What Made U.S. Health Care So Vulnerable to Covid-19

America’s health-care system, the most expensive in the world, is under renewed scrutiny because of the coronavirus pandemic. U.S. employers and households spend almost $4 trillion annually on medical care, yet America regularly lags its peers in key health metrics, and it registered the greatest number of confirmed coronavirus cases and deaths anywhere in the first six months of the global crisis. In advance of a presidential election in November, the virus’s assault shined a spotlight on the gaps and inequities in the market-driven approach of the only rich country not to have universal health care.

Government involvement in health care goes against the libertarian streak that distinguishes the U.S. from, say, the U.K. and Canada, whose state-funded health systems guaranteeing care for all are derided by some Americans as “socialized medicine.” Only about 36% of Americans, mainly the elderly and poor, receive health-care coverage through the government, via the Medicare and Medicaid programs. More than half of Americans have health insurance as a benefit through work (and can lose coverage if laid off). The 2010 Affordable Care Act, more commonly called Obamacare, has helped about 20 million Americans get health coverage by expanding access to Medicaid and subsidizing purchases of individual plans. Still, as of 2018, about 9% of the population, or 28.3 million people, had no health insurance.