It is in the United States that the COVID-19 epidemic has proved most deadly, even though its per capita health spending is the highest in the world. As such, the epidemic has brought into stark relief the chronic shortcomings of the country’s healthcare and health insurance systems (with their exorbitant costs, high inequality of access, underfunding of public health, and a hospital system governed by market logic). It has also revealed the drawbacks of the US federal system under the Trump administration, in particular its inability to manage a health crisis of such magnitude, most clearly exemplified in the incompetence of the president’s leadership.