The novel coronavirus is forcing Americans to go it alone. This is happening in a shockingly literal way, as families scatter and freeze and shelter in place. And it is happening in a structural way too: When calamity hits, Americans tend to face the shock by themselves.
Americans are no less susceptible to disease, joblessness, and family changes than their peers in rich nations, but they are made more fragile by these crises. The country has a thinner safety net, fewer public goods, and less social insurance than other countries. The United States spends roughly what other Organization for Economic Cooperation and Development nations do on pensions, or Social Security, and more on health care, for less coverage and worse outcomes. It spends less than a third of what the average OECD country does on helping the jobless, about a third supporting families with kids, and 50 percent less on incapacity, meaning disability, sickness, or injury that might keep a person from accessing the labor market.
Perhaps the country’s most pressing problem is its high uninsured rate. Every other country as wealthy as the United States has figured out how to cover its entire population, generally at a much lower cost, too. But roughly one in 10 Americans lacks any form of health-insurance coverage, which may lead them to delay seeking out medical help when they need it. For many of those with coverage, health care is still unaffordable and inaccessible. The average American family with private coverage pays $6,015 a year for insurance, on top of what their employer pays. On top of that, the average individual has a deductible of $1,573, meaning they need to spend that much out of pocket every year before their coverage kicks in. On top of that, many plans come with required “co-insurance” payments that are applied even after a person hits their deductible. These costs discourage sick individuals with insurance from seeking care. They also saddle American families with tens of billions dollars of debt a year: Two-thirds of American bankruptcies are related to medical bills.
What does this mean today? That Americans will avoid getting tested for the coronavirus and will avoid getting treated for COVID-19. That some untold number could go into debt, lose their homes, or declare bankruptcy because of the global pandemic—strains that will in turn do measurable damage to public health. Although the Centers for Disease Control and Prevention has promised that coronavirus testing will be free, it has not promised that the cost of care will be, leaving open the possibility that the uninsured will choose not to receive treatment, imperiling their own health and the health of others around them.
The government also fails to protect its people by not guaranteeing paid family leave and paid sick leave. These are benefits mostly granted by large employers; just a handful of states and cities operate mandatory paid-leave programs. One in three workers in the private sector has no paid sick days at all. Two in three do not have a short-term disability plan. And four in five do not have paid family leave. Congress recently expanded paid leave in response to the crisis, but not to all workers and not in any comprehensive way. That means that workers need to quit their jobs to attend to their dying parents. It means that a frightening share of workers in customer-service positions go to work no matter how sick they are, because they cannot afford to miss a paycheck. It means that the coronavirus pandemic will spread more easily, and cause more harm.
“From a worker perspective, there’s so much precarity related to what you might have access to and who controls it,” Vicki Shabo, a paid-leave expert at New America, told me. “From an employer perspective, most employer policies aren’t set up with the idea that a pandemic might substantially change operations for a long period of time. It shows that the lack of a public infrastructure to deal with a situation like this affects both employers and employees.”
The country does have an unemployment-insurance system that kicks in automatically to help people when the economy tanks—but it is hardly robust. Since the 2008 financial crisis, several states have slashed the number of UI payments people get after losing their job. They have tightened eligibility requirements. And they have reduced payments. Similarly, the Trump administration and many states have made it much harder to get payments from the Supplemental Nutrition Assistance Program. During a coronavirus-induced downturn, families will be at greater risk for food insecurity, eviction, and job loss; kids will go hungry; food pantries and social-service organizations will come under more strain.
All of this means Congress must act to provide families with sufficient benefits when a recession hits. But Congress is sclerotic, putting the country at extraordinary risk. “We have very little reason to assume that we’ll have the elected officials in place to take the necessary action,” Indivar Dutta-Gupta, the co-executive director of the Georgetown Center on Poverty and Inequality, told me. “I constantly hear people say that when there’s enough of a crisis, Congress will take action and turn something on. There’s nothing in our experience that suggests that’s correct.”
The federal government is not, of course, toothless during a disaster. The administration’s decision to declare the virus a formal emergency has allowed faster access to a bigger pool of federal funds. But the country’s emergency-response programs are not big enough, fast enough, or fair enough. Renters lose everything in wildfires. Families go without shelter and food after floods. The government is more responsive to wealthy communities than poor communities, and to wealthy people than poor people. And no specific government program is designed to combat a pandemic.
The United States also crucially underinvests in its children, with less public spending on preschool, childcare, and family allowances than nearly every other OECD country. That means American children are more likely to live in poverty than children in most other rich nations. This is already a catastrophe. It stands to become a worse one with the coronavirus pandemic. Millions of low-income families will see a breadwinner become sick or lose work. Millions of kids will lose what little safety they have.
Americans want to change this state of affairs: Paid leave, better unemployment-insurance programs, more affordable insurance, getting kids out of poverty—these are uncontroversial, bipartisan priorities. But our political system is not set up to move quickly and boldly. This crisis cannot go to waste, although it almost certainly will. And when the next pandemic or financial crisis or downturn hits, millions of families will face it alone.