The Coronavirus Crisis Will Force Us to Reconsider Universal Health Care
A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services
Today I talked to a dozen health care experts of widely differing views on what we should do. I also started chasing my biggest question: Will the Covid-19 crisis cause us to focus on providing health care for all?
There is a lot of “expert chatter” about opening the economy instead of waiting for adequate testing and readiness. The logic is that time is destroying the economy and potential for a comeback. They make reasonable points. Small businesses have 27 days of cash. Other medical problems loom. Many people are lower risk.
One strange and consistent thing about everyone who argues we need to open is that we can’t count on a vaccine. They make that argument by pointing to “evidence” that we can’t create a vaccine for many other infectious diseases (like HIV). Thus we might as well open sooner.
Let me digress about a vaccine. You can find evidence to find whatever fits your narrative:
- “It’s easy — we are very close”
- “It is 18 months away”
- “It will take years”
I don’t know which is right, but one thing I do know is what some people believe depends on the narrative they want to convey.
I’m not discounting this argument that we can’t count on a vaccine, or the huge frustration with the state of the economy and unemployment. It’s rough. I’d love to change it. But here’s the thing — the Federal Government doesn’t get to decide.
Trump thinks he “shut down the economy.” He didn’t. We did. For our own safety. Americans and their state and local leaders acted to save lives. Likewise “we” are the only people that can “open” the economy. How fast we spend money, how quickly employers hire, how eager people are to restart small businesses — or even whether we send our kids to school — depends on how safe we feel.
So how do we feel?
Americans are pretty clear. They want to do the right thing and are doing the right thing. And Americans are willing to continue to do it for some time. Even at great sacrifice. Americans have saved hundreds of thousands of lives by following #StayHome guidance. The economy can come back. Those lives would have been lost forever. Even with these measures in place, we have lost 50,000 people — likely more — 80% of whom don’t know who infected them. This means thousands of people have infected people and never knew it. And people don’t want that. By the way, New York is now well-past the number of deaths some internal Trump Administration sources predicted.
The Kaiser Family Foundation had an enlightening study on American’s attitudes towards social distancing and opening up the economy which I discussed yesterday:
On to the big question I have been asked to address, whether the Covid-19 crisis will cause us to focus on the future of public health and providing health care for all. The answer (and our future) hinges on a single important question: Will the Covid-19 crisis end up more like the crack epidemic or the opioid epidemic?
What do I mean by that? To policy makers, the crack epidemic happened to “other” people. Our policy response reflected that. No resources, no support, and criminalization.
The opioid epidemic happened to “us”, as far as the powerful people were concerned. To white people. To all communities. Urban & rural. Wealthy & poor. And our policy reaction had resources, empathy, and more holistic policy discussions.
People in nursing homes, public housing, prisons and detention centers are getting hurt disproportionately. If that’s how we end up thinking of this crisis, I believe our response will be disappointing. Certain politicians will of course want to act in that situation. But others won’t. They’ll call for austerity after the crisis. And move to guarded gate communities.
Compare that to what happens if everyone feels this is happening to them, or someone they know. Then both parties will find consensus on major action. Constituents will be both scared and empathetic as they are to the opioid crisis. It will be “our” problem. 9% of Americans say they know someone who has died from Covid-19. 40% believe either they, or someone else, has had Covid-19.
This commentary is clearly just my opinion. I know it sounds cynical and people may not agree. But my experience with the political process and the lessons of the past is that our memories are short and our empathy not evenly distributed. Unless we feel the threat.
Losing more lives is too expensive a way to learn this lesson. I don’t wish the experience of losing, or almost losing someone, on one more person. But those who do will say this is not a normal virus. This causes blood clots, or fuels your immune system, it travels your body from organ system to organ system. These are just early systems with limited data. Undiagnosed deaths can look like many things.
Experts disagree over what we should do to open the economy — that is a reflection of where we are. Italy has done 2x more tests than the US. Many have put out a “plan” including me, but if that plan is put out with any pride, the reality is likely to make us all humble.
This story is pulled from my daily COVID-19 updates on Twitter
