Waynesboro resident David Colton, Ph.D., is the author of “The Case for Universal Health Care” (Clarity Press, 2019) and he writes biweekly articles about this topic at his blog universalhealthcarenow.com. Before he retired, Dr. Colton held administrative positions at Western State Hospital and the Commonwealth Center and taught health administration classes at Mary Baldwin University. I asked him how universal coverage — if we had it — would influence the nation’s response to the COVID-19 pandemic.
The U.S. is the only developed country that does not guarantee health care to all its citizens. And while our current system provides good care to those who do have health insurance, it is, nonetheless, more costly to deliver than in countries that provide universal coverage. Nor are our clinical outcomes always as good as those countries with universal health care. Unfortunately, these problems are worsened under the pressure of combating the COVID-19 virus.
From an economic perspective, when you have universal health care you don’t have to worry whether you can afford treatment. For example, under the plan proposed in my book, there are multiple sources of revenue, including taxes, to pay for health care. But these taxes are low and spread throughout the economy, thus the cost for individuals and businesses would be lower than what we pay today and yet everyone would be covered.
In comparison, about 28 million Americans currently don’t have health insurance and that number is surging as more and more Americans find themselves out of work and without health benefits. Worse, President Donald Trump was asked if his administration would reopen the ACA insurance exchanges so that people could sign up for insurance and he said no. Thus, if you don’t have health insurance and need to be hospitalized for treatment of the coronavirus, you’ll be hit with a huge bill. Obviously, this wouldn’t happen if we had universal coverage.
And even if you have health insurance, treatment can be costly. During his first address to the nation, Trump said insurers would wave all copayments for coronavirus treatments. Actually, they said they would wave copays for coronavirus testing. Testing is cheap, whereas treatment can be very expensive, especially if you need to be hospitalized in the ICU. Fortunately, most health insurance plans will cover treatment of viral infections. However, nothing was said about waving deductibles. Many Americans have high deductible insurance premiums, where they are on the hook for the first $2,500 or more of their medical costs, so if they need treatment for the virus, they will still have hefty out-of-pocket expenses. With universal health care plans like I propose, there are no copays and deductibles.
Keep in mind that prior to his address to the nation, Vice President Mike Pence met with representatives of the health insurance industry, so Trump and members of his administration knew exactly what the insurance industry was willing and not willing to do. Consequently, the assertion that insurers would wave copays for treatment was patently false.
During his address, Trump also said his administration would prevent surprise medical billing. Surprise billing occurs when a medical provider who is not part of your insurance network provides you with treatment. In that case, you are responsible for the amount of the provider’s charge not covered by your health insurance. For example, suppose you are hospitalized for treatment of COVID-19 and the pulmonologist does not participate in your insurance plan. She bills you $12,500 and your insurance company pays her their standard rate of $7,800. If she was a member of your insurance plan, she would have to accept that amount as payment in full. However, because she is not a member of your insurance network, you are responsible for the difference of $4,700. Surprise billing doesn’t occur with universal health care as there is only one insurer and thus no out-of-network providers. And this was another promise that Trump cannot keep as it’s medical providers and not insurers who are responsible for out-of-network billing.
Because of these problems, many Americans won’t be able to pay for their COVID-19 treatment. That’s one of the reasons Congress has put funding in their COVID-19 relief bill to help hospitals underwrite these costs. With universal coverage, these relief funds, which add to the nation’s budget deficit, wouldn’t be necessary.
It’s important to point out that universal health care is not socialized medicine, despite what some critics of this approach contend. Socialized medicine is when the government is the sole provider of health care; providers such as doctors, nurses, and pharmacists work for the government. Under my proposal, and proposals like Bernie Sanders’ Medicare-for-All, hospitals and medical providers continue to work as private, for-profit entities.
In addition to economic concerns, universal coverage could help in coordinating the health care system’s response to the pandemic. The program I’ve proposed consolidates all of the government’s many health agencies, such as the CMS, CDC, FDA, NIH and AHRQ under one department, which would improve efficiency and effectiveness. For example, the Agency for Health Research and Quality (AHRQ) employs the scientists who could be coordinating much of the research we need to defeat COVID-19. However, in his 2018 budget proposal, Trump wanted to eliminate the agency entirely, and in 2019 his budget proposal included big budget cuts to the AHRQ and the National Institutes of Health; fortunately that funding was reinstated by the Democratic led House of Representatives. Under the universal health care program I’ve proposed, these agencies would see increased funding because their revenues would come from the same health care tax that pays for individual health insurance.
We are in the midst of a public health emergency, which should remind us of the importance of ensuring all Americans have access to the medical care they need regardless of ability to pay. As a nation we engage in public health practices to protect all members of society from illness and disease. For example, as a result of public health initiatives Americans no longer worry about getting cholera, diphtheria, tuberculosis, polio, malaria and myriad other diseases. We have access to clean water and don’t pollute our rivers by dumping raw sewage into them. And we trust our public health agencies because they’re created to serve society rather than profit from it. Ultimately, the health of our nation depends on the health of its people.