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Coronavirus: For the public health, profits should not drive our health care system

Written by Diane Archer

Elisabeth Rosenthal writes for the New York Times on how the US market-based health care system has undermined our ability to contain the spread of the novel coronavirus.  Many other countries–which have health care markets largely not driven by profits–have done a far better job of containing the virus than the US. For the public health, profits should not drive our health care system.

Today, more than 71,000 people have died from COVID-19, at least 1.2 million have tested positive and 30 million people are unemployed. The National Institutes of Health was well aware of the threat of a coronavirus in the US. But, our health care system was not at all prepared when it hit.

The US relies on different corporate entities, such as pharmaceutical companies, insurance companies and hospitals, to play in the health care market. Because they are driven by profit, these companies focus on the here and now and the areas where they can most benefit such as specialty care. They have no interest in investing in preparing so as to prevent or contain a pandemic that might not happen for months or years.

The federal government in the best of times has little control over these companies to address the pandemic. As a result, the response is not what is needed and the public health suffers.

Here are some of the failures:
  • Ventilators: Because hospitals are businesses, they have no financial reason to have enough ventilators to handle patients in a pandemic. It would cost them too much money. They fare better financially doing elective procedures such as joint replacements. The CDC reported on this problem in a 2017 paper. Rosenthal points out that cruise ships are required to have lifeboats and life preservers even though they don’t plan to use them, but we don’t require hospitals to have adequate numbers of ventilators.
  • Testing: Without adequate testing, it’s hard to open up the country. But the labs that process the tests have no financial incentive to set up a system to handle the tests pre-pandemic. There was no billing code or price for the test. And, the process to get approval from the FDA is cumbersome and costly. To speed up the testing once the pandemic hit, the FDA approval requirement was waived. As a result, there are many tests that are not terribly accurate. And, there was no way to match labs able to process the test with people getting the test. South Korea, on the other hand, has a national health system that could coordinate testing with the labs. Rosenthal states that the Trump administration could have done something similar but it’s unclear how without a national health system.
  • Personal protective equipment and supplies: There are many pieces that need to be in place in order to do testing and have necessary personal protective equipment. Those pieces that are not profitable tend to be in short supply. It’s not enough for health care workers to have gloves only, or masks only. To be safe, they need the full array of equipment. But, again, there’s no coordination to ensure that it is all available rather than the most profitable pieces. The government should require an adequate supply always be in reserve. Instead, the federal government had states outbidding each other for the equipment and supplies they needed driving up prices enormously.
  • Hospital coordination: The federal government does not coordinate hospital care. And, hospitals compete with one another. The wealthy hospitals have no desire to treat COVID-19 patients so do not let people know when they have beds available. Consequently, some hospitals have been overrun, while others have had room for more patients but have not helped out.
  • Hospital expectations: Hospitals should be expected to be prepared for a pandemic, particularly the non-profit hospitals. Two-thirds of hospitals are non-profit.

Rosenthal appreciates that our health care market is broken because it is unable to take care of the public health during this pandemic. It is driven too much by profits and not enough by illness, she says. She also thinks that the federal government could force good behavior from the profit-making health care entities. How exactly she does not say, but she is likely speaking about an ideal world rather than the world we live in.

Alone, Medicare for All would not fix these problems, which Rosenthal makes clear. But, it’s hard to see how a federally-run health system isn’t necessary to achieve a good response.

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