Medical evidence has revealed that elderly people face an increased risk of dying from the disease, along with people of all ages who have chronic health issues, such as diabetes, obesity and hypertension. Among those with underlying conditions who are dying from the virus, a disproportionate number are living in poverty or are African American or Latinx. Why? Because these populations often do not have, or cannot afford, access to the preventive medicine that can help them stay healthy. A primary care provider’s job is to keep people well, including managing highly treatable conditions such as diabetes and hypertension. Uncontrolled, these maladies can make a person vulnerable to potentially deadly diseases like Covid-19, as well as heart attacks and strokes.
But it’s not just Covid-19 that has had an outsized impact on communities of color and people with low incomes. The prohibitive cost of health care in the US means many people can’t afford to take preventative action — leading to more suffering down the line as they develop health conditions that could have avoided. A patient I’ll call James recently came to the emergency department in Spokane, Washington, unable to speak or move the right side of his body. His stroke symptoms had started three days earlier, but he had unpaid hospital bills after a heart scare five years ago, and he dreaded engaging with the health care system again. He works at a convenience store and doesn’t have health insurance. The price tag and out-of-pocket costs associated with the plans available on his state’s insurance exchange had put coverage out of reach for him. Despite his father dying young of a heart attack and his mother having diabetes, he had not seen a doctor in years. Unfortunately, James’s delay in seeking care for his stroke meant it was too late for him to take clot-busting medication. His best hope is rehab, which might help him recover the ability to speak, walk, and use his right arm.
The frustrating thing for those of us who care for patients is that so much of their suffering is completely unnecessary. People who are able to control the risk factors of stroke (which include blood pressure, cholesterol and diabetes) are much less likely to need the expensive medical interventions we use regularly in American medicine. In James’s case, generic blood pressure medicine can be purchased for as little as $ 48 a year; hospitalization for stroke and subsequent rehab could cost well over $ 20,000. We can do better for people like James, and we’d save a fortune as a society by doing so.
The Covid-19 pandemic has cast the disparity between the haves and the have-nots in a harsh light. If people including low-wage workers, those experiencing homelessness, and the undocumented cannot afford to seek preventive care and testing, they risk their own lives, with the possibility of becoming super-spreaders if they have no choice but to continue working while sick.
Universal access to primary care is essential for many Americans to improve the quality and length of their lives and to reduce the threat of contagion. Studies show primary care-oriented health care systems are associated with lower mortality rates and fewer heart disease and cancer deaths. The late Dr. Barbara Starfield, a pediatrician who advocated for universal primary care, demonstrated that across many countries, healthcare systems that offer comprehensive primary care improve population health at lower costs and with greater equity.
Universal access to preventive care should be a right, not a privilege. If the US were to adopt universal primary care under a “capitated” model — in which primary care doctors are paid fixed sums per patient — a single, monthly fee would cover everything from annual physicals to skin checks, immunizations, pelvic exams, blood tests, and evaluation for and treatment of chronic diseases and other illnesses. This could be conducted either through in-person visits or via telehealth video chats, phone calls, and online messaging. Primary care physicians could also coordinate specialist care when necessary and serve as a quarterback when a patient’s health needs get complex.
With the government already funding nearly 40% of the care in the US through Medicare and Medicaid, and given the amounts that emergency care hospitals must absorb without being reimbursed, providing universal primary care should help lower overall health care costs over time by reducing the need for emergency room visits and hospitalizations. Further proof of the value of this approach is that other countries that are predominantly oriented toward primary care spend far less on health care per person than in the US.
As we wage the battle against Covid-19, it has become all too clear that the US would benefit from universal primary care. We can keep private insurance and the high-end specialty care America excels in, while also revamping access to the basic, foundational health infrastructure in the US. By enabling universal access to primary care, we can eliminate some of the inequities illuminated by this pandemic. We can afford to make basic health care a human right rather than a privilege. Until the simple prevention and treatment of common ailments is within reach for all, everyone in this country will be vulnerable.