Will the COVID-19 crisis usher in changes to the American healthcare system?

The Quarantine Zone
1

Even before COVID-19 came along, Healthcare has been a huge issue in America. Obama overhauled things with the imperfect ACA and Trump has been steadily dismantling it and in the race to unseat him in 2020, healthcare has been the main issue driving many voters.

Due to the pandemic, the flaws of our current system have been exposed to the point where even those quite content with their own care can see the problem for everyone else: Millions are suddenly without the jobs that their health insurance was tied to. A teenager died because he was turned away from an Urgent Care for not having insurance. Meanwhile, our mishmash of competing for-profit systems means that states are literally bidding against each other for life-saving equipment such as masks and ventilators.

When it’s all said and done and the bill comes in - not just in dollars but in lives lost - will this be such a shock to the country that the demand for reform is finally going to be loud enough to stiffle the checkbooks of the healthcare insurance industry? When everyone can see that countries with centralized and universal healthcare fared far better than we did will that manage to move the needle? Will Medicare for All go from a burgeoning idea many Democrats want but which seems unlikely to something that can actually be implemented?

I do hope that Democrats in national and statewide elections make reforming this system a big part of their campaigns and platforms. Maybe them sweeping into office could be a difference-maker.

At the end of the day, my belief is that if the fallout from COVID-19 doesn’t change anything, nothing will.

2

I’d like it to, but America is a plutocracy and I don’t see anything changing.

Things to consider is that nations like Italy spend half what we do on health care, but they still have more doctors and hospital beds. 4.1 vs 2.6 physicians per 1000 people, 3.4 vs 2.9 hospital beds per 1000 citizens.

Italy spends about $3500 per capita on health care vs about $11,000 in the US. So after this is all over people may look at how nations like Italy spend far less but still have more doctors and hospital beds. But I still don’t think it’ll be enough to do anything about it.

But I don’t think any of it will change. The plutocracy is so deeply entrenched that I don’t see politicians doing anything about this issue. There is nothing stopping blue states from expanding coverage, making health care more humane or reducing costs. But for the most part they just nibble at the edges of our broken system.

What might happen is you see ballot initiatives for meaningful reform and ballot initiatives for meaningful state level universal health care pick up over the coming decade. But even then, even in blue states I expect the state government to try to stop them the same way the republicans tried to overturn the ballot initiative in Florida to give felons the right to vote.

3

I’m not quite as pessimistic. The thing to watch for is what hit insurance companies and hospitals take from all the people who can’t pay their bills. That’s a direct hit into the heart of the plutocracy, besides adding greatly to the number of people affected by this issue.

4

You no pay insurance company bill, insurance company no pay your doctor bills.

And doctor come after YOU for money!
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5

… And you can’t get blood from a stone, yes. So the insurance companies and medical providers are still out their money.

6

I’m deeply pessimistic. If the US does get true universal health care (cost effective, universal coverage, no more bankruptcies, low deductibles and copays, elimination of networks, etc) I don’t think it’ll happen on a national level until the 2050s or so.

I think it may happen on a state level starting in the 2030s.

But I just don’t have a lot of faith in politicians to stand up to private industry. Even in blue states where democrats safety control 80% of the state legislature seats, they won’t address this issue or do anything meaningful about it. Just reforms around the edges.

7

After a twenty minute laughing spell…no of course not.

8

Yeah, no. Why should all of those layabouts get the same level of health care than those of us who actually care enough about our health to pay for it? If you want good health care, you need to work for it, ffs!!! We’re already giving food stamps to brown people, what else do they want?

IMO, its more likely that pet owners will start getting a tax deduction for vet bills.

9

I agree to a point with Wesley Clark. But I think Biden, if he gets even a 1-vote advantage in the Senate, will pass something to shore up the ACA, providing stronger subsidies, lower deductibles/co-pays, and maybe a public option. Republicans will try to filibuster. But I predict that the Dems will get rid of the filibuser if they get a majority in both houses, and use 2021 and 2022 to pass some legislation around healthcare.

I must admit that my own views on healthcare have shifted a little bit during the pandemic. I used to be somewhat opposed to a public option. Now, I think every state should have one. There’s no reason for America to have people with no insurance, and declaring bankruptcy over healthcare bills. It’s just politics at this point that’s stopping us, and specifically Republicans who despise half the country.

10

My take is from a different angle. Covid has hit and will hit smaller hospitals and many medical practices hard. I see the impact as even poorer healthcare options in rural America and even more rapid consolidation of systems with even fewer rural ones left standing. More consolidation on the hospital side usually results in higher prices for private insurance (and charged to the uninsured).

Huge national debt in the wake of this will make government investment in revolutionary structural change less likely.

But a public option starts to look even better. Reforms that address rural lack of care will get GOP support.

11

I guess that the pandemic has moved me a little in this area. If Biden is elected, and the Senate flips to the Dems, I hope they get a little more bold in this area. To me, a public option would be a way to do that. We’ll see.

12

Here’s an article on what Biden might do if elected in the healthcare arena. It would basically be a re-work of the ACA, plus a public option.

“The quickest, fastest way to do it is build on Obamacare,” Biden said at the first debate of the Democratic Party, back in June 2019. “To build on what we did.”

He would create a new government insurance plan to be sold on the ACA markets. The 2 million or so people currently stuck in the Medicaid expansion gap would be automatically enrolled, for free. Obamacare’s tax credits would be enhanced, pegged to more generous insurance, and eligibility for government assistance would be available to anybody. Nobody would pay more than 8.5 percent of their income on insurance premiums.

Obamacare was supposed to help sever the link between health insurance and work, making it easier for people to change jobs or start their own business because they could buy insurance on the marketplace. There are anecdotes of people taking advantage of that opportunity, but restrictions written into the law on who qualified for coverage and financial assistance slowed down any large-scale shift. Biden’s public option would be available to the 150 million people who get insurance from their job, potentially opening the door for millions of Americans to join a government health program of their own volition, another step toward realizing the law’s vision.

“Extending a public option and premium subsidies to people with employer coverage is possibly the most powerful and underappreciated part of Biden’s plan,” Larry Levitt, executive vice president at the Kaiser Family Foundation, told me. “The largest number of Americans get their health insurance through an employer, and this starts to address their affordability concerns in a way the ACA never has.”

Biden could also reverse the administrative actions taken by Trump — cutting outreach programs, loosening regulations where possible — that have undermined the ACA and likely contributed to the recent uptick in the uninsured rate.

His plan still wouldn’t quite achieve universal coverage, by the Biden campaign’s own admission. Undocumented people living in the US would be left out, for starters, and some people who likely find health insurance to still be unaffordable. But the campaign estimates 97 percent of Americans would have health insurance under those reforms."

13

I could see non employer entities given an option to cover their members. Give people an option outside their employer. Churches, Credit unions, trade unions, small business groups. Why can’t BLM or BBB offer group coverage to their membership? I could see those types of changes.