Public Health at Private Expense

The new coronavirus pandemic has highlighted one of the most baffling incongruities in U.S. health policy: the central government plays only an advisory role in matters of public health. Individual health care consumers are expected to pay the price for their own actions in support of the broader public.

The most prominent issue where this may be seen is in connection with the flu. The federal government’s most important role is in producing the “wash your hands” posters, which encourage everyone to limit the spread of an infectious disease by stepping up their personal hygiene throughout the day. The more important factor in limiting the spread of flu, though, is if people suffering from flu stay home and aren’t out in the world or in the workplace spreading the disease to others. In theory, policies prevent anyone who takes that step from losing their job by doing so, but these policies aren’t effectively enforced. A person who wants to do the right thing to limit the spread of flu by staying home from work usually gives up whatever money they would have earned from the job and in many cases, risks losing the job altogether. Staying home from work does not necessarily do anything for the flu sufferer — it is only a benefit to the larger public — but it is the individual who bears the costs and the risks involved. Of course, it is the same story for anyone who elects to undergo a flu vaccine. The person must purchase the vaccine and take on the modest risk involved for little to no personal benefit, but a significant benefit to the public.

These issues are magnified now that the world is facing an unofficial coronavirus pandemic. The new coronavirus is vaguely similar to flu in that it affects the lungs, but it so far appears to be 50 to 100 times more deadly. The federal government’s response so far has been mainly come the form of advice to individuals: wash hands frequently and avoid large crowds.

The most valuable thing a government can do is to test as many people as possible so that people who have a coronavirus infection can isolate themselves from the world. In the United States, though, only a tiny fraction of health care and emergency workers known to have the symptoms of coronavirus have been tested — and virtually no one else has been able to get a test. No one seems to know exactly how many tests have been produced, but it is a small number, possibly fewer than a thousand in country with a third of a billion people. When people have been able to get tested, in most cases they have been required to pay for the test. There are occasional reports of costs approaching $2,000. For many people, that is a month’s pay.

Along the same lines, there has been some speculation about a coronavirus treatment or vaccine. Any such drug is surely more than two years away, and that is being optimistic about it. But if such a drug were to be discovered, we already know that under current policy, patients will bear the cost of any prevention or cure.

This approach is a particular problem for a disease that is primarily spread by people who have no symptoms. Most otherwise healthy people under 50 years old who contract coronavirus will not, on their own, know they have it. They will never exhibit the characteristic cough or fever and never be at much risk from the disease themselves, yet they may spread it to, on average, one other person per day — accounting for the exponential growth rates seen for coronavirus. If asked to pay for a medicine to prevent this from happening, most of them will not be able to afford the cost.

The economic incentives are all wrong. The physical materials that could limit the spread of coronavirus — at present, mainly a matter of testing — are an urgent matter of public health. As such, they should be paid for by the public, and not be left to the uncertainties of a person’s financial condition and willingness to sacrifice for the public good. Limiting the spread of a pandemic does not work if only the fortunate few are able to be involved.

The United States has long had more severe flu seasons than comparable countries because of the government’s arm’s-length approach to public health. Now the United States risks being the country with the greatest number of deaths in the coronavirus pandemic. But this fate could be changed with a change in policy that gives the government an official interest in the health of the country’s people.

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