Featuring Dr. Philip Verhoef, Clinical Professor of Medicine at the University of Hawaii and ICU physician: How has our fragmented healthcare system affected our ability to perform basic public health functions? What lessons can we learn from other countries with nationally-centralized electronic health records? With host Brenda Gazzar, Dr. Philip Verhoef takes a closer look at Taiwan’s Medicare-for-All system and how it made identifying COVID hotspots faster and easier. How can the U.S. strengthen its response to future pandemics?
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America’s Fragmented Healthcare System & COVID-19
—– TRANSCRIPT —–
Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host Brenda Gazzar. Today, we’ll talk to an intensive care unit doctor about the ways Medicare for All could benefit us in a pandemic.
Dr. Philip Verhoef is a clinical assistant professor of medicine at the University of Hawaii and an ICU physician and immunology researcher in Honolulu. He cares for critically ill children and adults and has cared for COVID patients during the current pandemic.
This is the second episode in a series with Dr. Verhoef about the deadly coronavirus.
Welcome to Code WACK!, Dr. Verhoef.
Verhoef: Thanks, it’s a pleasure to be here.
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Hawaii hasn’t seen a significant surge of coronavirus cases yet like New York and California have. Do you feel like you would have enough personal protective equipment like masks if there is a surge?
Verhoef: You know, I think that we have an adequate amount and that’s basically been because you know we haven’t had to go through as much of it right now because we don’t have a crisis situation like they have in New York City, where they are just running out of it. For us, all of the hospitals here have basically planned for this. They’ve said ‘alright, we know this could be coming. We’re going to implement measures now that slow down the use of the Personal Protective Equipment so that we don’t go through it quite so quickly.
In any given day, I might have otherwise gone through a dozen masks and 25 gowns before we knew this was coming. And now that we know that this is a possibility, everybody is being much more careful to not throw things away, to not unnecessarily dispose of things that might actually be quite valuable and necessary down the road. From what I understand, we are okay right now and that’s assuming that we can continue on this trajectory. If things get bad, things may get tight for us. And I know one thing I worry about sometimes is if the mainland has their peak before Hawaii does, they’re going to use up all the PPE that’s available and we’re going to be having to scramble. So I think everyone here very much has the that on of ‘let’s be as conservative as we can in the event that something happens, we need to be as well prepared as we possibly can be.’
Got it. Do you think Medicare-for-All would lend itself to better public health than our current system and why?
Verhoef: It really will depend on how the system is designed. The Medicare system that we have now is certainly not perfect. Patients are still responsible for some significant co-pays. There are problems with Medicare Advantage plans, which generally are less efficient and have more narrow networks. There are incentives built in for doing more visits to make more money, these kinds of things. And so, a lot of those incentives need to be eliminated under a new healthcare system.
Advantages to Centralized Health Information Systems
But as far as public health goes, one of the ways that other countries that have national health insurance plans work is that they can share information freely about patients and hotspots through centralized medical records, through centralized health information systems. This is one of the ways that Taiwan stayed on top of the COVID outbreak. They were able to identify where more people were coming in with acute respiratory illnesses and say, ‘oh, these may be places that are COVID hotspots.’ We can see that by looking at the data directly and so optimally, under a Medicare for All system, we also have a single Electronic Health Record system that allows real examination of public health without having to try and get every city’s health insurance records to talk to each other. And this is also really helpful when you have people that travel throughout the country instead of having to reinvent the wheel each time a patient presents to a new health provider. If we have a centralized health records system that would really help from a public health standpoint too but I think one of the other issues this pandemic has illustrated is that we have probably been underfunding public health for a really long time, and they are now completely stretched thin and so the work of a public health department depends on interfacing with all of the hospitals.
Obstacles to Public Health Data-Sharing in U.S.
The state health department for every state in the country gets all of the data on positive COVID patients and has to collate that and present that on a daily basis and everyone is following that on the Johns Hopkins website or state health department’s web page but it’s not easy as a public health department to interface with all of these different competing institutions, right? They all have their own interests, they all want to protect their data in their own ways, and so to have a single unified healthcare system under a single-payer, would make much of that so much easier because no longer are entities competing with each other or afraid to share data. It simply becomes part of how the healthcare system works. You have the individual hospitals but they’re all covered under the national health insurance program, and data from that national health insurance program gets managed through state and local health departments so we can track disease and help improve the care of patients.
Thank you so much, Dr. Verhoef. Find more Code WACK! Episodes on ProgressiveVoices.com and on the PV app. You can also listen at HEAL dash C-A dot org. This podcast is powered by HEAL California, which uplifts the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.
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