Virus Threat’s Harsh Light

The rapidly unfolding global coronavirus crisis can’t help but get us thinking in a familiar vein:  woulda, coulda and shoulda. In the United States, if federal authorities hadn’t been hamstrung under a president who apparently thinks he knows more than professional disease-fighters and whose first impulse was to worry about his own political skin rather than Americans’ health, there would have been an earlier, stronger effort to prepare for the virus’s spread.

Test kits and other medical supplies could have been manufactured and stockpiled so that states such as North Carolina now wouldn’t be scrambling to get them. Steps to keep people from infecting each other could have been taken sooner. Guidelines for how and when to be tested should have been clearer and more consistent.

What it boils down to is inescapable: As a nation, we’ve come perilously close to bungling our chance to mitigate the effects of coronavirus disease before they get out of hand. Who knows how many among us have been left to experience disruption and/or financial hardship, to become sick, perhaps even to die.

Fortunately, there have emerged brave and far-sighted leaders at both the federal and state levels who are rising to the challenges and doing their utmost to curb the damage. And from the standpoint of the N.C. Council of Churches, this is an opportunity to revisit long-standing priorities now spotlighted as even more urgent.

• Those priorities involve improving the ability of all North Carolina residents to obtain adequate medical care when they need it, at a price they can afford.
• They involve workplace policies, ideally established voluntarily by employers acting out of enlightened self-interest but with government regulations as a backstop, ensuring that employees are not coerced into coming to work sick because they can’t afford to stay home.
• They involve robust investment in the entire public health enterprise, from development and testing of new vaccines to support for care providers serving in remote communities.
• They involve approaches to health care financing that are fairer, more efficient and more comprehensive in terms of who receives care and when. Special interests that drive a gigantic, for-profit health care industry must be brought under a regulatory framework that serves the public interest first and foremost.
• And there’s this: Amidst a crisis in which someone who can’t afford to see a doctor may not only be at greater personal risk but also may endanger anyone else he or she comes in contact with – whether at work, school, at a store or simply somewhere at random – the importance of bringing as many as a half-million more uninsured and poverty-stricken North Carolinians under the umbrella of Medicaid has never been so obvious.

Bound together

Perhaps with the COVID-19 outbreak we’re seeing an affirmation of something we’ve realized in the abstract but seldom seen demonstrated so vividly: Just as a chain is only as strong as its weakest link, so can our communities guard themselves against diseases arriving from distant corners of the globe only if each and every one of us can promptly obtain care and treatment.

It may prove impossible to achieve 100 percent protection in the face of a novel and aggressive virus such as the one that has killed upwards of 3,000 people in China and that now has forced Italy into a nationwide lockdown. But we must be able to take the kind of measures that have a good chance of containing it. A health care system that in too many instances leaves people on the outside looking in – especially people who find themselves low on the economic ladder – makes us all more vulnerable, even those of us lucky enough to be able to see a doctor of our choosing practically any time we want.

Of course, it’s true that the coronavirus’s actual danger has not been easy to gauge. Even if the scale of infection becomes large, it may be that the risk of serious complications or death for a given individual will remain relatively low.

However, aggregate numbers could mask the risk for people who are elderly or, for example, whose immune systems already are under stress. We don’t have to strain to imagine a scenario where a poorly paid, uninsured staffer at a nursing home comes to work while contagious – perhaps in denial because he or she fears losing pay. And then a bad situation quickly becomes worse.

It’s imperative, then, that the Trump administration and congressional leaders from both parties come together to make sure all Americans and their children are cushioned from the potential economic shock of missing work because of acute illness with a contagious disease.

That will require bucking strong resistance among some employers to the concept of universal paid sick leave, as well as having to figure out how to help the self-employed. But expecting sick people to either tough it out at work or stay home and lose money can no longer be an option. Too much is at stake – everyone’s health, along with an economy already edging toward the brink with closures, cancellations, shortages, travel restrictions, and plummeting stock values. 

Ahead of the spread?

As the true public health experts now are warning us, it’s likely that the crisis will continue to worsen before it finally runs its course. An alarming specter indeed is the chance that the health care system itself – hospitals, doctors’ offices, labs, suppliers of all kinds – will be overwhelmed with a surge of cases. That’s the reason for being especially cautious now, before the spread can accelerate.

It’s also time to buckle down against those long-standing disparities in access to care that affect so many of our neighbors. The White House makes vague assurances that coronavirus testing will be available without co-pays for the insured. But what about the many folks stuck with high-deductible insurance plans? Deductibles, too, can be disincentives to seeking care. What about those who have no insurance at all? In the midst of a pandemic, there could hardly be a better use of public funds than to make sure the costs of testing and treatment are covered for everyone, period.

For several years now, the Republicans who control our legislature have refused to go along with a straightforward broadening of the Medicaid program – financed mostly with federal funds – that would mean better health care for thousands of people now caught in a cruel coverage gap. The basic objection is that it might cost too much, even considering the federal share.

Gov. Roy Cooper, pushing for Medicaid expansion, vetoed a proposed state budget that failed to include it, and last summer the veto was upheld with support from Cooper’s fellow Democrats. With another budgeting cycle now in the offing, and as the virus threat looms, the Council of Churches urges Cooper and his allies to stand their ground. Republicans certainly can’t boast about their judgment in these matters after trying to cut $42 million worth of personnel from the Department of Health and Human Services.

An expanded Medicaid program wouldn’t be a cure-all. But it would help many North Carolinians lead healthier, more productive lives. And for every coronavirus patient it enabled to receive proper care, it would help protect the rest of us as well.