What does the Pandemic Reveal about Our Public Health Systems?

Students consider how the coronavirus pandemic has revealed gaps in our public health system, amplifying calls for universal health insurance and a national paid sick leave policy.

To The Teacher

The rise of the coronavirus pandemic has revealed some major gaps in our public health and social welfare systems. As things are currently structured in the United States, many people would not be able to afford testing and treatment for the coronavirus on their own—and many don’t get sick pay that would allow them to stay home from work if they are ill. 

A coronavirus relief proposal Congress passed on March 17, 2020, provides many workers being treated or quarantined for the coronavirus with two weeks of paid sick leave, and covers the cost of coronavirus tests. But the need for this emergency legislation has raised much discussion about how Americans are less healthy and more vulnerable to infectious disease because of our patchwork health insurance system and lack of mandated sick pay for workers. 

This lesson examines how the worsening pandemic has revealed gaps in our public health system, amplifying calls for universal health insurance and a national paid sick leave policy. Questions for discussion follow.


Reading 1: The Healthcare Gap

On March 17, 2020, Congress passed a coronavirus relief package that includes funds to help people cover the cost of getting a coronavirus test. The legislation also requires that many employees must be given two weeks of paid sick leave if they are being treated or quarantined for Covid-19. 

As things are currently structured in the United States, without such emergency action, many Americans would not be able to afford to be tested or treated for Covid-19 (or any other illness). This is because millions of Americans don’t have health insurance, and many others have health insurance that is inadequate. 

This has led to a broader discussion about how Americans are less healthy and more vulnerable to infectious disease because of our patchwork health insurance system and lack of mandated sick pay for workers – problems that go far beyond one particular emergency.

In an article in Health Affairs on the coronavirus relief package, Katie Keith wrote: 

Whether and how coronavirus-related testing and treatment will be covered by public and private insurers has been a point of discussion since the coronavirus outbreak began. Without additional cost-sharing protections or assured coverage, individuals who otherwise need to be tested or treated may decline to seek care simply because they are worried about costs. This could further spread the virus and lead to a higher mortality rate. Affordability concerns are heightened for those who are uninsured or underinsured—and may be further exacerbated by an economic downturn that results in reduced hours and incomes for workers.

Ensuring widespread access to coronavirus-related testing and treatment is also challenging due to America’s fragmented coverage system. Most people are enrolled in health insurance through their employer (or a family member’s employer). Others receive coverage through Medicare, Medicaid, or CHIP. Millions more are covered in the individual market and through military programs. And about 20 million people remain uninsured.


In a March 9, 2020, article for USA Today, Philip A. Verhoef, a physician at Hawaii Permanente Medical Group and assistant professor at University of Hawaii, argued that in order to ensure public health, our country should go well beyond free testing and extend our federal Medicare program, now designed primarily for seniors, to everyone:

Congress is grappling with the problem of surprise medical bills, but will its Band-Aid approaches make a difference? As a physician, I’m trained to look beyond superficial symptoms to diagnose the underlying ailment. When patients pay thousands of dollars each year for “good” private insurance, how does a health care system allow them to walk away from a single hospital visit with debilitating medical debt? These concerns have become even more pressing with the spread of the new coronavirus and the costs associated with prevention, testing and treatment….

Right now the current Medicare system is covering the costs of coronavirus testing, protecting patients just as it was designed to do. This health emergency is another argument for expanding such protections to all Americans.
Working in various hospitals across the country, I have met so many patients who delay or avoid needed care for fear of surprise bills and financial catastrophe. That's risky for them and, in the face of a threat like coronavirus, for all of us. It doesn’t have to be this way. 


For Discussion

  1. How much of the material in this reading was new to you, and how much was already familiar? Do you have any questions about what you read?
  2. Do you think legislation covering the cost of coronavirus legislation is adequate? Why or why not?
  3. Does the lack of universal health insurance in the U.S. pose a public health threat? Why or why not? 
  4. Imagine that you have outstanding health insurance coverage. How might someone else not being insured affect you during a global pandemic? 


Reading Two: The Sick Leave Gap

As the Covid-19 outbreak has spread in the United States, public officials have called for the implementation of “social distancing” measures and for workers who feel sick to stay home from their jobs. 

In general, taking prolonged time off from work due to illness is a luxury that many U.S. workers cannot afford, because they lack paid sick leave. For them, staying home means going without a paycheck and jeopardizing their ability to support themselves and their families.

In a March 11, 2020 editorial, the New York Times editorial board discussed the consequences of the lack of paid sick leave in this country. The editors wrote:

[M]any of the nation’s big restaurant chains, in particular, do not provide paid sick leave. Nationwide, only 45 percent of workers in the hotel and food service industries get paid sick days, compared with 97 percent in the financial industry, according to the latest federal data. The list of restaurants that don’t pay sick workers to stay home is a roll call of familiar brands, including Burger King, Chick-fil-A, Jack in the Box, Wendy’s and Panera.

One consequence: The Centers for Disease Control and Prevention reported in 2014 that “one in five food service workers have reported working at least once in the previous year while sick with vomiting or diarrhea.”

Other developed nations, and a number of American states and cities, already mandate some form of paid sick leave, and some congressional Democrats have seized the coronavirus moment to push for a change in federal law. Such a change is long overdue, and would be welcome news.



The coronavirus aid package passed on March 17, 2020 mandates two weeks sick leave for those either infected with Covid-19, caring for an infected family member, or negatively impacted by a school or care facility closing. Unfortunately, the measure excludes people who work for companies with more than 500 employees—which is a large portion of the workforce.

Current debate centers around whether this limited measure should be expanded—and whether paid sick leave should remain the law of the land even after the coronavirus pandemic. Terri Gerstein, the director of the State and Local Enforcement Project at the Harvard Law School Labor and Worklife Program, discussed the issues at play in a March 4, 2020 article for The Hill, ultimately concluding that even a temporary program is better than nothing:

Paid leave advocates would prefer a lasting solution, but a short-term provision would be a start. Moreover, proof of such a concept could lead some lawmakers or employers to extend the policy. Business associations typically oppose paid leave obligations, which is an utterly irresponsible position right now and contrary to the beliefs of their own members, but a time limit might lessen resistance….

Coronavirus [further] illustrates the harm of allowing large companies, including those in the gig economy, to misclassify their workers as independent contractors instead of employees. We also need a sustainable solution to this, but there is an immediate need. Drivers, delivery workers, and house cleaners interact with the public, leading to higher than average potential exposure and spread. They need paid leave to stay home while sick. One approach to consider is the Massachusetts paid family and medical leave law, which covers businesses that use 1099 forms, indicating independent contractor status, for over 50 percent of the labor force across the state.

Ideally, our nation would have had robust paid sick leave laws long ago. But this is not a perfect world. Congress should take action, as should states and cities. If they need to make imperfect compromises, like a sunset provision or subsidy program, they should not hesitate to do so. After all, what is worse, an imperfect solution or a paralyzing pandemic?



However, worker’s rights advocates are taking a stronger stance in favor of making paid sick leave permanent for all working people, including those—such as cleaners and caretakers employed in individual homes—who are excluded from many federal labor protections. In March 14, 2020 statement by the National Domestic Workers Alliance (NWDA), Executive Director Ai-jen Poo argued:

Everyone, especially people on the frontlines interacting with the sick and older people, needs to be able to take time off if they’re sick, quarantined or need to care for someone they love, without fear of losing income or employment. Workers should not be forced to choose between putting food on the table and protecting their health or the health of their loved ones. Whether you are the only employee in your workplace or work with more than 500 coworkers, all workers should have paid sick leave. The Senate must immediately approve the Families First Coronavirus Response Act and include permanent sick days for everyone in future coronavirus emergency legislation.



Paid sick leave could be a temporary stopgap implemented to slow the spread of the current pandemic, or it could be a permanent measure providing long-term protection against the spread of infectious diseases. Which option prevails will largely depend on whether the public rallies behind paid sick leave as a policy that our country needs.

For Discussion:

  1. According to the reading, why might some workers be hesitant to stay home, even if they feel sick?
  2. What paid sick leave provisions are included in the Coronavirus Response Act that passed the House of Representatives? Do you think they are adequate? Why or why not?  
  3. Imagine that you have generous sick pay coverage from your employer. How might someone else not having sick pay affect you during a global pandemic? 
  4. Do you think that  employers be required to provide paid sick leave even after the coronavirus pandemic is over?
  5. What are some of the public health policies that you might put in place to make our society more prepared to handle infectious diseases in the future? 


Research assistance provided by Akin Olla.