medical system, socio-economics: itza mess

Our Health Insurance System Was Not Built for a Plague

https://slate.com/business/2020/04/coronavirus-crisis-health-crisis.html?fbclid=IwAR3ZgNUjYupRsGZ-V0ALdeaMTq9bTmGXFTH9hB5LXsKjg9DS1FkBj_dTnoE

In ways large and small, it has become painfully clear that our health insurance system was not built to deal with a crisis like the coronavirus.

The system’s biggest failings are almost too obvious to state. Almost. There’s our ghastly uninsured rate, for instance. When you’re trying to fend off a global pandemic, it’s ideal that everybody in the country has some sort of health coverage so that they can get tested and seek treatment rather than become a vector for transmission. Before this whole debacle began, there were 28 million Americans without any coverage. And even those who were insured risked racking up thousands of dollars in medical bills if they stumbled into the wrong emergency room for a test.

Last month, the president finally signed a bill designed to make all coronavirus testing free, even for those without insurance. Crucially, it covered not just the diagnostic test itself but also the cost of a visit to the doctor’s office or the ER, which is often billed as a separate item. However, there are still ways patients can get trapped into paying, such as if they accidentally go out of network or get additional tests to check for other illnesses like the flu. And if someone actually ends up hospitalized with COVID-19? That too could become expensive. While a number of major insurers, such Cigna, Humana, Aetna, and UnitedHealth, have promised to waive out-of-pocket costs for their customers, those decisions don’t apply to self-insured health plans, where companies directly pay their employees’ health care costs. These kinds of policies cover the majority of Americans with job-based coverage, and it will be up to each individual company to decide whether to eliminate cost sharing for their workforce.

To put it another way: Despite Congress’ best attempt at an intervention, Americans could still end up in mountains of debt because they were victims of a plague.

Making matters worse, millions of Americans are likely losing the job-based insurance they relied on now that the economy is going into a deep freeze and layoffs are mounting. We don’t know the exact number of people who have been kicked off their coverage, but the Economic Policy Institute estimates that 3.5 million faced a high risk of forfeiting it over the last two weeks. That number is only going to grow.

Getting new coverage, unfortunately, could require jumping through a number of hoops, especially if your income is too high to qualify for Medicaid (in some states, unemployment benefits alone could put you over the limit) and you aren’t rich enough to afford the premiums on COBRA (really, who is?). Part of this is due to pure pettiness on the part of the Trump administration, which has refused to reopen healthcare.gov—the federal insurance exchange that 32 states rely on—for a special enrollment period. As a result, people who lost their jobs and insurance will have to submit extra paperwork to prove that they’re allowed to apply for Obamacare outside of the normal open enrollment period. As this is the first economic disaster that has led to mass layoffs since the exchanges started running in 2014, no one is really sure how long it will take to process those forms. Thankfully, most of the states that run their own marketplaces, including California and New York, have opened theirs back up, which should spare their residents a headache and reduce the bottleneck.

But that isn’t the only bureaucratic absurdity people will have to deal with. When Americans apply for Obamacare coverage, they are required to estimate their income for the coming year so that the government can calculate the insurance subsidies they are eligible for. If the number is vastly different from what they reported on their previous year’s tax return, they have to provide documentation explaining why. But most people who’ve just lost their jobs have no idea how much money they’ll earn for the coming year, because the economy has been shut down in order to fight a pathogen, and we have little to no idea when it will open back up. A lot of people are going to be blindly guessing; if they pick a wrong enough number, they’ll have to pay back some of their subsidies when they file taxes in 2021.

In the end, these hurdles are probably going to prevent some people from getting insurance, even though they need it. Paperwork has a way of tripping people up. During Thursday’s coronavirus press briefing, Vice President Mike Pence said that the White House is working on a plan to pay hospitals directly when they care for uninsured COVID-19 patients, apparently by purloining some money from the $100 billion medical supply fund Congress created. That does’t change the fact that newly uninsured Americans will still risk financial strain if they fall ill from anything other than coronavirus. It also means there will be less money left over to, you know, buy hospital supplies.

Our health insurance system is a rickety kludge, full of financial traps and bureaucratic headaches. Even in good times, it doesn’t function acceptably compared with what other rich countries enjoy. But with the coronavirus, its problems have become magnified, forcing Congress to play a game of catch-up that has failed to address the many holes. Many on the left have pointed out that a system like single payer would eliminate all of these troubles; people would have insurance, all the time, no matter what. But you don’t need “Medicare for All” to fix the issues we’re now grappling with. If Americans had truly affordable health insurance options that weren’t tied to their employers and always kept out-of-pocket costs low, it would be enough. But what do we have right now? Just like the coronavirus, it’s a public health nightmare.
US doctor in Canada: Medicare for All would have made America’s COVID response much better

America needs a health care system that puts public health ahead of profits. I know we can do better. I see it everyday in Canada amid the coronavirus.

Dr. Khati Hendry
Opinion

https://www.usatoday.com/story/opinion/voices/2020/08/05/canadian-medicare-covid-response-model-for-america-doctor-column/5547006002/?fbclid=IwAR0rjRUno-E8doQenGBzbsr0jGcJKQ6Fcu_IK8l9meckmy1XeLXAegsZNBM

I’m a family physician who moved to Canada from California 14 years ago, largely because of Canadian Medicare, the country’s national health insurance program. I’ve been much happier practicing medicine where my patients have universal coverage. It frees up doctors like me to focus on patient care and frees patients to focus on their health, instead of worrying about how to pay for it.

But I have never felt more grateful to work in a universal health care system than during the COVID-19 pandemic. My heart aches for the millions of Americans who have fallen ill and then have had to worry about how they will pay for tests and treatment, who have gone to work while sick for fear of losing their health coverage or who have lost not only their jobs but their insurance, leaving them at risk for financial ruin.

While no country is immune from COVID-19, Canada has been able to mount a much more effective response. Canada’s infection rate is a tiny fraction of that of the United States, and trending downwards. Its health system has two big advantages when fighting the pandemic: universal health coverage and an administratively simpler system.

Canadian Medicare is good for patients

Canada’s publicly financed single-payer system covers everybody, regardless of age, health or job status. No one loses coverage due to COVID-19. Canadian Medicare covers services like hospital and emergency care, doctor appointments and lab tests—without copays, deductibles or medical bills. Everyone is in a single “network,” so there are no artificial limits on which hospital or health provider a patient can see. As a result, Canadians are much less likely to delay testing or treatment for COVID-19, or for the chronic medical conditions that increase the risk of severe illness and death from the virus.

Canada’s universal system also has made it easier for medical and public health professionals to respond quickly — and together — without the administrative headache of multiple insurance companies.

In my province of British Columbia, our ongoing history of collaboration between physicians and the provincial health system made it easier to coordinate responses from hospitals, primary care clinics and long-term care facilities. From the start, emergency response committees held daily meetings to address challenges of hospital capacity, distribution of supplies and protective equipment, testing procedures, staffing policies, telemedicine, COVID-19 protocols and the safety of health care workers. The British Columbia public health officer gives regular updates and guidance as we move through pandemic phases.

Instead of primary care practices shutting down and forcing patients to go without care, as reported in many parts of the United States, we have been able to work together through our province’s longstanding “Divisions of Family Practice.” Most of us work in private practice, but we get help to coordinate with other family doctors to make sure that on-call shifts are covered, our practices are safe and our patients get the care they need during the pandemic. I have not had to care for a patient with COVID directly yet, but I have been part of the extensive planning process.

As health care shifted from in-person to virtual practically overnight, Canadian health authorities put systems in place for more provincial phone triage, patient self-assessment protocols, virtual care software and better internet access to remote areas. The province made investments to support the needs of vulnerable populations, such as aboriginal communities, and those who are homeless, live in rural areas, travel for agricultural work or struggle with mental illness or addiction — groups that have suffered disproportionately from COVID-19 in the United States.

Many of my American colleagues tell me that they’re burned out from administrative demands and anguished from seeing patients not get the care they need because of cost. Now it is worse, as the number of uninsured has soared with the pandemic. My message for them is this: I know we can do better, because I see it every day. It is worth fighting for a system that puts public health ahead of profits: Medicare for All.

Biden just told CNN he's not concerned about losing the left since he won without supporting Medicare for All anyway. "I didn't support it then and I don't support it now."

12 million people have lost their insurance since March. pic.twitter.com/JIIYoqSIXQ

— Rob Byrne (@RobByrneDC) September 30, 2020