Wolf10’s diary entry about The Political Economy of COVID-19 inspired me to write this separate diary about a related topic.
Nearly all discussions of M4A centers around who should be covered and what is the cost. We are told that medical care is a right, or that it is a privilege. We read about individuals suffering or dying or being ruined financially by the cost of health care. The focus is on individuals and their families. The uninsured and underinsured are privileged, the rest are not. People ask questions beginning with, “Why should I have to spend my hard-earned money…”
But I have been obsessing over the question, “What is the significance of 67 million Americans being underinsured or uninsured in a time of increased risks from communicable disease?” I’m concerned about the incentive to avoid seeking medical care until they are seriously ill when they might be infected with something very dangerous, like COVID-19. I’ve commented more than once that when I recently visited the ER and stayed overnight for observation, it generated a bill for well over $10K. Unless a person has very good insurance or are reasonably well off, that could be ruinous. Am I overstating it to say that 67 million uninsured or underinsured are 67 million potential “Typhoid Marys?”
If my neighbor does not see a doctor when he might be infected, that is a direct threat to me and mine. And it’s not just a matter of people who are feeling ill and need to be diagnosed and treated and quarantined. It seems that a person can be an asymptomatic carrier of COVID-19. People who are uninsured (and to some extent the underinsured.) are simply outside the system, and that increases the likelihood that they’ll spread the disease.
Because I’m a “geriatric” patient (hate that word, “geriatric,”) I see a doctor regularly, twice a year, and get half-hour appointments — even though I’m not ill, so afar as I know. Sometimes a pharmacist shows up to review my meds with me. If I have health concerns — any little thing, I can call and speak to a doctor or nurse at any time. If I were worried that I might have been exposed to a contagious disease, I could easily get advice about the risk and what to do. What is more, I know that I can. I’m not limited to consulting Dr. Google. And it’s all covered, except for a trivial co-pay.
But back to my next-door neighbor. If he can’t see a doctor and is infected, my life is at risk. All my wonderful medical care could be entirely beside the point. Where communicable diseases are concerned, we are most certainly all in this together. Saving money by leaving tens of millions of people outside the system is not just cruel, it is potentially suicidal behavior.
Politically, we have to be aware that a great many people are empathy-impaired. Pointing to the suffering of others is not effective in changing their minds. But focusing on the threat to them and their families might have a real impact. And talking about the economic impact of an epidemic might also be appealing, especially when we have the highly visible example of China.
I think this also relates to the question of incremental change. A “Medicare for all who want it,” approach sounds swell. But as long as any substantial number of people are outside the system, the risk of infection is increased for all of us.