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COVID Contention

COVID causing a Global economic downturn now, pushing 60 million people into poverty and risking a world war due to rising nationalism

Reinhart, September/October 2020, CARMEN REINHART is Minos A. Zombanakis Professor of the International Financial System at the Harvard Kennedy School. Subsequent to the completion of this article, she was named Chief Economist at the World Bank.VINCENT REINHART is Chief Economist and Macro Strategist at Mellon, The Pandemic Depression, Foreign Affairs, https://www.foreignaffairs.com/articles/united-states/2020-08-06/coronavirus-depression-global-economy

The COVID-19 pandemic poses a once-in-a-generation threat to the world’s population. Although this is not the first disease outbreak to spread around the globe, it is the first one that governments have so fiercely combated. Mitigation efforts—including lockdowns and travel bans—have attempted to slow the rate of infections to conserve available medical resources. To fund these and other public health measures, governments around the world have deployed economic firepower on a scale rarely seen before. Although dubbed a “global financial crisis,” the downturn that began in 2008 was largely a banking crisis in 11 advanced economies. Supported by double-digit growth in China, high commodity prices, and lean balance sheets, emerging markets proved quite resilient to the turmoil of the last global crisis. The current economic slowdown is different. The shared nature of this shock—the novel coronavirus does not respect national borders—has put a larger proportion of the global community in recession than at any other time since the Great Depression. As a result, the recovery will not be as robust or rapid as the downturn. And ultimately, the fiscal and monetary policies used to combat the contraction will mitigate, rather than eliminate, the economic losses, leaving an extended stretch of time before the global economy claws back to where it was at the start of 2020. The pandemic has created a massive economic contraction that will be followed by a financial crisis in many parts of the globe, as nonperforming corporate loans accumulate alongside bankruptcies. Sovereign defaults in the developing world are also poised to spike. This crisis will follow a path similar to the one the last crisis took, except worse, commensurate with the scale and scope of the collapse in global economic activity. And the crisis will hit lower-income households and countries harder than their wealthier counterparts. Indeed, the World Bank estimates that as many as 60 million people globally will be pushed into extreme poverty as a result of the pandemic. The global economy can be expected to run differently as a result, as balance sheets in many countries slip deeper into the red and the once inexorable march of globalization grinds to a halt. ALL ENGINES DOW In its most recent analysis, the World Bank predicted that the global economy will shrink by 5.2 percent in 2020. The U.S. Bureau of Labor Statistics recently posted the worst monthly unemployment figures in the 72 years for which the agency has data on record. Most analyses project that the U.S. unemployment rate will remain near the double-digit mark through the middle of next year. And the Bank of England has warned that this year the United Kingdom will face its steepest decline in output since 1706. This situation is so dire that it deserves to be called a “depression”—a pandemic depression. Epidemiologists consider the coronavirus that causes COVID-19 to be novel; it follows, then, that its spread has elicited new reactions from public and private actors alike. The consensus approach to slowing its spread involves keeping workers away from their livelihoods and shoppers away from marketplaces. Assuming that there are no second or third waves of the kind that characterized the Spanish influenza pandemic of 1918–19, this pandemic will follow an inverted V-shaped curve of rising and then falling infections and deaths. But even if this scenario comes to pass, COVID-19 will likely linger in some places around the world. So far, the incidence of the disease has not been synchronous. The number of new cases decreased first in China and other parts of Asia, then in Europe, and then much more gradually in parts of the United States (before beginning to rise again in others). At the same time, COVID-19 hot spots have cropped up in places as distinct as Brazil, India, and Russia. In this crisis, economic turmoil follows closely on the disease. This two-pronged assault has left a deep scar on global economic activity. Some important economies are now reopening, a fact reflected in the improving business conditions across Asia and Europe and in a turnaround in the U.S. labor market. That said, this rebound should not be confused with a recovery. In all of the worst financial crises since the mid-nineteenth century, it took an average of eight years for per capita GDP to return to the pre-crisis level. (The median was seven years.) With historic levels of fiscal and monetary stimulus, one might expect that the United States will fare better. But most countries do not have the capacity to offset the economic damage of COVID-19. The ongoing rebound is the beginning of a long journey out of a deep hole. Although any kind of prediction in this environment will be shot through with uncertainty, there are three indicators that together suggest that the road to recovery will be a long one. The first is exports. Because of border closures and lockdowns, global demand for goods has contracted, hitting export-dependent economies hard. Even before the pandemic, many exporters were facing pressures. Between 2008 and 2018, global trade growth had decreased by half, compared with the previous decade. More recently, exports were harmed by the U.S.-Chinese trade war that U.S. President Donald Trump launched in the middle of 2018. For economies where tourism is an important source of growth, the collapse in international travel has been catastrophic. The International Monetary Fund has predicted that in the Caribbean, where tourism accounts for between 50 and 90 percent of income and employment in some countries, tourism revenues will “return to pre-crisis levels only gradually over the next three years.” Not only is the volume of trade down; the prices of many exports have also fallen. Nowhere has the drama of falling commodity prices been more visible than in the oil market. The slowdown has caused a huge drop in the demand for energy and splintered the fragile coalition known as OPEC+, made up of the members of OPEC, Russia, and other allied producers, which had been steering oil prices into the $45 to $70 per barrel range for much of the past three years. OPEC+ had been able to cooperate when demand was strong and only token supply cuts were necessary. But the sort of supply cuts that this pandemic required would have caused the cartel’s two major players, Russia and Saudi Arabia, to withstand real pain, which they were unwilling to bear. The resulting overproduction and free fall in oil prices is testing the business models of all producers, particularly those in emerging markets, including the one that exists in the United States—the shale oil and gas sector. The attendant financial strains have piled grief on already weak entities in the United States and elsewhere. Oil-dependent Ecuador, for example, went into default status in April 2020, and other developing oil producers are at high risk of following suit. In other prominent episodes of distress, the blows to the global economy were only partial. During the decadelong Latin American debt crisis of the early 1980s and the 1997 Asian financial crisis, most advanced economies continued to grow. Emerging markets, notably China, were a key source of growth during the 2008 global financial crisis. Not this time. The last time all engines failed was in the Great Depression; the collapse this time will be similarly abrupt and steep. The World Trade Organization estimates that global trade is poised to fall by between 13 and 32 percent in 2020. If the outcome is somewhere in the midpoint of that wide range, it will be the worst year for globalization since the early 1930s. This depression arrived at a time when the economic fundamentals in many countries were already weakening The second indicator pointing to a long and slow recovery is unemployment. Pandemic mitigation efforts are dismantling the most complicated piece of machinery in history, the modern market economy, and the parts will not be put back together either quickly or seamlessly. Some shuttered businesses will not reopen. Their owners will have depleted their savings and may opt for a more cautious stance regarding future business ventures. Winnowing the entrepreneurial class will not benefit innovation. What is more, some furloughed or fired workers will exit the labor force permanently. Others will lose skills and miss out on professional development opportunities during the long spell of unemployment, making them less attractive to potential employers. The most vulnerable are those who may never get a job in the first place—graduates entering an impaired economy. After all, the relative wage performance of those in their 40s and 50s can be explained by their job status during their teens and 20s. Those who stumble at the starting gate of the employment race trail permanently. Meanwhile, those still in school are receiving a substandard education in their socially distanced, online classrooms; in countries where Internet connectivity is lacking or slow, poorer students are leaving the educational system in droves. This will be another cohort left behind. National policies matter, of course. European economies by and large subsidize the salaries of employees who are unable to work or who are working reduced hours, thus preventing unemployment, whereas the United States does not. In emerging economies, people mostly operate without much of a safety net. But regardless of their relative wealth, governments are spending more and taking in less. Many local and provincial governments are obliged by law to keep a balanced budget, meaning that the debt they build up now will lead to austerity later. Meanwhile, central governments are incurring losses even as their tax bases shrink. Those countries that rely on commodity exports, tourism, and remittances from citizens working abroad face the strongest economic headwinds. What is perhaps more troubling, this depression arrived at a time when the economic fundamentals in many countries—including many of the world’s poorest—were already weakening. In part as a result of this prior instability, more sovereign borrowers have been downgraded by rating agencies this year than in any year since 1980. Corporate downgrades are on a similar trajectory, which bodes ill for governments, since private-sector mistakes often become public-sector obligations. As a result, even those states that prudently manage their resources might find themselves underwater. The third salient feature of this crisis is that it is highly regressive within countries and across countries. The ongoing economic dislocations are falling far more heavily on those with lower incomes. Such people generally do not have the ability to work remotely or the resources to tide themselves over when not working. In the United States, for instance, almost half of all workers are employed by small businesses, largely in the service industry, where wages are low. These small enterprises may be the most vulnerable to bankruptcy, especially as the pandemic’s effects on consumer behavior may last much longer than the mandatory lockdowns In developing countries, where safety nets are underdeveloped or nonexistent, the decline in living standards will take place mostly in the poorest segments of society. The regressive nature of the pandemic may also be amplified by a worldwide spike in the price of food, as disease and lockdowns disrupt supply chains and agricultural labor migration patterns. The United Nations has recently warned that the world is facing the worst food crisis in 50 years. In the poorest countries, food accounts for anywhere from 40 to 60 percent of consumption-related expenditures; as a share of their incomes, people in low-income countries spend five to six times as much on food as their counterparts in advanced economies do. THE ROAD TO RECOVER In the second half of 2020, as the public health crisis slowly comes under control, there will likely be impressive-looking gains in economic activity and employment, fueling financial-market optimism. However, this rebound effect is unlikely to deliver a full recovery. Even an enlightened and coordinated macroeconomic policy response cannot sell products that haven’t been made or services that were never offered. Thus far, the fiscal response around the world has been relatively narrowly targeted and planned as temporary. A normally sclerotic U.S. Congress passed four rounds of stimulus legislation in about as many weeks. But many of these measures either are one-offs or have predetermined expiration dates. The speed of the response no doubt was driven by the magnitude and suddenness of the problem, which also did not provide politicians with an opportunity to add pork to the legislation. The United States’ actions represent a relatively large share of the estimated $11 trillion in fiscal support that the countries of the G-20 have injected into their economies. Once again, greater size offers greater room to maneuver. Countries with larger economies have developed more ambitious stimulus plans. By contrast, the aggregate stimulus of the ten emerging markets in the G-20 is five percentage points below that of their advanced-economy counterparts. Unfortunately, this means that the countercyclical response is going to be smaller in those places hit harder by the shock. Even so, the fiscal stimulus in the advanced economies is less impressive than the large numbers seem to indicate. In the G-20, only Australia and the United States have spent more money than they have provided to companies and individuals in the form of loans, equity, and guarantees. The stimulus in the European economies, in particular, is more about the balance sheets of large businesses than about spending, raising questions about its efficacy in offsetting a demand shock. Central banks have also attempted to stimulate the failing global economy. Those banks that did not already have their hands tied by prior decisions to keep interest rates pinned at historic lows—as the Bank of Japan and the European Central Bank did—relaxed their grip on the flow of money. Among that group were central banks in emerging economies, including Brazil, Chile, Colombia, Egypt, India, Indonesia, Pakistan, South Africa, and Turkey. At prior times of stress, officials in such places often went in the other direction, raising policy rates to prevent exchange-rate depreciation and to contain inflation and, by extension, capital flight. Presumably, the shared shock leveled the playing field, lessening concerns about the capital flight that usually accompanies currency depreciation and falling interest rates Just as important, central banks have fought desperately to keep the financial plumbing flowing by pumping currency reserves into the banking system and lowering private banks’ reserve requirements so that debtors could make payments more easily. The U.S. Federal Reserve, for instance, did both, doubling the amount it injected into the economy in under two months and putting the required reserve ratio at zero. The United States’ status as the issuer of the global reserve currency gave the Federal Reserve a unique responsibility to provide dollar liquidity globally. It did so by arranging currency swap agreements with nine other central banks. Within a few weeks of this decision, those official institutions borrowed almost half a trillion dollars to lend to their domestic banks. The fiscal stimulus in the advanced economies is less impressive than the large numbers seem to indicate What is perhaps most consequential, central banks have been able to prevent temporarily illiquid firms from falling into insolvency. A central bank can look past market volatility and purchase assets that are currently illiquid but appear to be solvent. Central bankers have used virtually all the pages from this part of the playbook, taking on a broad range of collateral, including private and municipal debt. The long list of banks that have enacted such measures includes the usual suspects in the developed world—such as the Bank of Japan, the European Central Bank, and the Federal Reserve—as well as central banks in such emerging economies as Colombia, Chile, Hungary, India, Laos, Mexico, Poland, and Thailand. Essentially, these countries are attempting to build a bridge over the current illiquidity to the recovered economy of the future. Central banks acted forcefully and in a hurry. But why did they have to? Weren’t the legislative and regulatory efforts that followed the last financial crisis about tempering the crisis next time? Central banks’ foray into territory far outside the norm is a direct result of design flaws in earlier attempts at remediation. After the crisis in 2008, governments did nothing to change the risk and return preferences of investors. Instead, they made it more expensive for the regulated community—that is, commercial banks, especially big ones—to accommodate the demand for lower-quality loans by introducing leverage and quality-of-asset restrictions, stress tests, and so-called living wills. The result of this trend was the rise of shadow banks, a cohort of largely unregulated financial institutions. Central banks are now dealing with new assets and new counterparties because public policy intentionally pushed out the commercial banks that had previously supported illiquid firms and governments. To be sure, central bank action has apparently stopped a cumulating deterioration in market functioning with rate cuts, massive injections of liquidity, and asset purchases. Acting that way has been woven into central banks’ DNA since the Fed failed to do so in the 1930s, to tragic effect. However, the net result of these policies is probably far from sufficient to offset a shock as large as the one the world is living through right now. Long-term interest rates were already quite low before the pandemic took hold. And in spite of all the U.S. dollars that the Federal Reserve channeled abroad, the exchange value of the dollar rose rather than fell. By themselves, these monetary stimulus measures are not sufficient to lead households and firms to spend more, given the current economic distress and uncertainty. As a result, the world’s most important central bankers—Haruhiko Kuroda, governor of the Bank of Japan; Christine Lagarde, president of the European Central Bank; and Jerome Powell, chair of the Federal Reserve—have been urging governments to implement additional fiscal stimulus measures. Their pleas have been met, but incompletely, so there has been a massive decline in global economic activity. THE ECONOMY AND ITS DISCONTENTS The shadow of this crisis will be long and dark—more so than those of many of the prior ones. The International Monetary Fund predicts that the deficit-to-GDP ratio in advanced economies will swell from 3.3 percent in 2019 to 16.6 percent this year, and in emerging markets, it will go from 4.9 percent to 10.6 percent over the same period. Many developing countries are following the lead of their developed counterparts in opening up the fiscal tap. But among both advanced and developing economies, many governments lack the fiscal space to do so. The result is multiple overextended government balance sheets. Dealing with this debt will hinder rebuilding. The G-20 has already postponed debt-service payments for 76 of the poorest countries. Wealthier governments and lending institutions will have to do more in the coming months, incorporating other economies into their debt-relief schemes and involving the private sector. But the political will to undertake these measures may well be lacking if countries decide to turn inward rather than prop up the global economy. Globalization was first thrown into reverse with the arrival of the Trump administration in 2016. The speed of the unwinding will only pick up as blame is assigned for the current mess. Ope borders seem to facilitate the spread of infection. A reliance on export markets appears to drag a domestic economy down when the volume of global trade dwindles. Many emerging markets have seen the prices of their major commodities collapse and remittances from their citizens abroad plummet. Public sentiment matters to the economy, and it is hard to imagine that attitudes toward foreign travel or education abroad will rally quickly. More generally, trust—a key lubricant for market transactions—is in short supply internationally. Many borders will be difficult to cross, and doubts about the reliability of some foreign partners will fester. Yet another reason why global cooperation may falter is that policymakers may confuse the short-term rebound with a lasting recovery. Stopping the slide in incomes and output is a critical accomplishment, but so, too, will be hastening the recovery. The longer it takes to climb out of the hole this pandemic punched in the global economy, the longer some people will be unnecessarily out of work and the more likely medium- and longer-term growth prospects will be permanently impaired. The shadow of this crisis will be long and dark—more so than those of many of the prior ones The economic consequences are straightforward. As future income decreases, debt burdens become more onerous. The social consequences are harder to predict. A market economy involves a bargain among its citizens: resources will be put to their most efficient use to make the economic pie as large as possible and to increase the chance that it grows over time. When circumstances change as a result of technological advances or the opening of international trade routes, resources shift, creating winners and losers. As long as the pie is expanding rapidly, the losers can take comfort in the fact that the absolute size of their slice is still growing. For example, real GDP growth of four percent per year, the norm among advanced economies late last century, implies a doubling of output in 18 years. If growth is one percent, the level that prevailed in the shadow of the 2008–9 recession, the time it takes to double output stretches to 72 years. With the current costs evident and the benefits receding into a more distant horizon, people may begin to rethink the market bargain. The historian Henry Adams once noted that politics is about the systematic organization of hatreds. Voters who have lost their jobs, have seen their businesses close, and have depleted their savings are angry. There is no guarantee that this anger will be channeled in a productive direction by the current political class—or by the ones to follow if the politicians in power are voted out. A tide of populist nationalism often rises when the economy ebbs, so mistrust among the global community is almost sure to increase. This will speed the decline of multilateralism and may create a vicious cycle by further lowering future economic prospects. That is precisely what happened in between the two world wars, when nationalism and beggar-thy-neighbor policies flourished There is no one-size-fits-all solution to these political and social problems. But one prudent course of action is to prevent the economic conditions that produced these pressures from worsening. Officials need to press on with fiscal and monetary stimulus. And above all, they must refrain from confusing a rebound for a recovery.

Lack of public health infrastructure makes it difficult to control COVID

Blumenthal, July 22, 2020 David Blumenthal, M.D., M.P.P., Elizabeth J. Fowler, Ph.D., J.D., Melinda Abrams, M.S., and Sara R. Collins, Ph.D., July 22, 2020, New England Journal of Medicine, Covid-19 — Implications for the Health Care System, https://www.nejm.org/doi/full/10.1056/nejmsb2021088

The United States has 4% of the world’s population but, as of July 16, approximately 26% of its Covid-19 cases and 24% of its Covid-19 deaths.17 These startling figures reflect a deep crisis in our public health system. Put simply, that system failed to quickly identify and control the spread of the novel coronavirus. The United States did not make testing widely available early in the pandemic, was late to impose physical-distancing guidelines, and has still not implemented either as widely as needed.18 National guidance on managing the pandemic has been inconsistent and delayed. Many states have now abandoned stringent physical-distancing guidelines without careful attention to public health measures needed to prevent resurgence. Although inadequate leadership and excessive partisanship have played a role in these shortcomings, other factors are also in play. Public health is a quintessentially governmental function, undertaken collectively for the public good at the national, state, and local levels. In part because of many Americans’ distrust of government, public health functions have historically been underresourced.19 The trained personnel who are needed for contact tracing — a traditional public health function long applied to such age-old afflictions as tuberculosis and sexually transmitted disease — are now scarce. Tellingly, there is no national public health information system — electronic or otherwise — that enables authorities to identify regional variation in the demand for, and supply of, resources critical to managing Covid-19. Without such information, authorities have no way to direct vital resources from areas of surplus to areas of undersupply. It is no exaggeration to say that the United States currently lacks a functioning national system for responding to pandemics.

anada proves single payer reduces CDOVID-19 spread

Wendell Porter, former President of CIGNA Health, August 6, 2020, Washington Post, The Health Care Scare, https://www.washingtonpost.com/outlook/2020/08/06/health-insurance-canada-lie/?arc404=true

Nevertheless, I spent much of that year as an industry spokesman, my last after 20 years in the business, spreading AHIP’s “information” to journalists and lawmakers to create the impression that our health-care system was far superior to Canada’s, which we wanted people to believe was on the verge of collapse. The campaign worked. Stories began to appear in the press that cast the Canadian system in a negative light. And when Democrats began writing what would become the Affordable Care Act in early 2009, they gave no serious consideration to a publicly financed system like Canada’s. We succeeded so wildly at defining that idea as radical that Sen. Max Baucus (D-Mont.), then chair of the Senate Finance Committee, had single-payer supporters ejected from a hearing. Today, the respective responses of Canada and the United States to the coronavirus pandemic prove just how false the ideas I helped spread were. There are more than three times as many coronavirus infections per capita in the United States, and the mortality rate is twice the rate in Canada. And although we now test more people per capita, our northern neighbor had much earlier successes with testing, which helped make a difference throughout the pandemic. The most effective myth we perpetuated — the industry trots it out whenever major reform is proposed — is that Canadians and people in other single-payer countries have to endure long waits for needed care. Just last year, in a statement submitted to a congressional committee for a hearing on the Medicare for All Act of 2019, AHIP maintained that “patients would pay more to wait longer for worse care” under a single-payer system. While it’s true that Canadians sometimes have to wait weeks or months for elective procedures (knee replacements are often cited), the truth is that they do not have to wait at all for the vast majority of medical services. And, contrary to another myth I used to peddle — that Canadian doctors are flocking to the United States — there are more doctors per 1,000 people in Canada than here. Canadians see their doctors an average of 6.8 times a year, compared with just four times a year in this country. Most important, no one in Canada is turned away from doctors because of a lack of funds, and Canadians can get tested and treated for the coronavirus without fear of receiving a budget-busting medical bill. That undoubtedly is one of the reasons Canada’s covid-19 death rate is so much lower than ours. In America, exorbitant bills are a defining feature of our health-care system. Despite the assurances from President Trump and members of Congress that covid-19 patients will not be charged for testing or treatment, they are on the hook for big bills, according to numerous reports. That is not the case in Canada, where there are no co-pays, deductibles or coinsurance for covered benefits. Care is free at the point of service. And those laid off in Canada don’t face the worry of losing their health insurance. In the United States, by contrast, more than 40 million have lost their jobs during this pandemic, and millions of them — along with their families — also lost their coverage.

Federal action critical to pandemic response

Blumenthal, July 22, 2020 David Blumenthal, M.D., M.P.P., Elizabeth J. Fowler, Ph.D., J.D., Melinda Abrams, M.S., and Sara R. Collins, Ph.D., July 22, 2020, New England Journal of Medicine, Covid-19 — Implications for the Health Care System, https://www.nejm.org/doi/full/10.1056/nejmsb2021088

The novel coronavirus is unlikely to be the last pandemic we face.27 To control Covid-19 and prevent unnecessary suffering and economic damage from future pandemics, the United States will need to improve its capacity for collective action to protect the public’s health. This starts with building the ability of state and local public health authorities to implement basic disease-control measures, such as testing, contact tracing, and isolation of affected persons. Because states often lack the means to create these capabilities, federal support and guidance would be required. And because microbes do not respect state boundaries, containing infection depends on cross-state coordination. Only the federal government can reliably lead such interstate collaboration. The federal government currently lacks all the authorities needed to play this role effectively. This leadership vacuum leaves the country unprepared to mount an effective, unified response to emerging infectious threats. Of all the problems highlighted by Covid-19, creating federal leadership capacity may be the most challenging. Some Americans simply have an aversion to centralized power of any kind. And an increase in the federal role would potentially shift the balance of power between Washington and state governments. Nevertheless, it is hard to imagine an effective approach to containing pandemics that doesn’t involve national direction. As long as one state or region continues to harbor infection, the nation as a whole remains at risk.

health insurance critical to slowing COVIVD and creating a recovery

National Center for Coverage Innovation @ Families USA, January 31, 2020, https://familiesusa.org/wp-content/uploads/2020/08/COV-184_Job-Loss-Report_07-31-20-1.pdf, Without Federal Support for Health Insurance, Many More Jobs Will Be Lost

This new report focuses on a fourth result of major declines in health coverage: Health coverage losses prolong and deepen the economic downturn. Reopening the U.S. economy depends on reducing COVID-19’s incidence and stopping the virus’s spread. Health insurance is crucial to that effort since it lets people seek diagnosis and care as soon as they begin feeling sick. Health coverage is vital to economic recovery for another reason as well: Comprehensive health insurance directly supports employment. It is the foundation of America’s health care sector, which makes up almost one-fifth of the entire U.S. economy. If fewer patients have health insurance, hospitals and other health care providers, many of which are important local employers, receive less reimbursement. Revenue reductions can force providers to lay off staff, creating ripple effects that hurt the surrounding economy as well. To project the magnitude of total job losses resulting from health insurance reductions, we begin this paper by describing the health care industry’s role during the COVID-19 recession thus far. We then estimate the number of workers in each state who could become newly unemployed because of revenue reductions triggered by health coverage losses, assuming a baseline unemployment rate of 15%, only slightly improved over levels in May 2020. The nominal unemployment rate was 13.3% for that month, but the U.S. Bureau of Labor Statistics explained that, correcting for errors, the true unemployment rate was approximately 16.4%.4Appendix 1 (page 11) describes our methodology  and explains the limitations of our analysis. Two uncertainties are particularly important, however, so we highlight them here as well. First, we base our analysis on economic conditions in May. The economy could improve or worsen in the coming months, which means that job losses could be lower or higher than those we estimate here. Economic forecasters describe our country’s near- and medium-term future as unusually uncertain, hinging in large part on progress combatting COVID-19.5  The recent renewed spread of COVID-19 in many states suggests that this report’s assumption of continued overall economic conditions much like those in May is not unreasonably pessimistic. Second, our analysis relies on health insurance projections based on past relationships between labor market conditions and health coverage. With today’s pandemic-driven downturn, the coverage effects of increased unemployment may turn out to differ from those in the past.  If so, our job loss estimates could ultimately prove too high or too low. Despite these inherent uncertainties, our core finding seems hard to dispute. Major health insurance reductions will cut revenue and trigger significant job losses in the health care industry and other businesses. Protecting comprehensive health insurance should be a priority for policymakers, even if their primary focus is now on economic recovery With one in seven American workers employed in health care, numerous jobs remain at risk if Congress does not protect the comprehensive health coverage needed for doctors, hospitals, and clinics to remain open and fully staffed. As of June 2020, 16.5 million people, or 14% of all private sector workers, were still employed in health care — more than the number who worked in all of the country’s retail stores or all of its manufacturing plants.9 Note: Other third-party payments include work site health care, other private revenues, the Indian Health Service, workers’ compensation, general assistance, maternal and child health, vocational rehabilitation, other federal programs, the Substance Abuse and Mental Health Services Administration, other state and local programs, and school health. Health insurance provides 79 cents of every dollar in revenue received by hospitals, doctors, clinics, and other health care providers (Figure 2). If fewer patients have health insurance, the health care industry loses revenue, forcing additional job cuts. Employment outside health care will suffer as well if medical offices lay off more staff or close their doors, buying fewer goods and services in local economies. In the next section, we show the potential magnitude of those effects