The COVID-19 pandemic has taught us much about public health, economics, hygiene, class, race, leadership, and the like. It has also highlighted the fact that our government does not take responsibility for the health care of all of its citizens.
There are many reasons for this, of course, including the country’s foundational principle of federalism; the near irrelevance of health care when the Constitution was written, and our geographical separation from the two world wars that gave battlefield governments their sense of social responsibility.
One could argue, however, that if our government had established a universal health care system similar to the one outlined in the Medicare for All Act of 2019, we would have been better prepared to deal with the crisis. Consider:
1 — The UHC agency would have been situated, along with the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration, in the Department of Health and Human Services. As this consummate DHHS carried out its mission “to enhance the health and well-being of all Americans,” it would have prioritized national health preparedness: Strategic National Stockpile maintenance, testing readiness, supply-chain security, stateside production capacity.
From the first suspicion of the pandemic it would not have been a hastily assembled White House Task Force calling the shots, but this DHHS, primed with a reserve fund earmarked, as Title VI of the MFA says, “to respond to the costs of treating an epidemic.” And it would not have been politics or turf, but DHHS expertise, including the UHC system’s national database and tracking capabilities, that would have continued to guide policy. Fifty different governors would not have had to reinvent the wheel of response.
2 — The UHC agency would have already had in place infrastructure to oversee testing and contact-tracing, disseminate directives, facilitate randomized clinical trials, and procure supplies through familiar price-negotiation channels. Comprehensive data would have been easily accessible, obviating the White House’s need for an HHS Protect to go looking for it.
3 — In March, Congress passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act. The dual focus of the bill – economic and health care support – meant that health-care funding was beholden to extraneous economic and ideological debates. A DHHS well-informed about the entire health-care system could have quickly prepared a package of needs for Congress’ fast-track consideration.
4 — During the pandemic, providers have responded to declining revenue with furloughs and closures. In a UHC system, cash flow to providers and suppliers could have been easily maintained or even increased, as in Medicare’s Accelerated and Advance Payment Program.
5 — Millions of workers now suddenly uninsured are facing cruel choices: maintain pricy coverage through COBRA, try to figure out possible Medicaid or Marketplace eligibility, or give up and “go bare.” In a UHC system: seamless coverage.
6 — Even many of those with employment-based insurance have no doubt avoided testing or treatment to avoid cost-sharing expenses (deductibles, co-pays). In a UHC system they, along with the uninsured, would have sought care more readily, thus reducing community spread. This may apply especially to vulnerable populations.
7 — Predicted 2021 premium increases to pay for COVID-19 expenses could cause employers and individuals to drop coverage. With MFA, equitable taxes would simply be adjusted over time.
In many ways, then, one can argue that our country could be dealing more effectively with COVID-19 if we had in place a universal health care system. Indeed, one could argue that, the pandemic passed, our country could deal more effectively with health care in general with such a system in place.
Dr. Daniel Bryant is a retired Portland internist, and a member of Maine AllCare, which advocates for universal health care.