We Already Have Public Health Models That We Could Scale Up to Fight Coronavirus

We cannot afford to come out of the coronavirus crisis without ending a health care system that decides whether we live or die based on our ability to pay the bill. Luckily, we already have working models to do just that.  

A hospital employee wearing protection mask and gear shows a swab for coronavirus testing at the Brescia hospital, Lombardy, on March 13, 2020. Miguel Medina / AFP via Getty

Former Montana senator Max Baucus distinguished himself in Congress by being a dutiful errand boy for the nation’s health insurers and pharmaceutical companies. As chair of the Senate Finance Committee, he was one of the leading architects of the Affordable Care Act (ACA), whose key provision, the individual mandate, guarantees multibillion-dollar profits for the health insurance industry. He refused to allow Medicare for All advocates to testify before his committee and played a decisive role in preventing a public option from being included in the bill. The nearly $4 million in campaign contributions he received from the private health industry from 2003 to 2008 was money well spent on the politician who was known around Washington as the “Senator from K Street.”

Despite his bought-and-paid-for hostility to public health insurance, Senator Baucus was responsible for writing an extremely obscure provision into the ACA, one that takes on new significance in the light of the coronavirus pandemic. The insurance industry’s kept senator made everyone living in the small town of Libby, Montana, potentially eligible for Medicare coverage because of a serious public health emergency.

Libby is a former mining town near the Canadian border that suffers from one of the worst environmental disasters in the country’s history. For decades, asbestos fibers in the vermiculite ore mined in the area poisoned the residents of Libby and the surrounding county. As a Huffington Post report on the disaster describes it,

Libby is a story of government inaction and corporate greed. In the 1920s, the Zonolite Co. began mining vermiculite just outside of town. In 1963, W.R. Grace purchased the mine, which remained in operation until 1990. At its peak, it is thought that the Libby mine was producing 80 percent of the world’s supply of vermiculite, a mica-like mineral that when heated expands into a lightweight, fire-resistant material that’s been used primarily in insulation and fertilizer. On its own, vermiculite is not known to be harmful to human health. The vermiculite from Libby, however, was tainted with tremolite, an extremely toxic form of asbestos.

The company knew about the dangers of tremolite as far back as the 1960s but chose to cover it up. After journalists uncovered the story, the Environmental Protection Agency (EPA) put the contamination in Libby on the Superfund list and declared it a “public health emergency” in 2009. All told, the EPA spent $600 million on the Libby asbestos cleanup project. It has been successful, but it cannot undo the hundreds of asbestos-related deaths, and the thousands of illnesses that have taken their toll over the years and will continue into the future.

The mining company initiated its own health insurance program to provide care to victims, but it only covers asbestos-related illnesses. By contrast, the Medicare program that Baucus wrote into the ACA offers full medical coverage to local residents who meet the eligibility requirements.

The benefits are provided through the Social Security Administration, which aggressively promoted the program in Libby after its establishment. To most Americans, a 2010 report on the program by a local Montana newspaper will read like a dispatch from an alternate dimension:

A small army of federal bureaucrats has descended on northwest Montana, helping victims of Libby’s asbestos contamination to sign up for unprecedented Medicare benefits . . . “This is a new thing for Social Security,” said Nancy Berryhill, the administration’s regional commissioner. “No other group like this has ever been selected to receive Medicare.” . . .

Berryhill said she did not know how much long term care might cost for an average asbestos patient, saying that sort of analysis was irrelevant to her directive to help patients register for coverage. Her storefront in Libby, and the additional staffers in Kalispell, will remain on the job as long as needed, she said, recognizing that although continued applications will be received for years, the initial months will likely prove busiest for processors.

On Monday, while about 60 people walked into the Libby office, another 50 or so called the Kalispell hotline. “We want to make it simple and fast,” she said, adding that people need only bring their Social Security number and an identification, such as a driver’s license. For those whose incomes are limited, she said, financial assistance can be available to help cover Medicare premiums, deductibles and co-payments.

“We want to get the word out,” she said, “and we want to get eligible people signed up.”

Medicare coverage was extended to the people of Libby at the stroke of a pen, and those who were eligible were enrolled almost immediately. When Medicare first went into operation in the 1960s, it covered 19 million people just eleven months after President Lyndon B. Johnson signed it into law.

Compare this with the confusion, complexity, and ineptitude that marred the launch of the ACA’s online insurance exchanges. There is no good reason why Medicare coverage cannot be rapidly expanded on a massive scale to those who need it. As the coronavirus pandemic bears down on our woefully unprepared health system, the tens of millions of uninsured and underinsured Americans certainly fall into that category.

We should look to Libby’s example and demand the extension of Medicare coverage to everyone affected by COVID-19, which, considering the social and epidemiological impact it will likely have, ultimately means all of us. A public health crisis of this magnitude demands a radical response, the cost of which will ultimately be less than whatever frantically improvised and thoroughly inadequate half-measures the current regime can come up with.

This is the first global pandemic of our lifetimes. It will not be the last. We cannot afford to come out of this crisis, with all of the unnecessary suffering and death it portends, without ending a health care system that decides whether we live or die based on our ability to pay the bill.