As a worldwide pandemic, COVID-19 belongs to no single system of health care. It has affected countries with comprehensive, universal care as well as countries with inadequate or incomplete coverage, like us. But COVID-19 has impacted the U.S. particularly hard, with a higher number of confirmed cases than anywhere else in the world (nearly 3.8 million as of July 21st and rising very rapidly), https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html), and a higher mortality rate (3.7%) than many less-developed nations. In large part this is due to our lack of a comprehensive system of national health insurance, like Medicare for All.
Many casualties of our pandemic are found at the “fault lines” of U.S. society. Think of individuals facing economic hardships who cannot socially distance because it would mean losing a job and precious income. Think of those imprisoned, detained, or the frail institutionalized elderly. Sadly, many of the characteristics that conspire to make people sick are rooted in systemic, long-time racism ingrained in our society and difficult to change.
Our U.S. healthcare financing is a clumsy mixture of public, private, and employer-based insurance. As the COVID-19 calamity has shown, our current “hodgepodge” financing denies high-quality care to people who are economically and socially underprivileged. We also allow increasing numbers of Americans to fall into these deprived categories as massive job losses lead to terminations of health insurance. Prior to the pandemic, unemployment was much lower. When statisticians include those underemployed or discouraged from seeking work, the current unemployment estimate is 18.3% (the long- term average is 10%)(https://ycharts.com/indicators/us_u_6_unemployment_rate_unadjusted).
Our number of uninsured was much too high before COVID-19, but now it has reached heights not seen since the passage of the ACA (Obamacare) in 2010. For example, between May 21 and May 26 of this year, the Census Bureau estimated that 20.5 million U.S. adults were uninsured; of that number 15.5 million were unemployed. The total number who were uninsured at some point during the current year will be much higher. Rates of uninsurance in the South are consistently higher than the national rates (https://www.kff.org/other/state-indicator/total-population/).
Short-term economic assistance meant to help the newly unemployed will generally fail to address their medical needs. Among indigent people with no job, few can successfully negotiate with a private-sector insurance plan whose main goal is to make a profit. Preserving community health is rarely the purpose of private-sector plans. We don’t need to wait for more data on this subject.
The past few decades show that the U.S. spends more per capita on its health care than any other nation in the world, and yet has poorer health outcomes than most developed countries. According to OECD data (2018), U.S. per capita health care cost is $10,586 as opposed to much lower figures in other developed nations, like France ($4,965) and Canada ($4,974) with better mortality and morbidity statistics than ours (https://doi.org/10.1787/4dd50c09-en). Our percentage of GDP spent on healthcare is 16.9% as compared to 11.2% for France and 10.7% for Canada. If we perpetuate our inefficient way of financing health care, we will bankrupt ourselves while doing without vital public expenditures like replacing our decaying infrastructure and investing in education.
No system is perfect, but more-inclusive models around the world finance health care more cost-effectively. Other countries have done better during the coronavirus pandemic, such as Austria, Denmark, Germany and Japan (https://www.endcoronavirus.org/countries). A financing system that includes everyone will minimize discrimination against the poor. It will also expand public-health programs that mitigate the historical impacts of racism.
Protesters of all races and ages in the streets of America’s cities have shown that our country wants major systemic changes. Now is the time to design and implement a simplified U.S. healthcare financing system that leaves no one uninsured or underinsured.
Universal healthcare coverage will not eliminate systemic racism or erase a pandemic, but it will provide a solid platform of good health for Americans to stand on. We call for expanded, improved, Medicare for All to prevent so many of our fellow citizens from falling through the cracks.
Erica Heiman, M.D., is an internist and medical educator based at Grady Memorial Hospital in Atlanta. She is an active member of the Georgia Chapter of Physicians for a National Health Program (PNHP). Jack Bernard, former Director of Health Planning for Georgia, is a retired SVP with a national healthcare corporation and a former Republican county commissioner in Georgia. Henry Kahn, M.D., practiced medicine for nearly 40 years. He is Professor Emeritus at the Emory University School of Medicine and adjunct faculty at the Rollins School of Public Health and Morehouse School of Medicine.