that could even vaguely resemble a gong dong, a grass-roots mass campaign, is tolerated. This has institutionalized an organizational logic and structural framework of highly imperfect, sometimes contradictory, rigid top-down public emergency response mechanisms. These mechanisms are actively hostile to the transparency and independent state health authority that its public health campaign needed against this unforeseen outbreak. They are better suited to respond to outbreaks of political and material brush-fires. This led to China’s slow and counter-productive initial response.On the other hand, China, despite sharing many of the systemic dysfunctions as the US, has preserved a medical professionalization based on simplicity, fluid protocols, patent-free treatments and medicines, and popular accessibility, as well as potentially backed up by a material command structure that can be coherently mobilized for the national interest. They also could mobilize local party members as a ready-reserve for popular enforcement once initial reactions and political confusion were overcome. That allowed them to organize treatment and containment responses whose effectiveness the United States would be horrified to achieve, even if it could.China’s leadership is engrossed with maintaining social stability through active social and economic management. The goal is adequate employment and a rising standard of living to promote stability, and stability to promote economic growth. On the other hand, the US leadership deliberately promotes social insecurity as a means of labor discipline and social control, resulting in a polarized society.Thus, in contrast to the universal social mobilization necessary in the US, we see exclusion and selective concentration. With the Covid-19 epidemic, ventilators could be produced more cheaply and in greater quantities, but preference is given to the most expensive, patented-feature-rich, deluxe-models. Use of these expensive ventilators is for patients that have deteriorated to the point where many won’t survive, even if they are cured of the virus. Lengthy use of ventilators for advanced Covid-19 is physically traumatic, potentially bearing complications that can be debilitating or fatal.Less invasive, traumatic, and expensive treatments at less severe levels of Covid-19, such as intravenous vitamin C and holistic medicine, are dismissed in favor of promises of time-consuming development of expensive and scarce patent medicines. Delays in diagnosis and treatment is early treatment itself, also called “letting nature take its course”, as if nothing can be done until the patient gets worse.Likewise, some evidence shows that masks may not prevent contracting Covid-19, but may at least reduce the load of exposure, which may reduce the severity of illness. Added to this, more severe infections are more likely to lead to long-term health problems, particularly inflammatory and auto-immune reactions. Those reactions can even include provoking allergic reactions to the expensive pharmaceuticals necessary to save the patient. The American system systematically increases costs, and reduces effectiveness and efficiency through restricting and delaying accessibility as a design choice.The lack of public regulation leaves no other standard than the complicity between commercial and political interests, including insurance, pharmaceutical, and provider industries. Patients are reduced to objectified consumers based on where they fit in this model. If a patient can’t afford something, doctors will conclude there is something wrong with the patient, not with the options given to the patient. After all, the doctor is making a fortune off of the patient and assumes the patient has a sheep to fleece, too. Smaller charges, and cheaper procedures, are refused because given the same profit margin, the more expensive option is more profitable. An individual patient wanting a lower-profit procedure is not worth their valuable time, nor is a lower-profit population segment. The medical gaze and the vast gulf of social inequality means that many doctors are completely disconnected from their patients’ realities. Deeper pocket institutions dominate the process and determine the provider’s perspective.Scarcity is built not only into the provision of services, but into the corporate buy-outs of smaller clinics and hospitals to concentrate services in vast expensive, centrally-located campuses that monopolize the medical market in order to set prices at will. Increased money to for-profit health providers, like in the cases of banks bailed out in 2008, would be most profitably used by healthcare companies to buy out rivals and consolidate the market, not to increase beds and services, or to decrease wait times.What public clinics exist are often adjuncts of the private system, mostly careful not to offer competing services, supporting the for-profit sector by providing limited services to low-income people. They are often operated by the local public health departments, confusing that agency’s role. Treatments often consist of giving patients referrals to private providers that they know those patients can’t afford. While some public health officials are adamant about performing their public duty, pressure to under-report pandemic infections has resulted firing and public discrediting of whistle-blowers. Meanwhile, hospitals have accepted that they can only prioritize but not meet public needs, and they depend upon public health officials to help manage public perception of this.Pandemic response #1, recommended by public health authorities: One hand washing the other.The subordination of public health to personal providers presents a fundamental structural contradiction to pandemic control. Pandemic control requires testing that is uniform, systematic, and comprehensive. When public health authorities refer the public to private healthcare providers, who test for individualized treatment according to the providers’ interests, an ineffective and profiteering response is hard to avoid. When public health authorities subordinate themselves to the needs of business “flexibility”, even those who test positive are brought back to the workplace. When data and public information is fetishized as private property, there can be no rational coordination, such as between hospitals, nursing homes, or other providers: Nor importantly, among employees or citizens.CDC regulations state that someone who is positive can return to work after being positive for 30 days. Meanwhile, a plethora of agencies with particular jurisdictions and mandates set contradictory standards. Many healthcare workers are not tested because positive tests could lead to staff shortages. And since health is a strictly private matter, outbreaks can be covered up under the guise of protecting personal information.Since the US lacks a structure to provide universal healthcare access, one must ask what the financial arrangements for universal testing would look like. In many cases, even free testing requires a doctor’s order, which can be costly, especially if it requires an ER visit. Meanwhile, testing would remain voluntary, which means the most irresponsible and selfish people, who are most likely to do stupid things, are most likely to not be tested.And even when the state provides health insurance, there is no legal requirement that it be accepted, and no mechanism to regulate fees. There is only participation in the market. Since the state’s insurance pays less, and there is no legal obligation to accept it, providers who accept it subsidize the excessive profits of those who refuse it. The market does not regulate but deranges economy by redistributing wealth upward to the most predatory.Ron Paul, doctor and perennial presidential candidate of the libertarian right in the US. As a doctor, he refused to accept patients with state health insurance on the principled grounds that it was paid for with “stolen money”. A personally convenient principle and definition of theft. Paul called the Covid-19 pandemic a ‘hoax’, and called for Anthony Fauci to be dismissed from the White House Coronavirus Task Force to stop him from hurting the stock market and grabbing power for big government; After all, power is currently in the right hands, where God’s wisdom put it: Those of the Wall Street barons who finance his presidential bids.Since the for-profit healthcare industry has such monopolistic powers, and those profits work in parallel with those of the pharmaceutical companies and insurance companies, the more money put into this system, the higher the profits and less the service. In answer to one reader who doubts this, I would add that according to David Belk, author of The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States: “The revenue for any health insurance company is tied directly to its expenses. In other words, the more a health insurance company spends each year, the more revenue they can earn (through premium increases the next year). Therefore, the last thing any health insurance company would want is for their overall expenses to drop.”This is not simply a racket or scam, however, but an integrated system of vertical and horizontal monopoly. It is deliberately structured for absence of substitutes, many buyers but most lacking negotiating leverage, price discrimination, and legal protection. And despite the ideological pretense of economic liberalism, since this is a monopoly, participation is by definition not voluntary, nor is exclusion.The private insurance system is the tip of an ice-burg of a system not only of collusion for inflated price-fixing, but parallel strategies from patent monopolization, price kickbacks, and corporate buy-outs. Monopolistic practices reduce treatment options through service rationing and market exclusion. The 2012 buy-out of ventilator manufacturer Newport Medical Instruments by Covidien to remove their simpler and less expensive rival ventilator from the market is a case in point. This is a system that doesn’t necessarily respond to increased investment the way free-market ideology teaches us it does.US HOSPITAL CONSTRUCTION SPENDINGThis enormous increase in debt-financed hospital construction has been paralleled by the closing of small cash-starved rural hospitals with lower profit margins and smaller urban hospitals to engage in real estate speculation. This trend continues to accelerate, even during the Covid outbreak, as shown for the first quarter of 2020 alone.Wait times for service have increased at a time when increased money has gone into hospital and clinic construction, mostly financed on debt that includes junk bonds.During the Covid-19 response in the US, the Trump administration announced that environmental regulations would not be enforced during the crisis. What could that possibly have to do with the pandemic, besides the chronic excuse that ‘business’ needs more money? Answer: The same thing as the country’s weak food safety regulations and weak work safety regulations. In response to the pandemic, the Trump administration’s Department of Transportation has also removed limits on the hours many truck drivers can (be forced to) work. Or as they put it, they would, “provide hours-of-service regulatory relief to commercial vehicle drivers.”What a relief! Clearly, America is over-protected.Those regulations exist within a legal system dependent on civil litigation to enforce the laws that do exist, rather than direct enforcement by the state, as exists in Europe. This creates a legal system subordinated to powerful individuals and entities who can purchase the law and suppress its enforcement, as enforcement is tied to a weak and politically complicit public authority.What this has to do with an effective epidemic response is that, as I said, for most intents and purposes the US does not have a genuine and coherent public health system. It simply isn’t anyone’s job. It is not the private providers’ job and isn’t supposed to be. It isn’t the public authorities’ job, as they are tasked with defending private interests. It is then left to ‘personal responsibility’ and ‘choice’. Choice is a word that neoliberals chant like a mantra, but more perceptive people understand that what is called ‘exercise of choice’ usually is just a right-wing double-talk for exercise of privilege. Even elections are not really choices but exercises in privilege by the most powerful.Times like the Covid-19 pandemic of 2020 reveal how deeply and fundamentally divided and contradictory our societies are, but liberal ideologues can say that looked at from a certain perspective events like these affect us all equally and bring us all together as one. We can choose to rely on our neighbors and families and come together in a common effort. The virus doesn’t discriminate and we’re all in this together. Were it only so, as it is the sentimental imaginations of these people.Yes, looked at from a certain perspective, the perspective of someone privileged. Yes, we are all coming together to funnel trillions to corporations, speculators, and capital markets. Yes, those who have the money and security to prepare for events like this, as they can prepare for major medical events of other kinds, or even retirement, do have a choice and do come together to secure their private, personal interests. Yes, the virus doesn’t discriminate, but people do, and they do in their use and abuse of the pandemic, and in who receives testing and treatment, who gets protected and exposed, and who dies abandoned in their homes.No matter how much is funneled into private interests, aspects of the public interest will be left unattended, or even worsened, by all matters being decided by a competition of winners and losers. Regardless of what course is taken, no universal solution will be implemented, because anything universal would be a right rather than a privilege. Americans never even speak of their social rights, only obliquely of a social “safety net”, for a reason. Unequal and inconsistent treatment and prices seen in American healthcare reflect the parallel lack of equal educational advantages, livable wage job opportunities, affordable housing options, environmental and work safety standards, and legal protection.The Association of American Medical Colleges estimates despite market saturation in many specialties under current conditions in the industry, an overall shortage of over 20,000 doctors in the US in 2017. In addition to that number, there is an added shortfall of 30,000- 95,000 doctors that would be needed immediately in order to equalize healthcare use patterns across race, income and social demographics, insurance coverage, and geography, “in addition to the policy changes and economic considerations needed to improve equity.” Lack of medical insurance was described as a relatively lesser issue among these. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/31/13/3113ee5c-a038-4c16-89af-294a69826650/2019_update_-_the_complexities_of_physician_supply_and_demand_-_projections_from_2017-2032.pdfThe Covid-19 pandemic has brought out the deep and fundamental structural divisions and inequalities determining national responses to the crisis, and demonstrates the misanthropy of the ruling ideology that justifies it.Aside from the fundamental structural change that the US would need to undergo to do what the more advanced countries like China and Korea are doing, Americans would have to undergo an equally fundamental change in their fanatical neoliberal ideology. There is a reason that communist governments have been popular and successful in countries with high rates of infectious diseases that have long gone unattended by their predecessor regimes.Public health, however, is not a communist idea, but a small “d” democratic one, a popular institution. It is therefore an idea opposed by fanatical anti-communists, and by stubborn regimes of entrenched interests, like the current American one, which has proven systematically incapable of improving the lives of the bulk of its own people for more than half a century now despite extreme need.The principle upon which the fight against disease should be based is the creation of a robust body; but not the creation of a robust body by the artistic work of a doctor upon a weak organism; rather, the creation of a robust body with the work of the whole collectivity, upon the entire social collectivity.Someday, therefore, medicine will have to convert itself into a science that serves to prevent disease and orients the public toward carrying out its medical duties. Medicine should only intervene in cases of extreme urgency, to perform surgery or something else which lies outside the skills of the people of the new society we are creating.The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices.From: On Revolutionary Medicine, Ernesto Che GuevaraEven if I were to accept the fantasy that the US has the best health care in the world—a laughably ignorant and subjective claim—that best treatment could only apply to a small group of winners. In American thinking, that is the “best” outcome.In Chinese thinking, the “best” solution may not be the best treatment for a minority of the population that looks like something from a science fiction movie. The solution is important, but access to the solution is important too. The best solution is the one that balances the best outcome with benefit reaching the most people. A solution that is a less Buck Rogers, but still an effective treatment that applies to 99% of the population, is seen as better.Western allopathic medicine objectifies the patient and projects the doctor’s interests and views onto the patient, as a number of studies of racism in western medicine has shown, referring to the abuses of the “medical gaze”. Health care providers in both countries treat patients according to their own treatment goals, not the patients’ goals or any “objective” need. This cultural tendency as to what constitutes the ‘best’ solution will color what subjective judgment providers make.Let the Market sort ’em out.Someone who hasn’t worked in the US healthcare system, let alone during this pandemic as I have (though in my case I am an active observer rather than an interested one), might naively think that American doctors would like to do a more comprehensive job of infection control, but they are victims of the larger healthcare system. This vastly underestimates the violent hostility many doctors and nurses have to administering any tests ‘unnecessary’ to their own needs as healthcare providers, and takes certain reassurances from them too much at face-value. This naivete misunderstands their role integral with an entire system. It also assumes that public health authorities in the US don’t have interests parallel with the dominant social interests, often deferring to the private system.The spiral of infection this anti-testing attitude provokes can lead to misleading complaints by the medical profession. Though doctors may complain that the healthcare system in the US isn’t supporting them as they would like it to, don’t assume you know what they mean by that, or it is necessarily in your interest.And while the liberal mantra of individual choice is invoked whenever the broader interest rears its devil-spawned head crowned with hissing snakes, it is these same people, as Margaret Thatcher famously did, who say, ‘TINA’, There Is No Alternative. Tax cuts starve public services. Regulatory agencies are often administered by the corporate lawyers and executives whom they are supposed to be regulating but instead protect. This means that structures that could provide public interest have been subordinated to a system of specific private interests.Legal roles supporting Dr. ZaiusConsolidation of regulatory agencies in the name of ‘efficiency’ means that agencies have such a broad and disparate set of missions that they can’t effectively perform all the many functions they are assigned; Their broad mission scope creates a vague and complex mechanism for enforcement where regulation is undertaken. And while these choice-loving people hate ‘big government’, they ignore that corporations only exist at all by virtue of charters granted by governments. They say that those governments who abrogate that part of their power to those companies should demand nothing in return, even that those companies pursue their private profit in the broad public interest. Instead, they say, these companies should be left to their ‘choices’. They tell us that where regulation is in order, it should be “self-regulation”.For the American private healthcare system, there is nothing it can do with “mild” cases of Covid-19. “Mild” does not describe the experience of the person with the illness, but the requirements for healthcare provider treatment.Treatment in early stages and while symptoms are less severe, as China did along with quarantine dormitories to deliver that treatment while controlling contagion, simply can’t be translated into American private care terms. In the US, most of these people would fall under the category of, DENIED, not worth the system’s valuable time. Meanwhile, there is simply no institutional place for them to exist in the American neo-liberal ideological and economic structure.This kind of treatment in Wuhan is deemed worthwhile because of a broader concept of value, not strictly a private one.What the American system did instead is to promise to send checks to ‘everybody’ and tell them to stay home for an indeterminate time. It was a questionable promise, already disproven by those who have been excluded from payment, but for the sake of argument: That money could go to certain private individuals to help with their choices, and to provide private treatment, which may include testing IF it is relevant to that personal treatment. But the distribution of cash simply evades the question of the contradiction of a personal strategy against a social problem, such as a public health crisis.Some think that such spending makes us all a closer and healthier big family with common interests. But most of the bailout money will be spent to privilege maintenance of business as usual and the status quo everywhere, including in the healthcare system. So, how can anyone seriously believe that any amount of such money could change anything when that’s what it is prioritized to prevent?Personal emergencies and circumstances will take precedent over public prevention, because that is not a private service. This will inevitably lead to infecting others. No personal treatment regime will be tailored to preventing progression of the illness once, let alone before, it is contracted, unless it relates to that individual’s treatment begun after they became seriously ill.Putting more money into a system that prefers high-cost treatments of serious illness over treatment of a multitude of lower-cost, less-serious early stages of the illness, doesn’t necessarily mean improved outcome. It does, however, while reducing the total number of patients, carry the highest cost per patient treated, obviously by more exclusively and more often treating more highest-cost patients. This is the definition by which many claim that the US has the ‘best’ healthcare in the world.Compare this mapWith this mapThe American system has a toolbox of hammers, which is why it has “wars” over social issues, such as poverty and drugs; It has no such scalpels as a universal system of testing, universal data collection and sharing, comprehensive safety regulation, and targeted isolation that are the cornerstones of an effective contagion response. Where it has such tools, such as the NSA’s data collection, re-purposing them for public access contradicts why they exist. Blunt instruments ensure that the system’s fundamental details are not altered or eliminated.“War Is a Racket. It always has been…one in which the profits are reckoned in dollars and the losses in lives”—Smedley Butler. Fitting caption to Trump, acting as self-proclaimed “war president”, invoking Defense Production Act and authorizing trillions to the oligarchy.Wars are logically fought to defend the existing society, the status quo. War is a means of addressing a question by mobilizing a society rather than by changing a society in any fundamental way. The endless social “wars” are fought as a defense of privilege against whatever that privilege feels may be challenging it. The War on Poverty at the height of the cold war was fought against the threat of a rival system emerging.Just as testing is subordinated to private treatment, so is protective gear. In the US, masks have also been privileged to healthcare professionals, though not to say necessarily available to them. Their public at first was actively discouraged from wanting, much less using, them systematically. American authorities then moved on to encouraging DIY solutions that ignore standardized quality and effectiveness, coordination, and the reason that disposable PPE is disposable. Rather than reducing exposure, or taking responsibility, the American system thinks mostly of reducing liability.By contrast, in China, people in public places wear face masks so they won’t infect others. Americans are acting in ways that do not care about infecting others, as there is no shame in it and little profit in infection control. In fact, a display of defiance is a rejection of potential liability—a cornerstone of business. The western ideal of freedom gives a false sense of liberty that the objective reality of the virus has made impossible, not “big government”; This is something that only privilege can ignore.Thatcherism #1: A person’s first duty is to themselves.Rather than being a problem of individual or collective psychology, this is a matter of a particular psychology, championed by powerful, interested narcissists, that imposes itself onto policy, even in collectivist shame cultures, like Japan.Whatever is going on in society is somehow not real to people with this ideology. Society is something that happens to somebody else, often beneath them, if at all. Hence, they view the pandemic as a hoax or those with public space concerns as paranoid meddlers.We see the sobering implications of this extreme ideology at work in the Covid pandemic. Despite the British NHS being state-operated, it exists within the same ideological and financialized regime. NHS’s public efforts are contradicted and sabotaged by a society where public health emergencies and private emergencies are distinct and separate, and one is exclusively privileged over the other. Predictably, the UK’s response to the pandemic has been among the worst in Europe in terms of infection and mortality rates, as the crisis has been left to be solved by individuals and families in the scope of their private lives, and by statistics.Americans can treat infection as a public order question, but not as a public health issue. That’s because the public is a threat hanging over the privileged, not something they share in.They can lock down the country, but they can’t universally distribute effective face masks, because that is an individual matter to be solved by uncoordinated individuals with unequal standards, no particular professional training, and disparate intentions.Contrast American DIY this with the kind of comprehensive public health crisis response in by Taiwan:Deutsche Welle (DW) English language report on Taiwan’s face-mask strategy.In the American cultural ecology, there simply isn’t any central agency to administer the tests on a massive scale, even on autopsies, and no systemic logic for one to exist or be organized for public use. Even the CDC lacks such a mandate, deferring to local authorities that may not even exist in some places, much less cooperate with other jurisdictions. There would be nothing for a central authority to do with the information, even if they had it.Where data is even collected, there is no comprehensive standard or systematic process that enables data to be combined from local health authorities in a way that we can even get an entirely coherent national picture. ProPublica reports, “the quality and speed of the data coming in varies so much that it can feel like wrangling reports from more than 50 countries.” There’s Been a Spike in People Dying at Home in Several Cities. That…The same ProPublica article says American public health authorities can not even give real time Covid-19 data to the public in April 2020 because of, “thin staffing or antiquated computer systems”. If this is war, America is going to war with the military it has, not the one it needs.What does exist within the American healthcare system is an ecology of service providers and vendors, and an infrastructure that supports that system. To understand that ecology, let’s take a look at the supply chains that support the American healthcare system.Service provider supply-chains can be vague, mysterious, and complicated. That is even more true for health service providers because of safety concerns, standards that can be subjective, a decentralized market, and multiple people within an organization who can be responsible for ordering supplies. Healthcare supply chains contrast with traditionally more integrated and centralized manufacturer supply chains.Manufacturer supply chains tend to be throughput-oriented, while healthcare supply chains tend to lack standardized processes that help overcome bottlenecks and systematically address quality control issues. American private health care systems center on individual doctors, even in large groups, who may have unique preferences in terms of quality and quantity assessed per appointment or procedure.The US is geographically diverse and spread-out. Given that most US healthcare is provided by disparate providers and non-acute centers rather than hospitals, there are few centralized inventories, and no large public stockpile. Disparate providers have different needs based on staffing and local circumstances and infrastructure. There is no standard distribution, quantity, price, or availability, and a plethora of parallel markets.Despite some particularities, this is not entirely unique to the American healthcare system; However, in the US, this highly imperfect, slow responding, and inefficient supply chain system exists in an economic and political regime hostile to regulation, long-term planning, or overall economic coordination. Coordination would smooth out supply, but it would also have the unwanted effect of reducing speculative and market profits from imperfect information, local imbalances and supplier availability, bulk and limited purchase, and market swings. This means that, in the US, there is no structure or motive to meaningfully coordinate and track all raw and finished materials in that supply chain. Materials may be hoarded or encounter production or distribution bottlenecks, but there is no recognized process for resolution or command.On the contrary, the Defense Production Act invoked by President Trump to coordinate the public response has been interpreted to turn this problem on its ear. It was iconically used to attack the site of the first work and food safety regulatory reforms of the 20th century in the US, the meat packing industry. The Trump administration identified supply chain “bottlenecks” as regulatory closing of unsafe work environments in the meat packing industry by state and local authorities. Meanwhile, rather than enforcing high uniform quality control, such as in use of PPE by health workers, policy has been to allow relaxation in standards, resulting in elimination or a multiplication of particular workplace protection regimes, further complicating the market. Complication also enhances profits.The freedom of speculative and other capital to circulate, and prices and supplies to fluctuate unhindered, is a priority to those with commanding positions in the intangible goods economy, which the United States dominates. Bottlenecks in the flow and leveraging of capital, not in production or delivery, are the issue. Or, to be more explicit in what I am saying, there is a direct connection between deregulation, which has been done for reasons of speculative profit, and the demotion or absence of public health and other infrastructures necessary to mount an effective pandemic response.Due to commodities being rapidly resold and arbitrarily repackaged on an international scale countless times a minute, horse meat ended up shuffled into IKEA’s beef lasagna like financial packages were turned into toxic assets in the financial crisis of 2008. Enron made billions before going bankrupt by profiting from the change in value of oil and gas, not the price itself. Such crises only attract lawmaker interest when it threatens to provoke unwanted regulation, which it’s their job to prevent, rather than protecting public health and interest.In the case of surgical masks, the Covid-19 panic led to some withholding of materials and supplies, including finished products. 3M, which manufactures some N95 masks, does not sell them directly to health care providers. Instead, they use distributors who are free to charge whatever they see fit and withhold supplies themselves, or to sell them to other middle-men. This also gives an example of the unnecessarily complicated and vague supply chain management that reduces quality at point of service, and makes supply chains, and products and services, mysterious.To further inflate prices, companies have resisted converting production to much needed medical supplies, such as PPE, because that would reduce their rate of profit on existing stock, which is the reason for hoarding, and reduce profit margins on future sales in an monopoly-established market demand. Any expansion of production must happen within that system of monopoly. What is produced is diverted to the highest profit markets, not the place of greatest need. That includes primary resources, such as cotton used to make masks, that speculators withheld from manufacturers to raise the price. The US Pentagon, with its revolving career door to its contractors, has not had the world’s best record of being an institution that suppresses the corruption and delays that a mysterious and complex process can elicit.Once the Covid-19 pandemic resulted in medical supply shortages, American lawmakers responded with protectionist legislation to protect American medical supply chain vendors from Chinese competition against what they weren’t making and selling. This is the precise opposite of the Chinese response, which was to ease import taxes on pandemic essential supplies for epidemic preventative public health measures until domestic production could catch up.This is based on two distinct ideas of economy. The Chinese idea of economy, having been influenced by socialism and their specific culture, sees economy as a collective body as well as an arena of personal profit. The American idea of economy is strictly one of personal profit, dismissing all else as “inefficiency”.The American president delegated policy-setting for invocation of the Defense Production Act to people like his chief China advisor, trade-warrior Peter Navarro—a man without expertise either about China nor in public health and infectious disease control. The intersection of the US pandemic response with the trade war against China is not arbitrary nor the result of what Chinese responsibility for this pandemic may or may not exist.Monopolies rely on controlled production and closed markets. Markets are controlled through some level of production as well as exclusion. The “liberation movement” pushing to maintain production, even in the face of drastically reduced demand and rising inventories, has no better example than the Covid-induced oil glut. That came about as a result of nations refusing to reduce production in order to maintain their existing market share at a time of plummeting consumption.Oil tanker waiting off-shore with nowhere to put its cargo. Crude oil prices temporarily entered negative territory in 2020, when inventories from over-production was set to exceed storage capacity. Though exacerbated by the Covid-19 panic, over-production of oil is a long-standing issue.Under supply-side economics, production and consumption have lost any direct connection, with production for its own sake and for market dominance, unrelated to economic coherency. Instead, production is finance capital-driven and directed toward wealth concentration and cost reduction. Ideally, the suppression of wages is compensated with exports expanding markets by undercutting rival nations’ wage costs. Under pandemic conditions, this model is in chaos. The auto industry is pushing for an unregulated return to work and unregulated market, in order to maximize profits, despite rounds of factory start-up and shut-down from outbreaks, supplier bottlenecks causing backlogs alongside excess inventories, and lack of available stock of specific options in a production model based on high consumer-specific variants.While war-time production commands were invoked by President Trump, there was no public health authority to participate in prioritization and standards to direct and coordinate production. Instead of a public health or infectious disease experts, efforts are overseen by interested parties and political appointees. Those officials act in continuation of overriding policies and existing business relationships, not necessarily in the interest of fighting the pandemic itself.This kind of direction of efforts, where the pandemic itself was a secondary consideration, has even meant forced prioritization of some things, such as chloroquine, that has no proven value against Covid-19; That is according to President Trump’s own scientific experts on his pandemic task force and a director of the agency overseeing vaccine development efforts.The arbitrary privileging of chloroquine purchases, production, and even export for Covid-19 treatment has diverted supplies of the drug away from patients with conditions the drug is proven to help. What this can be thought to have accomplished would only occur to a “businessman”, like Trump or Navarro: They are fulfilling the needs of a targeted market demand that they have themselves created or that may not even objectively exist, regardless of the broader implications or its impact on overall human needs.Why specifically chloroquine as the arbitrary choice of expensive patent snake-oil cures for Covid-19? According to one article, The Covid-19 "Manhattan Project" and its Ties to the CIA : “Novartis, working on a hydroxychloroquine treatment for the virus, paid (Donald Trump’s recently convicted lawyer Michael) Cohen more than $1 million for “policy insights” after Trump’s election in 2016. After their relationship was leaked, Novartis apologized. Later, a congressional investigation revealed the real objective of Novartis, the company: “explicitly sought to hire Michael Cohen to provide the company ‘access to key policymakers’ in the Trump administration…”Policy in implementing the DPA is to “negotiate” price and quality through the market, not to regulate it; The complex decentralized medical supply chain in the US makes such command implementation both legally and technically more complicated, and all the more in need of coordination on the highest level, including international.It has been said that the cure is worse than the Covid-19 disease. Perhaps they are, but this is only said to evade that prevention, through a rapid, coherent, regulated public health response would have avoided both, as it has in Taiwan. There, the regulatory infrastructure was already in place, and will remain so.Safe work, production, and product regulations would require vastly increased staffing, specialization, and litigation by the Occupational Safety and Health Administration, among others. Instead, a regulatory regime is being negotiated by public pressure and market operations, including illegal reopening. It is being negotiated by lawyers and business people rather than set by public health experts.Pandemic-response regulation would strengthen the role of unions, who have a leading role in complaint-driven investigations. It would strengthen direct spot policing authority to inspect businesses for violations, such as exists in Taiwan. It would be:Leaving regulation of the pandemic to private companies, and their own profit and security driven priorities, has demonstrated itself to result in companies hiding outbreaks and whitewashing compliance through their control of information. This is done to evade employee opposition and imposition of public regulation. Only that kind of enforced state regulation would provide effective and supply-chain consistent measures to better ensure consumer and employee safety, as well as integrate into a coherent social response necessary to contain contagion.Employee temperature check at Amazon, which has not prevented infectious outbreaks at their facilities, nor has it contributed to coordinated efforts to control the pandemic. It has fragmented them. Policy under the Trump Administration has been toward systematic fragmentation of response to evade blame, and to disorient public response.Placing testing in the hands of private doctors and hospitals is just as fundamental a conflict of interests. American private care is about doctors rationing services to individuals to contain costs and maximize profits, while providing testing to serve their treatment regimes and profits. The public interest is not in their scope. Asking hospitals and doctors to implement a regime of universal testing doesn’t actually make any sense in the context of their logic and role. There is nothing THEY can do with the data from those results, because they don’t test for data points.Test results would need to be managed by a public health system that doesn’t exist in America, that nobody is responsible for creating, and that the existing system will continue fighting furiously to block, sabotage, undermine, prevent, and exploit any opportunity to achieve its opposite.That isn’t to say the American system can’t respond at all to infectious outbreaks. The response to hepatitis shows it can, but only within existing frameworks. In the case of hepatitis, success in reducing the overall incidence of the disease in the US, even while local outbreaks continue, has come from public vaccination campaigns. This means individuals receive injections, even provided by public nurses and clinics.In the case of an infectious disease that doesn’t have the private treatment option of vaccination, the system doesn’t have many effective solution options. Despite success with reducing hepatitis, the increases in lyme and other vector-borne diseases in the US demonstrates the systemic indifference or hostility to anything that doesn’t fall within the treatment goals and methods of the existing healthcare infrastructure.Even in the case of vaccination, vaccination records are often discarded, though some states have recently been developing a limited registry. However, since the providers have no obligation to keep the records, and public authorities have no mandate to keep records either, responses tend to be incidental and uncoordinated. The lack of organization, as well as a lack of international coordination, make it difficult to martial a response when there isn’t a vaccine manufacturer and/or major stake-holder to lobby for it.President Trump has pursued a deliberate policy of local entities creating their own infection control regimes rather than the federal government, including establishing a presidential task force that severed and further fragmented existing national emergency response networks. Ineffective, but in-line with pre-existing policy and resistance to taking any action that would harm corporate profits and deregulation. One of Trump’s first actions was to initiate a travel ban, which many experts contend is an ineffective strategy, but aligned with his existing hermetic and xenophobic policies.His America-first policies see everyone as a competitor. In April, 2020, he moved to cut off the World Health Organization’s funding in a competition with its authority, calling its response too, “Chinese”. Ironically, WHO’s failings in the Covid-19 crisis, which are real, may be the product of WHO’s lack of independent enforcement authority over governments and lack of American interest in such institutions. This made WHO weak to Chinese pressure and influence, as they tried to coax more information from China without alienating them. In another irony, equally in line with American de-regulatory policy, cutting WHO funding will do nothing to alter Chinese policy, but it will hinder efforts by poorer, smaller nations, estimated to be half of 182 countries surveyed by the IMF, who lack their own resources that can as effectively oversee pandemic efforts. Meanwhile, lack of complete information sharing mean that every interested party must endlessly duplicate each other’s research efforts if only just to insure having all the relevant detail, costing time and wasting limited resources on counter-productive competition.Of course, sidelining WHO also supports American efforts to control market concentration. One example is how this serves US attempts at domination of vaccine development, which is subordinated to the American healthcare monopoly system. WHO’s organizational logic would potentially support vaccine development and administration outside this closed system. That has the potential to allow outside interests to invade the American market by diversifying sources. Such a development would potentially abrogate intended American domination of global markets.Apparently, those supporting this course of action against the Chinese virus would like a more American response; As if this is a national, rather than a human, problem, or as if the problem is governmental and foreign“interference” rather than the objective reality making state intervention and international coordination necessary.Listening to the experts is never enough and isn’t a solution in itself. As with Global Warming, some have advocated “listening to the science”; However, science can only tell us about the disease, not how to implement a response to it. That’s a political rather than a purely technical decision that can be left to engineers and markets to sort out. When left to the experts, those decisions and strategies are left to the experts’ bureaucratic interests and social biases. A xenophobic nationalist course of action simply contributes to entrenched national interests dominating that nation’s response, and in doing so obstructs what may be the most appropriate response to the situation. One of the first principles of managing infectious disease is that they are specific, and have specific requirements.As Prof. Terry Lum told a committee of the UK parliament investigating that country’s high nursing home death rate compared to Hong Kong’s, the UK relied on its own past experience and the institutional logic that evolved from experience with flu epidemics, while also conforming to a strictly private solution within existing structural frameworks. In the UK, and in the US, nursing homes are vulnerable due to the casualization of health workers employed at multiple locations, and lack of community isolation facilities as a contagion firewall. Instead, every individual nursing home requires their own on-site containment wards, which is a practical impossibility.Countries that experienced the SARS and MERS outbreaks may have developed organizational processes and structures more appropriate to Covid-19. The American rejection of international expertise, in favor of its interested domestic experts, means America will not learn from foreign experience; Instead, as with each nursing home, Americans will be required to re-invent the wheel under conditions that resist change inconsistent with existing structures and practices, ensuring that responses permanently lag behind developments. Without structures for national and international coordination, lessons, when learned, are learned too late and when ignored, serve only the entrenched interests at the expense of the public. Meanwhile, the lack of shared resources results in weak links that promote outbreaks that will spread.One group of experts, Scientists to Stop Covid-19, is led by self-styled “venture capitalist” Dr. Tom Cahill, and includes such notables as biotech and pharmaceutical philanthropist Michael Milken, (pictured above as young hot-shot junk bond promoter) implicated by Ivan Boesky for racketeering and securities fraud and pardoned by Donald Trump on February 18, 2020. Another member of the group is Peter Thiel, whose philanthropy goes beyond medical solutions to include seasteading, literally creating off-shore private capital havens beyond the laws of any nation. He justifies himself through the intellectual pretensions of fascism expressed in the “theories” of Carl Schmitt. Thiel has also made news in threatening to move operations he controls out of California because of what he calls California’s over-regulation of the pandemic. The Wall Street Journal reported that “the FDA and the Department of Veterans Affairs (VA) have implemented some of their suggestions, namely relaxing drug manufacturer regulations and requirements for potential coronavirus treatment drugs.” Actions by the members of this group revealed a significant intersection of interests: Not only have they vastly profited by benefit from, and insider knowledge of, new laws, regulatory changes, government purchases, and treatments though; They also have also used advanced knowledge of, and participation in formulation of, trade war measures against China to reap stock and bond market windfalls.In the US, limited public health authorities, which are often local, also often have limited authority to direct jurisdictions as to what steps to take. Instead, it is often experts in non-public health related areas, under no central coordination or authority, to make decisions when and how it suits them. Agencies may purchase vaccines, but that doesn’t necessarily connect with IP, storage, distribution, and administration of the vaccines. Each step is uncoordinated and ad hoc, leaving no one watching the watchers. This not only causes slow and haphazard response, but quality control, corruption, and competition issues. During the Covid-19 crisis in the US, the price of ventilators has multiplied as different states, jurisdictions, and companies compete to purchase those available.New York Governor Cuomo speaks about ventilator purchase competition.I could go on about patents and patent monopolies, healthcare industry kickbacks to doctors, financing an entire economy or individual sectors such as healthcare through unsupportable debt bubbles, and tax policies that encourage charges so excessive that they can’t be paid, with the resulting secondary market of the selling of unpayable consumer debts being a leading source of hospital profits. I could also talk more about trade wars and tariffs, and data ownership issues in sharing pandemic related data with the public having implications that stretch to Google, Facebook, and other data barons. I could even go into tax regulations and subsidies that support existing manufactures and services (that is lobbyists for entrenched interests) over creating new ones, or measures that promote specific American colonization schemes, such as genetic engineering. This answer is only the tip of a very large and largely ignored, unexplained, or neoliberal-splained ice-burg.Administering and overseeing this glacier are public officials who live their lives in a bubble of lobbyists; They are protected by a public who, like their public officials, have their narcissism catered to, while they live in a self-absorbed bubble, indifferent or hostile to anything outside their private scope.It may even be claimed that if you don’t have a solution, then there isn’t a problem. Since the American pandemic response can not be repaired within the current parameters of its healthcare system, they tell us there is nothing to be done except continued expansion of deregulation, austerity, and liberal economics, while waiting for ‘herd immunity’ to kick in.However, to put it more succinctly, you just can’t get there from here.

In 1970, a Zambia-based nun named Sister Mary Jucunda wrote to Dr. Ernst Stuhlinger, then-associate director of science at NASA's Marshall Space Flight Center, in response to his ongoing research into a piloted mission toMars. Specifically, she asked how he could suggest spending billions of dollars on such a project at a time when so many children were starving on Earth.Stuhlinger soon sent the following letter of explanation to Sister Jucunda, along with a copy of "Earthrise," the iconic photograph of Earth taken in 1968 by astronaut William Anders, from the Moon (also embedded in the transcript). His thoughtful reply was later published by NASA, and titled, "Why Explore Space?"(Source: Roger Launius, via Gavin Williams; Photo above: The surface of Mars, taken by Curiosity today, August 6th, 2012. Via NASA.)May 6, 1970Dear Sister Mary Jucunda:Your letter was one of many which are reaching me every day, but it has touched me more deeply than all the others because it came so much from the depths of a searching mind and a compassionate heart. I will try to answer your question as best as I possibly can.First, however, I would like to express my great admiration for you, and for all your many brave sisters, because you are dedicating your lives to the noblest cause of man: help for his fellowmen who are in need.You asked in your letter how I could suggest the expenditures of billions of dollars for a voyage to Mars, at a time when many children on this Earth are starving to death. I know that you do not expect an answer such as "Oh, I did not know that there are children dying from hunger, but from now on I will desist from any kind of space research until mankind has solved that problem!" In fact, I have known of famined children long before I knew that a voyage to the planet Mars is technically feasible. However, I believe, like many of my friends, that travelling to the Moon and eventually to Mars and to other planets is a venture which we should undertake now, and I even believe that this project, in the long run, will contribute more to the solution of these grave problems we are facing here on Earth than many other potential projects of help which are debated and discussed year after year, and which are so extremely slow in yielding tangible results.Before trying to describe in more detail how our space program is contributing to the solution of our Earthly problems, I would like to relate briefly a supposedly true story, which may help support the argument. About 400 years ago, there lived a count in a small town in Germany. He was one of the benign counts, and he gave a large part of his income to the poor in his town. This was much appreciated, because poverty was abundant during medieval times, and there were epidemics of the plague which ravaged the country frequently. One day, the count met a strange man. He had a workbench and little laboratory in his house, and he labored hard during the daytime so that he could afford a few hours every evening to work in his laboratory. He ground small lenses from pieces of glass; he mounted the lenses in tubes, and he used these gadgets to look at very small objects. The count was particularly fascinated by the tiny creatures that could be observed with the strong magnification, and which he had never seen before. He invited the man to move with his laboratory to the castle, to become a member of the count's household, and to devote henceforth all his time to the development and perfection of his optical gadgets as a special employee of the count.The townspeople, however, became angry when they realized that the count was wasting his money, as they thought, on a stunt without purpose. "We are suffering from this plague," they said, "while he is paying that man for a useless hobby!" But the count remained firm. "I give you as much as I can afford," he said, "but I will also support this man and his work, because I know that someday something will come out of it!"Indeed, something very good came out of this work, and also out of similar work done by others at other places: the microscope. It is well known that the microscope has contributed more than any other invention to the progress of medicine, and that the elimination of the plague and many other contagious diseases from most parts of the world is largely a result of studies which the microscope made possible.The count, by retaining some of his spending money for research and discovery, contributed far more to the relief of human suffering than he could have contributed by giving all he could possibly spare to his plague-ridden community.The situation which we are facing today is similar in many respects. The President of the United States is spending about 200 billion dollars in his yearly budget. This money goes to health, education, welfare, urban renewal, highways, transportation, foreign aid, defense, conservation, science, agriculture and many installations inside and outside the country. About 1.6 percent of this national budget was allocated to space exploration this year. The space program includes Project Apollo, and many other smaller projects in space physics, space astronomy, space biology, planetary projects, Earth resources projects, and space engineering. To make this expenditure for the space program possible, the average American taxpayer with 10,000 dollars income per year is paying about 30 tax dollars for space. The rest of his income, 9,970 dollars, remains for his subsistence, his recreation, his savings, his other taxes, and all his other expenditures.You will probably ask now: "Why don't you take 5 or 3 or 1 dollar out of the 30 space dollars which the average American taxpayer is paying, and send these dollars to the hungry children?" To answer this question, I have to explain briefly how the economy of this country works. The situation is very similar in other countries. The government consists of a number of departments (Interior, Justice, Health, Education and Welfare, Transportation, Defense, and others) and the bureaus (National Science Foundation, National Aeronautics and Space Administration, and others). All of them prepare their yearly budgets according to their assigned missions, and each of them must defend its budget against extremely severe screening by congressional committees, and against heavy pressure for economy from the Bureau of the Budget and the President. When the funds are finally appropriated by Congress, they can be spent only for the line items specified and approved in the budget.The budget of the National Aeronautics and Space Administration, naturally, can contain only items directly related to aeronautics and space. If this budget were not approved by Congress, the funds proposed for it would not be available for something else; they would simply not be levied from the taxpayer, unless one of the other budgets had obtained approval for a specific increase which would then absorb the funds not spent for space. You realize from this brief discourse that support for hungry children, or rather a support in addition to what the United States is already contributing to this very worthy cause in the form of foreign aid, can be obtained only if the appropriate department submits a budget line item for this purpose, and if this line item is then approved by Congress.You may ask now whether I personally would be in favor of such a move by our government. My answer is an emphatic yes. Indeed, I would not mind at all if my annual taxes were increased by a number of dollars for the purpose of feeding hungry children, wherever they may live.I know that all of my friends feel the same way. However, we could not bring such a program to life merely by desisting from making plans for voyages to Mars. On the contrary, I even believe that by working for the space program I can make some contribution to the relief and eventual solution of such grave problems as poverty and hunger on Earth. Basic to the hunger problem are two functions: the production of food and the distribution of food. Food production by agriculture, cattle ranching, ocean fishing and other large-scale operations is efficient in some parts of the world, but drastically deficient in many others. For example, large areas of land could be utilized far better if efficient methods of watershed control, fertilizer use, weather forecasting, fertility assessment, plantation programming, field selection, planting habits, timing of cultivation, crop survey and harvest planning were applied.The best tool for the improvement of all these functions, undoubtedly, is the artificial Earth satellite. Circling the globe at a high altitude, it can screen wide areas of land within a short time; it can observe and measure a large variety of factors indicating the status and condition of crops, soil, droughts, rainfall, snow cover, etc., and it can radio this information to ground stations for appropriate use. It has been estimated that even a modest system of Earth satellites equipped with Earth resources, sensors, working within a program for worldwide agricultural improvements, will increase the yearly crops by an equivalent of many billions of dollars.The distribution of the food to the needy is a completely different problem. The question is not so much one of shipping volume, it is one of international cooperation. The ruler of a small nation may feel very uneasy about the prospect of having large quantities of food shipped into his country by a large nation, simply because he fears that along with the food there may also be an import of influence and foreign power. Efficient relief from hunger, I am afraid, will not come before the boundaries between nations have become less divisive than they are today. I do not believe that space flight will accomplish this miracle over night. However, the space program is certainly among the most promising and powerful agents working in this direction.Let me only remind you of the recent near-tragedy of Apollo 13. When the time of the crucial reentry of the astronauts approached, the Soviet Union discontinued all Russian radio transmissions in the frequency bands used by the Apollo Project in order to avoid any possible interference, and Russian ships stationed themselves in the Pacific and the Atlantic Oceans in case an emergency rescue would become necessary. Had the astronaut capsule touched down near a Russian ship, the Russians would undoubtedly have expended as much care and effort in their rescue as if Russian cosmonauts had returned from a space trip. If Russian space travelers should ever be in a similar emergency situation, Americans would do the same without any doubt.Higher food production through survey and assessment from orbit, and better food distribution through improved international relations, are only two examples of how profoundly the space program will impact life on Earth. I would like to quote two other examples: stimulation of technological development, and generation of scientific knowledge.The requirements for high precision and for extreme reliability which must be imposed upon the components of a moon-travelling spacecraft are entirely unprecedented in the history of engineering. The development of systems which meet these severe requirements has provided us a unique opportunity to find new material and methods, to invent better technical systems, to manufacturing procedures, to lengthen the lifetimes of instruments, and even to discover new laws of nature.All this newly acquired technical knowledge is also available for application to Earth-bound technologies. Every year, about a thousand technical innovations generated in the space program find their ways into our Earthly technology where they lead to better kitchen appliances and farm equipment, better sewing machines and radios, better ships and airplanes, better weather forecasting and storm warning, better communications, better medical instruments, better utensils and tools for everyday life. Presumably, you will ask now why we must develop first a life support system for our moon-travelling astronauts, before we can build a remote-reading sensor system for heart patients. The answer is simple: significant progress in the solutions of technical problems is frequently made not by a direct approach, but by first setting a goal of high challenge which offers a strong motivation for innovative work, which fires the imagination and spurs men to expend their best efforts, and which acts as a catalyst by including chains of other reactions.Spaceflight without any doubt is playing exactly this role. The voyage to Mars will certainly not be a direct source of food for the hungry. However, it will lead to so many new technologies and capabilities that the spin-offs from this project alone will be worth many times the cost of its implementation.Besides the need for new technologies, there is a continuing great need for new basic knowledge in the sciences if we wish to improve the conditions of human life on Earth. We need more knowledge in physics and chemistry, in biology and physiology, and very particularly in medicine to cope with all these problems which threaten man's life: hunger, disease, contamination of food and water, pollution of the environment.We need more young men and women who choose science as a career and we need better support for those scientists who have the talent and the determination to engage in fruitful research work. Challenging research objectives must be available, and sufficient support for research projects must be provided. Again, the space program with its wonderful opportunities to engage in truly magnificent research studies of moons and planets, of physics and astronomy, of biology and medicine is an almost ideal catalyst which induces the reaction between the motivation for scientific work, opportunities to observe exciting phenomena of nature, and material support needed to carry out the research effort.Among all the activities which are directed, controlled, and funded by the American government, the space program is certainly the most visible and probably the most debated activity, although it consumes only 1.6 percent of the total national budget, and 3 per mille (less than one-third of 1 percent) of the gross national product. As a stimulant and catalyst for the development of new technologies, and for research in the basic sciences, it is unparalleled by any other activity. In this respect, we may even say that the space program is taking over a function which for three or four thousand years has been the sad prerogative of wars.How much human suffering can be avoided if nations, instead of competing with their bomb-dropping fleets of airplanes and rockets, compete with their moon-travelling space ships! This competition is full of promise for brilliant victories, but it leaves no room for the bitter fate of the vanquished, which breeds nothing but revenge and new wars.Although our space program seems to lead us away from our Earth and out toward the moon, the sun, the planets, and the stars, I believe that none of these celestial objects will find as much attention and study by space scientists as our Earth. It will become a better Earth, not only because of all the new technological and scientific knowledge which we will apply to the betterment of life, but also because we are developing a far deeper appreciation of our Earth, of life, and of man.The photograph which I enclose with this letter shows a view of our Earth as seen from Apollo 8 when it orbited the moon at Christmas, 1968. Of all the many wonderful results of the space program so far, this picture may be the most important one. It opened our eyes to the fact that our Earth is a beautiful and most precious island in an unlimited void, and that there is no other place for us to live but the thin surface layer of our planet, bordered by the bleak nothingness of space. Never before did so many people recognize how limited our Earth really is, and how perilous it would be to tamper with its ecological balance. Ever since this picture was first published, voices have become louder and louder warning of the grave problems that confront man in our times: pollution, hunger, poverty, urban living, food production, water control, overpopulation. It is certainly not by accident that we begin to see the tremendous tasks waiting for us at a time when the young space age has provided us the first good look at our own planet.Very fortunately though, the space age not only holds out a mirror in which we can see ourselves, it also provides us with the technologies, the challenge, the motivation, and even with the optimism to attack these tasks with confidence. What we learn in our space program, I believe, is fully supporting what Albert Schweitzer had in mind when he said: "I am looking at the future with concern, but with good hope."My very best wishes will always be with you, and with your children.Very sincerely yours,Ernst StuhlingerAssociate Director for Science

I can't add to much to Peter Gribble's answer, but I will tie it explicitly into health research and outcomes.Bisexual denial and erasure:encourages bisexual persons or other people with non-binary sexualities not to seek medical care nor get tested due to poor treatment in the health care systemis a part of the poor ability of bisexual persons to access support systems, which are often designed for monosexual participantsleads to under- or misrepresentation of bisexuality or other minority sexualities in research or epidemiologyleads to poor outreach among bisexual populations for the purposes of public healthis a contributing factor to a variety of poorer mental health outcomes in bisexual or other communities with minority sexualitiesis a contributing factor in ignoring bisexual or minority sexual behaviors in safer sex literature (for instance, ignoring anal-to-vaginal sex in literature aimed at men)contributes to the under-funding or lack of funding for outreach in populations with a minority sexualitycontributes to a reluctance to seek legal aid when domestic or other forms of intimate partner violence are experiencedcontributes to a reluctance to seek legal aid when a hate crime has been committedis a contributing factor in the "homogenization" of the LGBT community (the popular presumption that LGBT people are white, wealthy, and/or politically powerful)is associated with an increased likelihood of substance abuse, presumably as a coping mechanism for stress (~30% of the sample in the included study)is associated with an increased risk of suicidal ideation (two to three times higher in the included studies)Typecasting:encourages the public perception that persons with more fluid sexuality are an important disease vector for the transmission of STI causing other vectors to be ignored in research on public healthencourages the public perception that bisexual persons are deliberately involved in the spread of STI among the populationencourages riskier behavior in populations with minority sexualityencourages the public to associate minority sexualities with crime, deviance, and/or other undesirable qualitiesis a contributing factor to ignoring bisexuality and minority sexualities in women (male bisexuality was a research focus for quite some time because bisexual men were assumed to be responsible for HIV infections in straight populations)is a part of relationship problems that may contribute to mental health issues (the assumption that people with fluid sexualities are also liars and unfaithful)is divisive of the political and social power needed by LGBT communities (since it alienates an unknown amount of it)And finally, bisexual persons are more likely to have exposure to intimate partner violence, child abuse, and housing adversity (homelessness or insecure housing) than straight people, and more likely to experience intimate partner violence than gay men or lesbians. (Page on nih.gov)As a personal comment, I've spent many years feeling uncomfortable when talking to doctors because of the reactions of health care professionals to my answers when I talk about my sex life. Until very recently, answering that you have had both male and female partners caused some nastiness at the doctor's office (the refusal to offer preventative care, the presumption that I was infected with an STI*, rude behavior**, etc).I've also been uncomfortable discussing it in general with mental healthcare providers for the same reasons--because it impacts the quality of medical and mental health care I receive, especially where it pertains to options offered me, information offered me, and the behavior of people working in those fields.While I happen to be the kind of person who would actually go to the library or google and research whether or not a particular activity causes risk, the fact that I have to do it for myself is emblematic of a problem. Just because I can do that research doesn't mean everyone can, and if education is left up to individuals and the consequences are serious, the public health implications are equally dire.Bisexuality also was used as a a political tool against LGBT rights. I don't think people remember how bad the AIDS crisis was--if not for activism, LGBT people with AIDS and/or simply those needing health care would be ignored or allowed to die, which was Regan's policy on the whole damn thing in the late eighties and early nineties. Feel free to google the pictures of people dying in hospitals while the US government ignored and then were very slow to approve any sort of treatment for HIV/AIDS. They died because of the refusal to allow minority sexualities to be considered as worth outreach and not as disease vectors, when they were discussed at all.*** The amount of misinformation or lack of safety information that targets populations with minority sexualities is still killing people, especially among trans populations.Source Material:Barker, Meg and Darren Longridge (2008). "Bisexuality: working with a silenced sexuality. Page on open.ac.ukFinneran, Catherine and Rob Stephenson (2013) "Intimate Partner Violence Among Men who Have Sex with Men: A Systematic Review. Page on nih.govFinneran, Catherine and Rob Stephenson (2013) "Gay and Bisexual Men's Perceptions of Police Helpfulness in Response to Male-Male Intimate Partner Violence. Gay and Bisexual Men's Perceptions of Police Helpfulness in Response to Male-Male Intimate Partner ViolenceFish, Julie. (2007) "Navigating Queer Street: Researching the Intersections of Lesbian, Gay, Bisexual and Trans (LGBT) Identities in Health Research. Page on socresonline.org.ukKertzner, Robert M., Ilan H. Meyer, David M. Frost and Micheal J. Stirratt (2010) "Social and Psychological Well-Being in Lesbians, Gay Men, and Bisexuals: The Effects of Race, Gender, Age and Sexual Identity. Page on nih.govKing, M. et al (2008) "A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people." A systematic review of mental disorder, suicide, and deliberate sel...Lee, Jieha and Hyeouk Chris Hahm (2012) "HIV Risk, Substance Use, and Suicidal Behaviors among Asian American Lesbian and Bisexual Women." Page on nih.govLogie, Carmen et al (2012) "'We Don't Exist': a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada." Journal of the International AIDS SocietyMcLaughlin, Katie A. et al (2012) "Disproportionate Exposure to Early-Life Adversity and Sexual Orientation Disparities in Psychiatric Morbidity." Page on nih.govMule, Nick J et al (2009) "Promoting LGBT health and wellbeing through inclusive policy development." Promoting LGBT health and wellbeing through inclusive policy developmentNamaste, Vivian et al (2007) "HIV and STD Prevention Needs of Bisexual Women: Results from Projet Polyvalence. Page on www.cjc-online.caRoss, Lori et al (2014) "Mental Health and Substance Use among Bisexual Youth and Non-Youth in Ontario, Canada. Mental Health and Substance Use among Bisexual Youth and Non-Youth in Ontario, CanadaSandfort, Theo G. M. and Brian Dodge (2008) "'...And Then There was the Down Low': Introduction to Black and Latino Male Bisexualities." Page on nih.govScrimshaw, Eric W., Karolynn Siegel, Martin J. Dowling, Jr. and Jeffery Parsons (2013) "Disclosure and Concealment of Sexual Orientation and the Mental Health of Non-Gay-Identified, Behaviorally-Bisexual Men." Page on nih.govYoshino, Kenji (2000) "The epistemic contract of bisexual erasure" Page on kenjiyoshino.comYoung, Rebecca and Illan H. Meyer (2005) "The Trouble With "MSM" and "WSW": Erasure of the Sexual-Minority Person in Public Health Discourse. Page on nih.gov___________________* I'm very, very careful, but I've had the experience of being told I needed testing every month or had several of the same tests run on me because anyone who is willing to sleep with men and women MUST be infected with something. I've also had medical professionals act like they didn't want to touch me (in the 1990s) when they found out I am not monosexual nor straight. And then there's the faces and the whole "being judged" thing.Who doesn't love a sneering lecture on what a filthy--sorry, risky--person you are delivered by your doctor?** Including some very painful GYN exams from people who didn't want to touch me and made it very clear that they were disgusted by doing so by being rough.This whole "acceptance" thing is recent.*** If I seem pissed, it's because I knew a few people who contracted HIV/AIDS and were essentially treated like pariahs in the 1990s, and whose deaths were... if not encouraged, then certainly seen as an eventuality caused by their orientation.Or to put it another way, they were told they were going to die because they were gay and all gay people were going to get AIDS/HIV and die (not to mention the whole "it's god's punishment" thing, which used to be pretty popular. See: the right wing party platform since the 1980s.)One of the saddest conversations I've ever had was with a gay man who lived several doors down from me around 1993, who had stopped bothering to take his medication because he was going to die anyway, and couldn't afford to take it. And no, the funding for the HIV/AIDS drug cocktail is not always easy to get, nor was it particularly good in the early 1990s.We sat down and got drunk one night, and he talked about how the doctors treated him. Let me put it this way: the medical system can make a big difference in your willingness to live based on how they treat you when you come in for care. They didn't want to touch him, his family wouldn't talk to him, and he had no one at home.He was told there was no hope both by medical professionals and by society, so he had no hope.Because someone should remember him, his first name was Kenny. His last name is nobody's business. He's dead now.