Our Health-Care System Is Killing People

Photo: Joe Raedle/Getty Images

We still don’t know much about the 17-year-old who may have died of COVID-19 in California. He lived in the city of Lancaster; his father, also sick, is an Uber driver. He had no known preexisting conditions, and no health insurance either, according to a new Gizmodo report. In a YouTube video, Rex Parris, the mayor of Lancaster, suggested the teenager’s lack of insurance contributed to his death. When the sick teen reported to urgent care, staff allegedly turned him away. “He didn’t have insurance, so they did not treat him,” Parris said. Instead, they told him to go to a nearby public hospital.

He tried. But the delay may have cost him his life. “En route to AV Hospital, he went into cardiac arrest. When he got to AV Hospital they were able to revive him and keep him alive for about six hours,” Parris continued. “But by the time he got there, it was too late.”

Though the teen tested positive for COVID-19, the Centers for Disease Control and Prevention have launched an investigation into his death to rule out any other medical factors in his death. But he wouldn’t be the only COVID-19 patient to die partly because of a lack of health insurance. A Pittsburgh, Pennsylvania, woman died from the virus after she refused to go to the hospital for care. “She didn’t have insurance. She thought she might not be able to pay the bills,” her son told the Pittsburgh Post-Gazette.

There are probably other cases like theirs, and behind each one, a person killed by our collective failure to protect them. About 45 percent of American adults were either uninsured or underinsured in 2018, the Commonwealth Fund estimates. Those people are uniquely vulnerable to the effects of any pandemic. They’re more likely to wait to seek care for fear of the expense, or to go entirely without it, and their ranks will increase over the next weeks and months. Because we tie health insurance to employment, a COVID-connected recession could potentially strand thousands, if not millions, without secure access to health care in the middle of a pandemic.

Our health-care system is not the best in the world, as the New York Times credulously claimed a few days ago. It is failing. Heavily privatized, dependent on the whims of industry and the vagaries of insurance companies, it is collapsing under the weight of a crisis. Rural hospitals continue to close for lack of funds, and leave the communities they serve without quick access to care. Even in wealthy, urban areas, doctors and nurses don’t have enough masks, enough ventilators, enough protective shields, enough scrubs. In Philadelphia, city officials tried and failed to convince the millionaire owner of Paladin Healthcare, Joel Freedman, to lease them the public hospital he purchased and closed last summer. Sprawling corporations donate masks here and there. But charity can’t plug the gaps through which the poor and the dying fall. Health care is a public good. Policy-makers just don’t treat it that way, and now we’re reaping what they’ve sown.

The fractures in our health-care system should not be understood as failures of the market. The market is working exactly as intended. It’s working for people like Joel Freedman, and for private insurance companies like Aetna. It was never meant to save lives.

The nature of the pandemic leaves elected officials with little recourse but to expand government. Democrats who may have once balked at the idea of handing out cash to the needy are championing a temporary universal basic income. As inadequate as the Senate’s emergency rescue package might be, it still represents a sharp deviation from mainstream Democratic policy. Big government suddenly looks like less of an electoral risk. While all emergency pandemic measures don’t make sense as long-term solutions, they should make something clear to the political class: Private industry will not safeguard the public. Corporations don’t exist to protect anyone; they exist to make profit. Human beings are valuable to them inasmuch as they have bank accounts to plunder. The mission of government, and the missions of companies like Aetna or Amazon, or of private-equity investors like Freedman, are irreconcilably different. Aetna can’t serve God and Mammon.

Those lessons won’t lose urgency as the pandemic winds down. There will be other crises, and we can’t survive them with the system we have now. Though the immediate priority of policy-makers is to stanch the public’s bleeding, they will at some point have to consider steps to make the next crisis less devastating for the people they serve. But to do so successfully, they’ll have to reconsider their hostility to radical health-care reform. All the hand-wringing over consumer “choice,” the fearmongering over cost, the blinkered insistence that American voters will never support more government control over health care take Democrats further and further away from solutions that would help save lives in the next pandemic. When people don’t have health insurance, they die. This was true before COVID-19, and it will remain true until elected officials do something to make coverage a universal experience. The answer isn’t Joe Biden’s public option, which would leave 10 million people without health insurance, but Medicare for All, which automatically enrolls everyone. One policy is expansive enough to meet the challenges the coronavirus creates. The other clearly isn’t.

In any pandemic scenario, the goal is to contain infectious disease as quickly as possible. But that’s much more difficult when large numbers of people delay or even avoid basic care because it’s beyond their means. It’s more difficult, too, in an unhealthy country, weakened by inadequate access to care. What COVID-19 makes clear, or should, to everyone is the universal quality of public health. No community truly suffers in isolation. Pain spreads. But we favor some communities over others, and we rank their pain, too. A health-care system that prioritizes a person’s ability to pay over their need for care can’t do anything in a crisis but fail.

To condition access to health care on employment status shifts the frame so what should be a right instead looks like a privilege. That perspective is killing people, and universal coverage means access to preventative care, which keeps people healthy and better able to fend off infection. Losing a job would no longer mean losing health care. While for-profit hospitals tend to oppose Medicare for All on the basis that it would undermine their bottom line, facilities would no longer lose millions caring for patients too poor to pay them, and public policy could ameliorate the transition’s financial impact. As matters stand, hospitals have an incentive to prioritize and recruit patients with private insurance. Inequality might be lucrative, but that isn’t a good reason to let it flourish.

Democratic skeptics of Medicare for All should remember what the alternative looks like. A 17-year-old in an outbreak tried to go to the doctor. He didn’t have insurance. They didn’t treat him. He died.

Our Health-Care System Is Killing People