As the COVID-19 pandemic escalates in the United States, as uninsured and underinsured Americans begin to contract the virus, and as millions more lose their jobs in the economic shutdown and find themselves thrown off their private health insurance, inquiring minds want to know: Is Joe Biden really still against Medicare for All?
“Are you now reconsidering your position when it comes to single-payer health care?” asked MSNBC’s Yasmin Vossoughian yesterday.
“Single payer will not solve that at all,” Biden answered.
His position has not changed since the Democratic Party presidential primary debate on March 15, when Biden balked at Bernie Sanders’s suggestion that having single-payer health care would reduce the devastation of the coronavirus pandemic. Known as Medicare for All in the United States, a single-payer system would automatically extend to everyone and be free at the point of service.
“With all due respect to Medicare for All,” Biden said, “you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All.”
That’s not how most Italians characterize the crisis facing their country. Even the Italian center-right claims that “the Italian system is holding up, thanks to its universal nature,” and that it would be foolish “to treat only some, and not others.” “Universal public health care is doubtless the reason why Italy hasn’t collapsed,” wrote two Italian observers in Jacobin, arguing that it explains why “the difficulties we face haven’t yet turned into mass tragedy.”
In the two weeks since Biden declared that national health insurance would have no impact, save maybe a negative one, the United States has overtaken Italy and every other country in the world in the number of confirmed coronavirus cases. In cases per capita, New York City is on track to surpass the hardest-hit cities and regions in both Italy and China.
And as Sanders and other Medicare for All advocates predicted, the fact that we don’t have single-payer health care is adding new dimensions to the crisis that are unique to our country, and uniquely horrific.
On March 12, seventy-eight-year old Ofelia Rousseva grew fatigued and slept for the better part of two days. Visiting her son in Greenfield, Pennsylvania, Rousseva, a renowned choir director from Bulgaria, lacked American health insurance, and she was reluctant to go to the hospital because of the cost. On Thursday, March 19, she died in her son’s home. The official cause of death was acute respiratory distress syndrome caused by COVID-19. Her son, a Lyft and Uber driver who has also tested positive for the novel coronavirus, is unable to hold a funeral for her.
On March 13, a seventeen-year-old boy in the Los Angeles area appeared fine. “He was healthy, he was socializing with his friends,” said the mayor of Lancaster, California. The unnamed boy, with no previous health conditions, grew sick over the next few days. On March 18, he was taken to an urgent care clinic. Despite his worsening condition, he was refused treatment and instructed to go to a nearby hospital because he lacked health insurance. On the car ride between facilities, he went into cardiac arrest. The hospital was able to keep him alive for six more hours before he died. The boy tested positive for COVID-19.
In the past month, Italy has seen many horrors. But it has not seen horrors like these, because in Italy, nobody is turned away for lack of health insurance, and nobody is hit with a bill they can’t pay as punishment for being sick.
Instead of Medicare for All, the United States has a patchwork of public and private health care options. For most people who are over the age of sixty-five and some disabled people, publicly funded Medicare is available. For people who can prove they make under a certain income threshold and meet other requirements, which are often complicated and designed to thin the rolls, publicly funded Medicaid is an option. For the most part, everybody else either gets their insurance through their employer or can purchase it themselves on the Obamacare exchanges.
More than 10 percent of people in the United States are uninsured. If you have no money and no job in a state that has work requirements for Medicaid, you have no insurance. If you have a job that doesn’t give insurance, pays you too much for you to qualify for Medicaid, but doesn’t pay you enough to afford health insurance on the Obamacare exchanges, you have no insurance. This amounts to millions of uninsured people already — people who, if they were to contract the coronavirus, as many certainly have and will, might be afraid to seek treatment or be turned away.
And there’s another category of uninsured person in the United States that suddenly matters a lot. If you lose your job, and with it, your employer-provided health insurance, you have no insurance. You can pay for an extension of your insurance, called COBRA, but if you lose your job during a national economic shutdown and you can’t find another, then you have no guaranteed source of income, making the already-expensive COBRA likely unaffordable.
Our private health insurance system is therefore creating a horrifying new problem: it’s generating millions of new uninsured people in the middle of an economic disruption caused by a public health crisis. These are people who, should they be infected, may be reluctant to seek treatment due to the high cost, or who may be turned away by clinics that are legally allowed to reject the uninsured.
Between the United States’ millions of already-uninsured people, millions of newly uninsured people, and millions upon millions more whose insurance imposes prohibitive cost-sharing on them — destined to become especially prohibitive during an economic shutdown when money’s tight across the board — that’s a whole lot of Americans who will be boxed out. Eventually, many of those who hesitate to seek care will end up at the hospital anyway, but by then, it could be too late.
There are a host of other ways private health insurance intersects with the current crisis. For example, the prevalence of uninsurance and underinsurance obstructs access to preventative care in the United States, which makes Americans less healthy than people in comparably wealthy nations — which makes our populace more vulnerable to serious expressions of COVID-19.
Another problem is that some nonessential employers are still requiring their employees to keep working, and if these workers refuse to show up, they risk being fired. Even if they could go without wages, many workers reasonably calculate that they can’t go without health insurance. This is potentially creating a situation in which the need to retain health insurance is encouraging people to congregate at their employers’ command, fueling the spread of the virus.
Joe Biden was wrong when he said that the coronavirus pandemic had “nothing to do with Medicare for All.” The notion is naturally seductive to Biden, who is friendly with the private insurance industry and vigorously opposes Medicare for All, but it’s a lie, and a dangerous one.
Many have been beating the drum for single-payer health care for decades, not least among them Bernie Sanders. Prior to the pandemic, the idea was already winning solid majorities in Democratic Party primary exit polls, and has even occasionally won majority support among Republicans. But now that the crisis has hit, its time has genuinely come.
Joe Biden would presumably like the government to pay for coronavirus treatment, but his narrow suggestion raises issues. Given that COVID-19 will remain among us after the acute crisis subsides, when will COVID-19 patients be asked to pay again? Will his program cover long-term damage caused by scarring infections? If someone has a medical condition made worse by COVID-19, how far does government payment extend?
Furthermore, we need to ask: If a system is not good enough for COVID-19, why is it good enough for cancer? The proliferation of questions like these underscores the superior wisdom of comprehensive single-payer health care. Joe Biden is wrong. Medicare for All is rational, humane, and achievable. We need it before the crisis began, we desperately need it now, and we will need it when the crisis is over.