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Opinion Biden’s at-home coronavirus test program epitomizes our public health failures

A resident processes a self-administered at-home covid-19 test, received through a government program, in Easton, N.H., on Dec. 7. New Hampshire is conducting an experiment in offering free at-home rapid covid tests to all residents, and one outcome is already clear: Demand is sky-high. (John Tully/Bloomberg)

Last week, with covid-19 cases surging and more Americans testing positive for the omicron variant, White House press secretary Jen Psaki was asked at a news briefing why the United States doesn’t provide universal free at-home coronavirus tests. “Should we just send one to every American?” she retorted sarcastically.

But scientists and public health experts weren’t laughing. They quickly noted that many other countries have done just that. In Britain, citizens can request free tests be delivered to their door. France, Germany, and Singapore, to name just a few, all provide coronavirus tests at little or no cost.

Instead, the United States will rely on private insurers to reimburse the cost of at-home tests — and on Americans to front the money, retain receipts and navigate what can be a convoluted reimbursement process.

Psaki’s comment may seem uncharacteristic for an administration that has promised to expand testing and “follow the science.” But it was emblematic of the nation’s decades-long reluctance to invest in public health measures that would help Americans survive crises such as the pandemic.

In the United States, health measures that have worked elsewhere often get dismissed for their price tags. But we already spend more of our gross domestic product on health care than any other wealthy country. Yet, compare our health care to that of other high-income nations, and we come in last for accessibility, affordability and equity.

That’s in part because less than 3 percent of the $3.6 trillion we spend on health care each year is earmarked for public health and prevention measures. Instead, we expend hundreds of billions on soaring drug prices and administrative fees. Those costs are exacerbated by our complex private-insurance system, which leaves 28 million people without health insurance, primarily people of color or with low incomes.

So the problem isn’t that the United States doesn’t invest in health. It’s that we spend far less effectively than anyone else — indirectly through insurance companies instead of directly to people and reactively when disaster strikes instead of proactively when people are still healthy.

This has a staggering cost — not just in dollars but in human lives. Our public health system was woefully unprepared for the pandemic, with fewer physicians, hospitals and hospital beds per capita than similar nations. Nearly 40,000 state and local public health jobs have disappeared since the 2008 recession. Sure enough, in 2020, the United States had the highest excess mortality rate of all wealthy nations due to the pandemic. And now, 1 in 500 U.S. residents have died of covid-19, despite us spending more on covid-19 relief than any other country.

The Post's View: What the pandemic disaster teaches for next time

Nevertheless, there’s no time like the present to revamp our approach. We can invest in both a better response to covid-19 and preventive measures to improve our long-term public health. And existing models can guide us.

Countries in Europe and Asia are reintroducing masking guidelines, vaccination mandates, and indeed, free coronavirus testing at point of service. While President Biden’s vaccination mandates for federal and private workers are crucial, many Americans will be left vulnerable while those mandates are entrenched in legal battles. Taking several sweeping precautions at once, as our peer countries have, can help close the gap as winter sets in and cases skyrocket.

Still, covid-19 measures can only be as effective as the public health infrastructure supporting them. In recent decades, Costa Rica successfully overhauled its health care system to prioritize public health measures, including “targeting the most readily preventable kinds of death and disability.” Now, their life expectancy exceeds that of the U.S.

Public health also requires public trust — and we need look no further than a U.S. territory to find a better model for outreach. In Puerto Rico, health officials and nonprofits have conducted door-to-door vaccine drives to connect with all populations. Now, nearly 90 percent of adults are vaccinated and the territory’s case positivity rate is second lowest in the world, behind only New Zealand.

Thankfully, some reforms could soon be implemented. Proposed measures in Biden’s Build Back Better bill — including funds directed to community intervention, health equity programs, paid medical leave and Medicaid expansion — would help. But to be truly prepared for future crises, a Medicare-for-all health-care system would be even more effective — after all, similar systems have already helped other wealthy nations adopt more quick, equitable and consolidated covid-19 responses.

Such policies already have the widespread support of Americans — 58 million of whom struggle to afford essential medication and are eager to see the Build Back Better bill give the government the power to negotiate drug prices. That we haven’t seen movement on issues like these has nothing to do with popular support — but could have something to do with Congress inviting more pharmaceutical lobbyists than representatives to Washington.

Biden claims we’re “throwing everything we can at this virus.” But other countries with less to give have done more. If we’re ever going to emerge from this health crisis — or be prepared for the next one — it will require political organizing and imagination to attempt solutions that have already worked beyond our borders.