Here in the United States, we’re about to see the outcome of a cynical experiment involving 327 million involuntary human subjects.
We’ll see what happens when extreme health care inequality collides with a virus that doesn’t discriminate.
We’ll see what happens when the spit hits the fan.
In the U.S., where health care is rationed according to the ability to pay, those who have high-deductible insurance, significant co-pays for services or no insurance coverage at all are far more likely to let conditions go undiagnosed and untreated.
A 2018 survey by the University of Chicago and the West Health Institute found that over the previous year, 44% of Americans didn’t see a doctor when they were sick or injured due to cost.
Stunningly, 40% of Americans surveyed said they were more afraid of having to pay for health care if they were seriously ill than were afraid of actually getting seriously ill (33%).
So, that means potential coronavirus vectors are out there avoiding health care all across the country simply because they can’t afford it.
And among this group that’s nearly half of all Americans, a significant percentage have no paid sick time and are far more likely to go to work sick.
One recent survey found that 90% of workers admitted to coming to work sick occasionally, and 33% said they come to work all the time when they’re sick.
This is precisely the situation the World Health Organization is desperately trying to address.
To stop the rampant spread of COVID-19, the WHO recommends “stay home if you feel unwell” and “if you have a fever, cough and difficulty breathing, seek medical attention and call in advance.”
Easy to say.
“The massive inequities in the U.S. are dramatically exposed in times of pandemic,” said Sarah McAfee, director of communications for Center for Health Progress in Colorado. “Our laws and policies limit the opportunity” for us to execute a successful public health response in the face of the fast-moving health threat.
We’re reduced to having to plead with people to do the right thing even if it’s at huge personal expense.
The Miami Herald reported that a man voluntarily submitted to a coronavirus test when he experienced flu-like symptoms after traveling abroad for work. He said he wasn’t that sick but wanted to undergo the test just in case so he could do whatever was necessary to protect the community.
For his responsible behavior, he was billed $3,270. (The bill was reduced to $1,400 after the Herald called the company for comment.)
To his credit, Gov. Jared Polis has been aggressive in mobilizing the state’s response to the virus, providing emergency paid sick leave and keeping the public well informed about the fast-moving outbreak.
Colorado’s proactive testing effort, including one of the nation’s first drive-through testing stations at Lowry, is exceptional in no small part because testing is free.
Still, economic disparities affect our ability to cope with the pandemic at the most basic level.
“Supplies and health care resources are hoarded by those with the financial ability to do so,” McAfee said, leaving large populations to fend for themselves without disinfectants or stockpiles of food, often in housing situations where self-isolation is nearly impossible.
Even information is distributed inequitably with few accommodations made for those who are not English speakers or have limited access to the internet where most of the up-to-the-minute advisories, guidelines and warnings are posted.
While it’s not news that we have an economic model for health care that relies explicitly on systematic neglect of a large percentage of the population, the dangers of that strategy are vividly and grimly exposed in a disease outbreak.
And that leads to some pretty irrational behavior.
While one worrisome hotspot for the disease is Aspen, home to the famous and fabulous, rich white people haven’t been shunned – at least not yet – for fear of disease.
Instead it’s people of Asian descent. Even Asian restaurants have experienced a noticeable drop in business.
Meanwhile, McAfee noted, “there’s just as severe an outbreak of coronavirus in Italy and people here aren’t boycotting Italian restaurants.”
So, while we’re hunkered down at home taking our temperatures, guarding our toilet paper supplies and avoiding crowds, we have an opportunity to consider what might actually help in a future pandemic.
Cost no longer is an excuse for inaction. The response of the stock market says it all.
We’re all equal in this viral soup. We’re all in this together.
Diane Carman is a Denver communications consultant.
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