Originally appeared in Jacobin on March 18, 2020.
Photo by Duncan C. (via Flickr)
Every gap in health coverage threatens to accelerate COVID-19’s spread. If the estimated 87 million Americans who are uninsured or underinsured delay testing or treatment due to cost, we will struggle to “flatten the curve” of the pandemic no matter how well we socially distance. Our health system may well collapse under the weight of COVID-19 cases, as did the health systems in Northern Italy and China’s Hubei Province. If this happens, we will run out of ventilators for those who need them, while our capacity for routine lifesaving interventions, like stents for people who have heart attacks and emergency surgeries for trauma victims, will be curtailed.
Our inadequate preparation for COVID-19 extends beyond the lack of guaranteed health care for all. Years of underfunding the Center for Disease Control (CDC) and its laboratories impedes our ability to track, confirm, and intercept cases. Furthermore, chronic disinvestment from local and state departments of health prevents us from addressing emerging health crises and communicating vital information to communities. This lack of investment in public health infrastructure is symptomatic of a system oriented toward covering individuals rather than communities. Our vulnerabilities speak to our health system’s broad misallocation of resources.
We should recognize this misallocation, now dramatically highlighted by COVID-19, and fight for a collective approach that pivots the focus toward community health. Such a shift would mean moving resources toward more robust disease prevention through the CDC and overdue investments in the social and structural determinants that hold sway over our health, while also guaranteeing that every person can access health care when they need to.
The very real possibility of our health system becoming saturated by COVID-19 lends a sense of urgency to the question of universal coverage, one which many people may have never felt before.
In this critical moment, the COVID-19 pandemic may give us an unprecedented opportunity to mobilize new allies and expand the coalition advocating for single payer health care. Right now, we can expand that coalition and fight for Medicare for All (M4A) in the time of COVID-19.
Talk to your older family members and friends.
One of the clearest trends in this election cycle has been the generational divide, with younger voters consistently supporting progressive policies like the Green New Deal, M4A, and tuition-free public higher education while older voters much less likely to support them and the candidate (Bernie Sanders) who most consistently fights for them. Older people are also more likely to be adequately insured, and may not have deeply considered having health care denied to them. This is especially the case for older, wealthier people, whose wealth insulates them from the economic precarity that illness and injury reveal.
COVID-19 teaches a vivid lesson in our mutual dependence. It shows us how lapses in health care access endanger not only the health of the uninsured and underinsured, but everybody. Even so, COVID-19 is actually more dangerous for older generations, and intergenerational transmission has been one of the driving causes of COVID-19’s spread.
The virus has made clear what has always been the case: health care is never a question of individual choice and opportunity, but of collective safety and mutual responsibility.
If the health system collapses under COVID-19, it collapses for everyone, not just the uninsured and underinsured. As extraordinary measures are taken to provide tests and mobilize resources in order to stem the spread of the disease, an opportunity opens to make the case for universal health care. We must help our older family members and friends make an empathetic leap to conclude that there is no reason any of us should suffer from lack of access — now or after this pandemic. We must help them understand that we advocate for M4A because we are fighting for many lives — including their own.
Join a single-payer advocacy group.
The organization Healthcare-NOW is dedicated to training activists and mobilizing proponents of M4A around the country to share their personal narratives, engage in collective action, and give legislative testimony. You can share your own story with Healthcare-NOW, and find other M4A advocacy groups in your vicinity on this map.
Meanwhile, the Democratic Socialists of America (DSA) is organizing a pressure campaign on members of the House of Representatives to support M4A. Join a local DSA chapter and get involved in this work.
Pressure your legislators.
The COVID-19 crisis presents a chance to revive conversation about M4A legislation lying dormant in Congress. We wrote an open letter to our legislators. Sign it, and use it as a template for a message to your own legislators in the House and Senate.
If your legislators already support M4A, thank them and urge them to keep M4A in mind as they grapple with the current crisis. If not, demand they reconsider, in light of COVID-19, and bear in mind that when they are up for reelection, their constituents will remember how they acted, or failed to act, during this crisis.
Millions of Americans also still have the chance to elect a president who supports universal healthcare by voting and volunteering for Bernie Sanders, the only remaining presidential candidate running on M4A and the one who “wrote the damn bill.”
Pressure the medical establishment.
The American Medical Association (AMA) is the most influential guild of physicians in the country. In the early 1960s, the AMA employed then-actor Ronald Reagan to record propaganda decrying the evils of “socialized medicine” in an attempt to thwart the passage of Medicare.
Although Medicare became law, the AMA continues to oppose single payer. If you are a medical professional, talk to your colleagues in the AMA and build grassroots support to sway its leadership from below by joining an organization like Physicians for a National Health Plan.
Prepare to address common misconceptions about M4A.
You may meet opposition in your conversations about M4A, because the insurance and pharmaceutical industries have saturated our political discourse with anti-M4A talking points. The Kaiser Family Foundation recently conducted an opinion study that identified some messages commonly used to provoke opposition to M4A. Be an active listener and respond with kindness to the concerns of your interlocutors.
“M4A would be too expensive.” The truth is that our current system is too costly, while countries that have adopted single payer, like the United Kingdom and Canada, spend less than half of what we do on health care. While M4A would shift the way we pay for health care from premiums and employer contributions to individual and payroll taxes, overall US health care expenditure would plummet by an estimated $450 billion annually, and costs would decrease substantially for the vast majority of individuals. This interactive tool lets you change various parameters and see the resulting savings.
“M4A would limit choice.” The main choice that we would lose under M4A is which unaffordable insurance plan to pay too much for. Our choice of health care provider is already limited by exorbitant out-of-network fees, assuming we have insurance to begin with. With M4A, every provider would accept every person’s insurance, and we would be freer to choose our providers.
“M4A would lead to delays in medical testing and treatment.” To the extent that such delays exist in countries like Canada and the United Kingdom (and that extent is grossly exaggerated by M4A’s opponents), these aren’t intrinsic structural defects of the single payer system — they’re the result of budget cuts imposed by calls for austerity from the Right and center left.
The power of this particular time lies in the virus’s ability to pose a mortal threat to the economic interests and the lives of those holding the reins of power, across many spheres. But, as always, the greatest dangers remain for the most vulnerable and marginalized members of our communities, including people who are incarcerated, elderly, or immunocompromised.
The sense of dread beginning to dawn on the wealthy and powerful resembles the sense of dread already familiar to anyone who’s been uninsured, or denied health care for any other reason. The reality that our capacity to live healthy lives is fundamentally dependent upon the well-being of the people around us should be evident to everyone today, regardless of wealth, power, or privilege. We have an unprecedented, critical opportunity to reshape the conversation around universal health care going forward. Let’s make the most of it.