One of Bernie Sanders’s key rallying points in 2016, and again in 2020, was government-sponsored health care—what he called “Medicare for All.” As he argued, health care ought to be a basic human right. Especially in a country as wealthy as the United States, to deny anyone medical services because of inability to pay is epidemiologically and politically shortsighted, not to mention morally perverse.
Sanders’s opponents proclaim that “socialized medicine” contradicts an essential U.S. value: the individual’s right to choose. They conveniently forget that unmodified capitalism denies those who lack financial resources the opportunity to choose any care at all.
Defenders of the status quo also point to the allegedly prohibitive cost of government-sponsored health care. One obvious response is to tax the super-rich. Another is to divert funds from our military budget. The risk of U.S. defeat by a foreign invader is virtually nil; the threat of national disintegration because our economic system fails to represent the interests of ordinary working people is infinitely greater.
In one way or another, many countries less financially well off than the United States manage to provide medical service to all who need it. As an anthropologist, I have lived in some of the world’s poorest nations. The one I know best is the Solomon Islands, a former British colony in the southwestern Pacific. Solomon Islanders fortunate enough to have a stable job may earn the equivalent of US $10,000 a year. Large numbers, however, have no monetary income and live on what they grow in their gardens or collect from the sea. Yet even in the Solomons, medical care is free in hospitals and local clinics.
Last year, I spent six months in the Czech Republic. The ČR is not a poor country, but neither is it among the world’s richest. Prior to 1989, it was part of the Soviet bloc. Today, political opinion is diverse. The current prime minister, like Donald Trump in the United States, is a wealthy businessman; the president is a long-time social democrat who has morphed into a xenophobic nationalist. The Communists, with 15 parliamentary representatives, still constitute the country’s fifth largest political party, just behind the far-right “Freedom and Direct Democracy Party” with 22.
Despite that diversity of opinion, however, all Czechs seem to agree on one point. When I asked people what they most appreciated about living in the Czech Republic, free health care was universally cited. Even conservative interlocutors expressed astonishment that government-sponsored health care is controversial in the United States. The Czech system isn’t perfect. Everyone had areas of frustration and suggestions for improvement. But not one of my acquaintances advocated moving to a private, competitive, profit-driven system.
For countless U.S. residents, access to affordable health care can make the difference between a comfortable life and economic ruin. For some, the absence of a viable public system has meant a life of needless pain and disability. Sometimes, it’s the difference between life and death. Until recently, the debate for many has been abstract. The coronavirus changed all that.
Unsurprisingly, rates of infection and death from COVID-19 are highest in poor, crowded, minority communities. But with a highly contagious disease for which we have neither a vaccine nor an effective remedy, all are at risk—as demonstrated by infected members of the White House staff and UK Prime Minister Boris Johnson’s near-death experience.
Currently, control of COVID-19’s spread entails social distancing and contact tracing. The latter requires reliable testing. Then, once someone is identified as carrying the virus, the victim must be kept away from others and provided with symptomatic treatment to minimize the risk of serious complications or death. The last thing we need under these circumstances is to deny testing and medical support to those who can’t afford it. Everyone will benefit from making health care universally available. Should we fail to aid the poor and disenfranchised, all will suffer.
In partial recognition of this reality, the “Families First Coronavirus Response Act,” passed by Congress on March 18, mandates free coronavirus testing. To the extent that providers abide by the spirit of “Families First,” it is a small but significant step in the direction of “Medicare for All.” Unfortunately, lack of sufficient planning has meant the availability of far fewer tests than are needed. Moreover, numerous reports document instances where the cost of testing is not fully covered or, sometimes, not covered at all for those who need it.
U.S. medical coverage has changed over the years. Thanks to hard-won union contracts, employers often provide health insurance for their workers. Medicare and Medicaid offer health care for many elderly or impoverished patients. And the Affordable Care Act, aka Obamacare, makes medical insurance accessible for millions of Americans who would otherwise be on their own. Still, our system is a piecemeal patchwork, leaving many vulnerable. And, as COVID-19 makes inescapably clear, so long as any of our neighbors are at risk, not one of us is safe.