Is health care a right or a privilege? Coronavirus amplifies wealth disparities in US


Rolls of cash. Credit: Pixabay. 

Governor Gavin Newsom's office projects that as many as 25 million Californians could contract COVID-19. Residents are wondering who will be infected, if hospitals have enough supplies, and how treatment will be handled. 

On today’s Daily Dose, Dr. Michael Wilkes, professor of medicine and public health at UC Davis, says that low-income people will have a tougher time avoiding coronavirus.

“I've talked daily about the need to shelter in place and isolation, but low-income people just can't afford to follow it the way others can. Poor people live in cramped apartments. They might share bathrooms and kitchens. They don't have dishwashers that kill germs. They can't take their car to the store, the doctor. They've got to use public transportation. They need to go to work because their jobs can't be done remotely,” he says. “Remember that the elderly are amongst the poorest people in society. We think about going to the supermarket and stocking up food for a couple of weeks -- well, they can't. They live paycheck to paycheck. In fact, 40% don't even have enough money for an emergency.”

He quotes a patient who told him Thursday: “I don't even have a primary care doctor. I've never had a primary care doctor. Who would I call?”

Wilkes says the lack of a PCP really hit home for him. 

KCRW: Are people with a lower socioeconomic background more likely to get sick (in general) than someone who’s wealthier? 

Wilkes: “Probably yes. So COVID amplifies what's already a huge problem with disparities in health care here in America. And it really is forcing us to grapple with the idea of: Is health care a right or is it a privilege? If it's a right, then everyone should have equal access to high quality basic health care. And these days, that means free testing and treatment for everyone who's standing on American soil. Everyone. 

But I have patients, many who have no insurance. In fact, the estimates are that about 25 million Americans either have no insurance or have insurance with deductibles that are so high, they can't afford to get health care. 

So when they get sick, they're afraid to come in for testing. But then they get sicker and sicker. And when they do come, they're much sicker, and they're much more likely to have serious complications.”

If you have less access to health care, then you have less access to test kits? So maybe we're seeing more positive cases in higher socioeconomic backgrounds than is true? 

“Absolutely. I think that there's a disparity in terms of who's getting tested. Rich people get tested more for lots of reasons, be they Tom Hanks and his wife, or Idris Elba, the NBA players who got tested even when the tests were in short supply and the team consumed 20% of all tests, even though they didn't meet any CDC criteria. 

So, yes, our nation is built for the wealthy. And those with special status always have gotten better and more care. And in this case, that I think means more frequent tests, even when testing may not be the best use of very valuable and limited resources.”

Research experts suggest that as more cases show up -- treatment and supplies are going to be more limited. Is there going to be a disparity in what types of people get access to that treatment? 

“Absolutely. Increasingly, doctors across the country are saying it's time to waive the cost of treatment and testing, and that by doing this, it's not just the poor that are going to benefit, but everybody's going to benefit if we can keep this illness from spreading.

Hospitalization for an infected person is going to cost tens of thousands of dollars each. It will be even more if people get gravely sick. So prevention is far cheaper than treatment.

If we made COVID testing and care free, it wouldn't only just be humane and compassionate. But there's evidence that it would boost the economy long term. So to me, that's a no brainer. 

But for now, this is just the beginning of the epidemic here in America. Can you imagine what will happen if there is a shortage of respirators, and we need to decide as a society who gets them? Is everyone going to be given an equal choice? Now, I sort of doubt it.”




Caleigh Wells, Amy Ta


Caleigh Wells