As news of the COVID-19 pandemic changes hour to hour and minute to minute, I have been reflecting on not only information and precautions (see below), but on its relevance to improved Medicare for All.
PNHP, our parent organization, has developed an excellent dedicated webpage about the outbreak.
I want to offer you a few thoughts.
According to Ashish Jha, who runs the Harvard Global Health Institute, "Our response is much, much worse than almost any other country that's been affected.” Some of our shortcomings have to do with lack of leadership and planning. And some are related to our unique position among developed countries of not having universal access to health care.
In February, Osmel Martinez Azcue returned to Florida from a business trip to China. He soon developed flu-like symptoms. Under normal circumstances, he would have treated himself with over-the-counter medications and stayed home. But, aware of the coronavirus already devastating China, he did what he felt was the right thing for his community and went to the hospital for evaluation. They wanted to do a CT scan, which would have cost at least several hundred dollars. Knowing that his insurance plan was limited, Azcue asked them to do a seasonal flu test instead and discharge him if it was positive. Fortunately he had the flu, not COVID-19. But he later got a bill from for $3270—of which he owed $1400 after insurance. (See the Miami Herald article for details about why he had the limited plan he did.)
That story illustrates the how counterproductive our health care nonsystem is. Many people in this country have strong financial incentives to avoid care, lest they accumulate bills they can’t afford. Azcue was a responsible citizen, and he incurred a large bill for doing the right thing. We obviously can’t control an epidemic if people are discouraged from getting testing and treatment.
Although COVID-19 has been disastrous in some countries, others have controlled it much more effectively. Taiwan is particularly interesting, as it is only 81 miles and a short flight from China. Of its 23 million citizens, 850, 000 reside in and 404, 000 work in China. In 2019, 2.71 million visitors from the mainland traveled to Taiwan. Yet, as of March 13, Taiwan had just 50 cases and 1 death from the virus.
Like Singapore and Hong Kong, Taiwan learned the need to be proactive from the 2003 SARS epidemic and took action early. Among many interventions which you can read about here, they integrated their National Health Insurance data base with their immigration and customs database to figure out who was at risk. They aggressively screened people, then tested and quarantined according to a protocol.
Taiwan has a strong single-payer system. No doubt that was useful in their response because their population did not have to worry about the expense of care. But, also note that you can only mobilize a national health insurance database if you actually have national health insurance.
The COVID-19 pandemic is yet one more unfortunate example of how we would all be better off if everyone in our country could get the care they needed for their own health—and that of the rest of the country.
May we learn from this experience!
Remember to look at the PNHP webpage.
If you need current information on precautions and information, check Mecklenburg County Health Department for local information: https://www.mecknc.gov/news/Pages/Update-on-Novel-Coronavirus.aspx,
NC DHHS for state-wide information:
CDC for national information:
In the meantime:
And, most importantly, I hope you stay well.
Jessica Schorr Saxe, MD