PV, or Pre-Virus, advocates for national health insurance, citing convincing reasons, did not convince a swathe of the electorate. The employer-based system, after all, insured most of that swathe. A feasible plan would build on it, with safeguards to protect enrollees from the greediness of private insurers, with subsidies to help people buy insurance if they couldn’t afford the premiums, and with the government as insurer for almost everybody else. (A sliver to a chunk of the population would remain uninsured). Many progressives were willing, if reluctant, to accept pragmatic progress, hoping that the arc of justice was bending towards justice.
AV, or After Virus, not just our world, but the arguments for national health insurance, are upended. We have no choice.
First, Uncle Sam has stepped in already to spend billions on healthcare. Because the virus is so contagious, so lethal, the government is paying for much of the care. At least for the virus, forget co-pays and deductibles. Just get tested. The message is clear. Health over all. Even over ability-to-pay, which has been the cornerstone of American health policy. PV, the government insured more Americans than conservatives like to admit: the elderly, the disabled, the low-income, the government employees, the military, the veterans. AV, the list has grown. We may try to parse the expenditures — so much for virus-related illnesses, nothing for non-virus-related ones, like cancer, arthritis, diabetes. But that parsing by diagnoses grows difficult when patients present with a configuration of diagnoses, as many do.
Second, the employer-based system depends upon a thriving private sector. The economy has tumbled. Just as public health officials chart the number of COVID cases, economists track the number of people furloughed, the number who have applied for unemployment, the number seeking food stamps. “Payroll protection” is predicated upon optimism: we want to protect jobs for the AV upturn.
But when the upturn happens, no seer (except our president) blithely predicts life for all sectors. Will retail stores spring back? Will people shop for clothes, trying them on? Will sports arenas fill up, with mask-wearing participants sitting six feet from each other (it dampens the camaraderie of cheering)? What about planes? They need passengers more than a government bail-out. Will tourists once again sightsee across the globe? Some industries may hunker down for a few years, confident that with time and amnesia customers will return. Certainly the cruise and hotel industries hope so. Right now the hotels are filled not with tourists or business executives but with first-responders working 12-hour shifts. In time those industries may not only spring back, but adapt. In time new industries will soar (think Amazon, Zoom, Google). The key phrase, though, is “in time.”
Waiting in the wings for a pink slip are the employees of state and local governments. To date, those governments have held on to employees, often re-positioning them as crisis-helpers. But as tax revenues fall, those governmental employers may need to pare their ranks. Banks, mortgage companies and landlords may slash the payments due from homeowners and renters. Cities are not likely to forgive taxes. States depend on sales tax revenue; a plummeting retail sector translates to plummeting tax revenues. The upshot: more people unemployed.
AV, the crucial question looms: What percentage of our population will we leave without health insurance, without health care? The stop-gap measures of PV will not work. COBRA works only for former employees solvent enough to pay the full premium; it won’t work at all for former employees whose companies have folded.
As for Medicaid, the states and Uncle Sam have joined to insure some people who can’t afford insurance on the open market, but states have been trying to ratchet down those rolls. AV, those rolls will soar, forcing states and Uncle Sam to recognize that the poor and near-poor are not a social aberration, but part of the body politick. The federal government will have to step forward.
During this lockdown, we have seen dystopia overwhelm all of us, from hospital staff to supermarket cashiers, from pharmacists to nursing home residents to their families. If I have “it,” you may get “it,” which would mean that scores of others will get “it.” This virus is social. Many of us have reached out to neighbors we don’t know, family we barely see, friends we’ve lost touch with: how are you? The virus has temporarily stilled the race to succeed, to acquire, to spend; in our homes, we have zoomed to the world outside. A few robustly conservative (call them loony) ideologues, like Senate Majority Leader Mitch McConnell, call for letting hard-pressed states sink into bankruptcy. But the people in New York, Massachusetts, New Jersey, Washington — the virus-ridden states — are part of our nation. We won’t cast them adrift. (If we did, the bond ratings for every state, every city, red or blue, would plummet.)
National health insurance is now a necessity.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, June 1, 2020
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