Having Insurance Coverage Is Not Access to Care
It seems as if the fight for a single-payer health plan that covers every American is a thing of the past. Politicians now talk about expanding healthcare access — if they discuss the plights of their most vulnerable constituents at all.
What they fail to realize is that any system that demands payment at the point of care will, by design, leave some people out in the cold. The recent pandemic illustrated that private health is very much a matter of public concern. Here’s why having insurance coverage doesn’t equate to access to care — and what we should do as a society to make things better.
The Ongoing Problem of Soaring Healthcare Costs
The average American spent $10,966 on healthcare in 2019. That’s 42% more than Switzerland, the country with the next-highest per capita costs. Surely that means residents of this nation must be the portrait of health, right?
Unfortunately, no.
The United States is the only industrialized nation where more women are dying in childbirth with each passing year. This country ranks a dismal 33 out of 36 out of Organization of Economic Cooperation and Development (OECD) nations for infant mortality. Over 21,000 infants died during birth in 2018 alone.
The misery doesn’t stop if you make it through childbirth. According to the National Institutes of Health, more than 26,000 Americans die each year from otherwise treatable causes — merely because they lacked the money to go to the doctor. The ravages of the for-profit healthcare system fall disproportionately on the poor. Some people estimate as many as 64,000 people a year perish in this nation from otherwise preventable and curable diseases — had they only had access to basic modern healthcare.
We’re not getting the bang we deserve for our bucks with for-profit medicine. We spend more as a percentage of our gross domestic product (GDP) at 17% than the next most-expensive country at 12%.
Why is it so costly? Two words: bureaucratic inefficiency. While the other high-income nations all have some version of single-payer or universal coverage, the for-profit system creates a whole unnecessary industry — health insurers — whose principal purpose is collecting money from those who can’t afford it and then denying them care when they need it.
If your doctor determines you need a certain medication to live, there’s no need for a secondary stamp of approval from Aetna or Blue Cross/Blue Shield — but you have to have one if you hope to take a single dose.
If your physician says, “You need back surgery if you hope to walk without pain,” there’s nothing some administrator in an office hundreds of miles away can do to change that fact. However, they can insist you go through a month of unnecessary physical therapy before they’ll approve your procedure — potentially costing you thousands in copays that you cannot afford. Pay up or continue living in pain with impaired mobility.
The Lessons COVID-19 Should Have Taught
I’ll admit it: I felt a sense of wry vindication when countries like Norway advised their citizens to stay away from countries like the United States with “poorly developed” health services at the pandemic’s beginning. Now? I want to cry. Clearly, this historic event has taught our leaders nothing about public health.
The mortality rate from COVID-19 in the United States was over double that of the next-closest peer nation, the United Kingdom. Why couldn’t our country get it together amid a pandemic? After all, we have plenty of money and supplies, and they give out vaccines for free.
Mistrust of the medical system and science in general is one huge reason for vaccine hesitancy. Getting a jab might represent the first visit to a doctor someone without coverage or money a copay has had in years. Those with established relationships with a primary care physician feel comfortable with the answers they receive to their most pressing questions. Without that trust, people have to essentially rely on faith — a step not all are willing to take.
Furthermore, lack of access to routine medical care promotes the spread of conspiracy theories that inhibit people from taking common-sense measures to prevent infectious disease spread. For example, although scientific evidence supports the theory that mask-wearing protects both other people and the wearer, many places have abolished such requirements in indoor public spaces.
Why? Too many people believe myths such as mask-wearing causing carbon monoxide poisoning or impairing immune function. They kicked up fierce enough protests about imaginary violations of their rights that leaders like Arizona’s governor Doug Ducey tried to prohibit mask requirements in schools, although the provision was later ruled unconstitutional.
In what kind of country do leaders enact legislation to let viruses spread more rapidly amid a pandemic, carrying off more citizens? One where healthcare isn’t treated like the fundamental human right it is and is instead reserved as a privilege for the elite. Ordinary citizens have little choice but to muddle through conflicting information online — many of them can’t afford to merely ask their doctors.
COVID-19 should have taught Americans two things:
1. No One Is Immune From the Financial Devastation Brought on by Soaring Healthcare Costs
This pandemic forced people to make impossible Sophie’s choices. Do I stay home as health officials direct when I have symptoms if doing so means coming up short on rent? Do I bother to get tested if I know I can’t afford treatment, anyway? Do I report to the hospital if I think my symptoms warrant it or wait it out, knowing that the financial ramifications of this momentary, if life-or-death decision could haunt my family for years?
Americans wouldn’t face such predicaments if they had European-style protections like guaranteed healthcare and paid leave.
2. Public Health Is Very Much a Public Issue
You might think getting sick only impacts you, but that isn’t the case. Just like going without a COVID-19 test could mean unwittingly spreading the virus to others, neglecting other aspects of your health affects society as a whole.
For example, it costs $85 for a routine dental cleaning that could detect and treat issues like gingivitis. Letting the condition advance to Alzheimer’s or heart disease costs hundreds of thousands, driving up everyone’s costs.
It makes you wonder why they took the dental care provision out of Build Back Better — but again, this section is about what America should have learned from the pandemic. Clearly, losing 754,000 lives and counting taught us nothing.
Having Insurance Coverage Is Not Access to Healthcare
The only way to ensure that all Americans have access to — and trust in — the healthcare system is to create one that works for everyone through a single-payer system. Failing to do so at this point is the single most largest moral crisis facing the nation, as the lack costs billions in wasted spending while claiming tens of thousands of lives each year.
All insurance works on one basic principle — people pool their money, spreading the risk that a few individuals will need the resource. The Congressional Budget Office Report indicates how a single-payer plan would save billions over the next decade alone.
What the report doesn’t include is the vast savings in human suffering such a plan would provide to Americans who haven’t been able to afford to see a doctor regardless of the severity of their symptoms. It doesn’t illustrate how nearly half of all cancer patients would no longer lose their life’s savings because they got sick. It doesn’t highlight the relief on a single mother’s face when she realizes she can give birth without it costing her upwards of $30,000.
If 26,000 Americans perished in a terrorist attack, we’d build the bombs and planes to decimate the enemy yesterday. We have the capability, resources and knowledge to bring our nation’s healthcare system on par with that of other OECD countries. Our failure to do so is a dismal reflection of our lack of priorities.
Having health insurance is not and will never be access to healthcare. As long as anyone has to choose between going to the doctor and feeding their children or paying rent, treatable conditions will remain untreated. The results sicken not only the individual sufferer, but our very soul as a nation.
