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How Medicare for All Could Help Fight Pandemics

The climate crisis could make outbreaks like the coronavirus more common. Is America's for-profit health care system ready?

Mario Tama/Getty Images

Consider the life of someone with the misfortune of contracting coronavirus in the United States. Let’s call her Mary, and let’s say she works at an airport as a baggage agent, helping travelers locate their lost belongings. At work one day she starts feeling run down and develops a dry cough. It’s just a cold, she thinks. Maybe allergies. Her supervisor’s been on her case all week, so she doesn’t call in sick for risk of testing things. She feels worse as the week goes on. The health insurance Mary’s employer offers is too expensive to afford, but she also makes too much money to qualify for Medicaid. A visit to the urgent care near her house might run her $200. Rent, which went up again last year, is due next week. She keeps going to work until, while helping an irate customer find his bag, she starts to have more serious trouble breathing and faints. Her co-worker calls an ambulance. She’s placed on a ventilator on the way to the emergency room and admitted to the intensive care unit for oxygen therapy. A quick test confirms that Mary has 2019-nCoV, the strain of coronavirus causing the current outbreak. She’s placed in quarantine, her desk at the airport is shut down, and all of her co-workers are sent for testing. It’s not clear how many people she infected before winding up in the hospital. If Mary survives, she’ll have tens of thousands of dollars worth of medical debt to show for it. And she won’t be the only one in that position.

There’s a lot we don’t know about the coronavirus, with plenty of rumors and speculation flying around about its mortality rate and source, some of it plainly racist. What we do know is that public health crises, and infectious diseases, are expected to become more of a problem, not less, in the coming decades. “It would be difficult to make a case for climate involvement in this outbreak,” said Colin Carlson, a biologist, Intergovernmental Panel on Climate Change author and postdoctoral fellow at Georgetown University. “What I can tell you is that the rate at which things like this happen is increasing because of climate change.”

Carlson—who studies the relationship between climate change, biodiversity loss, and emerging infectious diseases—likens the situation to the state of attribution science for disasters when Katrina struck New Orleans, before it was possible to say with confidence whether that storm or any other had been caused by the climate crisis. But coronaviruses—in fact a family of viruses including SARS and MERS, in addition to the current coronavirus—generally develop in animals, infecting humans in events called “spillovers.” And scientists now know that climate-induced changes to the earth’s ecosystems are driving species into new habitats, where they can transmit diseases between one another and eventually to humans. Researchers are just now starting to be able to model how many cases of dengue fever and malaria might develop as the earth warms, Carlson told me. And while reducing greenhouse gas emissions is essential, he said, governments should also prepare for the public health effects of whatever level of warming ends up happening.

As with the current coronavirus outbreak, the places hit first and worst by climate-fueled ailments are unlikely to be in North America or Europe. They’ll be concentrated in less affluent countriesones that share the least historical responsibility for the climate crisis. That doesn’t mean, though, that the U.S. doesn’t face its own serious challenges for dealing with disease in a warming world. The first line of defense against epidemic is a strong and accessible health care system. And in that field, the U.S. is far from prepared.

“We tend to talk about Medicare for All and the Green New Deal separately, but Medicare for All is a climate adaptation strategy,” Carlson said. “In a country that spends the most on health care of anywhere in the developed world, we shouldn’t have preventable deaths caused by a lack of health care. But we have a system that is designed to deny people access to care.”

When Representative Alexandria Ocasio-Cortez and Senator Ed Markey introduced their Green New Deal resolution last February, its call for Medicare for All was treated by pundits as a wasteful add-on. For the right, it was one more bullet point on a socialist wish list to upend the American way of life. For respectable centrists, it was an expensive distraction from the more pressing work of scaling up clean energy.

But universal health care, Green New Deal architect Rhiana Gunn-Wright argued, would allow far more people to participate in an energy transition by ensuring that their health care isn’t dependent on staying in their current job. It’s also, Carlson added, key to dealing with the public health effects of climate change. “The people who are going to get sick are determined by very coarse geographies, but the people who are going to die is determined by access to health care,” he says.

Debates over the Green New Deal weren’t the first time climate and health care policy had been put at odds. The start of the Obama administration was considered a race between three competing priorities: the stimulus, the Affordable Care Act, and a cap-and-trade bill to bring down carbon emissions. The last one never made it to the Senate floor, and many of the environmentalists who worked on it blamed the White House’s outsize attention on the other two. There are signs that this dynamic is changing. Beyond Medicare for All’s inclusion in Green New Deal proposals, such as Bernie Sanders’s, Elizabeth Warren’s campaign released a detailed plan this week for investing in public health infrastructure like the Centers for Disease Control and Prevention and World Health Organization and transitioning to Medicare for All. “Our health depends on fighting climate change,” the plan declared.

Interconnections abound. As 2016’s Zika virus outbreak helped prove, rising temperatures are already expanding the areas over which diseases typically relegated to warmer climates can thrive. Lyme disease is expected to increase by 20 percent in the next decade, with greater range expected for West Nile virus and malaria, as well, through mosquitoes’ longer life spans. There are all manner of other ailments that warming fuels. More regular flooding will increase risks for waterborne illness. The risk of other diseases may increase as well, as droughts threaten farm production, fires threaten human and animal respiratory systems and habitat, and warming waters fail to support the types of marine life they once did, disrupting ecosystems that support human life up the food chain.

Not all of global warming’s health impacts are so obvious, but virtually all of them will be exacerbated by deep inequalities that make some people more vulnerable to disaster and disease than others. Within China and Wuhan, the city where the current outbreak began, as Rui Zhong and James Palmer wrote in Foreign Policy, it’s “the poor who were most likely to be in contact with the virus, it’s the poor among whom it will spread fastest, and it’s the poor who will likely be the main victims of over-repressive measures as the government, after weeks of what looked like a cover-up, snaps to action.”

Americans are well acquainted with similar dynamics. Years on from Hurricane Sandy, residents of New York City’s chronically underfunded Housing Authority continued to deal with the respiratory infections caused by mold from Sandy’s floods. While NYCHA buildings made up just 5 percent of the city’s buildings when Sandy hit, in 2012, they suffered 15 percent of its damages. An estimated 80,000 residents lost access to electricity, elevators, and hot water, sometimes for weeks on end. In Puerto Rico, thousands died after power outages triggered by Hurricane Maria, when many were forced to go without life-saving services like respirators and dialysis. In addition, the island had already been experiencing a Zika outbreak, and storm damage brought its monitoring services to an abrupt halt. In many cities, green space—which absorbs heat—is distributed largely along New Deal–era redlines, designed to exclude people of color from federal housing assistance. A study of 108 urban areas found that historically redlined neighborhoods were on average almost 5 degrees hotter in recent summers than those that weren’t. An estimated 739 people perished in Chicago’s three-day 1995 heat wave, in which isolated, elderly people were among the most vulnerable. The Chicago Public Health further found a Black-white mortality ratio of 1.5 to 1. And in majority-Black Lowndes County, Alabama, poor sewage infrastructure contributed to 34 percent of residents surveyed in a 2017 study testing positive for hookworm.

Epidemics like the current coronavirus outbreak tend to put the dangers of chronic inequality in terms even the wealthy can appreciate: People with quality health care will see a doctor early, helping to slow a disease’s spread. They’ll also be healthier to begin with, which helps fight infection. Leaving 27.5 million people uninsured is a public health crisis that will only worsen as temperatures rise. Medicare for All won’t solve the structural inequalities making people sick, which will require a far broader array of policy and investments in everything from housing to social services. But to protect public health in a warming world, universal health care is a no-brainer.