Letter: Medicare-For-All will have us prepared
To the editor:
At the final debate of the Democratic presidential primaries, Sen. Bernie Sanders stated that the coronavirus pandemic exposed "the incredible weakness and dysfunctionality" of the U.S. healthcare system. Joe Biden responded that the single-payer system of Italy had failed to protect it and that COVID-19 "has nothing to do with Bernie's Medicare for All." Of course, a single-payer financing system would not have prevented this pandemic from entering our country, but a national health program financed by the government could have helped contain it. Our first line of defense, however, is not the medical care system but rather our public health agencies. Unfortunately, federal, state, and local public health agencies have been underfunded for many years leaving us poorly prepared for this pandemic, particularly in providing early testing.
Healthcare financing, however, is also vital in fighting this pandemic. Those with coronavirus will need medical care and to be isolated. Testing is now free, but fear of ruinous ER or hospital bills could prevent many of the nearly one-half of Americans who are uninsured or underinsured from seeking treatment if infected. They will stay in the community where they will become sicker and remain a source of contagion to others.
Furthermore, as the economy tanks and millions of Americans lose their jobs, the number of uninsured will surely grow, and these people will face financial ruin from uncovered medical costs, whether due to coronavirus infection or other illnesses which will continue to occur. Those who still have insurance will find co-pays and deductibles more unaffordable as disposable income drops during the coming recession. This worsens the impact of the epidemic, makes it harder to contain, and would not occur in a Medicare for All healthcare financing system.
We also need such a system to more efficiently organize our health care infrastructure. Rural hospitals, such as North Adams Regional Hospital, and safety-net urban hospitals, such as Hahnemann Hospital in Philadelphia, are closing not because they are unneeded, but because they are unprofitable. While we have one of the highest ICU bed supplies in the world, these beds are unevenly distributed so that, as a 2010 study in the Journal of American Medical Association found, in an epidemic some areas could have empty ICU beds, and some areas would not have enough. This maldistribution of resources is often driven by markets, not medical needs. In this epidemic, uncoordination has caused hospitals and local and state governments to bid against each other for supplies and ventilators. Some hospitals have had to solicit donations of masks from the community. We do not have a healthcare system; we have a market system.
The U.S. spends twice per capita on healthcare as other developed nations, yet care is unaffordable for many and resources unevenly distributed. A national Medicare for All program would allow us to reshape our failed market-driven chaos so that we can plan for this pandemic and others that will surely follow.
Charles I. Wohl, MD,
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