When he was President Barack Obama’s chief of staff, Rahm Emanuel famously advised never to let a crisis go to waste. Advocates of universal, government-controlled health care in the United States are pursuing that strategy as the nation confronts the prospect of a coronavirus epidemic. Last week, seizing on a story about the $1,400 bill that a Miami man received for a hospital visit to get tested for coronavirus, they charged that the American system of private insurance isn’t up to fighting the spread of the virus. Critics contend that episodes like the one involving the Miami man, who has a high-deductible policy that some call a “junk” plan, will discourage people from seeking testing and treatment, thereby enabling spread of the contagion. The solution, according to Bernie Sanders? A national health-care system—the only system, he and his supporters believe, capable of handling a crisis like the coronavirus.
The problem with this claim, as with much of what advocates contend about nationalized health systems, is that it ignores how such systems really operate. Because health care under these plans is inexpensive or even “free,” people overuse it, driving up costs and forcing governments to limit access. That’s why long wait times and denials of service are typically more characteristic of national health systems than the American one. Indeed, last week, Japanese citizens bitterly criticized their government because its national health service, which citizens must enroll in if they don’t have employer-provided insurance, had limited coronavirus testing to just 5,700 people. Some critics accused the government of Prime Minister Shinzo Abe of suppressing testing to minimize the seriousness of the virus’s spread. Others saw it as a cost-saving move.
Government-controlled health-care systems are especially vulnerable to epidemics because, to control costs, they must strip as much overcapacity as they can out of their operations. During the 2017–2018 flu season in Britain, for example, the National Health System was overwhelmed. Patients regularly spent 12 hours in hospital emergency wards awaiting treatment, corridors were jammed with beds, and doctors postponed all but the most urgent surgeries, the New York Times reported. British doctors complained of “battlefield medicine” and “third world conditions.” That spring, in order to save money, the NHS stopped paying for a broad range of remedies for common ailments, including those treating constipation, cold sores, conjunctivitis, infant colic, and backache. About a year later, the country reported widespread shortages of some 80 common medications, such as the anti-inflammatory Naproxen. One reason: the service had driven down the price of drugs so far that manufacturers found “the U.K. a less attractive market.” At the same time, the NHS is notable for restricting access to expensive drugs that treat much more serious conditions. Before relenting to criticism, for example, the NHS spent four years refusing to give cystic fibrosis patients—including an estimated 5,000 children—access to Orkambi, a drug developed by U.S. manufacturer Vertex International.
What critics deride as America’s “patchwork” health-care approach is in fact a system that attempts to offer choices, rather than a one-size-fits-all national service. The Miami man’s “junk” plan is one of those choices—a low-cost, high-deductible plan, in which the patient agrees to pay for many ordinary procedures in exchange for cheaper premiums. These plans were in place in states like California before Obamacare; they were aimed at consumers, such as young adults, who were looking for protection against catastrophic costs but balking at the price of more comprehensive insurance. Obamacare placed restrictions on these plans, looking instead to force people into insurance exchanges. Two years ago, President Trump signed an executive order expanding access to these insurance policies. While critics have charged that some of the plans, like AARP’s limited insurance for seniors, fail to inform customers adequately about the restrictions on coverage, some consumers have expressed satisfaction at the services offered and the savings they accrued.
The real issue in the Miami case was where the man went for service. The costs he incurred were not even from a coronavirus test, but from other fees associated with visiting a hospital emergency room for examination. Indeed, after an exam showed that he had the flu, the man was not tested for coronavirus, even though the Centers for Disease Control is providing the tests without charge because it has designated coronavirus a public-health emergency.
The CDC has been justly criticized for ramping up its testing regime too slowly. But, as experts predict an inevitable increase in cases in the U.S., the agency is now working to make the tests widely available. As testing expands, so should the network of facilities that provide the tests, extending well beyond expensive hospital emergency rooms. Some health-care providers have even suggested setting up the equivalent of “drive-through” facilities, where people can be tested quickly and inexpensively, as South Korea has done. Similarly, when an effective vaccine becomes available, Washington can subsidize production to get the population immunized quickly.
All these efforts, and others like them, to address the coronavirus can be accomplished without revamping American health care. In fact, it is a system like ours that makes such efforts possible. Contrary to Sanders’s claims, the American health-care system, flaws and all, is better equipped than any other to handle a challenge like the coronavirus.
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