But as the death toll increased, a patient who was about to be ventilated in one of New York’s intensive care units had one last question for his nurse: “Who will pay for this? “
These are the last words of the patient to his medical team, Derrick Smith, a nurse anesthetist at a New York hospital, wrote on Facebook last week: “Grief on the next level – having to hear a dying patient use his last words to s worry about health care finances. “
In the richest country in the world, the Covid-19 pandemic has revealed the heart of a health system that is structurally incapable of coping with the pandemic. Federal and local governments, health insurers and employers have pledged to help Americans weather this crisis, but to do so requires a radical overhaul of a system that has for decades favored the cost of care.
“As this epidemic makes clear, at any time, any of us could get sick, be hospitalized, be on mechanical ventilation,” said Adam Gaffney, a critical care doctor in Boston. “And that in the United States could lead to potentially ruinous health costs.”
Gaffney is President of Physicians for a Nationalized Health Plan, a group of more than 20,000 health care professionals who support universal health care in the United States. PNHP members see firsthand the consequences of being forced to make cost-based medical decisions.
“I have heard patients say that they skipped their inhaler because they could not afford the dose,” said Gaffney. “I have heard from patients who have been without primary care for years because they were uninsured and have been hospitalized in the ICU.”
There were 27.9 million people without health insurance in 2018 and this figure is expected to increase by several million.
In 2018, 27.9 million people did not have health insurance and this number is expected to increase by several million due to the record unemployment rate. Meanwhile, the United States has more than 600,000 confirmed cases of coronavirus and more than 27,000 deaths, the actual numbers will be much higher.
The US government and major health insurers have said they cover the costs of Covid-19 tests and treatments, but the fear of bankruptcy and the Byzantine complexity of the system leave questions unanswered as to whether people will even seek care, let alone escape from a potentially crippling handicap. medical bill weeks or months later.
The cost of testing and treatment depends on whether the patient was insured, how they were insured and how well they survived. For example, a company that pays health insurance for its staff may decide not to cover an employee’s salary, even if the health insurance they use had said they would forgo Covid-19 payments .
And just overcome the American instinct to wonder how much the costs of medical treatment are an obstacle to the pandemic.
Since 2006, an average of 30% of Americans have delayed any type of medical treatment each year for a cost, according to polling firm Gallup. During this period, an average of 19% of Americans each year delayed treatment for a serious illness, according to Gallup’s December 2019 report.
According to a 2018 University of Chicago and West Health Institute survey, more Americans are afraid to pay for health care if they get seriously ill (40%) than they get seriously ill (33%).
It’s hard to fight an epidemic if people are afraid to go to the doctor
“It is difficult to fight an epidemic if people are afraid to go to the doctor, to be seen in the emergency room,” said Gaffney. “It could mean that some people don’t get tested, it could mean that some people delay care and risk harming their own health.”
Medical clinic closings and job losses in the event of a pandemic
The pandemic crisis is further exacerbated by the dedication of the system to the benefit of people. Medical workers are on leave and losing jobs due to the pandemic – including those on the front lines – as their employers seek to cut costs.
Alteon Health, a private equity firm that employs approximately 1,700 emergency physicians and other physicians, said it would temporarily cease providing benefits, including paid leave, according to the STAT health website.
While the intensive care units and emergency rooms are showing staggering numbers, there has been a pause on non-essential care which in turn has reduced the benefits of the medical system.
Without high-margin treatments such as physiotherapy, cosmetic surgery, and orthopedic procedures, medical systems struggle to pay salaries and cover administrative costs.
The American Academy of Family Physicians predicts that 60,000 family practices will close or dramatically decrease by June and 800,000 of their employees will be laid off, put on leave, or have their hours reduced.
And in the hallways of hospitals across the country, staff are not only alert to dry coughs and high temperatures, but also to the fact that their wages and work equipment depend on results.
Joe Manginn, an emergency nurse in Madison, Wisconsin, said, “The bottom line has always been far ahead and it takes an extra level of being aware of our minds so that we don’t waste money. “
Manginn and his wife, who is also a medical professional, are on alert for their own medical expenses.
“If we get sick and have to be hospitalized, it hits us financially with insurance and that kind of payment, but it also hits us financially because we can’t work anymore,” said Manginn. “This is a double blow for the health professionals who are doing it right now.”
His health insurance, which also covers their three children, costs $ 5,000 a year, plus the money they set aside for out-of-pocket expenses in a tax-free account.
“We work for the hospital, we should have the most access to it [healthcare], but unfortunately yes, this is not how our country is organized. “
Congress has allocated $ 100 billion to help hospitals. The White House said on Friday that hospitals that accept the funds will not be allowed to use two common billing practices: billing uninsured patients or billing them for care from a doctor who is in the hospital, but not directly employed by it.
As with other parts of the government’s planned response, questions remain as to the effectiveness of this money in tackling the complicated healthcare landscape and whether it will arrive in time to save jobs and clinics.
A financial burden on the front line, not insurers
This major disruption in the US health care system may leave nurses and doctors unemployed, but there are early indications that insurance companies could be isolated from the damage.
Not only have health insurance companies entered the crisis with capital, but many analysts have anticipated that these companies may have lower costs as fewer people seek routine medical care.
David Blumenthal, chairman of the Commonwealth Fund’s global health think tank, said people covered all year will always pay premiums, while insurers have fewer procedures to cover.
“We will continue to pay our premiums because we know we could get the coronavirus and end up in the intensive care unit and have to pay hundreds of thousands of dollars if we don’t have insurance,” said Blumenthal . “So we’re going to keep paying, but we’re not going to the doctor unless we absolutely need to. So this is good news for insurance companies. “
At the same time, the 16 million people who have lost their jobs in the past three weeks will weigh down the health care system if they join the ranks of the uninsured or those using Medicaid, public health insurance for people low income.
Blumenthal said that the economic crisis also had health repercussions, such as depression due to loss of income and malnutrition, which would make people more vulnerable to the disease.
Benjamin Sommers, professor of health policy and economics at Harvard TH Chan School of Public Health, said there were few signs that the pandemic is prompting the Trump administration to think about the health system. .
“We will have to see where the public will end up agreeing on what to expect from officials in response to this epidemic,” said Sommers, a practicing primary care physician.
ICU doctor Gaffney said he was certain that the way healthcare is funded in the United States is exacerbating the overall damage from the epidemic.
“At a time of soaring unemployment and a deepening recession, people will lose their coverage and see more and more medical bills if they get sick,” said Gaffney. ” It does not mean anything. “