America's fragmented health care system is one of the most indisputable issues, and the more significant consequences become apparent as the pandemic continues to spread rapidly. Unlike many other countries, America has one more factor to consider on their plate when creating the pandemic response—a way to provide medical care and testing to the 24.9+ million affected Americans, many of whom are uninsured. This comes as no surprise, seeing that the billing for the life-saving treatment easily contains the ability to catch you off guard and wipe your life savings as patients hospitalized for COVID are being fined on average $20,000, and in extreme cases, as much as $1.1 million. Michael Flor, for instance, a Seattle resident and COVID-19 survivor, spent the better of 62 days hospitalized and came out with a $1.1 million bill with costs consisting of room charges, ventilator use, testing, drug costs, and additional scans. "I feel guilty about surviving," was Flor's response, and rightfully so, as the 181-page bill is enough to deliver a heart attack. The only appropriate reaction is to laugh in disbelief as many laid-off Americans struggle to achieve adequate health insurance, many of whom are victims from different ethnic and age groups experiencing inequality, both in keeping their jobs and in obtaining fair insurance from their employers in the first place. It leaves many to fight hard at the end of the day and wonder if it is worth surviving and having COVID treated if it, in turn, means struggling to pay bills and living in a mountain of debt.
Putting a Price on Life
On average, Americans make fewer visits to the doctor than citizens in almost any other country. Case in point, a Gallup study conducted in 2019 found 33% of Americans before COVID put off treatment while 25% postponed care to a serious condition. Regarding the why factor, it all came down to the fact in hand that Americans face higher out-of-pocket costs for primary medical care, leading them to inevitably delay and even altogether overlook a recommended course of treatment. To paint the picture of just how rough it is, on top of the average costly treatment ($20,000) for each person, Americans who have pre-existing illnesses such as heart and lung damage are at a greater danger for complications from COVID and, in turn, risk costlier bills. Patients who aren't hospitalized are likewise to face expensive billing for outpatient treatments, ER visits and testing, which can cost anywhere from $62 (Maryland) to $302 (New Jersey) depending on the state; a step forward in comparison to the price of testing back in March 2020 which cost as much as $3000. This is particularly a burden to families and individuals who have been laid off from work and no longer have access to health insurance. Reportedly so, unemployment has increased by roughly 15.9 million individuals between February and June 2020, leaving millions without health insurance as the greater part of the U.S. population, 160 million people, receive health insurance through their employer. Under such unfortunate circumstances, 68% of citizens have stated that out-of-pocket costs are a heavy determinant of whether they seek healthcare for COVID-19 symptoms. While one in seven adults dismissed the idea entirely and said they would altogether avoid medical care when experiencing coronavirus symptoms due to the detrimental cost barrier. In any case, this can be deadly as testing is critical in not only providing the appropriate medication to those who needed to live but also in determining the rate of how fast the virus is spreading. Without knowing the extent of cases, experts will be unsuccessful in devising a more informed response regarding death and infection rates. Not to mention, failure to receive testing on the citizens' end will place everyone in harm's way as no efforts will be made to quarantine those affected, which in the long run, will only draw out the pandemic, increasing mortality rates and inflaming the economic impact on stocks and businesses. Through these statistics alone, can a lot be said about the healthcare system in America, a developed country, where citizens refuse life-saving treatment to avoid being liable to thousands of dollars in medical bills.
Employment Inequality Threatens COVID-19 Treatment
The various rising costs in COVID-19 testing and treatment is strongly associated with many healthcare disparities in America. The lower a patient’s income is, the less likely they are to afford treatment, let alone obtain quality treatment. According to a Pew Research Center survey in March 2020, 43% of U.S. adults say that they or someone in their household has lost a job or taken a cut in pay due to the pandemic. Job and wage losses are continuously being experienced by certain ethnic minorities, especially Hispanics (61%), Blacks (44%), lower-income (52%) people, and younger people (54%); and even without a financial emergency, approximately one in four adults (24%) also say they cannot pay some of their bills or can only partially pay their bills in a typical month based on the survey results. There are several factors that affect job vulnerability, including race, age, and gender. Women are more likely than men to not pay some bills. These specific groups are at further risk when it comes to the ability to afford coronavirus treatment due to their financial hardships amid the COVID-19 pandemic. Factors like discrimination and racism, healthcare access and utilization, occupation, educational and wealth gaps, and housing are associated with more COVID-19 cases, hospitalizations, and deaths in the areas where racial and ethnic minority groups reside and work. Community strategies preventing the spread of COVID-19 may cause unintentional impacts, such as lost wages, services, and increased stress for these groups. Furthermore, race and ethnicity play significant roles in health as they have an effect on socioeconomic status, healthcare access, and exposure to coronavirus related to the occupation. American Indians or Alaska Natives, Black or African Americans, and Hispanic or Latino persons have a higher risk of contracting, being hospitalized, or dying from COVID-19. The CDC reports that Black or African Americans and Hispanic or Latino Americans are 2.8 times more likely than white Americans to die from the disease, and Hispanic or Latino persons are also 4.1 times more likely than Whites to be hospitalized from it. Therefore, people of colour are more at risk of coronavirus implications, resulting in health disparities.
Flaw in U.S. Pandemic Response
When comparing the United States’ pandemic response to other countries, the rate of testing was slower early on. The healthcare system in America was more vulnerable when the virus came because of its high uninsured rate, high out-of-pocket healthcare costs, and low medical system capacity. For example, although Taiwan has high traffic with the Chinese mainland, it has a low number of coronavirus cases due to their universal healthcare. In Monte Silvano in central Italy, Paolone, 56, did not have to worry about the cost of his life-saving treatment. "I didn't pay for anything. Not a cent," he said. He didn’t have private health insurance nor was he employed, but that didn’t impact his access to treatment. The Italian system is funded through taxes, meaning that primary and inpatient care is free for all citizens and permanent residents. On the other hand, Blomberg, 35, lives in Muskego, Wisconsin. She has lost her job during the pandemic. Fortunately, he has medical insurance through her husband's employer–unlike the 28 million Americans who were uninsured in 2018; however, even with the insurance, the bill she is facing for her COVID-19 treatment costs a fortune. Those who do have health insurance may not seek care that quickly either. This is because they may face hefty deductibles and out-of-pocket costs for visits to the doctor, emergency room trips, and treatment. About 153 million Americans who have coverage through their jobs have to spend about $1,655 a year, on average, before their coverage kicks in. These disparities in health care existed long before COVID-19 even entered America, and they have stemmed from the U.S. system of private health insurance and the high out-of-pocket costs for medical care.
Currently, there are several temporary legislative interventions taking place. There is $175 billion in provider relief allocated by the Coronavirus Aid, Relief, and Economic Security Act, the Paycheck Protection Program and Health Care Enhancement Act. The extent of policies vary by insurer, state, cut-off dates, and levels of specificity though. However, it is unclear how much longer insurers and authorities will be on top of medical priorities as the virus shows no sign of slowing down, and this money won't be nearly as effective long term. The plan is to slow the spread of the virus by identifying and testing those with the virus; but in reality, this strategy is not as effective as it relies on people seeking a test first, which many will avoid because they just cannot afford it. One in six Americans gets a surprise medical bill after a trip to the emergency room. Nearly one in four Americans have avoided some form of medical care, including doctor visits, medications, vaccinations, annual exams, screening, vision checks, and routine blood work. You do not want to have a healthcare system in which people avoid seeking care even when their life depends on it just so they can avoid costly bills and medical debt. The Vice President of federal advocacy for the American Heart Association, Emily Holubowich, shared how the pandemic "shines a bright light on just how broken our health system is." The pandemic puts a spotlight on the need to promote the health and well-being of racial and ethnic minorities. As new virus strains emerge and coronavirus deaths surpass 400,000, the US must step up the fight against COVID-19 and turn the tide on the pandemic to ultimately eliminate these cost-related healthcare disparities and create an affordable and ethical healthcare system for all.
Written by Areeba Saleem and Tanya Kor
Edited by Joyce Qian