America’s health care system has failed the COVID-19 test
If you needed proof that the United States no longer has the best health care system in the world, the new coronavirus has delivered the evidence.
The brave doctors, nurses and other health professionals may be well trained. The clinics, hospitals and research centers may be well equipped. But they are not enough.
The failure comes from our poorly financed public health system, the amazingly fractured billing process, and the fundamental injustice of forprofit enterprises that exclude the most vulnerable.
The Centers for Disease
Control and Prevention epically failed in the early days of COVID-19 by giving bad advice and parochially developing its own tests. On Feb. 29, five days after the Coronavirus Task Force drafted recommendations to close schools and business, CDC director Robert Redfield spread false hope.
“The risk at this time is low,” Redfield told the White House press corps. “The American public needs to go on with their
normal lives.”
Redfield buckled under pressure from White House officials opposed to shutting down the country for fear of damaging the economy, and presumably President Donald Trump’s reelection bid. Instead, the CDC focused on testing, containment and contact tracing.
The problem, of course, is that politicians at every level had slashed spending on public health departments, most of which operate at the county level. Epidemiologists knew what to do but didn’t have the tools.
Rather than use tests developed in Asia, the CDC came up with their own test kits, which were faulty. Epidemiologists had to rely on anecdotal accounts from doctors to guess who needed to quarantine.
Contact tracing proved beyond the capacity of most health departments. Gov. Greg Abbott scrambled to hire 4,000 new contact tracers before expanding the reopening of Texas businesses on June 1.
When the state fell 1,000 tracers short of the goal, Abbott relaxed restrictions anyway. Republican and Democratic lawmakers, meanwhile, are calling for him to fire the politically-connected, inexperienced firm he hired to train new tracers. The CEO of MTX Group Inc. also lied about having a doctorate.
Infection rates, as predicted, are climbing and Texas still does not have enough contact tracers. Hospitals are beginning to worry about having enough beds. My colleagues Jenny Deam and Lauren Caruba embedded in two hospitals for several days and came back with harrowing stories.
One big question, of course, is how to pay for all of this. The federal government has agreed to reimburse insurance companies for testing, but there seems to be some confusion.
Different insurance companies have different policies. Some say they will only pay for testing if it is medically necessary, but they do not clearly define what that means. U.S. Rep. Katie Porter, a California
Democrat, recently got tested and promptly received notification she owed $76.
UnitedHealth explained it was likely a coding error, but some insurers will only cover in-network labs. Go somewhere else, and you will probably get a surprise bill your insurance will not pay. Even during a pandemic, the same old billing games are causing the same old problems.
Most cruel, though, is the way disadvantaged communities are getting hit triply hard. Low-income neighborhoods, particularly African American and Hispanic, are registering infection rates far beyond those of whites and people with money and insurance.
The causes are complicated. But African Americans and Hispanics are more likely to work in high-risk jobs as janitors, cooks, servers, drivers and porters at health care facilities. They cannot work from home.
Most of those jobs do not include health insurance, which means these workers do not routinely visit a primary care doctor or get low-price pharmaceuticals. The resulting chronic illnesses in these groups make them far more susceptible to the worst COVID-19 has to offer, and they are not covered if they fall ill.
“People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism,” Camara Phyllis Jones, an epidemiologist who recently served as president of the American Public Health Association, told the STAT health care news site. “That’s the thing that is slapping us in the face. Actually, it’s lashing us like whips.”
In several columns, I have called for more focus on protecting public health rather than charging for medical care. A public health system spends money on preventing illness with community programs and primary care rather than paying specialists to treat individuals with insurance in high-cost facilities.
Our failed public health response to COVID-19 should drive us to shift focus onto prevention and universal access. Because letting the coronavirus run rampant is costing us all, both socially and economically.