Like many Americans, bartender Danjale Williams is worried about the growing threat of the coronavirus. What makes the 22-year-old in Washington even more frightened – the thought of medical bills she just can’t afford, as one of almost 27.5 million people in the United States who don’t have health insurance.

“I definitely would second guess before going to the doctor, because the doctor’s bill is crazy,” she said. “If it did come down to that, I don’t have enough savings to keep me healthy.”

As the virus is causing more people to fall ill in the country, public health experts warned that the US has several characteristics unique among wealthy nations that make it vulnerable.

These include a large and growing population without medical insurance, the 11 million or so undocumented migrants afraid to come into contact with the authorities, and a culture of “powering through” when sick for fear of losing one’s job.

“These are all things that can perpetuate the spread of a virus,” said Dr Brandon Brown, an epidemiologist at UC Riverside.

The US has some of the world’s best hospitals and medical staff, but those not lucky enough to have good insurance through their employer, and not poor enough to qualify for state insurance, often opt out of the system entirely.

A routine doctor’s visit can run into hundreds of dollars for those without coverage.

That’s not to say uninsured people have no recourse if they fall seriously ill. US law requires that people who have a medical emergency can get the care they need, regardless of ability to pay.

Ms Abigail Hansmeyer, a Minnesota resident who along with her husband is uninsured, said that if she did fall ill, “we may seek out the emergency room for treatment”.

But being treated doesn’t mean the visit would be free, and the uninsured can still be lumped with huge bills after. “So we have to very carefully consider costs in every situation,” the 29-year-old said.

One of the key messages the Centres for Disease Control and Prevention has put out about the coronavirus is to stay home if you have mild respiratory symptoms, except to go to the doctor once you have called in and if they think you need to.

“But a lot of people, depending on their jobs, their position and their privilege, are not able to do that,” said Dr Brown.

The US is alone among advanced countries in not offering any federally mandated paid sick leave. Though private companies offer an average of eight days per year, only 30 per cent of the lowest-paid workers are able to earn sick days, according to the Economic Policy Institute.

For many of these people, missing even a day’s work can make a painful financial dent.

An October 2019 nationwide survey of 2,800 workers by accounting firm Robert Half found that 57 per cent sometimes go to work while sick and 33 per cent always go when sick.

The race is on to develop vaccines and treatments. Current timeline estimates for the leading vaccine candidate are 12 to 18 months, but will it be affordable for all? That question was put to Health Secretary Alex Azar in Congress. His response: “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest.”

Mr Ed Silverman, a columnist for industry news site Pharmalot, panned the comment as “outrageous”. “No one said profits are verboten,” he wrote. “But should we let some Americans who may contract the coronavirus die because the price is out of reach?”


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