COVID demonstrates time has come for single-payer health care

To the editor: In the op-ed “COVID is killing people in more ways than one” in the Dec. 15 Berkshire Eagle, Peter R. Orszag correctly pointed out that excess mortality in the U.S. this year has not only been due to COVID-19 but also because “40,000 more Americans than expected died this year from diabetes, Alzheimer’s [disease], high blood pressure and pneumonia.”

This is because many, fearful of acquiring COVID-19 in hospitals and medical offices, are putting off health care or, in these difficult economic times, are unwilling to incur medical expenses. As with many aspects of this pandemic, these indirect consequences have disproportionately affected low-income and Black and Hispanic Americans, and these disparities have been far worse in the U.S. than in other developed countries.

A study by the Commonwealth Fund, published in the December issue of Health Affairs, compared the health experiences of lower income people and the effect of income-related disparities during the early part of the pandemic in the U.S. and 10 other high-income countries. By every metric in this study, America fared worse than the other countries. For example, during the past year, half of U.S. adults with lower income skipped doctor visits, recommended tests, treatment or follow-up care or prescription medication because of cost. In contrast, just 12 to 15 percent of lower-income adults in Germany, the U.K, Norway and France reported doing the same. This has been exacerbated by massive unemployment during the pandemic and therefore the loss of employer-sponsored health insurance for approximately 12 million Americans.

With our fragmented, inefficient health care system, with 27 million Americans lacking health insurance and many more with inadequate coverage, and with the high cost of health care in the U.S., many Americans put off medical care and were unable to afford prescription medications even before the pandemic. The authors of the study concluded that “Achieving greater health equity in the U.S. will likely require policies that extend insurance coverage, make health care easier to afford and strengthen primary care.”

They also suggested greater investments to address the social determinants of health — factors beyond traditional health care, such as housing, education and nutrition, that also affect people’s health. “The U.S.,” they say, “has much to gain from examining the experience of countries where universal health coverage ensures people have access to affordable health care.” We can do this without additional per capita spending by enacting and implementing a single-payer Medicare for All health care system.

Charles I. Wohl, M.D., Lenox