There Are No Private Solutions to a Public Health Crisis

“What are we doing? Why are we just getting started?” Joe Biden said over the weekend. The former Vice President was vigorously questioning Donald Trump’s handling of the coronavirus crisis, or COVID-19. As the virus begins to spread in the country, it’s become a new line in the sand for Democratic politicians vying for the presidency. In a January op-ed, Biden asserted that as president, he would ask Congress to beef up the Public Health Emergency Fund, renew funding for hospitals that can isolate and treat people with infectious diseases, and fully fund the Global Health Security Agenda. But nowhere does he mention anything about the fundamental issues with the country’s health insurance industry and lack of paid sick leave.

Trump’s atrocious mishandling of the global pandemic makes it likely that coronavirus could become one of the defining issues of the presidential election. And there’s nothing like a public health crisis to more starkly illustrate the fact that private, small-bore solutions like the ones put forth by Biden will never be enough. When it comes to something on the scale of coronavirus, the policy platforms espoused by centrist Democrats are simply insufficient.

A health insurance system run by private insurers isn’t built to incentivize public good over profit. The mishmash way our insurance system is currently set up—with employer-sponsored health insurance, marketplace plans, Medicare, and Medicaid—means that nearly half of working-age adults are under- or uninsured. This, in turn, means that millions of people won’t go to the doctor soon enough (or at all) because of cost, which, to put it mildly, is an issue when it comes to containing an epidemic. Only a public health care system—one that offers universal access to all people regardless of class or race—can address a large-scale health crisis like coronavirus.

This disparity could be seen in what happened when the first confirmed case of the virus hit New York on Sunday. Governor Andrew Cuomo announced the next day that he was directing health insurers in the state to waive cost-sharing—or what you’d pay out of your own pocket—for medical treatment associated with coronavirus testing. Those insured through Medicaid would also not have any co-pays.

According to Cuomo’s announcement, the emergency regulation specifically does the following:

It’s a good step, but there remain holes. What about patients who are uninsured? Or those who end up somewhere out-of-network? And what about the people who, unaware of the governor’s announcement and accustomed to a byzantine health care system that can incur extraordinary surprise costs out of nowhere, will still avoid going to the hospital to get tested? All of this could be mitigated under single-payer health care, which Cuomo has slow-walked in the state.

When emergency regulations are necessary to cover what should already be covered, the gaps in the country’s health care system become even more painfully obvious. Just this past weekend, The New York Times reported that a father and daughter traveling back to the United States were put into mandatory isolation, only to find that such isolation would cost $3,918 and it wasn’t clear who planned to pay for it.

Many have already pointed out that the threat of coronavirus only makes the case for universal policies like Bernie Sanders’ signature Medicare-for-All more urgent. “A global health threat requires a maximally inclusive medical infrastructure that can comprehensively manage risks across the population,” Michelle Chen wrote at NBC. It also illuminates the need for robust paid sick leave policies that will allow workers to stay home if they feel ill; and for workers to feel empowered to take that leave when they have it. As The New Republic’s Kate Aronoff succinctly put it: “We’re all on this sick planet together.”

No matter what outbreak-specific health measures Biden would support, his overall policies—especially his push for a public option instead of Medicare-for-All—are insufficient, patchwork answers for this epidemic and the next one. Centrist Democrats who resent the idea of large public programs have no good answer for a crisis like coronavirus. When more and more people are reminded exactly the reasons why universal health care is a public necessity, policies like Medicare-for-All will begin to look like the more pragmatic answer.

Elizabeth Warren has put out a comprehensive plan for combating coronavirus that frames the solutions for the crisis in necessary large-scale terms, calling for free evaluation, diagnosis, and treatment of coronavirus as well as an emergency paid leave program. But only Sanders has a realistic chance of winning the nomination and mobilizing a grassroots effort once in office to start putting pressure to pass large-scale public programs like Medicare-for-All.

Many people are asking what they, personally, should do about the coronavirus. Wash your hands. If you feel sick, stay home if you can. But also, mobilize, support, and vote for the candidate who is most likely to make universal health care a reality.

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