The COVID-19 Pandemic Exposes Deep Flaws In America’s Broken Healthcare System
Above photo: A woman is taken by paramedics from a Chicago Fire Department ambulance into the emergency room at Roseland Community Hospital in Chicago, U.S., April 21, 2020. Reuters / Shannon Stapleton.
The coronavirus crisis is demonstrating why it’s time we replaced a system that exists purely for profits with one that puts public health first.
When it comes to the number of Covid-19 cases and deaths, the United States is off the charts compared to other countries. Although the USA comprises five percent of the global population, 32 percent of Covid-19 cases and 25 percent of deaths worldwide are there. By contrast, China, where the novel coronavirus originated, has one-tenth of the number of cases and deaths, despite having a population that is four times larger.
A disaster scenario is playing out across the United States, particularly in New York City where scores of refrigerator trucks have been brought in to hold the dead, hundreds of people are dying in their homes without medical attention every day, mass graves are being used to store bodies while mortuaries are overwhelmed, and health professionals lack basic personal protective equipment (PPE), ventilators, and dialysis machines.
Dr. Mike Pappas, a doctor there, has described the difficulties he and other health professionals are facing. The shortage of PPE means doctors and nurses are reusing masks and gowns and are sometimes working without them. They are wearing trash bags over their bodies to protect themselves and their patients from becoming infected. In an interview, Dr. Pappas spoke about the stress of not having enough staff, having to clear hallways and the cafeteria to make bed space, and the reluctance of hospital administrators to buy more ventilators.
As people in America struggle to wrap their heads around the twin crises of the rampant pandemic and collapsing economy, it is easy to blame the Trump administration for its failures to take rapid and effective action to contain the spread of infection and provide financial support. In reality, the roots of the crises precede Trump. The US would have fared poorly during a pandemic under any president.
It’s the system, stupid
The current disaster exists in large part because the US healthcare system is the opposite of what is needed. It is fragmented, discriminatory and designed for corporate profits, not the wellbeing of the public. Even before the pandemic, the United States had the highest number of preventable deaths compared to other wealthy nations and a declining life expectancy.
Nearly every facet of the system, which is twice as expensive as other developed countries, is designed to extract profit whether it is the hundreds of private health insurers that compete for the healthiest enrollees while avoiding those with health conditions, or the pharmaceutical corporations that charge whatever the market will bear. Even hospitals are shutting down essential departments such as obstetrics and pediatrics to make space for more lucrative areas like cardiology and orthopedics.
Two-thirds of US bankruptcies are caused by medical bills
There are now more than 30 million people without health insurance. In the past five weeks, as more than 26 million people filed for unemployment benefits for the first time, five million of them lost their health insurance. The number of uninsured is expected to rise by more than 13 million by June. On top of that, tens of millions of people with health insurance can’t afford care because of the thousands of dollars in out-of-pocket costs they must pay before their insurance benefits begin.
Even if a person has health insurance, there may not be anywhere to go for care. Over the past 45 years, as the US population grew by over 100 million, the number of hospital beds shrunk by about 600,000. Hospitals closed in rural areas because they could not bring in enough revenue to keep their doors open. Another 453 rural hospitals are teetering on the edge of closure out of the 1,844 that remain. In cities, hospitals that served poor communities for over 100 years are being shuttered to make way for luxury housing or retail space in gentrifying areas.
Another flaw that has been exposed by Covid-19 is the supply chain for goods and equipment. In February and early March, when patients went to hospitals with symptoms of the virus, there were few to no tests for diagnosis because the US chose to create its own tests rather than purchasing them from the World Health Organization. There have been severe shortages of protective gear. States have been fighting with each other to get basic kits as suppliers raise prices by as much as 1,000 percent.
This situation has made the call for a national improved Medicare for All healthcare system grow louder. If the US already had Medicare for All, many of the problems being experienced would not exist. Under the Medicare for All system, as defined by the congressional bill in the House of Representatives, every person in the US would be covered from birth to death without requiring payment before care is given.
This would alleviate the real fear Americans experience of financial ruin. For example, in March a nurse sought care and testing for Covid-19 symptoms and subsequently received a bill for $35,000 even though she was never admitted to the hospital. Two thirds of personal bankruptcies in America are because of medical bills.
Put people before profits
There’s a more fundamental case for a more socialized approach: it works better. A look at healthcare systems around the world that have performed well during the pandemic finds universal coverage, central planning, and the principle of health over profit are essential features. Even countries that are suffering from economic sanctions are doing a better job of containing the spread of infection than the United States.
Under a national improved Medicare for All, hospitals would not be closing their doors or shutting down departments that don’t generate high revenues in favor of more lucrative ones. Every hospital and health facility would receive a budget to cover operating costs and capital expenses. The days of investment companies buying up hospitals, running them into bankruptcy and leaving them stranded would be over.
Another key feature would be that the federal government would purchase pharmaceuticals and medical supplies in bulk to lower the cost and ensure states have what they need. Bidding wars and price gouging would cease to exist.
The US is an outlier in this pandemic in terms of the number of Covid-19 cases and deaths, and an expert predicts the next winter will be even worse as the flu season begins. But the US has been an outlier for a long time for spending the most on healthcare and still having poor health outcomes. Around the world, the countries that have handled the pandemic well, such as China, South Korea, Cuba and Venezuela, share common features of their healthcare systems: central planning, universal coverage and a focus on public health.
Whether America finally adopts a similar system depends on what people do to demand it, but there certainly has not been a more opportune time to make that demand.