It is, of all things, a Burger King commercial that sums the idea up nicely: we should all become “couch po-ta-triots.” It is now our patriotic duty to #stay home/save lives. That perspective of patriotism is hypocritical and discouraging when the United States has, for at least 30 years, made health – arguably even public health – the responsibility of the individual not the community.
Please understand I am not questioning stay-at-home orders themselves or encouraging people to ignore them. Social distancing is in our own interests as well as those of others. What I am is frustrated – frustrated with the pretense that our country cares for its citizens’ health. American politicians currently repeat “stay home/save lives” or other such slogans yet propagate public and economic policies that deny many citizens adequate health care and have damaged public health long-term, both financially and culturally. In this country, if you have lung cancer it is your fault for smoking, not that of a tobacco industry which markets an addictive product or a government that enables it to do so. If you are addicted to painkillers and opiates, you are weak and need to exhibit some willpower; you are not the victim of unethical pharmaceutical companies. If you can’t afford health care, you are lazy and should get a (better) job. But, now, a nearly overnight reversal and Americans owe it to the health of our country to stay home.
I’m not the first to ask what the country owes its citizens? Perhaps that is an unfair question, in light of various pandemic response packages working their way or already through Congress. The US has offered cash transfers to individuals; is that for the economy, health, or both? The Family First Coronavirus Response Act ensures paid sick leave, at least for some employees. But Congress has not passed a law to cover the medical bills of coronavirus patients. It has asked insurance companies to voluntarily waive the cost of COVID-19 tests and there are somewhat vague provisions in the CARES Act to provide hospitals with funds to cover the uninsured. The government failed to provide cost estimates. The Kaiser Family Foundation’s (KFF) tentative estimates for the current wave of hospitalizations alone (not any outpatient follow-up care or future waves) could range from roughly $14-40 billion, which could be as much as 40% of the funds set aside for the CARES Act. That Act, however, covers only the uninsured. KFF also estimates high out-of-pocket costs – and surprise out-of-network bills – for privately insured Americans, many of whom cannot afford to become ill.
Not only is the coverage under coronavirus response legislation partial, it is temporary. When COVID-19 is “over,” do we go back to existing health care and other social policies? (Or, the lack thereof?) As the Democratic presidential hopefuls squared off throughout the primaries, we heard proposals for universal health care or comprehensive health insurance, for increased minimum wages or universal basic income, and other such policies. Will the US move forward to care for its citizens? Will this pandemic be crisis enough to bring about significant policy change? If it does not, the hypocrisy only deepens.
I was struck by and therefore clearly remember Laurie Garrett’s (2000) Betrayal of Trust making the point that the 20th Century began with an emphasis on public health and ended with the Reaganomics attitude of “the collective be damned, all public health burdens and responsibilities [fall] to the individual” (p. 267). Today, those burdens fall most heavily on the disadvantaged: those who have lost their jobs to COVID-19, those who cannot afford to stay home from their jobs to stay safe, those at higher risk because of underlying conditions due to poverty or lack of health care, those who are underserved minorities, etc. The very demographics the US has neglected for decades are now expected to patriotically and enthusiastically support the community -- at whatever cost to themselves. Can patriotism, as important as it is for the life of nation, reimburse disadvantaged individuals who’ve been short-changed by it? I'm a willing “couch po-ta-triot” because it's the best choice for myself and my community, but I’m also a citizen frustrated with the hypocritical pandemic patriotism being sold to Americans who can’t afford it.