By now, most of us have heard of COVID-19, which the World Health Organization declared a pandemic yesterday. My educational background is in public health. During the foundational years of my education we would often talk and analyze the precise situation we’re undergoing from a theoretical perspective in epidemiology classes. It’s a little starling for me to see it come “alive”. These are the sources where I am currently getting my information from (links below):
Here are my personal concerns on the matter:
I am more likely to be a carrier.
I work in clinical research. I spend most of my time (80%) traveling through international hubs. While I myself haven’t traveled to an international destination in the past few months, I don’t know where my fellow travelers passing through these hubs come from. Just this week, I connected via Salt Lake City (an international hub) on three separate occasions: Monday, Tuesday, Wednesday. In addition to my constant travel, when I get off my flights, I spend my time working in hospitals and clinics. Privacy laws prohibit me from knowing the reason people are visiting the hospital and/or their doctor. As a result, although I’m asymptomatic at the moment (I have no symptoms), after I conduct a clinic visit tomorrow, I will be undergoing self-imposed quarantine until I have to travel again. I’m doing this because experts believe that the incubation period (time of exposure to time symptoms become evident) for the virus is about 5.1 days (Source). Now, as an individual I’m pretty healthy. So even if I contracted the virus, based on the evidence we currently have, chances are that I would recover. However, my individual well-being is not what the focus is here. This is about the health of the community – the health of the people I live with, the health of those in my enclosed neighborhood, and the health of the people in closest proximity to those I come in contact with. As of today, my workplace has not issued warning against domestic travel. The following sentence is going to be my personal view: While clinical research is necessary, I would not consider it critical – not in the context of a pandemic. I understand how the medical for-profit industrial complex works in the United States (I’ve talked about it on this blog before), however the reason I leaned towards studying the medical sciences in the first place was for the humanitarian aspect of the work. As an individual, I will always value people over profit.
Community Health – those with underlying conditions and compromised immune systems
Per the CDC, older adults, and those with chronic illnesses such as heart disease, diabetes, lung disease, and those with compromised immune systems are more at risk for COVID-19. Both of my parents fall under this category. Chances are that we all know at least one person that falls under this category.
Guaranteed Paid Sick Leave
I personally work for a company that provides me with benefits. I have paid sick leave, health insurance, vacation, etc. When not traveling, I work remotely. Unfortunately this is not a reality for many working Americans. Freelancers, hourly workers, etc. may lose wages which may affect pay for basic costs of living (rent, utilities, food) and debt (student loans, mortgages, etc). Even if the workers themselves may not need care, they may be the primary caregivers for a family member that potentially contracts the virus.
Health Insurance and Healthcare Cost
The social structure we’ve created isn’t conducive towards community wellbeing – towards the health of all. The American “Healthcare System” wasn’t designed for the people, it was designed for the profits. In a publication by the World Health Organization (WHO), the United States ranked #37 overall for healthcare systems in the world. Countries like Colombia, Morocco, Chile, and Costa Rica ranked above the US (Measuring Overall Health System Performance for 191 Countries, WHO). #37 doesn’t sound so bad, right? Considering there were 191 countries ranked, I suppose it doesn’t – if we’re going to look at this from the lens of competition. The ranking itself is a fun and interesting fact, but you know what makes it fascinating? The United States spends the most money in the world out of any country in its healthcare “system”. The US spends 17.8% of its GDP in healthcare – that’s about $3.5 trillion (Health Care Spending in the United States and Other High-Income Countries, The Commonwealth Fund). High expenditure for sub-par health outcomes doesn’t quite make sense, does it? What happens when we place value on profits over people?
Let’s take my health insurance policy as an example. I get paid on a bi-weekly basis. Every two weeks, the company I work for deducts a health insurance premium from my paycheck that pays for my employer provided health insurance. One of the first things I do when having new insurance is a review of the policy. As I’ve mentioned, this is a uniquely American-problem (the private multi-payer healthcare system). Every other wealthy nation in the world, has a single payer system. I live in the US, so I look at my health insurance policy to understand what my financial responsibility would be if I got sick. Now, most private health insurance policies have a deductible. A deductible is the amount of medical use dollars that you have to pay for prior to your insurance covering the cost of care. For example, after I pay for $1000 worth of medical care, then my health insurance will cover 80% of my in-network medical cost and 60% of my out-of-network medical cost (this is called co-insurance – your insurance pays a part and you pay a part). What is this in vs out of network thing? Health Insurance Companies establish networks of locations (hospitals, urgent care centers, clinics, etc.) and healthcare providers (doctors, nurse practitioners, physician assistants, etc) that they consider “in” their network vs “out” of their network. So while you can go to any provider that you want, the amount that you pay out of pocket after your deductible is met, depends on whether you go to an in or out of network provider. I did some quick research and I know which urgent care centers and hospitals I would go to so that I can receive my 80% coverage benefit (after the deductible) so that I would only pay 20% of the cost for an in-network provider rather than 40% of the cost for an out-of-network provider. Now, a lot of health insurance policies also have what is called an out-of-pocket-maximum. My particular out of pocket maximum is $4,500. What does this mean? Let’s say that I experience a medical emergency and an ambulance takes me to a hospital. I don’t know what the cost of care is for a COVID-19 visit: the cost of all required testing, treatment, and quarantine. Therefore, I can’t speak to the cost of care for those that contract the illness and receive care. The diagnosis for the emergency department visit discussed in this hypothetical scenario will remain theoretical. The job of an emergency response team is to take you to the nearest hospital to receive care not to figure out where you would pay less. So, if this emergency department visit ended up costing $20,000, I would pay 40% of the 20k up to $4,500 for an out-of network provider or 20% of the 20k up to $4,500 for an in-network provider. In addition to those costs, a lot of health insurance companies also have co-payments on top of the co-insurance I described above. For my particular health insurance policy the co-payments for urgent and critical care are as follows: $75 for urgent care and $250 for the Hospital Emergency Department. So that hypothetical emergency department visit could cost me up to $4,500 (co-insurance) + $250 (Hospital Emergency Department) co-pay + the cost of the ambulance.
Now, over the years I’ve had better health insurance policies and I’ve had worse ones. This is one of the better ones I’ve had. There are thousands of private health insurances in the United States with varying degrees of coverage. So much so, that there are a lot of Americans that are underinsured, even unknowingly until they experience a medical emergency. There are no regulations currently in place requiring health insurance companies to provide a minimum of full-coverage catastrophic care (aka medical emergencies). I’ve read a few articles on-line that state that health insurance companies will wave the cost of COVID-19 testing and treatment. I don’t know if that means all health insurance companies, but it’s certainly something to be optimistic about.
Lastly, there’s another group of Americans – the uninsured. According to PBS, there are 44 million American that are uninsured. Americans, that in the face of medical emergencies, have to carry medical debt. As my undergraduate advisor used to say, “The average American is one medical emergency away from bankruptcy.” Please note that employers are not required, by law, to provide employees with health insurance.
That’s all I have for today. I’ll close this off by sharing a series of hashtags that have been my political “cause” since 2007.
#medicareforall #peopleoverprofits #singlepayersystem #universalhealthcare