By Robert Devereaux, M.D.
The Roanoke (Va.) Times, December 13, 2020
The failings of an American health care system that is based on free-market principles have been laid bare by the worst pandemic the country has faced in 100 years. Most of us are familiar with the statistics that demonstrate that the U.S. has lagged far behind other industrialized countries in our ability to mount a coordinated response to the virus. We are near the top of the list for number of cases and deaths as a share of the population when compared to most developed countries. Compared to Canada we have had twice the death rate and a seven-day average of new cases that is nearly four times higher according to data from Johns Hopkins.
The reasons for our failed response are myriad but the shortcomings of a health care system that is based more on generating a profit than on improving the health of our citizens bears much of the blame. Undoubtedly lack of access to timely testing and care by the 30 million Americans who are still uninsured, and the 40 million more who are covered but still have trouble affording care due to prohibitively high co-pays and deductibles, has contributed to the nation’s poor response to the pandemic. Many of the millions who have lost their jobs have been unable to obtain affordable coverage. Undocumented immigrants have barriers to accessing health care, resulting in delays in testing and treatment for COVID, contributing to our poor performance.
Some private health insurance companies have profited mightily during the pandemic. According to an analysis published in the Journal of the American Medical Association, the profits made by United Health Care and Anthem doubled in the second quarter of 2020 as compared to the same period last year. This is due to decreased utilization of elective and preventive health care as our hospitals and clinics are dealing with the pandemic. Insurance companies are making record profits during a time when these resources should be going to fighting the virus or refunding premiums to patients who have taken economic hits during this difficult time.
Even with these large profits, I can attest as a physician practicing earlier this year in rural Southwest Virginia where high-speed internet is lacking, many insurance companies would reimburse telephone visits at only a small fraction of what they would pay for an in-office visit. On the other hand, Medicare and Medicaid, the “government-run” plans plans, would reimburse fully for the phone visits, as has also been the practice in Canada where physician practices and hospitals have fared fairly well due to the difference in how that country funds its health care system.
The only way our country will ever be able to address future pandemics — in addition to the chronic problems of limited access to health care by many, health care outcomes that are among the worst in the developed world, high costs, and iniquities in delivery of care to persons of color — is to revamp the way we finance health care. Single-payer health care or “Medicare for all” as proposed in legislation sponsored by Democrats in both the House and the Senate would provide care without out-of-pocket costs to all Americans. Savings from reduced administrative costs and profits estimated to consume over 30% of the current health care dollar would help extend coverage to all.
A single source of funding would also allow our country to devote more resources to public health and other preventative health strategies to improve the health of our population. It is time to separate health care financing from employment and remove the profit motive that is often at odds with providing the care that people really need.
Dr. Robert Devereaux is a member of Physicians for a National Health Program. He lives in Pembroke.