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How Can the US Confront Coronavirus With 28 Million People Uninsured?

The coronavirus has highlighted the moral imperative and the pragmatic rationale for universal health care.

A woman wears a protective mask while walking on the subway on February 27, 2020, in São Paulo, Brazil.

Part of the Series

As the coronavirus continues to spread around the world, we don’t yet know either the full scale of the unfolding global health disaster or the cumulative impact economically. But over the past week, as virus hotspots have emerged in South Korea, in Iran, in Italy and elsewhere, and as more and more countries find cases of the disease, we’re beginning to get a sense of the magnitude of what is unfolding.

China has spent two months trying to contain an outbreak. As an authoritarian country it hasn’t shied away from locking down megacities, even cocooning entire residential communities — allowing only one household member out every couple of days to go looking for food. Tens of millions of people are now living a dystopian existence essentially barricaded within their own apartment walls. Yet even with these emergency responses, large numbers have fallen sick and thousands have died. Meanwhile, consumer spending in the world’s second largest economy has all but ground to a halt. Month-on-month car purchases in the country are down by a staggering 92 percent.

South Korea has imposed extraordinary controls in Daegu, a city of roughly 3 million people. Italy has quarantined tens of thousands of people, deploying police and military to stop them from leaving the region that is at the center of that country’s outbreak. In Turkey, on Tuesday, a plane from Iran with a person on board suspected of carrying the virus was met at the airport by health officials and all the passengers were promptly quarantined for two weeks.

Until this week’s stock market swoon, the inevitable economic toll had gotten lost in the panicked coverage of the virus’s spread. When countries shut down rail and air and road routes in and out of regions, when schools are closed, when public gatherings are discouraged or banned, when curfews are imposed, and when nonessential businesses are shuttered, the economic cost is immense.

The intricately interconnected parts of the global trade and supply chain systems are unraveling at warp speed as the disease spreads, and, assuming these lockdowns last, the consequences will likely be economically devastating. If the stock market continues to sink, if factories remain shuttered, and if consumers pull back from spending, over the coming months there could be massive, and unexpected, spikes in unemployment and poverty, even in places not directly experiencing the mass transmission of the virus within their populations.

Trump’s Pollyannaish statements on coronavirus in the U.S. notwithstanding, this country will not, of course, remain inured to the epidemic’s consequences. That belated realization among investors was what triggered this week’s panicked stock market sell-off. Between Friday of last week and the close of business on Tuesday, the Dow Jones shed roughly eight percent of its value. On both Monday and Tuesday, the market dived on a scale reminiscent of the chaotic days during the summer and early autumn of 2008, as the housing crisis morphed into a broader financial crisis.

If the bad news about the virus’s spread continues, that market retraction will also continue over the trading days and weeks ahead, making what happened in the first days of this week only a prelude to a larger and longer crisis. Public health experts at the CDC and in the universities increasingly think it’s only a matter of time before the United States, too, experiences serious outbreaks. Indeed, the announcement late Wednesday afternoon that a Californian who had neither traveled to a hot zone nor been in close contact with someone who had has the virus signifies it is likely already starting to circulate within the U.S. If it is, the impacts will be huge, not just on the country’s overstretched health systems, but on the political and economic infrastructure. It’s not a stretch to imagine global stock market collapses over the coming weeks and a stark contraction of consumer spending and of employment in their wake.

Even if this dislocation doesn’t grow to the cataclysmic scale of the 1918-19 Spanish Flu, the coming months will surely force the U.S. to confront some glaring policy shortcomings — and to do so at speed.

Roughly 28 million Americans lack health insurance. That number has gone up every year of the Trump presidency and will continue to go up so long as current policies are in place that drive immigrants ever further outside the safety net, that encourage states to limit Medicaid access, and that make it harder for individuals to access health care exchanges set up under the Affordable Care Act. It’s pretty much impossible to rein in a pandemic, especially of a disease that is communicable before a sufferer becomes sick enough to visit the ER, with so many people entirely excluded from primary care coverage. Millions more, who do have insurance, are so under-insured and have such high deductibles that, in practice, they too do not visit primary care doctors nearly as often as they should.

So far, the Democratic candidates running for the presidency haven’t linked the virus outbreak to their calls for expanded and more affordable health care coverage. It’s past time for them to do so. With this outbreak, not only does the moral imperative for universal health care grow, but so does the pragmatic rationale: Germs don’t obey class and ethnic and national boundaries. If poor, uninsured people don’t get treated for viral pneumonia in proper facilities, they will spread that disease throughout the community. It will be impossible to bring regional outbreaks under control if huge swathes of the population cannot access doctors either because they are afraid they will be bankrupted by medical bills, or because they are terrified they will render themselves vulnerable to deportation by putting themselves onto medical system and government radars. And the more people remain untreated, the more the virus will spread, creating a cascading effect of health and economic consequences. Economically, it would likely prove to be far less expensive to expand health coverage to everyone now, rather than try to clean up the mess of an epidemic made worse by massive numbers of people being uninsured.

This isn’t an issue that can wait for a long policy debate post-election. In an emergency, policies have to meet new needs at speed. And right now, there’s an unprecedented need to expand the health care umbrella to everyone who lives in the United States.

But that alone is only one part of a much larger puzzle. Forty percent of Americans are only one missed paycheck away from poverty — they have no, or only minimal, savings to fall back on, and no cushion for paying monthly bills such as rent or mortgage, utilities, and car payments in the event of an unexpected economic jolt. If a region in the U.S. were to be locked down in the way that cities have been in China, South Korea, Italy and Iran, a vast number of that region’s residents would be quickly bankrupted, and a large proportion of small businesses that rely on a constant flow of customers would go under. Of course, this isn’t just about individuals; it’s also about the cascading economic impact on entire communities. Prolonged quarantines and lock-downs could devastate already financially on-edge neighborhoods as surely as de-industrialization devastated the Rust Belt and the 2008 housing crisis devastated everywhere from California Central Valley cities such as Stockton to urban regions of Nevada.

Unlike most of our peer nations, in the U.S. there is no legal right to paid sick leave, although the Family and Medical Leave Act does allow for up to 12 weeks of unpaid leave. In practice, the country’s sick leave rules are so ludicrously weak that they provide a strong disincentive for people, even in food processing and restaurants and other industries where germs spread particularly fast, to stay off work when sick. That’s as backward an approach as possible during a pandemic when health officials are urging the precautionary principle be adopted, and asking people to self-quarantine if they think they may have been in contact with a sick person. Again, while candidates such as Bernie Sanders have pushed for paid sick leave, they haven’t, as yet, linked it to the issue of quarantine.

During World War II, Winston Churchill’s government set up an insurance system, under the War Damages Act, in the U.K. to ensure that victims of the blitz who lost homes or businesses to the aerial bombardment wouldn’t be left to sink on their own. The insurance system was paid for out of tax receipts, and was designed so that that the state would cover these losses and large numbers of individuals, and communities heavily hit by the bombing, wouldn’t be left destitute. Surely, in an age of pandemic, of mass quarantines, and of sudden lockdowns, such an insurance system is similarly imperative in the U.S.

Yet, nothing in the Trump administration’s approach suggests it is thinking big-picture. Instead, it has asked Congress to appropriate a relatively paltry $2.5 billion to fight the virus’s spread — and half of that money will come from raiding other existing public health funds. That’s barely one-third of the amount that it is demanding from the Pentagon over the coming months to work on Trump’s border wall. While there seems to be no shortage of funds for the military and for crackdowns on asylum seekers and destitute migrants, the pool of resources isn’t there for a massive effort to buffer the impacts of coronavirus. Nothing suggests the administration would, for example, roll back tax cuts on the wealthy and on corporations to fund a mutual insurance program for its economic victims.

We are on the edge of the unknown, facing the possibility of a pandemic — and accompanying economic dislocation — on a scale not seen for generations. In the face of this, big and bold policy responses will likely be required, and required fast. Unfortunately, the Trump administration doesn’t inspire any confidence that it’s up to this enormous task.

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