An unvaccinated Covid patient in Minnesota. Credit: Aaron Lavinsky/Star Tribune via Getty Images

December 20, 2021   5 mins

An underdiscussed element of the Covid pandemic is the cost of the virus — not in American lives, but in American dollars. In the United States, a Covid hospitalisation costs $29,000 on average; if you’re sick enough to require an ICU stay and a ventilator, that average soars to $156,000. And in a country without universal healthcare, with a piecemeal system of private insurance that ties insurance coverage to employment, and amid a pandemic that has left many unemployed, an enormous number of Americans stand to find themselves underwater. There’s a looming crisis of Covid medical debt.

Already, their stories are legion: there’s the flight attendant who spent a week in the hospital with Covid, then spent six months fighting with his insurance company over the $25,000 bill. There’s the Phoenix family who were hit with a million-dollar claim summary and a bill for $700,000 while still grieving their father’s death. There’s the dental office manager, stricken with long Covid and still too sick to work, drowning in tens of thousands of dollars of medical debt.

Ten years ago, stories like these would have been held up by our country’s Left wing as proof of the continued, desperate need for healthcare reform. The stratospheric cost of healthcare, the idea that a citizen of one of the world’s wealthiest nations could go bankrupt just by falling ill, the prospect of a suffering person forgoing treatment because they couldn’t afford it: these were stains upon our country, the hallmarks of a broken system. Barack Obama summed it up best when he said, “In the United States of America, health care is not a privilege for the fortunate few — it is a right.”

The notion of healthcare as a human right was fundamental to the 2009 debates over Obama’s Affordable Care Act (ACA), as well as to the identity of political progressives: they argued fervently, at the time, that nobody, no matter who they were, should be left destitute just because they got sick. And the idea that affordable care or coverage might be tied in any way to one’s lifestyle choices was particularly offensive: when conservatives complained that an ACA mandate providing free hormonal birth control was akin to prostitution, it caused a nationwide scandal. And when a Republican governor proposed levying a moderate additional charge against Medicaid recipients who were overweight or smoked, the idea was widely derided as “noodle-headed” by progressives.

Indeed, the idea that the Left would ever limit someone’s access to healthcare on moral or ideological grounds was considered laughable — a bogeyman invented by the Right in the form of a memorably hysterical panic about “death panels.” When Sarah Palin claimed that Obama’s healthcare bill would ration care only to those deemed “worthy” by government bureaucrats, the fact-checking site Politifact declared it the Lie of the Year, writing, “Palin’s statement sounds more like a science fiction movie (Soylent Green, anyone?) than part of an actual bill before Congress.”

Suffice to say, things have changed. First, that actual bill is an actual thing, albeit a state rather than federal prospect: on December 6, Illinois state representative Jonathan Carroll advanced legislation to make unvaccinated Covid patients pay out of pocket for the cost of their medical treatment, whether or not they were insured, no matter how astronomical those costs might be.

Carroll rescinded the bill a few days later, citing a backlash that included death threats, but not before it found support in some remarkable places — including the Twitter account of the progressive organisation Occupy Democrats, which posted an all-caps clarion call:

“Illinois introduces a bill to force unvaccinated residents to pay out of pocket for their hospital treatment if they catch COVID, saying that they ‘must asume [sic] the risk’ and ‘take responsibility’ for their carelessness. RT IF YOU THINK THAT YOUR STATE SHOULD DO THE SAME!”

Just a few days later, Atlantic editor David Frum suggested that it was time for the country to return to normal — but while encouraging hospitals to “quietly triage emergency care to serve the unvaccinated last.” And last week, American supermarket chain Kroger announced that unvaccinated employees would be subject to a monthly surcharge on their health plans — and that if they contract Covid, they will not be given paid emergency leave.

In all these cases, the notion of depriving vaccine holdouts of affordable treatment was met with widespread acclaim — in keeping with the idea, promoted by everyone from the paper of record to the current President, that the pandemic would’ve been over ages ago if only they’d sucked it up and gotten their shot. And yet the folks cheering on these measures are the very same people who, only a few short years ago, mocked accusations that they supported ideologically-driven triage, while also grieving the indignity and suffering that punitive healthcare policies would inflict on the most vulnerable among us.

Granted, we still have a way to go before our real-life Covid response resembles a sci-fi dystopia; nobody, at least not yet, has advanced a bill to propose turning the unvaxxed into human Clif bars. But we’ve certainly come a long way from the rhetoric of the 2010s, and from a progressive Left that once defined itself by its willingness to care for other people without caveats. What used to be a narrative of universal compassion has been replaced by a tribal snarl, one to which we feel entitled in our eternally self-conscious selflessness. My mask protects you, but your unvaccinated status is an attack on me — and so anything I do to you in retaliation is an act of self-defence.

It’s not just that legislation like the Illinois bill would set a dangerous precedent — although it doesn’t take much imagination to understand that it does do this, too. Insurance companies already jump at every opportunity to avoid paying out a claim, and this would open the door to a world in which we might be left holding the bag for virtually any illness, injury, or accident, based on some distant bureaucrat’s idea that we could’ve been more careful. The obese patient who suffers a heart attack, the surfing enthusiast with skin cancer, the thrill-seeking youngster who breaks a leg while skiing at imprudent speeds: should they, too, be denied care or coverage for having brought this on themselves? (Do we want to think, for a moment, what kind of horrors might lie in store for women’s reproductive rights if a Republican-heavy legislature used this same logic to target abortion access for women who were “careless” about using birth control?)

There’s no need to imagine the impact of this ideological shift on our civic discourse, however: that, we can see already, every time the tribe that used to pride itself on compassion refers to the unvaccinated as “plague rats.”

Healthcare in the US has always been a system of carrots and sticks. Insurance carriers will subsidise your gym membership (carrot), or charge a higher premium if you smoke (stick), and they generally adhere to the common wisdom that an ounce of prevention is worth a pound of cure — especially when preventive medicine not only saves lives, but keeps costs lower for everyone involved. That’s the nature of privatised healthcare, and so it’s reasonable enough under these circumstances to be frustrated when certain people won’t do their part, won’t sacrifice for the greater good, won’t get their damn jab because it violates some abstract principle of bodily autonomy they’ve never before expressed much interest in.

But it’s one thing to find the unvaccinated frustrating; it’s another to openly fantasise about using the power of the state to punish them for their noncompliance, and another still to express dark and malicious glee at the prospect of their suffering or death. Never mind what this means for the health of the individuals in question — or even of the public at large. We have abandoned a principle that used to define us, and a vision of universal healthcare we used to passionately advocate for, all because we realised that an unjust system makes it easier to coerce and inflict harm on the people we don’t like. The American Left should be deeply worried about the state of its soul.

Kat Rosenfield is an UnHerd columnist and co-host of the Feminine Chaos podcast. Her latest novel is You Must Remember This.