Now that the the COVID-19 virus is spreading rapidly around the world, the Trump administration is scrambling to calm the public's fears about catching it. While Trump's claims about the nation's preparedness are severely exaggerated, the preparedness of individual Americans is an even bigger unknown; millions of us are not even prepared for a bad cold, much less a global pandemic. The combination of a profit-driven health care insurance industry and an exploitative low-wage economy means that a sudden illness could cost you your job, and a public health crisis could leave countless people priced out of critical care.
In recent days, the Democratic presidential candidates have rightly slammed Trump’s slow and chaotic response to the growing global health emergency. Yet the government’s greatest public-health failing today is the absence of a real public health care system.
A global health threat requires a maximally inclusive medical infrastructure that can comprehensively manage risks across the population. But the U.S. health care system excludes millions of people by design and makes critical health care services prohibitively costly for many poor families. Whether or not COVIC-19 becomes a full-blown crisis in the U.S., the health care system itself is a crisis, fueled by corporate greed and pernicious inequality.
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A major threat like the coronavirus would aggravate abysmal gaps in insurance coverage, which force people to routinely forgo essentials like a flu shot or blood pressure medication. According to surveys by the Kaiser Health Foundation, about 28 million nonelderly people had no health care coverage in 2018 — disproportionately people of color — and about 1 in 5 of them reported having avoided seeking needed care over the past year due to cost.
Even workers with employer-sponsored insurance face soaring premiums, often with deductibles exceeding $5,000 per household, despite the implementation of the Affordable Care Act. Roughly 40 percent of them reported struggling to pay for health care — mostly by making sacrifices such as cutting back on food purchases, taking on an extra job or taking on debt. Some 2 in 3 bankruptcies nationwide are still linked to medical costs.
How can a system that makes parents so terrified of medical bills that they avoid taking sick kids to the emergency room, and forces chronically ill patients to choose between their next meal or their next prescription refill, ever cope with a systemic health crisis like a coronavirus epidemic?
As Sen. Bernie Sanders, I-Vt., and Rep. Alexandria Ocasio-Cortez, D-N.Y., pointed out last week, the tensions surrounding the COVID-19 outbreak highlight the need for a universal "Medicare for All" system, which would protect against major public-health threats by ensuring everyone could access the care that they needed, regardless of income, without being deterred by fear of out-of-pocket costs or surprise medical bills.
But our lack of preparedness for a public-health emergency goes beyond hospitals and extends into our work lives.
The U.S. is virtually alone among affluent countries in failing to guarantee any form of paid sick leave, so many workers can't call in sick or stay home to tend to a sick child or elder without losing pay, if not their jobs. About 32 million workers nationwide do not have a single paid sick day — including 7 in 10 of the lowest-paid workers, and disproportionate numbers of Black and Latinx workers.
According to a 2010 survey by the Public Welfare Foundation, nearly a quarter of workers reported losing their job, or being threatened with job loss, for taking time off for a personal or family illness. Though some cities and states have passed paid sick leave policies, a lack of paid sick days is sadly commonplace in service professions like restaurant work and day care, in which workers interact constantly with the public. If workers cannot afford to take time off to deal with an illness, risk of contagion surges when they end up serving members of the public with a sore throat, or handling a room full of toddlers while battling the flu.
Paid sick time isn’t just a fringe benefit, it’s a critical public-health intervention. A 2013 study on the risks of an influenza outbreak revealed that “presenteeism” was responsible for a significant majority of workplace transmission, and that universal paid sick days could shave 6 percent off the workplace infection rate.
Another study on the 2009 H1N1 virus outbreak estimated that about 5 million workers nationwide — about 1.2 million of them Latinx — were infected because they lacked basic health protections like paid sick leave. In Washington state, a paid sick leave law has led to an 8 percentage-point drop in the number of food and retail service employees who work while sick.
While all service workers would be strained by a sudden virus outbreak, health care service workers would face a two-front battle: As critical front-line personnel, nurses often suffer from severe staffing shortages even under normal circumstances, making it difficult to take the sick time to which they are usually entitled. And a recent survey by National Nurses United also found that over half of nurses had not received information on preparing for COVID-19, and less than a third reported their employer was readily equipped with personal protective gear.
To deal with these glaring gaps in the medical infrastructure, the transition to a universal health care system must also transform and expand the health care workforce. The current Medicare for All bill in the House of Representatives would ensure adequate staff-to-patient ratios for nurses so that hospitals can effectively respond to major health threats while maintaining fair working conditions.
Although the panic around the coronavirus will likely pass before Congress passes universal health care legislation, it should spark a conversation on how the world's wealthiest country should cope with emerging global public-health challenges. Still, for countless workers, the impending pandemic threat might be eclipsed by the more immediate fear of being impoverished by the burden of a hospital bill. The country’s ill-preparedness for the latest public-health emergency is an acute symptom of a chronic malady in the health care-industrial complex: Even in times of universal crisis, health care remains a privilege for the wealthy rather than a human right.