Our system takes from the poor and working class to generate wealth for the already wealthy.

In March, Congress passed a coronavirus bill including $3.1 billion to develop and produce drugs and vaccines. The bipartisan consensus was unusual. Less unusual was the successful lobbying by pharmaceutical companies to weaken or kill provisions that addressed affordability — measures that could be used to control prices or invalidate patents for any new drugs.

The notion of price control is anathema to health care companies. It threatens their basic business model, in which the government grants them approvals and patents, pays whatever they ask, and works hand in hand with them as they deliver the worst health outcomes at the highest costs in the rich world.

The American health care industry is not good at promoting health, but it excels at taking money from all of us for its benefit. It is an engine of inequality.

Now is a difficult time to talk about the costs of health care. Doctors and nurses are risking their lives to fight the virus. We need more doctors and nurses. We need more beds, more ventilators and more protective equipment, and we need vaccines and drugs. High prices are not the best nor the only way to get drugs or vaccines that will win the war against the virus, but they can help.

Yet we cannot go on as we have been. America is a rich country that can afford a world-class health care system. We should be spending a lot of money on care and on new drugs. But we need to spend to save lives and reduce sickness, not on expensive, income-generating procedures that do little to improve health. Or worst of all, on enriching pharma companies that feed the opioid epidemic.

The crisis will, inevitably, change health care in countless ways. The industry might emerge as a superhero of the war against Covid-19, like the Royal Air Force in the Battle of Britain during World War II. If so, it might become even more untouchable than before. Or it may be seen as a financial predator that leaves many thousands with unpayable bills for coronavirus care.

But the virus also provides an opportunity for systemic change. The United States spends more than any other nation on health care, and yet we have the lowest life expectancy among rich countries. And although perhaps no system can prepare for such an event, we were no better prepared for the pandemic than countries that spend far less.

The first step to reform is to change the way we think about the health care system. Many Americans think their health insurance is a gift from their employers — a “benefit” bestowed on lucky workers by benevolent corporations. It would be more accurate to think of employer-provided health insurance as a tax.

One way or another, everyone pays for health care. It accounts for about 18 percent of G.D.P. — nearly $11,000 per person. Individuals directly pay about a quarter, the federal and state governments pay nearly half, and most of the rest is paid by employers.

In 2019, employer-based insurance plans cost an average of $21,000 for a family policy or $7,200 for a single person. This system requires companies to calculate whether a worker’s value to the company can cover both wages and benefits, a difficult test for less-skilled workers. Wages fall or employers shed or outsource these positions to companies with few benefits and fewer prospects for career advancement.

Rising health care costs account for much of the half-century decline in the earnings of men without a college degree, and contribute to the decline in the number of less-skilled jobs. Employer-based health insurance is a wrecking ball, destroying the labor market for less-educated workers and contributing to the rise in “deaths of despair.”

Rising costs are an untenable burden on our government, too. States’ payments for Medicaid have risen from 20.5 percent of their spending in 2008 to 28.9 percent in 2019. To meet those rising costs, states have cut their financing for roads, bridges and state universities. Without those crucial investments, the path to success for many Americans is cut off. We face a looming trillion-dollar federal deficit caused almost entirely by the rising costs of Medicaid and Medicare, even without the recent coronavirus relief bill.

Every year, the United States spends $1 trillion more than is needed for high quality care. Of course, that waste is also someone’s income; executives at hospitals, medical device makers and pharmaceutical companies, and some physicians, are very well paid.

American doctors control access to their profession through a system that limits medical school admissions and the entry of doctors trained abroad — an imbalance that was clear even before the pandemic. That keeps their numbers down and their salaries up. As of 2012, doctors were the largest single occupation in the top 1 percent. The business model under which most doctors practice isn’t working; without the revenue from high-paid elective care, some hospitals are now resorting to furloughs and layoffs of doctors and nurses.

Hospitals, many of them classified as nonprofits, have consolidated, with monopolies over health care in many cities, and they have used that monopoly power to raise prices. Many Americans, even those with insurance, face bills that they cannot pay, or are hit with “surprise” medical bills charged by providers working at in-network hospitals who have opted not to accept insurance. Ambulance services and emergency departments that don’t accept insurance have become favorites of private equityinvestors because of their high profits. Medical device manufacturers have also consolidated, in some cases using a “catch and kill” strategy to swallow up nimbler start-ups and keep the prices of their products high.

These are all strategies that lawmakers and regulators could put a stop to, if they choose.

They choose not to. And so we Americans have too few doctors, too few beds and too few ventilators — but lots of income for providers. While millions suffer, our health care system has turned into an inequality machine, taking from the poor and working class to generate wealth for the already wealthy.

The health care industry has armored itself, employing five lobbyists for each elected member of Congress. But public anger has been building — over drug prices, co-payments, surprise medical bills — and now, over the fragility of our health care system, which has been laid bare by the pandemic. This anger could breach the protective cordon in Washington.

If it does, what will we get instead?

A single-payer system is just one possibility. There are many systems in wealthy countries to choose from, with and without insurance companies, with and without government-run hospitals. But all have two key characteristics: universal coverage — ideally from birth — and cost control.

Britain, for example, has the National Institute for Health and Care Excellence, which vets drugs, devices and procedures for their benefit relative to cost. The institute can sometimes delay the availability of good treatments, but it prevents the public system from spending money on expensive therapies of questionable value. It is designed to put the interests of patients ahead of providers.

In the United States, public funding is likely to play a significant role in any treatments or vaccines that are eventually developed for Covid-19. Americans should demand that they be available at a reasonable price to everyone — not in the sole interest of drug companies.

At the very least, America must stop financing health care through employer-based insurance, which encourages some people to work but it eliminates jobs for less-skilled workers. Employer-based health care is a particular nightmare in this pandemic. In recent weeks, millions have lost their paychecks and their insurance, and will have to face the virus without either.

We are believers in free-market capitalism, but health care is not something it can deliver in a socially tolerable way.