Nevertheless, this crisis should and almost certainly will deeply affect how we think about our health-care system and what we’ll consider the next time we try to accomplish some kind of reform.
That could be as little as a year from now, with memories of the coronavirus still fresh in our minds.
Let’s begin by considering a few things the coronavirus crisis and the accompanying economic downturn have illustrated about our system.
Perhaps the most vivid is that untold numbers of people are going to get huge bills from being treated for covid-19. Insurance companies made a big deal about waiving cost-sharing for coronavirus tests, but if you get it and have to get treated, you could still face thousands of dollars in costs, especially if you have a high-deductible plan of the kind that has proliferated in recent years.
The number of people facing those costs will be enormous. As bad as the virus has gotten in some other countries, that’s one thing their citizens don’t have to worry about.
That’s not to mention the huge numbers of Americans who have no insurance at all — especially in Republican-run states that refused the Affordable Care Act’s expansion of Medicaid — and so either won’t seek care when they get sick or will have to have the state pick up their tab, further straining state budgets.
Not only that, because of this wave of patients needing expensive treatment, insurance premiums could rise by 40 percent next year. How many people are going to be saying that everyone loves their private insurance when that happens?
Then we get to the effects of the budding recession. As I’ve argued before, the fact that we force most people to get insurance through their employers not only has no rational basis (it’s an accident of history), but it also makes things incredibly complicated during an economic downturn.
Right now we’re scrambling to figure out what to do about the millions or perhaps tens of millions of people who are losing their jobs and so may lose health care. Should we subsidize them to keep their old coverage through COBRA? Increase ACA subsidies? Widen Medicaid? Some combination of those and more?
In any other system, we wouldn’t even have to ask those questions, because your coverage is not tied to your job. If you get laid off or quit or your company goes out of business, your coverage is unaffected. Wouldn’t that be easier and less stressful?
It was always a myth that if you like your employer-sponsored coverage, you can keep it — your boss can change it at any time and often does, even if you keep your job. But if some of the predictions going around are right and as many as a quarter to a third of Americans lose their jobs in this recession, the idea of keeping insurance tied to employment may seem even more absurd than it already was.
Advocates of Medicare-for-all will say these twin crises make the case for their preferred system stronger than ever. But even if we’re not ready to go that far, what we’re living through still reinforces every argument in favor of reform.
It will certainly make health care a more potent issue for Democrats in November, since the central pillar of President Trump’s health-care policy is to get the ACA declared unconstitutional, immediately tossing 20 million or so people off their coverage and taking away protections for those with preexisting conditions (such as, say, having had covid-19).
And if Joe Biden should become president, it will increase the pressure on him to forge ahead with the reform he advocated during the campaign, a surprisingly progressive plan centered on the creation of a public option that could quickly enroll millions of Americans in coverage that would be stable and secure even through another pandemic.
A year from now, that may look more appealing than ever. It won’t be easy to find silver linings for a pair of crises that we know will cause so much suffering. But if we get real health-care reform as a result, we could wind up with a more secure future.