Samples of coronavirus being prepared for testing in the New York health department's virology lab.
New York State Department of Health via The New York Times
Ideas
March 5, 2020 1:41 PM EST
Yamey is a physician and professor of global health and public policy at Duke University, where he directs the Center for Policy Impact in Global Health.

When Osmel Martinez Azcue returned to the US after a trip to China and developed a flu-like illness, he did exactly the right thing. He went to a hospital in Miami to get tested for the new coronavirus that causes COVID-19. Thankfully, he was clear of the virus—it was regular, seasonal flu. But imagine his shock when the bill arrived for $3,270 and his insurance company said he’d have to pay $1,400 out of pocket.

Stories like this one are playing out all across America. If any of the 28 million people without insurance develop symptoms and get coronavirus tests, they could face medical bills that could push them further into poverty. Azcue’s experience shows that even those like him who have insurance could be hit with eye-watering test costs.

The result is that people with symptoms are reluctant to get tested. In surveys prior to the outbreak, around a quarter to a half of those who have health insurance say they’ve avoided seeing a health provider when they have symptoms through fear of medical expenses.

If people with COVID-19 symptoms don’t get properly tested, we could have a catastrophe on our hands. Infected people could get sick and die. They could infect others. There would be avoidable suffering and a U.S. epidemic that would spiral out of control.

This is a remarkably clarifying moment in the contentious debate about the American healthcare system. Those of us who favor a single payer system, like Medicare for All, are finding that COVID-19 has suddenly opened a door to discussing socialized medicine. We can’t believe our eyes and ears when we see Republicans on TV—the same lawmakers who have fought tooth and nail to prevent health insurance coverage being extended to everyone—saying that coronavirus testing should be free. What a bunch of socialists!

They are right, of course. Even if you passionately believe that health care is not a right, and that only those who can afford to buy health insurance should receive it, surely at this moment you can see how dangerous this view is to your own health. If anyone is infected, we are all at risk. Helping others helps ourselves. We’re all in this together—rich and poor, healthy and sick.

The US is the only wealthy nation without guaranteed health coverage for all, and the giant holes in its patchwork health system make it much harder to tackle COVID-19. We need bold actions to close these gaps urgently.

New York Gov. Andrew Cuomo got it right when he mandated that the state’s health insurers must waive co-pays for the coronavirus tests. All states should do the same.

Around the world, we’ve seen governments adopting innovative approaches to expanding testing, like drive-through coronavirus testing stations in South Korea, free to all. The U.S. government needs to step up and fund a mass free testing program that uses such approaches. We’ve seen small-scale examples in America before, such as during the 2009 swine flu pandemic, when many cities or counties set up free clinics for testing and vaccination. Now’s the time for a similar nationwide effort.

When we develop COVID-19 vaccines, probably in around 12-18 months, these must also be made free at the point of care to every single person in America, insured or uninsured. Just like coronavirus testing, the vaccines should be seen as public goods. Fortunately, the Affordable Care Act mandates that health insurers must cover federally recommended vaccines at zero cost to patients. The federal government must also make sure that patients in federal insurance programs like Medicare, Medicaid, and the Veterans Administration, as well as the uninsured, pay zero. Protecting others protects everyone.

Finally, there’s one other hole that will need to be closed. We’re the only wealthy nation with no mandatory sick pay. During swine flu, 3 in 10 people with symptoms went to work, infecting up to 7 million others. Unless we pass an emergency provision on sick pay, we’ll see the same thing happening with COVID-19.

It’s a great paradox that we’re one of the world’s wealthiest nations, yet we provide no guarantees of health care or sick pay for all. COVID-19 is exposing just how vulnerable we are by letting so many people have to fend for themselves.

Contact us at editors@time.com.

Read More From TIME

Related Stories

EDIT POST