An exclusive healthcare system

The argument

The barriers posed by the healthcare system are manifold. And raise questions - should those that are unable to afford basic healthcare be treated? Should only the wealthy have access to a vaccine or coronavirus treatment? Since the virus arrived in the US, over 800 experts have written to US policymakers demanding action for the uninsured. Yet, these please have fallen on deaf ears. Federal governments have refused to commit to any agreement that would give these people treatment or access to healthcare, if they were struck by Covid-19. Unsurprisingly, without these measures passed, hospitals are now openly stating they will have to give priority to the insured. Soumi Saha, a Senior Director overseeing 4,000 hospitals explained this when she said "The truth is no one truly knows how much this will cost," and went on to explain their budgets were already overstretched. In this case, is it any wonder the virus is spreading as it is?

Context

The American healthcare system is famously exclusionary. Currently, more than 18 million Americans are without health insurance. Of those that do have insurance, 29% are categorised as 'underinsured'. It is therefore woefully underprepared for the arrival of a global health pandemic.

Premises

Counter-arguments

The question is why case numbers were so high, and the argument is about treatment access — two different things. Case counts are driven by transmission: testing availability, masking, distancing, the timing and stringency of restrictions, and the density of indoor gathering. Whether an infected person can afford hospital care bears on how badly they fare, not on how many people are infected. There is a transmission-relevant version of this argument — that fear of cost deters people from getting tested or from staying home, which suppresses detection and sustains spread — but the entry does not make it. The comparative record also cuts against insurance status as the explanation. Countries with universal, free-at-the-point-of-use systems — the United Kingdom, Spain, Italy, Belgium — recorded some of the world's worst per-capita case and death rates in the same period. If an exclusive healthcare system were the driver, those outcomes would be hard to account for. One factual claim needs correcting. The federal government did not refuse any provision for uninsured COVID care: legislation passed in spring 2020 established a programme reimbursing providers for testing and treatment of uninsured patients. The programme was criticised as partial, underfunded and eventually exhausted, which is a serious objection — but it is a different objection from the one made here. The entry also closes on a rhetorical question rather than establishing the causal link it asserts.

Rejecting the premises

[Rejecting P1] Barriers to treatment affect outcomes for those infected rather than the number of infections, and the transmission-relevant mechanism — cost deterring testing and isolation — is not the one the entry argues. [Rejecting P2] Federal legislation in spring 2020 did establish a programme reimbursing providers for testing and treating uninsured COVID patients; it was underfunded and later exhausted, which is a different criticism from a refusal to act.