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Trump’s Gilded Age Coronavirus Care Is a National Shame

The president’s recent health care antics make a mockery of all the ordinary Americans who’ve died in this pandemic.

Win McNamee/Getty Images

The nation surely breathed a sigh of relief last night, just as the president inhaled some very normal, deep, refreshing breaths, on the balcony of the White House, in front of television cameras—just a completely candid demonstration of perfect health. Donald Trump returned to the White House from the Walter Reed Army Medical Center, because he was feeling “better than [he] did 20 years ago,” according to the man himself. The road ahead may not be certain for the president: His doctor says that he isn’t “out of the woods.” One thing is certain, however: His experience in hospital was very different from the experience of the vast majority of Americans.

Trump needn’t fear the arrival of a big bill, for one thing, not even for the helicopter that whooshed him up to Walter Reed; most air ambulance bills for regular people are out of network and cost tens of thousands of dollars. Once Trump was settled, he had everything he needed at his disposal; every potential treatment or procedure was on offer. There was certainly no risk that the emergency room would be closed. There was no chance his reported symptoms wouldn’t be believed by his doctors or that his doctors wouldn’t have the equipment they needed to treat him. Perhaps you think that this is how it should be for the president of the United States, even one as awful as Trump. But even if he wasn’t president, one thing would still have protected him from the ravages of our health care system: his wealth. And there’s no excuse for a country where wealth and privilege buy better health care, and poverty ensures worse.

Trump’s treatment path, which was markedly aggressive, was not at all influenced by the prohibitive cost of potentially life-saving medical interventions. Regular people, meanwhile, have to worry that each new procedure or drug recommended by doctors over the course of a hospital stay is adding line items to the bill. Even privately insured patients might have to meet a deductible of up to $13,800 or pay a percentage of their overall bill as co-insurance. The price of everything on the patient’s bill can vary wildly, even within the same region. It’s not uncommon for patients to discover they’re being charged ridiculous amounts of money for simple treatments, like a single dose of Tylenol for $16. There is nought but the free market to regulate what hospitals charge patients without government insurance for these drugs, and the market is dropping the ball there.

According to chargemaster lists posted online, thanks to a Trump administration rule requiring hospitals to post price lists, Jefferson Hospital in Philadelphia charges $20 per 4 milligram dose of dexamethasone, the steroid that Trump received at Walter Reed. At Crozer-Chester Medical Center, a few miles away, it costs $9. Somehow, at Doctors Medical Center of Modesto, California, it’s $126. (One wonders why doctors at this facility don’t just give patients two 2 milligram tablets, which, on the same price list, only cost $43 each.)

Dexamethasone is one of the cheaper drugs in Trump’s regimen: Remdesivir, an antiviral medication for the coronavirus that was only recently approved, costs a hospital $3,120 for a typical privately insured patient or $2,340 for those with government insurance. (The raw materials for the drug cost about $10.) The basic medical procedures that Trump received, such as chest X-rays and CT scans, add up, as well. Doctors Medical Center charges $2,071 for a chest X-ray that is viewed once; at Baptist Medical Center in San Antonio, it’s $925. X-rays work the same in California as they do in Texas.

Expense is not an obstacle for someone in Trump’s plutocratic orbit, but Trump’s not a private citizen. He’s receiving world-class health care by dint of the fact that he’s the president of the United States. One of the more ironic things about Trump contracting the coronavirus—which, let’s face it, is already a candidate for an Eric Cartman–style overload of the funny receptors—is the counterintuitive possibility that his powerful position threatens the quality of the care he gets. This is a phenomenon known as “VIP syndrome,” in which rich, powerful, or otherwise well-connected people successfully demand not just special attention but specific courses of treatment that would otherwise not be medically recommended.

As The New York Times reported, Trump may be “demanding intense treatment despite risks he may not fully understand,” which could explain his receiving dexamethasone despite apparently still being at an early stage of the disease, when limiting the body’s immune response might be a bad idea. It is easy to imagine that Trump, having at one point received an upbeat briefing from his advisers that this steroid is absolutely going to defeat the virus, would demand the Very Strong Drug that’s doing great things for our country.

Yet it remains the case that the privilege of telling your doctors what treatment you want, even when those demands go against the best judgment of practitioners, is not one that’s routinely available to the rest of us. Think of times you might have gone to the doctor, having Googled your symptoms, and wanted to rule out a particular illness or receive a specific drug to treat your condition. The doctor may or may not agree—sometimes, it feels like they disagree just because you had the temerity to suggest something—but if they object, you have no real power to make countering demands. Depending on the situation, this might be to your advantage in the end, but this isn’t always the case. For VIPs, who usually believe that their wealth simply reflects their greater grasp on the world than the rest of us, even their doctors, the dynamic is different. They’re more likely to get the latest drugs and newest treatments.

The fact that Trump is able to direct his own care stands in direct contrast to the experience of low-income patients who, if they can even afford care, might find their doctors dismissive or rude. In multiple studies based on focus groups, low-income patients reported feeling patronized or judged by their doctors, or less wanted because of their Medicaid status. Many doctors simply don’t take Medicaid patients at all. Trump’s race, too, would help him, even if he weren’t president: There is a wealth of evidence showing that Black people, especially women, receive poorer medical care from doctors. We have harrowing examples from the same disease that has stricken Trump of Black women’s symptoms being ignored: Rana Zoe Mungin, a 30-year-old teacher from Brooklyn, died of Covid-19 in April after twice being turned away from the emergency room and told that her inability to breathe was just a panic attack. (Black women don’t often benefit from their VIP status: In recent years, Serena Williams and Beyoncé have published accounts attesting to their struggles to get adequate medical treatment.)

Trump is far from the only member of the gilded society receiving this sort of highly tailored care during the coronavirus crisis. The uberwealthy of Washington, D.C. call on private doctors for rapid coronavirus tests, via Tesla or plane, so that they can host and attend parties. Former New Jersey Governor Chris Christie was apparently able to check himself into hospital as a “precautionary” measure. Never mind the possibility that he would take up a needed bed or hospital resources—after all, this is a rich person we’re talking about—or that for normal people, the decision to admit someone to hospital is supposed to be based on medical need. Normal people can’t waltz into a hospital because they think they might get sick; many normal people can’t get into a hospital even if they are already very sick.

Compare Chris Christie’s preemptive stay at hospital to the experience of patients in Los Angeles County’s public hospital system, where poor people with no other option wait months for appointments with specialists, according to a recent Los Angeles Times investigation. The Times reported on several patients who had died waiting to be seen by the county’s doctors. Sometimes their requests for appointments, even for routine diagnostic procedures like colonoscopies, were denied as medically unnecessary. Just 57 percent of patients whose primary care doctors had requested an appointment within a specific time frame—say, within two weeks, or within three months—received timely appointments; the average wait time is more than two months. One patient profiled in the piece was recommended for surgery to remove a golf-ball-size tumor in her brain but never received an appointment at all. Nearly a year later, she was found dead by her five-year-old daughter on the bathroom floor. She was 30.

These are not rare or random mistakes. They are an understood fact of the way we provide care to the poor, a known flaw in the system that we nevertheless refuse to address. It is hard for the county to find doctors willing to accept these patients—one specialist mentioned in the piece only sees Medi-Cal patients once a week—and so it simply doesn’t try. The electronic system doctors use to consult with specialists is “designed to prevent or delay appointments with overburdened specialists,” according to primary care medical staff interviewed by the Times.

The U.S. tells itself the lie that it has a “safety net” health care system for the poor, where they can get Medicaid (except in 14 states where poverty alone doesn’t qualify you) or go to the nearest public hospital emergency room and receive care regardless of status. But when people have to wait months for appointments with doctors, while others with private insurance get to skip the line, you haven’t created a system. It’s certainly not “health care” when you consign poor people to being treated at emergency rooms, which can’t and don’t provide routine or preventative care. You can’t treat cancer or depression at the emergency room, after all.

It doesn’t especially matter to the American public if Trump dies of the coronavirus. If the polls can be believed, Covid-19 might only hasten what the American people plan to do at the ballot box. What does matter is that long before anyone had heard of this virus, poor people in America died needlessly in the chaos of our health care system, through systemic neglect and mistreatment that goes unnoticed and unremarked upon. Ordinary Americans live with unimaginable stress, physical pain, and illness that we simply choose not to treat. Their children discover their remains in their homes, where they died waiting to see a doctor or to receive a course of medicine—whatever scant measures were on offer. If we learn anything from Trump’s apparently impeccable care at Walter Reed, it should be to ask: Why him and not us?