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health as it happens

Fearing the doctor - The Week Magazine

For a few months, the United States was in the shocking position of beating Europe at a public health effort. America secured massive supplies of the coronavirus vaccines from the start, while the janky European Union bureaucracy was far behind — and so, for awhile, we were way ahead at getting shots into arms.

But now the U.S. is back where it belongs: being humiliated by European welfare states. Nearly all the richest nations in the E.U. have since passed up America at vaccination, and soon so will Finland, the Czech Republic, Greece, and Lithuania.

One under-noticed reason for this is the jalopy American health-care system. A large chunk of the U.S. population has learned to fear, distrust, and avoid the medical system if at all possible. The result is a large chunk of the population that is hesitating to get vaccinated.

Now, this argument must start with a caveat: The biggest obstacle to vaccination in the U.S. is surely the deranged state of the conservative movement. Everyone from Fox News' Tucker Carlson (the top-rated cable news host in the country) down to grassroots conservative Facebook moms have been pushing psychotic anti-vaccine conspiracy theories for months, so as to harm President Biden politically. That's why rural, conservative regions are the least-vaccinated parts of the country — and why thousands of conservatives who listened to Carlson are at death's door.

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But America's wretched health care is not far behind in terms of factors. As writer Natalie Shure points out, a recent Kaiser Family Foundation survey found that the uninsured had the largest share of unvaccinated people out of all sub-groups studied, with just 48 percent vaccinated (Republicans were just ahead at 52 percent, though that is a much larger group).

To be clear, as I previously argued, it is still the case that the mass vaccination campaign is an excellent proof-of-concept for Medicare-for-all. The reason America got so many shots done so fast at first was because the government set up mass clinics all over the country and gave them away for free. One reason we're struggling now is the ruinous side effects of the status quo health-care system.

In another Kaiser survey, a third of unvaccinated folks report that they haven't gotten the shot because of cost worries, and it's obvious why. A great many medical providers view the uninsured like a hungry vulture looking at a wounded puppy. Just a few examples out of thousands: one study found that the worst-behaved hospitals charged uninsured people 10 times the cost of care; corrupt providers have reportedly tried to steal people's car accident settlements, deliberately put themselves out of insurance networks so they can bilk the sick out of tens of thousands of dollars, turned ambulance services into extortion rackets, and on and on. Millions and millions of Americans have learned the hard way that going to the doctor for any reason can easily lead to shattering financial burdens.

In terms of the coronavirus, in most cases this worry is a false one, as the vaccine is indeed being given out for free in most places. But not everywhere! It turns out that — despite legal requirements from the Biden administration — providers have illegally charged some individuals for the vaccine. If you thought a global pandemic would be the time for medical swindlers to stop compulsively stealing money, you would be wrong.

This wretched system undoubtedly worsens the vaccine hesitation seen among people who are open to getting the shot but haven't gotten around to it. In addition to being a financial risk, interacting with the medical system is a giant pain in the neck at the best of times, due to all the paperwork and bureaucracy — and because the system has become so impenetrably complex, a large and growing share of people no longer have a personal doctor they see regularly and ask for advice. All this creates a habit of avoiding medical care even when it doesn't make sense. "I am here now, I am furious with myself … Because I was not vaccinated," one Louisiana COVID-19 patient told CNN recently. She had planned on getting the shot, but every time she thought of it "something would come up."

Then there is the lack of supporting structures like national sick leave, which adds a further roadblock. Yet another survey found that unvaccinated folks were worried they would suffer side effects but not be able to take a sick day at work. The U.S. is the only rich country without any national paid sick leave policy, and now we're all paying for it.

The American health-care system simply is not geared to protect the well-being of the bottom third or so of the country. But it turns out that even the poor can spread a deadly virus, and rich people can catch it. If we want to protect this country against future pandemics and run-of-the-mill illness alike, we need universal health care.