Federiga Bindi / Mar 2020
Coronavirus, or COVID-19, is going to play a major role in the 2020 American elections because of three variables: the economic slowdown, the peculiarity of the American health system, and the low level of workers’ rights. As Coronavirus will expose the contradictions of the American system, the discussion that will follow will benefit the Democratic candidates and in particular the two top contenders: Bernie Sanders primarily and, secondly, Joe Biden.
The most obvious element is economics. Trump was enjoying the country’s best economic outlook in years and this was one of his major strengths (“It’s the economy, stupid!”). The fear from the virus has already led to an economic slowdown, which is only going to worsen. In 2008, the economic crisis right before the elections, was a major factor in the success of opposition candidate Barack Obama.
But it is the two other variables that are going to be most important, because they will also make it impossible to properly fight the virus. There is still much we do not know about Coronavirus. We however know that is more infectious than normal flu, that it can aggressively attack lungs thus leading to the need for intensive care, and that it can be particularly bad for people with pre-existing conditions. One of these conditions seems to be diabetes, a condition shared by over 10 percent of the American population, mainly because of obesity.
One method that seems to be working in slowing – not stopping – the virus, is quarantine of entire areas with a high number of infected people – such as enforced in China or areas of Northern Italy. For quarantine to work, however, people need to cooperate and stay home for at least two weeks. This means working remotely or not working at all. Although sickness benefit schemes have been subject to reforms in almost all EU Member States over the past two decades, all European Union (EU) Member States provide sick leave and sickness benefits. On the contrary, in the United States there is no federal law requiring companies to provide paid sick leave and almost a quarter of all US workers don't have any. Only 19 percent of American workers have paid family leave. More than half of private sector workers in the leisure and hospitality industries, which tend to have a lot of face-to-face time with the public at places like restaurants and hotels, don't have access to paid sick leave. In addition, nearly 60% of part-time workers don't get paid sick leave. It is not uncommon for Americans to go to work / school when sick because of the cost of staying home. Two or more weeks off can financially ruin a family. Given the high level of infectivity of COVID-19, this however means that the virus will rapidly spread across the country, at levels that are unseen in Europe. As testing is finally slowly beginning in the US, there are already cases of infected people with no known contact with travelers. This likely means people do not know, or do not report the virus, continuing life as usual, exponentially multiplying infections.
The other reason many people are likely not to report the illness and seek care is the cost of healthcare. According to the US Census Bureau, in 2018, 8.5 percent of people, or 27.5 million, did not have health insurance. Obama’s Affordable Care Act (ACA, 2010) sought to address gaps in the health coverage system and led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals. The number of uninsured nonelderly Americans decreased from over 46.5 million in 2010 to just below 27 million in 2016. However, since the Trump administration’s changes to the policy, the number of uninsured people has steadily increased. 22 percent of American Indians and Alaskans, 19 percent of Latin Americans, and 11 percent among blacks are uninsured, and 45% of them say it is because the cost of coverage is too high. 48 percent of the uninsured adults forgo seeking care in 2018 because of cost. But even one in four (27 percent) of the insured do not seek care because of the high co-pays, or fear of uncovered fees.
In other words, many Americans, especially those with milder symptoms – but who are however still highly infectious to others - are likely not to report COVID-19 due to the impossibility of taking days off and/or to pay for the medical expenses. Senate Minority Leader Chuck Schumer called for Medicare to cover the coronavirus vaccine, which is still being developed and is at least months away from being widely available and which anyway would not benefit the uninsured. From a public security point of view, it would make sense to force employers to pay sick benefits and impose a moratorium on Coronavirus-related medical expenses. But this is politically impossible, especially under the current presidency.
And here is where the 2020 Elections come in. Health is a major issue in the Democratic primaries: while all candidates advocate for need to expand health-care coverage, they diverge on the how. Joe Biden’s record includes Obama Care, which he can rightly claim. However, the most ambitious plan is Bernie Sander’s Medicare for All, which would virtually eliminate private insurance by providing basic coverage for prescriptions, medical, vision, dental and mental health care. Private insurance would exist only for supplemental care outside of these basic provisions. As the COVID-19 will bring a Spanish Flu scenario, the need for universal health care – also including undocumented immigrants - will become the #1 issue in the public debate. The person who has been long advocating universal health care is Bernie Sanders. Suddenly, his proposals will not seem revolutionary (or socialist) anymore, rather just common sense.