We were told that if America passed Obamacare, it would result in death panels.
This lie was invented by Sarah Palin in 2009, during the fight for what would become the Affordable Care Act. It was the hysterical version of the common conservative critique that universal health care means government rationing.
“Virtually every European government with ‘universal’ health care restricts access in one way or another to control costs, and it isn’t pretty,” said a Wall Street Journal editorial about the ACA. The Journal allowed that our system already rations health care according to people’s ability to pay for it, but argued that that’s how freedom works: “This is true of every good or service in a free economy and a world of finite resources but infinite wants.”
This argument was always specious, but it looks especially absurd in light of the coronavirus tearing through the world. America’s inadequate health care system, far from increasing liberty, is poised to make death panels more likely.
As waves of sick people crash onto undersupplied hospitals, doctors are preparing to make choices about who will get access to ventilators and other equipment, and who will get only palliative care.
“Health workers are urging efforts to suppress the outbreak and expand medical capacity so that rationing will be unnecessary,” The Times reported. “But if forced, they ask, how do they make the least terrible decision?”
America is not alone in facing such harrowing calculations. In Italy, which has universal health care, a medical association has published guidelines for allocating scarce health resources, giving priority to “patients with the highest chance of therapeutic success.” But with our hyper-privatized and grossly unequal health care system, the crisis here could be even worse.
After months of inaction and misinformation from an administration that disdains expertise, the number of confirmed coronavirus cases appears to be growing at a faster rate in the United States than in any other country with a major outbreak, and we are not ready. America has fewer hospital beds per capita than most developed countries, and more chronic health problems like diabetes that may put infected people at a higher risk for complications.
Donald Trump has been waging war on the ACA since he came into office, and the number of uninsured Americans has, by one measure, grown by 1.3 million since he took office. “To contain the virus, people will need to call health care providers as soon as they develop any flulike symptoms,” said an article in Stat, a health news website. “But will they do so if it means losing money?”
“The United States by its policy choices has one arm tied behind their back and is hopping on one leg,” said Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Medicine. Suddenly, the poor state of public health in America is becoming a life-or-death problem for even the most privileged.
When people without access to doctors, paid medical leave or decent housing get sick and are unable to quarantine themselves, the coronavirus spreads more quickly to everyone. Those trapped in prisons or crowded into homeless shelters can’t practice the social distancing necessary to contain the pandemic.
“The infection can propagate through people we didn’t want to care for as a society,” Gonsalves said.
Elites in this country have long tolerated a dysfunctional health care system because, while it delivers relatively poor results for many people, it provides good care for those at the top. A study published last year in The Journal of the American Medical Association compared life expectancy in the United States and Norway. “Life expectancy was higher in Norway than in the United States in all income percentiles, except for the highest income percentiles, in which life expectancies were similar in the two countries,” it found. For a lucky few, everything ugly and unfair about American health care might, in the past, have seemed like someone else’s problem.
But now Americans of all classes are going to be competing for the same scarce health resources. Your top-tier health insurance is unlikely to get you seen any quicker if you find yourself gasping for breath in an overflowing emergency room. The New York Post reports that plutocrats who’ve tried to purchase their own $35,000 ventilators are coming up empty: “Money can’t buy something that’s not there.”
Hospitals are being forced to postpone treatments for people with cancer and heart disease. The richest people might find workarounds — celebrities have had an easier time getting tested than the rest of us — but wealth can’t fully protect them. No one is safe from the coronavirus until everyone is.
Since the election of Ronald Reagan, America has tended to value individual market choice over collective welfare. Even Democratic administrations have had to operate within what’s often called the neoliberal consensus. That consensus was crumbling before the coronavirus, but the pandemic should annihilate it for good. This calamity has revealed that the fundamental insecurity of American life is a threat to us all.
“There’s no such thing as society,” Margaret Thatcher famously said. “There are individual men and women and there are families.”
Tell that to the families effectively under house arrest until society gets this right.
Michelle Goldberg is an Op-Ed columnist for The New York Times.