The coronavirus pandemic is exposing the deadly failings of market-driven health care. It takes all of us to protect our health, yet our health system is divided and unequal. We have underfunded public health by $4.5 billion and diverted essential resources to pay for corporate tax cuts. We have prioritized profitability, not health risks and needs, as we divested from hospital beds, medical staff and equipment. Now we threaten uninsured coronavirus patients with $20,000 hospital bills instead of treating everyone for free. And because we have tethered health insurance to employment, the record 47 million workers facing layoffs in this economic collapse risk losing access to care together with their jobs.
These failings will change our lives. Because they are rooted in injustice, some will suffer more than others. While the virus affects us all, it doesn’t kill equally. We know that older and immunosuppressed people are at higher risk, yet we have been slow to protect our elders. In New York City, 70% of people dying are over 65 years old. We also know that some of us are much more exposed, such as essential workers — largely low-income people of color — immigrants, indigenous communities and incarcerated people. It is no coincidence that the poorest neighborhoods are the hardest hit. People deprived of resources cannot afford to isolate, practice social distancing, seek help or receive treatment. We have a history of redirecting epidemics to wreak havoc on those deemed more expendable: in the 1918 influenza pandemic, poor and indigenous people were more likely to contract the virus and to die from it. They lacked the resources to facilitate their own survival, and we failed to build adequate health and social systems to protect them.
We are about to repeat the same injustice. Health care in the United States is big bucks, driven by profits, fragmented by competition and beholden to shareholder greed. We spend 18% of our GDP on health care, yet come up short on all accounts. For twice the money than most countries, the United States gets shorter life expectancy, along with fewer doctors and hospital beds. Our public dollars shore up a private health industry that is neither equipped nor inclined to serve the common good. It rations care based on ability to pay and treats health workers as expendable. This is not a partisan matter: both Trump and Biden are doubling down on for-profit health care. It is an ethical challenge that gets to the heart of capitalism: should our health be subject to market forces, or do we have a collective responsibility to enable everyone to be as healthy as possible?
As the virus ravages our communities, our only hope is to force the health system to respond to our needs. Federal stopgaps to keep the health care patchwork from tearing at the seams — such as waived testing fees, increased Medicaid and hospital funding and production mandates for ventilators — are woefully inadequate. Some states have reopened health insurance marketplaces to allow laid-off workers to enroll in insurance plans that are too expensive to buy and too costly to use. Others have received federal waivers to contract with out-of state providers. Yet many hospitals have already been lost to mergers, private equity takeovers or budget cuts. Some private hospitals closed their doors in anticipation of losing money during the pandemic. In contrast, Ireland preemptively nationalized its private hospitals to prevent capacity shortfalls, and Spain did the same in the midst of the crisis. Our states and cities should take control of private facilities that put profits over patients and bring them into public service.
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As the crisis is deepening, some insurance companies are promising to waive patient cost-sharing for virus treatment, anticipating a big bailout followed by a 40% premium hike in 2021. Uninsured patients won’t benefit from waived fees, nor will the 60% of workers covered by employer self-funded plans, or those receiving out-of-network care. In the end, the federal government may have no choice but to step in and pay for everyone’s care by reimbursing private and public insurance plans, hospitals and states. But to accept and applaud such a health industry bailout as a one-off fix to a broken system would be a grave mistake. Even in the best of times, our profit-driven health system is responsible for at least 45,000 unnecessary deaths each year. People pay with their lives because we treat health care as a commodity rather than a public good.
The time for band-aids is over. Congress must fund Medicare (or Tricare) to provide free CovidCare for everyone, and then expand it to include all of us. There is a simple reason why Medicare for All has gained broad public support. It guarantees free access to care, regardless of how much money we have, what color our skin is or where we live. As hard as Italy has been hit by the virus, its universal health system — despite privatization pressures —guarantees access to treatment as a right, freeing people from fears over hospital bills.
Perhaps this pandemic will humble the neoliberal naysayers just long enough to hit the restart button on the Medicare for All debate. Let’s ask how many lives it will save, not how much money it will cost (or, rather, save). By putting health first, Medicare for All ensures that everyone receives care, regardless of payment, insurance or networks. If we must talk about money, let’s ask who pays. Medicare for All flips who pays for our health system: tax-based financing means that those who make more, pay more — the opposite of premiums and co-pays. Finally, let’s stop the fear mongering about dropping the coverage we bought, and focus on the peace of mind we deserve. Whatever epidemic, accident or illness befalls us, all of us — not just the privileged — must be able to count on getting the care we need. These days, most of us would be glad to receive such assurance.