The Covid vaccination campaign in Massachusetts been a frustratingly dismal failure. We are mired in a miserable situation in which the state’s vaccine appointment website is pretty much unusable, people can’t sign up for vaccines, many of those in the initial high priority groups (such as prisons and long term care facilities) have not been vaccinated, guards and staff in these facilities are refusing vaccines, and the overall vaccination rate is lower than in many other states.
How did we get here?
A Republican governor of a blue state, Governor Baker was elected largely on his reputation as a competent manager. (Prior to becoming governor he was CEO of Harvard Vanguard Medical Associates.) As governor, he inherited a robust Medicaid infrastructure, large consortiums of world class hospitals, high per capita numbers of physicians, very low rates of uninsured residents (about 3%), high literacy and computer ownership rates, reasonably deep and healthy public coffers, and centers of high tech genius and innovation.
For over a year anyone able to listen to the news (even Fox news) knew that we likely would have a vaccine and that it would need to get into the arms of residents of the state. Throughout the Covid pandemic Massachusetts residents have exhibited high rates of compliance with masking and it was reasonable to assume that they would want to be vaccinated. Governor Baker certainly knew all of that. And yet he chose not to use the past year to prepare adequately despite having the expertise and resources needed to develop and operationalize a good, fair and efficient plan.
Don’t get me wrong. I’m not suggesting that Governor Baker set out to hurt the residents of Massachusetts. I am, however, suggesting that he made choices that are part and parcel of a political and moral worldview that, I for one, find unacceptable.
Why Am I Such a Loser?
Let me begin with my own sob-story. On Wednesday we heard rumors that vaccines would become available to people age 65 and up. That’s my age group so I began checking the state’s sign-up website right away. I found some appointments but to sign up I would have to lie and claim to be 75 (the 65 and up choice had not yet been put in.) I chose not to lie. By early next morning, when the 65 plus age group was entered into the state sign-up system, the website crashed. I spent many hours that day re-checking and following dead-end leads, but did not manage to get an appointment.
I started off today vacillating between anger at myself for not being persistent or quick enough to snag one of the occasional appointments that showed up from time to time, and questioning whether my refusal to lie the previous day was really the moral high ground or if I was just being a self-righteous jerk. Just for some variety, I punctuated the self-flagellation with occasional moans of “I’m just not lucky.”
But now (literally this minute), at the urging of my spouse and a dear friend, I realized that my self-deprecating mantra echoes that of the abused, marginalized and homeless women I’ve worked with for the past decade. As I’ve described on this blog, these women spend decades navigating an institutional landscape that construes (and rewards) “success” and “recovery” as “owning up to my own mistakes”, and that forces them to make ridiculous choices between lousy (false) options over which they have no control (see, for example, “Failure By Design: Isabella’s Experiences with Social ‘Services’“). I recall, for example, Gloria who felt tormented by having to choose between a very long waitlist for an actual apartment or a shorter waitlist for a room in a crummy SRO. The rule was that she could not get on both lists. Desperate to get off the streets, she “chose” the shorter list. Six months later, when she was assaulted at the SRO, she blamed herself for “choosing” the wrong list.
At the time I told Gloria: It’s not your fault! You didn’t choose to be poor, you didn’t choose to be assaulted, and you didn’t choose the rules of the housing roulette game.
Back to Baker: How Did We Get into this Mess?
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The Republican administration in Massachusetts (and the United States) has consistently favored privatized health care over a government system. I’ve written about this elsewhere so for now, suffice it to say, we lack a coordinated, centralized, rational system for allocating resources. We are accustomed to there being healthcare “haves” and “have-nots” and to Americans having to “choose” between buying food and buying medicine. As a consequence, the United States has crushing racial and class health disparities and the poorest life expectancy of any developed nation.
A core principle of American healthcare is that individuals should “choose the coverage that’s right for you and your family.” Yet, not being prophets, we mere mortals cannot possibly predict what health problems may arise in the future. Any “choice” of insurance we make is made blind. And most of us don’t have the income to “choose” anything other than the cheapest, lousiest coverage. “Choosing” insurance is gambling on your future health, and as long as we have private health insurance we place our bets in a casino in which the house (that is, the insurance company) always wins.
That is the ideological underpinning of the Baker Administration. And so the Administration chose not to include primary care providers and community health centers in the vaccine roll out. They chose not to include members of communities most impacted by Covid in deliberations about the rollout process. They chose to put all of the vaccine eggs in the baskets of horrendously large and hard to access mass vaccination sites rather than in local communities where people can coordinate with their healthcare providers, know the pharmacists, can get to the vaccination sites, and don’t have to wait on lines for hours and hours – risking exposure to the virus.
They chose to set up the vaccine rollout via computer sign-ups, knowing that many of the people most vulnerable to Covid don’t have or can’t use computers. They chose not to construct a comprehensive, easy to navigate website (though, as we all know by now, a woman on maternity leave managed to put one together in her spare time in a couple of days).
They chose a system that puts the onus on individuals to “choose”. Unlike in Israel, for example, where people receive messages telling them when and where they are eligible for the vaccine in accordance to a clearly articulated risk assessment, we in Massachusetts have to spin the wheel of fortune. Should I stalk the Massachusetts “Vaxfinder” website, even though it provides very little information and doesn’t include pharmacies that may have vaccines? Or should I keep refreshing the CVS website? When two appointments suddenly show up – one a the baseball stadium and one at the football stadium – which one should I try to grab (knowing that both likely will be gone by the time I try to register for either)?
Going Forward
No, Governor Baker. The problems with the Covid response were not a computer glitch. Or “unexpected” February snowfall (in New England!). Or any other small mishap. The problems lie in your Administration’s attachment to ideologies and practices that demand individuals “take personal responsibility” for resources and conditions that are not under their control — to privileging the private over the public — to a moral discourse that blames individuals for losing out in what essentially is a government sponsored game of roulette.
So please, Governor Baker, I’m struggling here. Can you join my husband and friend and reassure me that it is not my fault? Can you at least consider offering the residents of your state a system in which you do not need to lie, have unlimited computer time or win at roulette in order to access health care and other basic necessities and human rights?