The US Medical System begins to fail under the pressure of Covid19.
The US public health system (or more correctly the Private health system) was splendid for those who were insured through their companies, or were able to afford to pay for their own health insurance. This left a very large number of people, estimates ranging from 20 to 40 million people without recourse to regular healthcare.
President Obama introduced an Act requiring the provision of medical care for a large number of people not covered by existing medical insurance provisions
The Act largely retained the existing structure of Medicare, Medicaid and the employer market, but individual markets were radically overhauled. Insurers were made to accept all applicants without charging based on pre-existing conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a fine/tax) and that insurers cover a list of "essential health benefits".
Congressional Republicans last year finally succeeded in repealing the Obamacare requirement that people buy health insurance or pay a tax penalty.
In December 2018, a federal judge in Texas ruled that the repeal of this "essential" part of the law meant the entirety of Obamacare is therefore unconstitutional.
The law, however, remains in place as an appeal heads to the US Supreme Court.
The mandate was not as successful as Obamacare's architects hoped in driving younger, healthier Americans into the healthcare marketplace.
Now, as they ditch their coverage, analysts say insurance firms are making up for the loss by charging more to the sick or medically vulnerable patients left behind.
President Trump is hell-bent to wipe out “Obama Care” in the same way as he seems to be neurotically fixated on erasing everything that Obama did.
Now Enter Covid19
The following is taken from a number of articles published in UK newspapers by US correspondents resident in that country.
“One day I woke up to hear that Covid19 had taken hold of my own community….. “We all knew that America’s patchwork for-profit would be a frail match against a vicious disease like Covid19 (It appears that the Trump administration ignored any such scaremongering!)But calls for reform were often chalked up to politics, and change was always delayed.
Now, as a bungled response from leaders in Washington DC continues to hamper any attempts to recover, decades of poor health policy have been exposed.
- In 1975, the population of the US was 215 million. Today, it is 328 million.
- In roughly that time, the US has lost 567,000 hospital beds, down from 1.4 million, because they were considered inefficient and unprofitable.
This was directly related to how people pay for healthcare. As the number of hospital beds fell, emergency departments also closed because they were the only part of the hospital required to treat patients who couldn’t pay
On average, the cost of healthcare per person between 1960 and 2015 has outpaced wage growth by roughly 2.4% each year, according to government economists.
We’ve also managed to exclude 9% of the entire population, or roughly 28 million people, from health insurance entirely, with catastrophic potential for people’s finances.
Is it any wonder then, then, that it is unaffordable for many Americans to see the doctor. That, last year, half of under-insured Americans delayed or skipped care because of prohibitive costs?
That, in turn, those untreated chronic conditions leave people vulnerable to Covid19.
And, that the most vulnerable among us, both to Covid19 and chronic health conditions, are poor people and people of colour?
It appears that many smaller hospitals, especially those in rural communities, are faced with bankruptcy and closure, as they cannot afford the twin costs of less insured business and the Covid19 crisis.
Britain Follows Closely behind
It is becoming clear that the United Kingdom, possibly excluding Scotland, which has a highly devolved government, is not far behind America. The rapidly mounting death rate is set to exceed that of Italy, the worst in Europe so far.
The reasons for this are not difficult to see:
- Gross underinvestment in the Social Care sector, particularly Care Homes for the disabled and elderly and care in the community. For some reason, deaths in care homes were not included in the official statistics until very late. Now it is clear that the gross neglect, wholesale privatisation, and ripping out of funding from local authorities has caused a terrible disaster, with spiralling deaths
- Privatisation and undermining the government public sector to a point where it is no longer able to effectively play its part in the co-ordination of national efforts to cope with the Pandemic, especially where it comes to the provision of essential medical and personal protection equipment (PPE)
- Successive Conservative governments, in power from 2010, despite a short coalition “partnership” with the Liberal Democrats, have obsessively undermined and depleted the public sector under the false banner of “Austerity”; claiming that the crash of 2007 was a result of overspending by the previous New Labour government, rather than the collapse of the Banking sector.
- To make matters worse, the Conservatives have pursued Brexit, departure from the European Union. The effects of this are yet to be seen, at a time when smallish countries like the UK need the safety blanket of wider international alliances
- Underinvestment in the National Health Service, a peerless national asset. It is only because of public support for a public health system, open to all at the point of use that the Conservatives sought to undermine it by stealth and packets of privatisation. Now that the Pandemic has struck the NHS has been a priceless asset. The Conservatives have switched public relations strategies, now referring to it as “Our NHS”!!
The major factor that stands out from the US and UK experiences is that a national Public Health system, providing equal access and high quality medical and social care for the whole population is an absolutely critical factor for a civilised Society.
America has never had one. Britain escaped from total disaster only because the NHS survived by the skin of its teeth from following the US experience.