As the coronavirus pandemic continues to sweep across the United States, with more than 2.3 million confirmed cases and over 120,000 deaths, it is has made vivid the systemic shortcomings of the uniquely inadequate public healthcare system in the wealthiest country in the world. Before the pandemic, 87 million people were uninsured or underinsured in the US. Today, the situation is far more dire. Since mid-March, over 45 million Americans have lost their jobs and for roughly half of those, that also means losing their employer-based health insurance in the middle of the national health emergency. This has raised the important question: If to contain the virus, people will need to call health care providers as soon as they develop any flu-like symptoms, will they do so if it means racking up a medical debt that could follow them for the rest of their lives?
Whether people are covered or not, the costs for coronavirus care can be devastating. People who are hospitalised for Covid-19 can expect to pay up to $74,310 for treatment if they're uninsured, or if their provider has determined the care they receive is out-of-network, according to an analysis by FAIR Health. But insured patients could spend as much as $38,755, the group found.
Avisha Nessaiver, co-founder and CTO of Birya Biotech told Majalla that while Federal and local governments have pledged to help Americans pay their way through this crisis, loopholes remain.
“For many who have lost their jobs due to COVID-19, there are government programs that help ensure that they remain insured. For those who lose their coverage entirely, they will often qualify for the Special Enrollment Period (SEP) to sign up for a new Marketplace plan. Some may be eligible for a premium tax credit to help pay for their coverage, and others who have experienced reductions in household income could qualify for free or low-cost coverage through Medicaid. Some states are even attempting to expand Medicaid eligibility so they can temporarily insure more of their residents during the pandemic,” he said.
“For those who don't qualify for the above programs, the picture is more bleak. The Families First Coronavirus Response Act passed by Congress requires health plans to fully pay for testing deemed "medically necessary," but does not address coverage of COVID-19 treatment costs for people who are uninsured. While no hospital would withhold treatment from a sick patient, the subsequent bill could be crippling, and the fear of said costs will often keep sick patients from seeking such help in the first place.”
Rough estimates predict that COVID-19’s secondary toll—deaths due to non-COVID-19 health issues and socioeconomic conditions may be in the same order of magnitude as the primary death toll from the disease due to people avoiding health care altogether.
According to a poll by the University of Chicago and the West Health Institute, more Americans are afraid of paying for healthcare if they became seriously ill (40%) than are afraid of getting seriously ill (33%). Since 2006, 30% of Americans each year on average have delayed medical treatment for cost, according to the polling firm Gallup. In that time, 19% of Americans each year on average have delayed treatment for a serious condition, according to Gullup’s December 2019 report. More than 30,000 people died every year because they couldn’t get to a doctor when they needed to see one. A fifth of Americans could not afford the drugs their doctors prescribed to them.
And if you are lucky enough to have insurance, it’s no guarantee that your healthcare will be affordable. Of the more than half a million families declared bankruptcy each year because of medically related debt, three-quarters had insurance when they got sick. Part of the problem is the massive deductibles—the amount of money you will pay in an insurance claim before the insurance coverage kicks in. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the Kaiser Family Foundation. Paying these high deductibles when cash flow is tight can be a real problem and can prevent patients from getting the health care they need, as well as changing the way physicians provide care. 80% of more than 700 independent physicians surveyed by Physicians Advocacy Institute said that their patients refuse or delay medical care due to concerns about cost insurance deductibles.
Nessaiver explains that while the young and healthy can often go for years never needing insurance even when they have it, for those chronic health conditions a lack of insurance is associated with an increased risk of worsening overall health. “Those with chronic health conditions will often require regular treatments and medications that are nigh-impossible to afford out of pocket. These individuals could start to see their health rapidly deteriorate soon after losing coverage,” he said.
This problem is exacerbated by the fact Americans are markedly less healthy than other high-income countries, despite spending more money (18% of its GDP) than any other country on health care. An estimated 60 percent of all Americans have at least one chronic health condition, and 40 percent have more than one. The U.S leads the developed world in diabetes, with more than one in 10 adults have Type 1 or Type 2 diabetes, including 17 percent of adults aged 45 to 64. It also has a higher heart disease burden than other high-income countries. Asthma rates rise every year and high blood pressure affects nearly one in three adults in the, including one-third of adults in their 40s and 50s.
A woman waits for a bus near a coronavirus testing site in Brooklyn on April 10, 2020 in the Brooklyn borough of New York City. (Getty)
These chronic conditions are considered comorbidities that raise patients' risk for developing severe and deadly COVID-19 complications, making Americans especially vulnerable to this particular pathogen.
The consequences of a lack of a national, publicly-funded universal health system and the high number of people with chronic health issues are compounded by a lack of paid sick leave. The US is one of only a handful of countries (almost all of them are low-income countries) with no national sick leave program. Although the Families First Coronavirus Response Act made it easier for many American workers to receive paid leave if they get COVID-19, are experiencing symptoms or are quarantined, the law excludes all sorts of employees. Large companies aren’t included in the law, and small companies can claim an exemption. This means many workers who come down with COVID-19, many of whom live paycheck to paycheck, are being forced to choose between starving or spreading the disease.
Making matters worse is the system’s health care infrastructure that is failing Americans. America only 2.8 hospital beds per 1,000 people, that’s fewer hospital beds per capita than most other countries in the developed world. It is estimated that the country only has about 45,000 intensive care unit beds. The US also has fewer doctors per capita too: 2.6 per 1,000 people, well below the comparable country average of 3.5 and lower than every country tracked by Peterson-Kaiser except for Japan.
Among the critical weaknesses within the system is the lack of coordination nationally — with individual states issuing varying medical guidance and competing against each other to secure protective gear — that has impeded the country’s fight to stop the virus, costing thousands of lives.
“The glaring problem in the US healthcare system revealed by the coronavirus outbreak is its lack of proper communication channels. This lack lead to consistently inefficient distributions of both supplies and information across the system. Given how outbreaks spiked in different cities at different points in time, we could have alleviated most of the shortages of both ventilators and PPE were we to have had systems in place for the sharing of those items. Similarly, as the disease swept through the nation we had thousands of clinicians struggling to figure out the best treatment practices through a process of informed trial and error," Nessaiver said.
“A unified database wherein practitioners could share their successes and failures could have saved thousands of lives. For every simple realization such as "turning ventilator patients on their stomachs improves outcomes" that gets picked up by the media, there could be hundreds of other treatment practices that never get shared."