with Paulina Firozi
Medicare-for-all advocates say the coronavirus pandemic makes their case.
The public health crisis, they say, boosts their arguments for a single-payer system and the comprehensive, affordable coverage it promises — even after a presidential primary in which Democratic candidates inched away from the controversial idea of overhauling the U.S. health-care system to have it resemble the nationalized programs in other countries.
People have lost their employer-sponsored health plans at record rates as unemployment skyrockets. It took weeks to ramp up testing in a clunky and complex health-care system. Some people are still getting billed for coronavirus-related testing, despite laws requiring it to be fully covered.
“I hate to say we needed a crisis like this because it has caused so much devastation, but certainly the crisis has highlighted the human toll of our broken health-care system,” Rep. Pramila Jayapal (D-Wash.), sponsor of the House Medicare-for-all bill, told me in a recent phone interview.
Jayapal hopes Joe Biden will use the coronavirus crisis to push for more dramatic changes than he previously backed.
Medicare-for-all is politically far out of reach: Its prospects faded further when Jayapal’s preferred pick for president, Sen. Bernie Sanders (I-Vt.), conceded the primary race to the former vice president. Biden, a critic of Medicare-for-all, has argued for a government-run “public” option to be offered alongside private plans, although he recently gave a nod to progressives by proposing Medicare’s eligibility age be reduced by five years to age 60.
Now Jayapal is playing a role advising Biden. She was appointed by Sanders to a health-care task force intended to unify the Democratic Party and provide recommendations to the nominee as the November election approaches, and she’s still making her case.
“I think this is a real opportunity for Vice President Biden to really make the case for all of the structural changes that need to be made that we are seeing having come to light during covid,” she said.
The pandemic has indeed ballooned the problems within the U.S. health-care system.
The nation’s tussle with the virus — which had claimed the lives of at least 97,000 people in the United States as of Memorial Day — has highlighted many of the practical problems that Biden, Sanders and the rest of the Democratic field spent the past year fiercely debating.
Foremost among them: what happens to people when they lose their jobs and the medical coverage that comes with it. Politicians across the political spectrum, including some Republicans, have long argued that there’s good reason to decouple coverage from the workplace.
The threat of losing employer-sponsored coverage has now become a reality for an estimated 27 million Americans.
They’re among the more than 38 million people who have filed unemployment claims across the country.
The situation illustrates how quickly the loss of a job can upend one’s health insurance. For Jayapal, that strengthens the argument for Medicare-for-all, which would guarantee everyone a government-backed plan covering a range of services at little or no out-of-pocket cost. (Although wonks agree it would also cost the government a huge sum of money.)
“All of a sudden, the argument that health care shouldn’t be tied to employment makes a lot of sense to people because there are so many people who lost their employer,” Jayapal said.
Sanders struck a similar tone:
It is catastrophic that tens of millions of Americans are losing their health insurance—on top of the millions already uninsured.— Bernie Sanders (@BernieSanders) May 16, 2020
Medicare must be empowered to cover all health care expenses during this crisis.
We can not abandon the American people.
Those who have lost their employer coverage do have some options: Existing federal laws allow those who have lost health insurance as part of losing their job to enroll in a plan on healthcare.gov at any time during the year. And families receiving the supplemental employment benefits provided by Congress are within the income threshold to qualify for subsidies, according to the Kaiser Family Foundation.
There’s also Medicaid coverage, though in some states that haven’t expanded the program, eligibility is generally set at a particularly low threshold. People can also consider signing up for a short-term health plan expanded by the Trump administration or continuing their group coverage for a limited time under COBRA, but that’s typically pretty expensive.
Polls show a majority of Americans are skeptical about something as dramatic as Medicare-for-all, in which private coverage would be done away with. But they’re more open to letting people choose to buy into the program.
Steep job losses among older Americans could strengthen Biden’s proposal to slightly expand Medicare eligibility, KFF President Drew Altman argued in an Axios column. He noted that unemployment among 55- to 64-year-olds is up to 12.5 percent due to shutdowns. That translates into a steep loss of health coverage among this group.
“Millions of uninsured 55-65 year-olds could add new urgency to calls for a Medicare buy-in if Democrats control the White House and Congress in 2021,” Altman wrote.
The coronavirus also highlights the lack of health-care affordability in the United States, even for the insured.
Even Americans with generous coverage are vulnerable to high deductibles and unexpected “surprise” medical bills after receiving out-of-network coverage through no fault of their own. In the case of testing and treatment for covid-19, the disease caused by the coronavirus, insurers aren’t always following measures signed by President Trump to protect patients from any additional costs, as Business Insider recently detailed.
And prices for medical procedures and prescription drugs are considerably higher in the United States than in any other developed nation.
That reality raises concerns about ensuring that every American is able to get a vaccine for the coronavirus once one is developed.
If and when the vaccine comes, it won’t do somebody any good if they can't afford it.— Bernie Sanders (@BernieSanders) May 20, 2020
This is not a time for the drug companies' profiteering.
A vaccine, when available, must be free and available to all people regardless of income.
Congress was trying to tackle some of these problems before the pandemic. Lawmakers were forced to put multiple bills on the back burner as they rushed to respond to the crisis with multiple enormous relief bills.
But the needs presented by the virus ensure these systemic problems are front and center — even if there’s no consensus on whether the best solution is Medicare-for-all, a public option or something else.
“Our broken, for-profit system left people vulnerable to covid-19 in a way that they would not have been,” Jayapal said.
Ahh, oof and ouch
AHH: The Trump administration has pledged to buy and distribute 100 million swabs to states by the end of the year.
The pledge to help with testing was made in its Covid-19 Strategic Testing Plan to Congress, which was delivered right before the legally required deadline, Amy Goldstein reports.
“The Washington Post obtained the 81-page document, called Covid-19 Strategic Testing Plan, from an individual on Capitol Hill who was not authorized to disclose it. Federal health officials did not release it publicly, submitting it to four congressional committees as required by law,” she writes.
The testing plan says that every state should aim to test at least 2 percent of its population in May and June. It states: “With support from the federal government to ensure states are meeting goals, the state plans for testing will advance the safe opening of America.”
The document also says that if 10 percent of tests are positive for the virus over the course of a week, that is “enough to assure broad coverage of the population.” It says that 41 states already have achieved that goal.
“The new report, prepared by the Department of Health and Human Services, elaborates on a blueprint the White House released last month for increasing the nation’s capacity for coronavirus testing,” Goldstein writes.
OOF: Nearly 100,000 Americans have died of the coronavirus.
People in many states are slowly starting to return to normal life. Some houses of worship tentatively opened over the weekend, but with a list of social distancing guidelines, Felicia Sonmez, Meryl Kornfield and Derek Hawkins report.
Memorial Day weekend drew large crowds to beaches, lakes and boardwalks. Many flouted social distancing, even as public health authorities warned that the coronavirus is not yet contained.
From Food and Drug Administration (FDA) Commissioner Stephen Hahn:
With the country starting to open up this holiday weekend, I again remind everyone that the coronavirus is not yet contained. It is up to every individual to protect themselves and their community. Social distancing, hand washing and wearing masks protect us all.— Dr. Stephen M. Hahn (@SteveFDA) May 24, 2020
“The combination of warm weather, a long weekend, and lockdown-induced fatigue have lead to large crowds at beaches and pools, prompting officials to warn that now is not the time to let up on social distancing,” Antonia Noori Farzan writes for The Washington Post’s live blog.
“Large crowds mobbed the boardwalk in Ocean City, Md., while law enforcement in Volusia County, Fla., said it was ‘one of the busiest weekends’ in recent years. Viral videos showed partygoers in Missouri’s Lake of the Ozarks drinking and tanning while listening to Lizzo at a crowded pool bar. Thousands headed to Tybee Island, Ga., to kick off the start of summer, and beaches outside Tampa filled up so fast that police began turning people away at 11 a.m.”
Deborah Birx, the White House coronavirus task force coordinator, said in an interview on ABC’s “This Week” that Americans should maintain social distancing even if they continued with outdoor activities.
JUST IN: "Social distancing is absolutely critical and if you can't social distance and you're outside, you must wear a mask," Dr. Deborah Birx tells ABC News' @MarthaRaddatz when pressed on her comments that people can visit beaches. https://t.co/27wiSnRlJE pic.twitter.com/0GseMUmc7P— This Week (@ThisWeekABC) May 24, 2020
When asked by ABC News’s Martha Raddatz whether it was right to reopen beaches and parks, given the weekend crowds, Birx said: “I think it’s our job as public health officials every day to be informing the public of what puts them at risk. And we’ve made it clear that there’s asymptomatic spread.”
Birx added: “So we really want to be clear all the time that social distancing is absolutely critical. And if you can’t social distance and you’re outside, you must wear a mask.”
OUCH: The pandemic has made its way across the nation’s rural regions.
The coronavirus first struck major metropolitan areas. But now it’s affecting counties with acres of farmland and cramped meatpacking facilities. It’s hitting regions that have prisons with close living quarters but few hospital beds, Reis Thebault and Abigail Hauslohner report.
That’s according to an analysis of case data and interviews with public health professionals in several states. “In these areas, where 60 million Americans live, populations are poorer, older and more prone to health problems such as diabetes and obesity than those of urban areas,” they write. “They include immigrants and the undocumented — the ‘essential’ workers who have kept the country’s sprawling food industry running, but who rarely have the luxury of taking time off for illness.”
Rural counties in the United States now have some of the highest rates of coronavirus cases and deaths, even surpassing some hard-hit New York City boroughs.
The communities are not easy to reach, and their health-care systems are already resource-starved. “To epidemiologists and physicians, this checkerboard spread was all very predictable. It was never a question of whether the virus would hit rural America, but when,” they write.
What a life is worth
Federal agencies typically estimate that the value of a human life is $10 million.
The government has spent decades studying what a life is worth – and these types of calculations are legally required for major new regulations, such as road safety laws, Todd C. Frankel reports. But this kind of approach has been missing from the debate about how to respond to the pandemic.
“The calculation — known as Value of a Statistical Life or VSL — is the amount people are willing to spend to cut risk enough to save one life,” he writes. “The VSL at most federal agencies, developed over several decades, is about $10 million. If a new regulation is estimated to avoid one death a year, it can cost up to $10 million and still make economic sense.”
Analyzing the costs and benefits of reopening the nation using the VSL could “force policymakers to confront the reality of their decisions in a much more precise way. Without it, they are left to gut feelings, educated guesses or political arguments,” he says.
Yet some economists are working on such an analysis of stay-at-home and social distancing orders, determining how extreme measures to avoid coronavirus deaths compare with the significant economic fallout. They’ve found that the lifesaving efforts are a good trade off.
“Economists at the University of Wyoming estimated the economic benefits from lives saved by efforts to ‘flatten the curve’ outweighed the projected massive hit to the nation’s economy by a staggering $5.2 trillion,” Frankel writes. “Another study by two University of Chicago economists estimated the savings from social distancing could be so huge, ‘it is difficult to think of any intervention with such large potential benefits to American citizens.’”
Twenty large hospital chains have recently received a total of more than $5 billion in federal grants.
That’s according to an analysis of federal data by Good Jobs First, a research group, the New York Times’s Jesse Drucker, Jessica Silver-Greenberg and Sarah Kliff report. While they received government help, these rich hospital chains were already sitting on more than $108 billion in cash.
The Cleveland Clinic, St. Louis-based Ascension Health, and Providence Health System in the Seattle area are among the large chains.
“With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled,” they write. “The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.”
Compared with hospitals with deep reserves that are getting a large portion of the funding, smaller and poorer hospitals are getting only a small fraction of federal aid. “Hospitals that serve a greater proportion of wealthier, privately insured patients got twice as much relief as those focused on low-income patients with Medicaid or no coverage at all, according to a study this month by the Kaiser Family Foundation,” they add.
Remembering the individuals behind the grim milestone:
- The New York Times highlighted some of the names and memories of those who have died, after putting 1,000 names in the paper over the weekend.
The hardest hit:
- The “special enrollment” period for individual Affordable Care Act coverage for those who lost their health insurance due to layoffs is coming to a close at the end of the month in most states, the Associated Press’s Ricardo Alonso-Zaldivar reports.
- Workers at meatpacking facilities are still getting sick, even as the industry tries to return to normal. There have been more than 11,000 infections tied to Tyson Foods, the nation’s largest meat processor, even as it has set up on-site medical clinics and started screening employees for fevers before their shifts, Taylor Telford reports.
- The number of working black business owners across the country has plummeted more than 40 percent, more than any other racial group during the pandemic, Hannah Knowles reports.
In the states:
- A study estimates that the coronavirus may still be spreading at epidemic rates in two dozen states, specifically in the South and Midwest, Joel Achenbach, Rachel Weiner and Isaac Stanley-Becker report.
- The World Health Organization said it would temporarily drop the antimalarial drug hydroxychloroquine from its global study of covid-19 treatments due to safety concerns, Kim Bellware reports for The Post’s live blog. Trump has touted the drug as a preventive treatment for covid-19 despite a lack of evidence and warnings about its side effects.
Around the world:
- Local health authorities across Germany have been using contact tracers since they first confirmed coronavirus cases earlier this year. “Epidemiologists say the effort has been essential to the country’s ability to contain its coronavirus outbreak and avoid the larger death tolls seen elsewhere, even with a less stringent shutdown than in other countries,” Loveday Morris and Luisa Beck report.
- The city of Wuhan in China said it had tested 9 million of its 11 million people for coronavirus in 10 days, the Wall Street Journal’s Wenxin Fan reports. Most of those swab samples have already been processed.