Helaine Olen made the case this week that our for-profit health system leaves Americans vulnerable to pandemics in a way a single-payer system might not. It forces citizens to weigh whether they can afford their co-pays and deductibles before seeking treatment. And to perhaps delay or avoid treatment that might help slow the spread of infection to others. Emergency room treatment for a sudden-onset illness like the coronavirus is even more costly.
The Kaiser Family Foundation reports that over half of employer-provided plans carry an individual deductible of more then $1,000. The average Affordable Care Act plan deductibles are over $4,000, and only about half of participants receive subsidy payments. Then there are the surprise medical bills that arrive from third-parties often long after after the initial treatment.
Olen writes:
The idea that people won’t think about all this when they consider going to the doctor is bonkers. Our system is set up to ensure that people prioritize their finances when they are sick. It’s the end result of the concept known as “skin in the game,” the idea — pitched by everyone from health-care wonks to insurance company insiders — that the way to get control of the high cost of American medical care is to turn the patient into a bargain-savvy shopper.
Stay home
Then there is the lack of paid leave issue Amanda Mull raises at The Atlantic. America’s workplace culture disincentivizes staying home when sick:
“With more than a third of Americans in jobs that offer no sick leave at all, many unfortunately cannot afford to take any days off when they are feeling sick,” Robyn Gershon, an epidemiology professor at the NYU School of Global Public Health, wrote in an email. “People who do not (or cannot) stay home when ill do present a risk to others.” On this count, the United States is a global anomaly, one of only a handful of countries that doesn’t guarantee its workers paid leave of any kind.
Try containing contagion when profit comes before people’s lives. Digby pointed out Friday that one reason we have a massive shortage of test kits for the virus is because under Trump the Centers for Disease Control “shunned the World Health Organization test guidelines” in favor of developing a more complex test of its own. It didn’t work.
“As a result, until Wednesday the CDC and the Food and Drug Administration only allowed those state labs to use the test — a decision with potentially significant consequences,” Pro Publica reports. By the time the agencies, under pressure, finally allowed hospitals top run their own testing (Wednesday), the government had declared a public health emergency requiring FDA approval of the tests:
Alexander Greninger, an assistant professor in laboratory medicine at the University of Washington Medical Center, said after he submitted his COVID-19 test, which copies the CDC protocol, to the FDA, a reviewer asked him to prove that his test would not show a positive result for someone infected with the SARS coronavirus or the MERS coronavirus — an almost ridiculous challenge. The SARS virus, which appeared in November 2002, affected 26 countries, disappeared in mid-2003 and hasn’t been seen since. The MERS coronavirus primarily affects the Middle East, and the only two cases that have been recorded in the U.S., in 2014, were both imported.
There are labs that can create parts of a SARS virus, but the FDA’s recommended supplier of such materials said it would need one to two months to provide a sample, Greninger said. He spent two days on the phone making dozens of calls, scrambling to find a lab that would provide what he needed.
Greninger said the FDA was treating labs as if they were trying to make a commercially distributed product. “I think it makes sense to have this regulation,’’ he said, when “you’re going to sell 100,000 widgets across the U.S. That’s not who we are.”
It is who we are with a cuthroat in the White House and metastasized capitalism drafting policy on Capitol Hill and in state legislatures.
Just-in-time expertise
Trump dismantled the CDC’s pandemic preparedness team two years ago because he did not want government epidemiologists just sitting around waiting for a pandemic. And because Barack Obama had hired them. Trump justified gutting the program because he could just get specialists off the street when he needed them. “We can build up very very quickly,” Trump said.
Tom Inglesby, director of the Johns Hopkins Center for Health Security, told the Washington Post, “You build a fire department ahead of time. You don’t wait for a fire.”
Under our private, for-profit system a hospital may have more people employed to bill you than to treat you, Mark Sumner quips at Daily Kos:
By treating health care like a business, Americans have already seen one of the first people who dared ask to be tested for COVID-19 get handed a bill for thousands of dollars, the primary result of which will be to dissuade other Americans from asking to be tested. Which is, right there, exactly the result that is best for insurance companies—and worst for the nation.
It’s an absolute certainty that Americans will hide their sniffles, drown their symptoms in over-the-counter drugs, and try to “tough it out” because they can’t afford health care. Besides, they have no paid sick leave, no paid child care, and no guarantee that missing a day’s work won’t mean being cast to the curb. All that “socialist” crap.
And because our whole system runs so excellently lean, American hospitals are already seeing shortages of everything from gowns to masks to painkillers, because the single-source, lowest-price vendor of those items happens to be in an area that’s already been overrun with the coronavirus. Not only have those factories on the far side of the planet been sitting idle for weeks, but what production has been available has been needed close to home.
Naturally, we have no issue with creating weapons stockpiles we hope never to need for killing people overseas. But saving our own lives at home? Nah. Taxes might go up. Better your temperature does instead, and your family’s. <cough, cough>
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