My Turn: Our system of health care failed during the pandemic

For the Monitor
Published: 1/25/2021 6:20:05 AM

The pandemic has highlighted some serious flaws in the U.S. health care system. Mislabeled as a “free market” system, Americans have spent more money on combating the pandemic and received fewer benefits per dollar than any other nation.

Our health care system has slowly been taking us to the proverbial cleaners, but the pandemic has put us in the fast lane.

Primary care is secondary to for-profit health insurance: The whole point of insurance is to provide funds in the event of an emergency or life-altering occurrence. Health insurance was and still is designed to cover the cost of catastrophic health care. This is the inherent problem of basing the nation’s health care on a system designed to only cover catastrophes: It was never intended for routine care.

Health maintenance, such as routine visits to a primary care provider, is a secondary issue to health insurance companies. Primary care appointments will cost you an extra copay, which may or may not be a part of your deductible. As a result of these extra costs, Americans tend to see their primary care providers less frequently than citizens of other industrialized countries. If you have no insurance, many practices will not even schedule an appointment.

One of the reasons that Americans are particularly vulnerable to the ravages of coronavirus is the high number of people with health risk factors such as obesity, diabetes, and hypertension. All of these risk factors are reduced with routine check-ups with primary care providers.

But costs alone are not the only reason Americans have fewer preventive visits. The lack of availability of primary care providers is also a byproduct of for-profit health care. Insurance companies reimburse (pay) primary care providers less than they pay specialists. More U.S. medical school graduates become specialists in order to pay off their education costs in a timely manner. This also explains why many U.S. primary care providers are either nurse practitioners, physician assistants, or a graduate from a non-U.S. medical school.

Pandemics require planning and prevention: The U.S. was warned of the coronavirus pandemic as early as December 2019. While it is true that China was slow in announcing details that would have helped to slow the spread of the disease, we can’t control what happens in China, but we could have taken precautions here at home, precautions that never materialized.

Sure, politics and a presidential denial were major factors in the devastating impact the virus had in the U.S., but the CDC and other public health agencies could have had more visibility earlier in the process to organize the preventative measures necessary to lessen the early impact of the virus. Given how poorly equipped our health care system is in preventing illness and the high number of people with health risk factors, this was a crucial oversight.

You can’t fight an invading army with militias: We have some of the most advanced medical teams and technologies in the world, but without a centralized, coordinating health care system, much of this advantage is wasted. The for-profit, “free market” approach to health care is based upon the principle of competition and fragmentation. When a strong, unified and swiftly moving invasion force like the coronavirus hits our shores, we have no coordinated system to combat it.

Our fragmented system against a powerful and fast-moving pandemic is akin to fighting an army with amateur militias. This problem was compounded by the president, who saw no need to take the necessary precautions recommended by the CDC and his security advisers. “Closing the border to China” except for 40,000 people cannot be considered a serious prevention, as verified by history.

The fragmented system can be subjected to a considerable amount of mixed messaging. One of the reasons that President Trump was able to politicize the virus and the U.S. response was the lack of a central medical voice giving us the facts. Dr. Fauci and to a lesser extent, Dr. Birx symbolized the central response to the virus, but without a system in place to direct the messaging to health care providers and facilities, much of that information was delayed or subverted.

There were other people with medical degrees who espoused unproven contrary messages that confused the public and led to unnecessary medical delays and death. Without a central system in place, this type of problem can recur and in even greater numbers.

Vaccination distribution problems: The U.S. had planned to vaccinate 20 million people by the end of December, but only 2.8 million actually received the vaccine. Unsurprisingly, our “free market” health care system played a major role in this discrepancy because it was never designed to treat the country as a whole.

Without a national system in place, pharmaceutical companies were doing their best to get their product to 50 different states each with several vaccine distributors. We came up with an organizational plan about which groups should receive the vaccines and in which order, but with a myriad of competing health care systems, there was no way to ensure that the vaccines reached the proper providers.

At the current rate of distribution, the U.S. is projected to reach “herd immunity” in October 2023.

The problem of tying health insurance to employment: You can’t claim that the U.S. has a “free-market” system of health care if individual consumers (that’s all of us) don’t pick the product, but our employers do. We wouldn’t tolerate it if our employers determined which grocery stores we could shop in, so why do we want our employers determining our health insurance plans and the doctors associated with those plans? Even if our employers offer a choice of plans, they, not we, get do decide which options are available.

Many people fear “socialized medicine,” where other people direct our health care, but that is exactly what we have now. How ironic that the social medicine fear mongers rave against “public options” where the individual members of the public pick their doctors and their health plans.

Here’s the problem: Before the pandemic, 10% of Americans had no health care coverage, and an estimated 30-40% of Americans were said to have inadequate health care coverage with high deductibles.

During the pandemic, many thousands of small businesses have closed and millions lost their insurance with their jobs. Now, many more people are without health care during the pandemic when they need it the most.

The future of American health care: How much we’ve learned from the pandemic depends upon where we go from here.

The private health insurance and pharmaceutical industries are each spending hundreds of millions of dollars in advertising and political funding to convince us that they should be the only option for health care. This effort will continue despite having the pandemic expose the inherit problems with our for-profit, fractionated, healthcare system.

There is no ideal health care system, but the health care system we have now is arguably the least perfect system possible due to its high costs and inefficiencies. We need an affordable, universal, easily accessible system under minimal political influence that can coordinate care in times of national medical emergencies such as a pandemic. This includes the need for basic health insurance that is independent of one’s employment.

Our current Medicare system is an example often cited that comes close to meeting those needs listed above. Expanding that system would be costly and cause an increase in taxes to support it which would be more than offset by not having to pay higher premiums. We would be able to eliminate other government programs that are more expensive (Medicaid, CHIP).

But that is only one possible solution for replacing the present system which costs more money and more paperwork. In other health care systems, Americans would actually see an increase in their disposable income and fewer medical bills. We would also see a faster and better coordinated response to future pandemics.

There may be other options to consider as well, but those options might require recreating a whole new system of care.

Most importantly, whatever option we choose, a universal health care system would address the need for preventive care which would save Americans sick days, hospitalizations, paperwork, time and money. It would also make us better prepared to weather or even prevent the next pandemic.

(Dr. James Fieseher lives in Dover.)

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