By Jonathan B. Kotch, M.D., M.P.H. and Jonathan Michels
Common Dreams, November 20, 2020
The federal response to the deadly coronavirus pandemic under President Trump has been a public health disaster with nearly 250,000 Americans dead and no clear end in sight.
In sharp contrast, President-elect Joe Biden pledged to mount a serious response against the coronavirus. Biden implored Americans in a recent speech to continue to wear face masks and announced a panel of health care experts to begin to counter a surge of COVID-19 hospitalizations throughout the country.
On the matter of health reform, however, the president-elect offers measures that would merely bolster and even expand the same private health insurance system that has generated increasing profit during the pandemic while depriving the country of the resources necessary to produce an adequate supply of PPE. Physicians, nurses and other frontline health care workers are fighting COVID-19 with their hands tied behind their backs.
Biden ran on returning the country to normalcy, but there was nothing normal about the American health care system even before the pandemic. In fact, our dysfunctional health care system remains an outlier among the rest of the developed world for not providing universal health coverage.
The American health care system devours an ever-increasing share of our economy with health spending accounting for an astounding 17.9 percent of the GDP, the highest in the world. Yet we have little to show for it. Americans suffer some of the worst health outcomes compared to other industrialized nations. Even before the coronavirus hit the U.S., life expectancy was on the decline. Our infant and maternal mortality rates are higher than those of any comparable country, and racial and ethnic disparities in infant and maternal mortality are getting worse.
The quality of American health care isn’t any good either. Shockingly, more than 250,000 Americans die each year from medical errors. That’s nearly as many as the amount of people that have died from COVID-19 as of this writing.
Is that the kind of return to normalcy that Americans want, need, or deserve?
The answer, of course, is no.
In poll after poll, Americans have indicated their preference for a universal, single-payer health care system. An exit poll on election day conducted by Fox News revealed that 72 percent of voters wanted a government-run health care system.
That publicly-funded system, more commonly known as Expanded and Improved Medicare for All, is within our grasp. All we need to do is call out those Senators and Congresspeople who are in the pockets of the private, for-profit health care industry. According to Open Secrets, health care providers, Big Pharma, medical equipment manufacturers, and drug and medical product retailers pumped $178 million into the 2020 election cycle so far. Separately the insurance industry (including but not limited to health insurance) added another $85 million. The new kid on the block, adark-money group called the Partnership for America’s Health Care Future, has been targeting Democrats who support either Medicare for All or the “public option” in its 2020 election year ad campaigns. No wonder legislators continue to ignore the clear desire of their constituents for a health care system that puts the public, not the shareholder, first.
For health care reform advocates who want to purge profiteering from health care, returning to “normal” is not an option.
More than 10 years after the passage of the Affordable Care Act (ACA),87 million Americans remain uninsured or underinsured. The ACA has not changed the fact that medical bills continue to push millions of people into personal bankruptcy, with Americans having borrowed a stunning $88 billion to pay for medical treatment in 2018 alone. Nor has the ACA halted the inexorable increase in premiums, deductibles and copayments that are blocking access to care for millions of workers and their families who have employer-based group health insurance that is too expensive to use.
Biden’s public option plan, which would enable people to enroll in publicly-funded insurance plans that would compete against private insurers on the ACA’s marketplace exchanges, won’t change this picture either. A 2013 analysis conducted by the Congressional Budget Office predicted that a public option would have “minimal effects” on the number of uninsured. For a real world example, we need only to look at the abysmal failure of the nonprofit health insurance co-ops that were given a similar mandate to compete with private insurance under the ACA. Out of the 26 original co-ops, only three exist today.
The public option is destined to fail as long as private health insurers are allowed to thrive. They will find new and increasingly sophisticated ways to undermine public insurance by cherry-picking the healthiest subscribers for themselves and shunting the more expensive, chronically ill patients to public insurance, compromising the potential savings that universal public financing of health care would yield.
While the historic election of Biden and Harris removed the immediate threat of a draconian take-down of the ACA, it does not augur well for the kind of transformative social change that Americans need right now. The struggle continues. Compromise and half-measures are not acceptable. Medicare for All remains the goal.
Dr. Jonathan B. Kotch, a board-certified specialist both in Pediatrics and Preventive Medicine, is Research Professor Emeritus in the UNC Gillings School of Global Public Health.
Jonathan Michels is a freelance journalist and a premedical student based in Winston-Salem, North Carolina. He is a member of the media team for Students for a National Health Program.