To get an idea of the impact of the coronavirus on the United States health system, just take a look at the bill for Michael Flor, a 70-year-old man from Seattle. His case became famous last May because, being one of the first infected with covid-19 in the United States, he spent 62 days on the verge of death in the hospital, 29 of them on a respirator, and survived. A month later, his name returned to the newspapers because a bill for 1.1 million dollars (about 930,000 euros) arrived at his house. The invoice occupies 181 pages in which absolutely each and every one of the treatments he received and the material used are detailed until reaching the final figure: 1,122,501.04 dollars.
Flor does not have to pay that amount because she is on Medicare, the United States' public health program for the elderly, according to information from the Seattle Times. The gigantic $ 175 billion aid package approved by Congress to deal with the pandemic also includes making COVID-19 testing and treatment free for everyone in the country. In other words, the pandemic has forced the United States to carry out a kind of universal health experiment, but limited to a single disease. And that experiment is opening up the debate on the health system on the channel.
Flor's bill itself is revealing of the kind of expenses a country is facing as of mid-October that has already done 64.3 million coronavirus tests. Due to the length and extreme of the treatment, it is a special case. A Fair Health study published last July stated that the average price of treatment for covid is $ 34,662 in the 20-30 age group and up to $ 45,683 in the 50-60 age group. It must be multiplied by the figures of the pandemic, which is starting a third wave of lack of control. In the two peaks that have occurred so far (April and July), there were more than 60,000 people hospitalized at the same time. Now there are 40,000 and it is rising fast. More than 220,000 people have already died.
Healthcare in the United States, except for the elderly like Mr. Flor and the very poor, is not public. Citizens need private insurance to access a doctor or pay for treatment out of pocket. And the vast majority of hospitals in the United States are businesses that live off what they charge customers and insurers. The pandemic is stretching to the limit the fragile seams of a system in which the sick are not sick, but consumers, and doctors are not doctors, but service providers.
In that context, patients do not trust federal aid, and with good reason. For example, there is the case of Carbery Campbell, a teacher who felt symptoms of covid-19 after returning to Florida from Spain. He went to the ER, was there for two hours, and then came across a bill for $ 6,545. When he called to say the test was supposed to be free, they cut him $ 30. The hospital wanted to charge him for everything other than strictly the covid-19 test.
This can happen to those who have insurance and believe they are covered. Andrés Martínez, a 31-year-old undocumented immigrant who lives in Los Angeles and works in a tattoo shop, doesn't even consider going to the doctor. He didn't even know he could. “I'm not going to go to the doctor if I'm not totally sure it's covid,” he says, fearing the cost.
Campbell gave his testimony to an association called Patients Rights Advocate, which fights for greater transparency in hospital prices. Their director, Cynthia Fischer, calls them "the cartel." “Opacity allows hospitals and insurers to make secret deals behind our backs and overcharge us. It is a fraud that is committed every day, ”he says by phone. Fischer pressed the White House to pass an executive order mandating price transparency. Donald Trump did it last year and it will take effect in 2021. Fischer praises Trump, believes that what is needed in health is more transparency and more market and that this will lower prices. The analysis of the order is not so clear.
That is the only concrete thing that Trump is known to have done for health, and it does not affect the pandemic. In reality, the coronavirus has forced Republicans to expand de facto public coverage. So far, the only ones who have experienced how the government helps with health spending are the 20 million people who were given access to private health insurance at subsidized prices by Obama's health reform. Republicans have been promising to end Obamacare for six years. The program is so popular that they have not succeeded even when they had the presidency and the majority in both houses.
For example, one of the most popular provisions of Obamacare is that it prohibited insurers from turning away clients for prior illnesses. It is an issue that affects about 130 million people. It is so important that Trump repeats over and over again, at every rally, that he is going to "protect people with previous illnesses", when he has not presented a plan in four years to do so, and nobody really knows how he is going to do it. without Obamacare.
The United States is the country that spends the most on health, 17.7% of its GDP (3.6 trillion dollars in 2018). And yet around 28 million people do not have access to health insurance. Of those who do, most people get their health insurance through their job. The pandemic has destroyed 22 million jobs, of which only half have been recovered so far. A recent study by The Commonwealth Fund estimated that an additional 14 million people have been temporarily left out of the sanitary environment due to the pandemic.
Among those who do have insurance, many include copays, deductibles and exceptions that, in practice, represent a financial blow if hospitalization is necessary. Joe Biden proposes to broaden the criteria to enter Medicare (one step less than the “Medicare for all” to the European one proposed by the left of his party) and to make an optional public health insurance for those who cannot afford a private one.
The pandemic is not only destroying lives financially, it is also destroying the hospital economy. According to a study by the University of North Carolina, 15 rural hospitals have closed in the US so far this year, 11 of them since March. The reason is that they are focused on the coronavirus and cannot charge for other things. "People are avoiding going to hospitals so as not to get infected and so that they do not pass a bill, and with good reason," explains Arturo Vargas Bustamante, professor of Health Policy at the University of California at Los Angeles (UCLA).
"What hospitals charge the most is for selective treatments," explains Vargas. That is what people are not doing. Because he does not want to go to the doctor and because the beds have to be free for the pandemic. “With the pandemic they are in great demand, but with the federal grant they are not charging the usual amount. They do not reimburse them for all their expenses when all your patients have stopped going to the hospital ”.
That's what explains why hospitals try to charge patients for anything they can argue is not related to coronavirus. “For example, if you have gone to the hospital by ambulance and you have covid, they cover it. But if you went because you thought you had covid, and then it turns out that it is not, they charge you, ”explains Vargas. This results in mistrust towards the system, which results in the difficulties of the medical industry, which increasingly strains the contradictions of the health system.
Now, Obamacare is in serious jeopardy and Democrats hope it will be the great mobilizer of the vote next Tuesday. Healthcare was the primary concern of voters in the 2018 legislatures, and Republicans' efforts to destroy a system that was saving 20 million lives cost them a majority in the House of Representatives. The pandemic and all the contradictions it has exposed can only accelerate that debate.
He is in danger because on November 10, just after the elections, the Supreme Court is going to hear a case that could definitively end Obama's public subsidy program. Republicans have not been very subtle in explaining why they wanted to confirm at all costs to Justice Amy Coney Barrett, which solidifies a conservative majority of six to three in the court: they want the Supreme Court to destroy Obamacare, what that they could not do without risking the seat. Vargas believes that such a decision would be final to really and thoroughly rethink the health system. It may be towards more market, as Fischer and Trump want, or towards more public coverage, as the Democrats want. That no longer depends on the Supreme, but on the ballot box.
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