When it comes to the American health system, whether before or after the ACA legislation was approved and implemented, there’s a lot of debate as to its relative quality, with what might be best called the corporate conservatives espousing the view that it’s the best in the world, while those who have watched insurance company premiums rise rapidly, particularly pre-ACA, along with prescription prices and, in general, health costs, suggest that whatever quality it may be, its cost of access makes it second-rate. The latter folk also point at comparative surveys which indicate the American health system doesn’t produce world-leading outcomes.
For my money, these public debates produce far more heat than light. Each side tends to turn it into a shouting match. Conservatives, particularly the political animals, tend to simply shout louder and louder about how it’s the greatest in the world, as if it’ll make their points true. Liberals treat each element of the debate as if they’re independent variables, which they are not (and the less political conservatives point this out, such as the libertarians). As an example, conservatives will suggest that the American capitalist model of a health system motivates corporate entities to pursue the creation of better medicines, so if we shift to a more socialist model, as many on the left advocate, this may mean that the expensive and long-term research required to create a single effective medicine will become a far less attractive investment target. The liberals, at least in the big public debate, simply ignore the point, and I don’t try to follow the more reasonable debates where they might address this point – because I’m not even sure where to find such debates.
So things like the Medicare-for-All debate with its flapping of hands about costs is less interesting than it should be to me. For the participants, it’s accounting and cost curves; for me, it’s a potentially complex health system ecological problem in which the actions of the participants may influence the behaviors of entities which produce medicines, while we’re currently in a system in which certain medicines are no longer produced or researched. There are many, many factors to consider – Do companies with profitable chronic treatments stop researching actual cures? Is it valid to compare our health system outcomes to anyone else seeing as most medical treatment research is American funded? – I find the zealotry often exhibited by partisans of both sides completely inappropriate and a sign of the basic unseriousness of such people – whether their name is Cruz or Sanders.
What brought this out? Well, the COVID-19 outbreak, and I’ll turn to Steve Benen, as he provides both the information and a relevant observation:
At first blush, this Miami Herald story may seem like a report about a local guy who caught the flu. But the closer one looks, the more interesting it becomes.
After returning to Miami last month from a work trip in China, Osmel Martinez Azcue found himself in a frightening position: he was developing flu-like symptoms, just as coronavirus was ravaging the country he had visited. Under normal circumstances, Azcue said he would have gone to CVS for over-the-counter medicine and fought the flu on his own, but this time was different. …
So why did this story generate national attention? A couple of reasons.
Let’s start with the fact that Azcue ended up with expensive medical bills, not because he’s uninsured, but because he has what the Miami Herald charitably described as a “very limited insurance plan.” Or put another way, he has one of the “junk plans” the Affordable Care Act tried to eliminate, but which Donald Trump and his team are quite fond of. Consumers are attracted to the low costs of these coverage plans, right up until they get sick.
In Azcue’s case, within weeks of being sent home, he started receiving thousands of dollars in medical bills — with more likely on the way, because he was treated by some out-of-network physicians — in addition to instructions on his medical history. Azcue’s private insurer wanted him to prove that his flu wasn’t related to a pre-existing condition. …
As for the other angle of interest, what happens when the coronavirus outbreak spreads in the United States and many Americans — who are either uninsured or under-insured — avoid seeking medical care because they’re concerned about bills they can’t afford?
The Herald spoke to Georgetown’s Sabrina Corlette, who explained, “When someone has flu-like symptoms, you want them to seek medical care. If they have one of these junk plans and they know they might be on the hook for more than they can afford to seek that care, a lot of them just won’t, and that is a public health concern.”
This highlights a point which doesn’t get the attention it deserves, and that’s how health is not an independent condition for each of us, but rather our health, and our conduct, has the potential to impact those around us to a devastating degree. It gets worse – for those of us who are world travelers, and there are so many in that class, the potential to wreak havoc with a highly contagious pathogen is really quite amazing.
Up ’til now, the most vivid example of this concept has been the struggle of anti-vaxxers to not be subject to vaccinations, and how the impact of unvaccinated carriers of ancient scourges such as measles and mumps can be devastating for those who are vulnerable, such as infants not yet eligible for vaccination, and those with compromised immune systems that dare not accept vaccinations.
Someday, we may repeat the anti-vaxxers parade of frantic denial with a hypothetical COVID-19 vaccine, but at present we’re seeing a different aspect of health system vulnerability, as Benen makes clear: an individual’s choices being detrimental to the society around them. Simply, given the cost of reasonable insurance, individual A, who may be poverty-stricken due to circumstance, will decide to save money by taking advantage of a Republican-sponsored “junk plan”; when they find themselves ill, possibly with the disease du jour, and they realize that the expense of treatment for something they may not have will ruin them, then they refrain from any authoritative treatment.
Now they’re spreaders. Hello, individual B who brought the soup to the sickly individual A. Your Good Samaritanism will be the death of you. Literally.
So this gives some weight to the argument that a more socialistic approach to the health system is appropriate. The argument over the potential of treatments being discouraged, vs the potential for having to bury several million corpses, and the economic damage that their sudden loss of contribution, is a worthy argument to have.
But way too vivid for my taste.
