US primary health care can be cheaper and more equal. Here’s how.

Medical evidence has revealed that elderly people face an increased risk of dying from the disease, along with people of all ages who have chronic health issues, such as diabetes, obesity and hypertension. Among those with underlying conditions who are dying from the virus, a disproportionate number are living in poverty or are African American or Latinx. Why? Because these populations often do not have, or cannot afford, access to the preventive medicine that can help them stay healthy. A primary care provider’s job is to keep people well, including managing highly treatable conditions such as diabetes and hypertension. Uncontrolled, these maladies can make a person vulnerable to potentially deadly diseases like Covid-19, as well as heart attacks and strokes.

But it’s not just Covid-19 that has had an outsized impact on communities of color and people with low incomes. The prohibitive cost of health care in the US means many people can’t afford to take preventative action — leading to more suffering down the line as they develop health conditions that could have avoided. A patient I’ll call James recently came to the emergency department in Spokane, Washington, unable to speak or move the right side of his body. His stroke symptoms had started three days earlier, but he had unpaid hospital bills after a heart scare five years ago, and he dreaded engaging with the health care system again. He works at a convenience store and doesn’t have health insurance. The price tag and out-of-pocket costs associated with the plans available on his state’s insurance exchange had put coverage out of reach for him. Despite his father dying young of a heart attack and his mother having diabetes, he had not seen a doctor in years. Unfortunately, James’s delay in seeking care for his stroke meant it was too late for him to take clot-busting medication. His best hope is rehab, which might help him recover the ability to speak, walk, and use his right arm.