The COVID-19 pandemic has starkly highlighted the cracks in the U.S. healthcare system, especially with regard to public health and the social safety net. What if we had Medicare for All? Learn more in this commentary by HEAL California’s contributor, Mark Wrede.
Commentary
COVID-19 Fail: An indictment of our healthcare system
Almost everything in many American cities is closed: no dine-in restaurants, no bars, no museums, no theaters, no sporting events, no concerts, no theme parks, no public venues. Major thoroughfares are empty. The boulevard lights are on, but the windows are dark and, in some places, giant television screens play without an audience.
As bad as things are, most experts doubt these measures will be enough. The fact is, in spite of what the White House is pushing, the nation is (or should be) on hold indefinitely.
With our fragmented healthcare system, we’re not likely to turn things around quickly.
Even though we had plenty of advance warning from China and Italy, the U.S. government and its healthcare system have failed to effectively respond to the crisis.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, admitted that “…the [U.S. healthcare] system is not really geared to what we need right now.”
The U.S. fumbled the most critical first step in stopping an epidemic: to catch it before it reaches the level of community spread. The way to do that is to test as many people as possible in an outbreak, identify those carrying the virus, track all the people they’ve been in contact with, and place them all under quarantine.
If a test subject has been in contact with a person who has tested positive for COVID-19, the source of transmission is known. But if a subject should test positive having no contact with an infected person, the source of transmission is unknown. This would mean that either the subject came into contact with a person not yet known to be infected, or with a contaminated surface. In other words — from the community.
Since the U.S. failed to get ahead of the virus with widespread testing, we now have to take more drastic measures to slow its spread. There are some who might see social distancing or sheltering-in-place as an overreaction to a minor outbreak, but there is a sound basis for aggressively curtailing in-person contact.
Once community spread has occurred, there may already be ten to a hundred unidentified persons who are infected for each known patient. At that point, it’s essential to limit everybody’s contact with each other.
How has the fragmented U.S. healthcare system prevented an effective response to COVID-19?
First, the high cost of testing and treatment deter Americans from seeking health care in the first place. Our system of private health insurance entails high out of pocket costs that patients must bear to even begin the process of getting care. Although many politicians and insurance providers promise to waive patient costs for COVID-19 testing, they have made no such promises for treatment costs.
Persons who carry the virus certainly face significant costs if they seek medical help. A short hospital stay with treatment can top $20,000 for insured patients and possibly even more for the uninsured.
Then there’s the ragged, underfunded American social safety net.
Too many Americans lack paid sick leave. Being diagnosed and quarantined may prove financially disastrous as families can no longer afford their rent or mortgage, food or other daily expenses.
According to the Washington Post on March 19, 2020 “State unemployment insurance offices are reporting real-time record spikes in claims,..”
Worse, many workers do not even have the status of employees. During this crisis, workers in the gig economy can anticipate no work, no income, and no unemployment benefits.
Meanwhile, the numbers of afflicted Americans continue to grow, as thousands remain untested. COVID-19, like most viruses, spreads exponentially through the population. Some mathematical models suggest that by the end of April, over one million Americans will be infected. At this point the potential for contact has spread so widely that persons with mild symptoms are being advised to not even seek testing, so as to allow those resources for those in more critical health.
Given our failure at early detection and tracking, our only option is to stop the spread before it overwhelms our hospitals. We can do that by reducing the potential for exposure, also known as flattening the curve. This means spreading the peak of infection out over a longer period of time, reducing the chance that our hospitals will be overwhelmed like what has happened in Italy.
What if we had Medicare for All?
If Medicare for All had already been implemented in the U.S., our national response might arguably have been more direct, timely, and effective. Nations with single-payer healthcare systems such as Taiwan and South Korea were able to coordinate a public health response much more quickly than the U.S.
While many balk at the supposed high cost of Medicare for All, it is actually much less expensive than our current system. What we’re spending today to subsidize the cost of healthcare for uninsured and/or underinsured Americans will likely far exceed what we would have paid if we already had a Medicare-for-All system in place.
According to journalist Bob Hennelly, in his commentary “A Revolution by Pandemic” (Salon, March 22, 2020)
…our vaunted American health care system — which is designed to maximize shareholder profits and discourage patients from using it — turns out to be antithetical to promoting the public health. This for-profit model is based on scarcity, which rations access to care, ventilators and personal protection equipment for medical staff, all to feed the insatiable bottom line.
Clearly, it’s long past time to fix our healthcare system once and for all. Medicare for All is only one of many essential reforms that Americans desperately need, and we need it yesterday!
–Mark Wrede
Mark Wrede is a freelance content researcher and writer living in Los Angeles, California. markwrede@ca.rr.com
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