Markets don’t work in a public health crisis

Osmel Martinez Azcue, who got a $3,270 bill for a coronavirus test

In China, we have already started to see more people being released from quarantine than new confirmed cases of the novel coronavirus. The initial curve has peaked. Though there were some criticisms of the way Chinese authorities handled the outbreak in the first couple of weeks, it now appears that the crisis response from the Chinese government has been more than adequate to the test.

What did the People’s Republic of China do right? Well, first off: it made testing for COVID-19 free at the point of use. Honestly, that was the only humane and the only reasonable thing to do. As the otherwise-hostile Isabella Steger notes over at Quartz:

“This is exactly why there are few infection cases in the US. People there don’t even want to go have the test [because of the cost],” wrote one user, responding to an article about an American man returning from Wuhan who received a large bill after US health officials placed him in quarantine. In China, testing and treatment for coronavirus is free.

The mainland Chinese health care system in general delivers better care at better prices to the people who need it most in a crisis: the poor, the immune-compromised and the elderly. In this crisis that’s unfolded since the Chinese New Year, the Chinese government has mandated that coronavirus testing be free for the user. In contrast, American hospitals are charging anywhere between $1000 and $3,200 (in the case of Osmel Martinez Azcue from Florida) for administering a coronavirus test.

The fact that insurance companies do so much to hide the information from the insured until they can slap them with a four-figure bill shows, not only how inhumane the American health care system is, but also how ill-prepared it is to deal with a public health crisis of this magnitude. Financial worries and the threat of medical debt are keeping Americans away from clinics and hospitals. This should be gravely concerning to anyone concerned about public health efforts, because the infection will spread faster and will claim more lives, the more cases of COVID-19 go untested and untreated until it’s too late. As David Wallace-Wells at New York Magazine put it yesterday:

The testing shortage is catastrophic: It means that no one knows how bad the outbreak already is, and that we couldn’t take effectively aggressive measures even we wanted to. There are so few tests available, or so little capacity to run them, that they are being rationed for only the most obvious candidates, which practically defeats the purpose. It is not those who are very sick or who have traveled to existing hot spots abroad who are most critical to identify, but those less obvious, gray-area cases — people who may be carrying the disease around without much reason to expect they’re infecting others. Into this vacuum has stepped the Gates Foundation and Amazon, which are trying to deliver large-scale testing capacity at least within Seattle.

But in what awful, dysfunctional universe do we live that it has fallen to private companies and philanthropies to deliver necessary medical support in a time of American pandemic? There is probably no stronger argument for public health care than the crisis we are living through today, and no more grotesque indictment of our present system that leading providers and insurers had to be cajoled into waiving fees and co-pays to even deliver tests.

Only a few short weeks ago, the corporate American news media were all but salivating over the idea that the novel coronavirus was a ‘test’ of the legitimacy of the Chinese communist authorities – and behaved as though it was merely a Chinese problem and one that would not spread to the West. But life comes at you fast. Now, it appears, our own public health system is being weighed and measured and found wanting in comparison with China’s. And the infuriating thing is that this coronavirus outbreak really isn’t the test of an either-or choice between civil liberty and decent long-run health outcomes. There are readily-available models of democratic governance with protections for needed civil liberties, which can also provide this kind of comprehensive response, at low cost to the people who are most vulnerable.

Actually solving this problem and preventing future ones, however, doesn’t appear to be on anyone’s agenda on either side of the political aisle – unless we count outsiders like Bernie Sanders and others promoting Medicare for All. Certainly centrist-wonk Democrats have no desire at all to better prepare the health-care system for the next outbreak, and the Republicans have even less. So instead we are getting two reactions: official denial and anti-Asian racism, with semi-official proxies in the media like Tucker Carlson being the biggest proponents.

This is not a call to panic; panic does no one any good. Speaking personally, I’m not for stockpiling toilet paper or hand sanitiser. But it’s past time to get real about what it will take to save American lives in the future. The novel coronavirus may not look like a big deal in the present moment, but that will change; and even if it does blow over with few deaths – In shâ’ Allâh – there will absolutely be future public health crises. Only a system which can react to such crises in a manner that is not driven by the profit margin stands a chance of being effective.