The debate over the role of government in addressing income inequality, housing insecurity, debt accumulation, and health care continues, now against the grim backdrop of the raging coronavirus. It is difficult to articulate the speed with which the U.S. and, indeed, the world, has descended into an existential crisis. We are experiencing an unprecedented public-health event whose diminution and potential resolution rests with a series of prescriptions, including settlement-in-place orders, that will annihilate the economy. The deadly spread of COVID-19 demands enclosure as a way to starve the searching virus of bodies to inhabit. The consequences of doing so removes workers from work and consumers from consumption; no economy can operate under these conditions.

American life has been suddenly and dramatically upended, and, when things are turned upside down, the bottom is brought to the surface and exposed to the light. In 2005, when Hurricane Katrina and its aftermath ravaged the Gulf Coast, it, too, provided a deeper look into the darkness of U.S. inequality. As the actor Danny Glover said then, “When the hurricane struck the Gulf and the floodwaters rose and tore through New Orleans, plunging its remaining population into a carnival of misery, it did not turn the region into a Third World country, as it has been disparagingly implied in the media; it revealed one. It revealed the disaster within the disaster; gruelling poverty rose to the surface like a bruise to our skin.”

For years, the United States has gotten away with persistently chipping away at its weak welfare state by hiding or demonizing the populations most dependent on it. The poor are relegated as socially dysfunctional and inept, unable to cash in on the riches of American society. There are more than forty million poor people in the U.S., but they almost never merit a mention. While black poverty is presented as exemplary, white poverty is obscured, and Latinos and other brown people’s experiences are ignored. As many as four in five Americans say they live paycheck to paycheck. Forty per cent of Americans say that they cannot cover an unexpected four-hundred-dollar emergency expense.

This is a virus that will thrive in the intimacy of American poverty. For years now, even in the midst of the economic recovery from the 2008 financial crisis, rising rents and stagnant salaries and wages have forced millions of families to improvise housing; nearly four million households live in overcrowded homes. This is the cruel irony of the San Francisco Bay Area’s shelter-in-place mandate: the region is at the epicenter of the U.S. housing crisis, as exemplified by its growing unsheltered homeless population. How do you practice social isolation without privacy or personal space? There are the crowded public offices that poor people congregate in to navigate access to services and income. There are the emergency rooms that function as primary health-care providers—not to mention the county jails and state prisons.

Economic inequality is exacerbated by racial injustice, both held in place by a threadbare social-safety net. Black and brown populations are particularly vulnerable to infection because poverty is a fount of underlying conditions, such as diabetes, hypertension, pulmonary disease, and heart disease, that make it more likely that the virus will be deadly. They are also more vulnerable because greater rates of poverty and under-employment have hindered access to health care. In Milwaukee, the most segregated city in the U.S., where black unemployment is four times the rate of white unemployment, the majority of diagnosed coronavirus cases are middle-aged black men. And as anyone who has ever had to wonder how they will make their rent payment knows, the stress of economic uncertainty is corrosive, eating into the capability of the immune system.

But the danger of contracting the coronavirus will hardly be the problem of the poor and working class alone. Those who, because of poverty and insecurity, are most vulnerable to infection also have disproportionate contact with the broader public, through their low-wage retail and service work. Consider the plight of the home health-care worker. Millions of such workers attend to a largely elderly and homebound population for meagre hourly wages and often without health insurance. In 2018, home health-care workers, eighty-seven per cent of whom are women and sixty per cent of whom are black or Latino, made an average of about eleven dollars and fifty cents an hour. These workers are the sinews of our society: they must work to insure that our society continues to function, even as that work poses potential threats to their clients and the general public. Their insecurity, combined with the failure of meaningful action by the federal government, will make the suppression of the virus nearly impossible.

Thus far, the Trump Administration has predictably bungled the response to the coronavirus. But the Democratic Party’s response has been hampered by its shared hostility to unleashing the power of the state, through the advance of vast universal programs, to attend to an unprecedented, devolving catastrophe. About half of American workers receive health insurance through their employer. As job losses mount, millions of workers will lose their insurance while the public-health crisis surges. In the last Democratic debate, former Vice-President Joe Biden insisted that the U.S. doesn’t need single-payer health care because the severity of the coronavirus outbreak in Italy proved that it doesn’t work. Strangely, he simultaneously insisted that all testing and treatment of the virus should be free because we are in crisis. This insistence that health care should only be free in an emergency reveals a profound ignorance about the ways that preventive medicine can mitigate the harshest effects of an acute infection. By mid-February, a Chinese government study of that country’s coronavirus-related deaths found that those with preëxisting conditions accounted for at least a third of all COVID-19 fatalities.

Dismissing the necessity of universal health care also shows an obliviousness to the power of medical expenses to alter the course of one’s life. Two-thirds of Americans who file for bankruptcy say that medical debt or losing work while they were sick contributed to their need to do so. The costs of medical treatment become a reason for postponing visits to the doctor. A 2018 poll found that forty-four per cent of Americans delayed seeing a doctor due to its cost. Already, half of Americans polled have said that they worry about the costs of the testing and treatment of COVID-19. In a situation like the one we are in, it becomes easy to see the ways that encumbered access to health care exacerbates a public-health breakdown. N.B.A. players, celebrities, and the wealthy have access to the coronavirus test, but attending nurses and frontline health-care workers, community health centers, and public hospitals do not. Health-care inequalities are problems that have been left unattended, creating so many small, imperceptible fractures that, in the midst of a full-scale crisis, the structure is collapsing, shattering under its own weight.

The case has never been clearer for a transition to Medicare for All, but its achievement clashes with the Democratic Party’s decades-long hostility to funding the social-welfare state. At the heart of this resistance is the pernicious glorification of “personal responsibility,” through which success or failure in life is seen as an expression of personal fortitude or personal laxity. The American Dream, we are told, is anchored in the promise of unfettered social mobility, a destiny driven by self-determination and perseverance. This ingrained thinking evades the fact that it was the New Deal, in the nineteen-thirties, and the G.I. Bill, in the nineteen-forties, that, through a combination of federal work programs, subsidies, and government-backed guarantees, created a middle-class life style for millions of white Americans. In the nineteen-sixties, as a result of prolonged black protest, Lyndon Johnson authored the War on Poverty and other Great Society programs, which were intended to lessen the impact of decades of racial discrimination in jobs, housing, and education. By 1969, with Richard Nixon at the helm, during an economic downturn that ended what was then the longest economic expansion in American history, the conservatives attacked the notion of the “social contract” embedded in all of these programs, claiming that they rewarded laziness and were evidence of special rights for some. When Nixon ran for reëlection, in 1972, he claimed that his campaign pitted the “work ethic” against the “welfare ethic.”