The COVID-19 pandemic should be a powerful catalyst for health care finance reform.
By Lila Rosenthal, MD
On a recent bike ride on Flagstaff, my husband witnessed an accident. Another cyclist was quickly descending just ahead of him, and she inadvertently veered left of the center line. Mercifully, she was able to force a fall in a way that protected her from hitting an on-coming car, but she fell hard. A law enforcement officer was in the immediate area and was on the scene quickly. He called for an ambulance, but the rider—stunned, dazed, perhaps concussed—overheard and muttered, “No, I can’t afford …”. The ambulance was cancelled, fortunately, the rider managed to stumble away from the scene of the accident with assistance.
From my vantage point as a family physician for nearly 20 years, I have been bearing witness to an epidemic of medical financial anxiety. So many of our friends and neighbors lack reliable, affordable health insurance. Many have health insurance instability due to life changes, such as divorce or job loss. People with high deductible insurance often don’t fill prescriptions, or they postpone visits and procedures until they have met their deductible, against medical advice. The cyclist above was forced to think about bills and charges, rather than her health and safety, seconds after experiencing a traumatic accident. All of this financial insecurity contributes to anxiety when people should be tending to their physical and mental well-being.
Among developed nations, it is uniquely American to suffer medical financial anxiety after a health catastrophe because of our failure as a society to create a federal health care financing system that transcends age, income, employment status, and marital status. A national health insurance program, such as Improved Medicare for All (IM4A), is often referred to as a “single payer” system because the government is the only payer of medical bills, as opposed to the current patchwork of for-profit companies, non-profit organizations, and government programs.
This perpetuates a highly inequitable and unstable health care delivery system, with poor returns on health care expenditures. Severe disparities—many of them racial and ethnic— cannot be remedied until we all have the same health insurance card in our wallets. Imagine if this card were issued at birth and had no expiration date or renewal hurdles. Imagine that such a card stays with you whether you divorce or experience job loss or change. Imagine if you didn’t have to decide to postpone filling a prescription or schedule a surgery until you have met a preposterously high deductible.
The current debacle of health care financing in the United States keeps people in jobs they don’t want to be in just for the security of health insurance. This phenomenon is often referred to as “job lock,” and it stifles economic growth, entrepreneurship, and innovation. It contributes to depression and anxiety. It keeps people in marriages they don’t want to be in- sometimes abusive marriages- or pushes couples to marry prematurely in order to have health insurance coverage.
The global COVID-19 pandemic has set off a tsunami of high unemployment and underemployment, physical and mental illness, and premature death. The pandemic has further exposed deep fissures of inequality that desperately need filling. As a nation, we are at a crossroads. What kind of society do we want to shape for future generations? In this upcoming election season, I urge voters to choose candidates who are committed to reducing our collective anxiety by supporting IM4A. Here in Boulder, please join me in urging our City Council to pass a resolution in support of IM4A. A groundswell of support for such measures at the local level across our state and nation signals to our elected officials that the will of the electorate is more powerful than the deep-pocketed for-profit health insurance lobby.
If you are moved to unite with other Coloradans who share the commitment to creating a true commonwealth, because a rising tide raises all ships, please join me in volunteering with and donating to the Colorado Foundation for Universal Health Care (CO4UHC), https://couniversalhealth.org/).
This is the time for meaningful, lasting, profound reformation of health care financing in America. COVID-19 is catastrophic. We can build a fairer and less anxious society from the ashes of this crisis.