Varun Saraswathula | After COVID-19, we need to consider universal health coverage in the United States

The COVID-19 pandemic has introduced tremendous anxiety into our lives. Our jobs, relationships, and routines have been irrevocably disrupted, and a path to normalcy (whatever that means anymore) is unclear. Above all else, however, we’re anxious about falling ill. For many in America, the greatest concern lies not necessarily in the disease itself, but with the bill that comes afterward. 

A recent Gallup poll found that 14% of Americans would not seek treatment if they showed symptoms of COVID-19, and 9% of Americans would not seek treatment even if they suspected a coronavirus infection. The reason? Cost of care. When only looking at responses from individuals making less than $40,000 a year, the rate jumps even higher: 22% would avoid treatment for symptoms, and 14% would avoid treatment for a presumed infection. This is troubling for a number of reasons. Obviously, it’s disheartening to see people eschew medical treatment for any reason, but especially during a pandemic, those individuals are likely to infect others, potentially thousands of people. By setting up and maintaining a system where people can’t access resources they desperately need, we actually hurt ourselves. The only way to solve this is by implementing universal healthcare. 

This is by no means a recent debate. For decades, healthcare has been a priority for the American populace, but it became more front and center in our nation’s discourse before the election of 2008, when former President Obama promised to help America’s uninsured. And he absolutely delivered — the Affordable Care Act was monumental in its impact on the American healthcare system. America’s uninsured population dropped from 46.5 million in 2010 to 27 million in 2016, but while the ACA was an incredible piece of legislation, it didn’t go far enough. Our uninsured population declined, but the number of underinsured Americans still remains concerningly high, hovering at around 45% in 2018.

Uninsured individuals are more likely to be low-income and people of color, and subsequently may not be able to take time off of work if they or a family member falls ill with COVID-19. Many uninsured individuals also work jobs that put them at a greater risk of contracting the virus: in 2018, the occupations with the greatest number of uninsured workers were construction laborers, cooks, drivers, cashiers, and waiters, many of whom must work during this time of crisis, due to the essential nature of their work. More importantly, America’s uninsured are the most likely to be denied medical care of any population. While the 1986 Emergency Medical Treatment and Labor Act mandates that all emergency rooms treat patients without regard to ability to pay, it does not require hospitals to provide care at no cost, and does not mandate hospitals to treat non-emergency cases. Our policies make sure our uninsured stay alive, but we kick them to the curb before giving them a chance to heal.

As one of the richest countries in the world, it’s staggering that we leave such a large portion of our population behind. Those of us with the resources to access medical care don’t necessarily have those resources because we earned them in our own right; many of us have them simply because we won the lottery of birth. Therefore, it’s up to us to support those without adequate health coverage, using the tools of our collective enterprise to give them that care. Dissenters to this worldview would likely claim that in a capitalistic society, poverty is necessary, and it’s a lamentable — but inescapable — truth that some just cannot have access to healthcare. However, dozens of other developed countries demonstrate that this is simply not the case.

When observing the healthcare infrastructures of other developed nations, our healthcare system is comparatively abysmal. A study conducted by the Kaiser Family Foundation looked at the coverage rate of citizens in 14 other developed countries, and the results were sobering. Belgium had an uninsured rate of 1.3%, four other nations had an uninsured rate of 0.1%, and nine other nations had an uninsured rate of 0%, compared to our rate of almost 10%. It’s not an inescapable truth that some cannot have access to healthcare: it’s an abhorrent idiosyncrasy unique to the United States.

Another argument is that, though our healthcare system is regrettably inequitable, it provides care that surpasses the quality found anywhere else. However, in the Commonwealth Fund’s 2017 ranking of healthcare systems in eleven other developed nations, the United States came in dead last. In the categories of Health Care Outcomes, Equity, and Access, we were eleventh. Our life expectancy is lowest among our peer nations. We have the third lowest physician visits per capita, and lowest number of physicians per 1,000 population. Where does the United States rank first among peer nations? Per capita spending on healthcare. Percent of chronic disease burden. Percent rate of obesity. 

It’s true that this data does somewhat of an injustice to the parts of the American healthcare system that are effective. An exceptional amount of the world’s healthcare innovation comes from the United States, a fact that these comparative studies often fail to acknowledge, and we excel at many preventative health measures, identifying cases of breast cancer and annually vaccinating our citizens at rates much higher than other nations. But the depressing truth is that the American healthcare system underwhelms from almost any perspective. It’s astonishing that, while we’re one of the richest countries in the world, we don’t have the decency to give many of our own basic access to healthcare. Instead of supporting our most vulnerable, we leave them on their own during their darkest hours.

More than 30 million people have filed for unemployment in the United States due to the coronavirus pandemic, and a large number of them are likely to lose their employment-based health insurance in the coming year. Many of them will be able to gain subsidized coverage through the Affordable Care Act, but in the fourteen states that have not expanded Medicaid coverage, many will find themselves in a precarious situation, particularly if they have the misfortune of contracting the coronavirus — on top of a dangerous viral infection, they would have to deal with financial devastation. I just don’t understand how, as a society, we can allow this to happen without feeling any remorse.

We need universal health coverage in the United States. This is not a radical or subversive political idea, but a simply rational and moral one. And the truth is, most Americans agree: about 56% of Americans support a national single-payer system, and almost 70% support a public option that would compete with private insurers. My insistence for universal healthcare isn’t necessarily an endorsement of Medicare-for-All, and certainly isn’t a call to dismantle the mechanism that is America’s private insurance industry. Healthcare infrastructures globally almost always have robust public and private components, and I hope our own system, at least in the near future, becomes an equitable collaboration between government-run and private payers. 

This is an unprecedented time in global history, and it’s up to us to deal with it appropriately. It’s imperative that we do right by our neighbors, our friends, and our coworkers. Every human life has equal value, and it’s time for our healthcare system to recognize that.

VARUN SARASWATHULA is a College sophomore from Herndon, V.A. studying the Biological Basis of Behavior and Healthcare Management. His email is vsaras@sas.upenn.edu.