By The Editorial Board
The New York Times, March 6, 2020
In late January, as the new coronavirus was making its first incursion into the United States, the Supreme Court upheld the Trump administration’s contested “public charge” rule, which enables federal officials to deny green cards to immigrants who use social safety net programs. The decision received scant media attention, in part because it was overshadowed by the emerging epidemic. But public health experts warn that the two stories are intimately, perhaps disastrously, related: Infectious disease outbreaks have a long history of preying on society’s most vulnerable, disenfranchised members. Noncitizens who don’t have access to health insurance, nutritious food or safe, affordable housing fall squarely into that category.
Doctors and immigration advocates have long worried that the public charge rule would present a grave public health danger. The rule could deter millions of noncitizens — even those who were not technically subject to its provisions — from using programs like Medicaid, WIC and SNAP or from seeking medical care of any kind, lest they imperil their immigration status.
The wisdom of each of those measures will be sorely tested now, as the coronavirus threatens to morph into a full-blown pandemic.
Already, citizens who are underinsured or uninsured are being slammed with medical bills that they can’t afford when they seek testing and treatment for the virus. Unsurprisingly, experts say that many of them are bound to avoid such care as the outbreak rages on. If quarantines become routine, tens of millions of low-wage workers, many of whom don’t have health insurance or paid sick leave, will not be able to stock up and stay home. One shudders to think what will happen if the courts dismantle the Affordable Care Act in the next year — a move that could ultimately leave 21 million or so more people without health insurance.
It’s easy to see how all this fear might feed on itself in the months ahead and also where that might lead. If citizens struggling to cover their own health care nurture resentments against any group perceived to be getting help to which they themselves are not entitled — or worse, if they grow xenophobic and subscribe to the notion that immigrants carry diseases — they might be compelled to endorse policies even more draconian than those already in play.
The best way to break this cycle of fear and further contagion is to dispense with zero-sum thinking and stitch together a safety net big enough, and strong enough, for everyone.
NYT Reader Comment:
By Don McCanne, M.D.
Why should we have “a safety net big enough, and strong enough, for everyone” only during an epidemic? Every day people face potential financial hardship, suffer from injury and illness and perhaps die prematurely. We need a “safety net” that is ready for all of us, all of the time.
The single payer model of an improved Medicare that covered everyone would do just that. Such a system would have built-in surge capacity plus the support of our public health agencies standing ready for us when the need arises.
Let’s not just tweak the system for one threatened pandemic. Let’s fix it forever for all of us.
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