We’re all fixated on the Trump administration’s day-late-and-billions-of-dollars-short response to the increasing likelihood that coronavirus will cause a public-health crisis in the United States. But the fact remains that even if the government were fully prepared, many Americans will face another barrier to receiving care that will make the crisis worse.
That barrier is their wallet.
Medicare-for-all is usually presented as a moral argument: The United States is the richest country ever known; it is not right that we don’t guarantee access to easily affordable and accessible health care like every other First World country. But this situation is not simply immoral — it also leaves the United States at a major disadvantage when it comes to combating global pandemics.
We don’t want people to be wondering whether they can afford to visit the doctor if they think they’ve got this contagious and possibly deadly disease. But by happenstance, ideology and shortsighted, penny-wise-pound-foolish thinking, we’ve set up a situation that will force many to do just that.
According to the Kaiser Family Foundation, more than half of all workers with employer-provided health insurance face an annual individual deductible of more than $1,000. In a survey conducted with the Los Angeles Times, about half of respondents said they or a family member postponed needed care because they were worried they couldn’t afford the bill.
The situation can be even worse for people who purchase their insurance on the individual market. The average individual deductible for a plan purchased on an Affordable Care Act exchange is more than $4,000, and only about half of purchasers receive any help with that sum via cost-sharing subsidies. The Trump administration has compounded this financial quagmire by approving the sale of so-called junk insurance plans that place hard limits on how much the plan will pay out in hospital and pharmaceutical costs in return for a lower monthly premium — frequently leading to high bills that the plans may or may not cover.
There is also the growing problem of surprise medical bills. These occur when someone seeks treatment in an emergency — and I think we can all agree that suspected coronavirus is the definition of an emergency — from a hospital or other medical facility in their network, only to subsequently receive a bill from a doctor or lab affiliated with that institution who wasn’t in network after all.
The idea that people won’t think about all this when they consider going to the doctor is bonkers. Our system is set up to ensure that people prioritize their finances when they are sick. It’s the end result of the concept known as “skin in the game,” the idea — pitched by everyone from health-care wonks to insurance company insiders — that the way to get control of the high cost of American medical care is to turn the patient into a bargain-savvy shopper.
Instead of confronting the medical-industrial complex, the onus is on the sick person to fight the health-care power. The result? People skip out on seeing the doctor, hoping things will get better. They cut their prescription pills in half because they can’t afford to get a refill. We are a country where people in their 20s die because they can’t afford their insulin bill. “The costs they have to incur are a real barrier to getting the care they need,” longtime Medicare-for-all advocate Wendell Potter explained to me.
Or, as Azcue told the Herald, “How can they expect normal citizens to contribute to eliminating the potential risk of person-to-person spread if hospitals are waiting to charge us $3,270 for a simple blood test and a nasal swab?”
Viruses and infectious diseases don’t check your deductibles, co-pays and network access before they strike. Doubters may claim that our nation can’t afford Medicare-for-all, but it’s increasingly likely that we are about to discover just how costly our current system really is.