But it’s not just Covid-19 that has had an outsized impact on communities of color and people with low incomes. The prohibitive cost of health care in the US means many people can’t afford to take preventative action — leading to more suffering down the line as they develop health conditions that could have avoided. A patient I’ll call James recently came to the emergency department in Spokane, Washington, unable to speak or move the right side of his body. His stroke symptoms had started three days earlier, but he had unpaid hospital bills after a heart scare five years ago, and he dreaded engaging with the health care system again. He works at a convenience store and doesn’t have health insurance. The price tag and out-of-pocket costs associated with the plans available on his state’s insurance exchange had put coverage out of reach for him. Despite his father dying young of a heart attack and his mother having diabetes, he had not seen a doctor in years. Unfortunately, James’s delay in seeking care for his stroke meant it was too late for him to take clot-busting medication. His best hope is rehab, which might help him recover the ability to speak, walk, and use his right arm.
The frustrating thing for those of us who care for patients is that so much of their suffering is completely unnecessary. People who are able to control the risk factors of stroke (which include blood pressure, cholesterol and diabetes) are much less likely to need the expensive medical interventions we use regularly in American medicine. In James’s case, generic blood pressure medicine can be purchased for as little as $48 a year; hospitalization for stroke and subsequent rehab could cost well over $20,000. We can do better for people like James, and we’d save a fortune as a society by doing so.
The Covid-19 pandemic has cast the disparity between the haves and the have-nots in a harsh light. If people including low-wage workers, those experiencing homelessness, and the undocumented cannot afford to seek preventive care and testing, they risk their own lives, with the possibility of becoming super-spreaders if they have no choice but to continue working while sick.
As we wage the battle against Covid-19, it has become all too clear that the US would benefit from universal primary care. We can keep private insurance and the high-end specialty care America excels in, while also revamping access to the basic, foundational health infrastructure in the US. By enabling universal access to primary care, we can eliminate some of the inequities illuminated by this pandemic. We can afford to make basic health care a human right rather than a privilege. Until the simple prevention and treatment of common ailments is within reach for all, everyone in this country will be vulnerable.