Think about this fact: GoFundMe, the leading fundraising platform, reports that one in three of the site’s campaigns is to pay for medical bills.
The site hosts more than 250,000 such campaigns, raising more than $650 million each year. Taglines are terrifying and heartbreaking: “Help Jhansi Fight High Grade Brain Tumor,” “Save Niles Life,” and “23-Year-Old Fighting End-Stage Heart Failure.” Sometimes the money is for people who are uninsured, but it’s also for those who have insurance policies that require enormous deductibles and copays.
Siri Lindley is one such patient. She has a diagnosis of acute myeloid leukemia. Her ask: “We invite you to help us reach our goal of $200,000 so that Siri and her family can focus on her treatment and not have to worry about the building medical bills and expenses that lie ahead.” Lindley is also selling sweatshirts and tank tops embossed with the word BELIEVE.
Believe? Believe in what? It’s hard to believe in a healthcare system that forces thousands of people who are gravely ill to raise astronomical amounts of cash for their medical bills on a for-profit website called GoFundMe.
This is America?
The odds for fundamental healthcare reform in this country just got worse—the day after Senator Bernie Sanders, the original and long-time proponent of Medicare-for-All, dropped out of the Democratic presidential race, and as we confront a catastrophic health crisis unlike anything in our lifetimes.
COVID-19 had by publication time caused over 14,000 deaths in the United States. And the racial disparities are plain to see. The Cook County medical examiner’s office and the Chicago Department of Public Health found that 68 percent of the city’s deaths were African Americans, who make up only about 30 percent of Chicago’s total population. In New York City, the Latinx and African American communities are dying at the highest rates.
It’s simply not possible to respond to a pandemic in a rapid and coordinated way when over 27 million people are uninsured.
COVID-19 is exposing on an unprecedented scale how deeply dysfunctional, deadly and racist our for-profit healthcare system is—despite the grit and determination of those working on the front lines. It’s simply not possible to respond to a pandemic in a rapid and coordinated way when over 27 million people are uninsured and 87 million are underinsured.
The US also lacks a fully functioning public health infrastructure because of cuts in spending over the last decade. “Public health accounts for less than 3 percent of overall health expenditures, a percentage that has been falling for decades, and is about half the proportion in Canada or the UK,” said Dr. David Himmelstein, co-founder of Physicians for a National Health Program and professor of public health at the City University of New York at Hunter College.
He added, “One result is that state and local health departments that are on the front lines in dealing with epidemics have lost 50,000 positions since 2008 due to budget cuts.”
The response by the Centers for Disease Control and Prevention (CDC) and the National Security Council’s Pandemic Response Unit has been disastrous. Frontline healthcare providers are begging for basic medical supplies: masks, plastic gowns, gloves and ventilators. Incredibly, the CDC said healthcare providers should use bandanas and scarves as makeshift masks while caring for patients. Garbage bags have been fashioned into gowns.
Even doctors at Bellevue Hospital in New York City have applied to the GoFundMe lottery to raise money for personal protective equipment (PPE). This is in the richest country in the world. It is an obscenity.
Catastrophic US Failures in Other Crises
We’ve been here before. COVID-19 isn’t the first time that the US healthcare and public health systems have failed to mount an adequate defense against a deadly epidemic. The AIDS crisis which started in the 1980s was ignored by the government for several years. President Ronald Reagan didn’t say the word “AIDS” in public until the end of his presidency, in 1987. Hospitals and clinics were overwhelmed by thousands of uninsured patients, initially gay men, who were critically ill.
For years HIV spread unchecked across the country. The homophobic and racist Reagan administration wasn’t interested in funding research for a test for the virus or making sterile syringes widely available. Nor did the pharmaceutical industry want to invest in developing drugs—until is was guaranteed large profit margins and patent protection.
In 1985, when L. Patrick Gage, a vice president at Hoffman-LaRoche, was asked about investing in research for drugs to treat HIV, he put it bluntly: “This will sound awful, but you have to understand that 100,000 people isn’t a market that’s exciting. Sure, it’s growing, but it’s not an asthma or a rheumatoid arthritis.”
It does sound awful, putting profits before patients’ lives. Communities of color, the poor and injection drug users were disproportionately infected with the virus. In 2000, 448,060 people died from AIDS. The parallels between the Reagan and Trump non-responses are eerily, sickeningly similar.
We’ve had similar death tolls for years. Why has the government never declared a public health emergency?
But COVID-19 is taking place in the midst of another, unaddressed and deadly crisis—one that stretches back to the 1990s. In 2018, over 67,000 people died of drug overdose (mostly drug combinations, mostly involving opioids). We’ve had similar death tolls for years. Why has the government never declared a public health emergency?
Unlike with the coronavirus, there are medications that massively reduce opioid-involved deaths: Methadone and buprenorphine. Both are underutilized or unavailable in many parts of the country. This a direct result of restrictive regulations—like the X-waiver to prescribe buprenorphine and daily clinic attendance and limited take-home doses of methadone—that were put in place by the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMSHA), and which cost lives.
But because of COVID-19, suddenly these deadly and outdated rules have been dramatically revised. Now, 14 and 28 day take-home doses of methadone are more widely available and the DEA temporarily suspended the requirement that patients see a buprenorphine prescriber in person.
Why did it take a viral pandemic to make lifesaving medications available with minimal barriers? How many people would be alive today if the regulations had changed decades ago? Please imagine the rage and grief of people who lost a loved one to an opioid overdose because they couldn’t access buprenorphine or methadone.
This is America?
A Shameful Global Outlier
A key factor in combating the coronavirus in other countries is a national healthcare system that guarantees coverage to every single person. David Fisman an epidemiologist at the University of Toronto explained, “In a time of crisis like the coronavirus pandemic, having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.”
Not so in the US. It’s the only high-income country in the world that fails to guarantee healthcare to everyone in the form of a comprehensive, national health insurance program. And as a result, 18,000 people die each year from lack of health insurance. That is criminal.
Americans have been told for generations that a national healthcare system is too radical, that it would never work. We are going to be told that again during a 2020 presidential election contested by Joe Biden and Donald Trump—a duo who will portray the very idea as extreme. Biden has already suggested that if he were president, he would veto Medicare-for-All legislation.
But for anyone paying attention to how the coronavirus is spreading and the mounting death toll—or to anyone with the slightest knowledge of what other, less wealthy countries provide for their citizens—what is truly extreme is that it’s even a question that everyone should have the right to medical care.
Despite economic recessions, no one in these nations ever “loses” health coverage.
The private, for-profit healthcare system leaves Americans uniquely vulnerable to a pandemic. Currently, 27 million people are uninsured. That number will undoubtedly grow as the economy continues to crash and possibly tens of millions lose their jobs. In the past two weeks alone, a staggering 10 million workers filed for unemployment. Roughly half of all Americans get health insurance from their employer, so these vast, industry-wide layoffs mean not only losing income, but also medical coverage.
There is bad news, too, for those who manage to keep their health insurance: Premiums in 2021 could increase by more than 40 percent, according to a new report by Covered California.
The coronavirus crisis has painfully revealed how linking medical coverage to employment status makes no sense. The countries below don’t tie healthcare to work. So despite economic recessions, no one in these nations ever “loses” health coverage. The US, again, is the extreme outlier.
Image via Qasim Rashid/Twitter
How will the uninsured pay for treatment if they are hospitalized? Trump signed into law the Families First Coronavirus Response Act. It would make COVID-19 testing free—but not treatment. And that’s a huge problem.
Just ask Danni Askini. She has lymphoma and was sickened with the coronavirus. Several trips to the ER, a battery of lab tests and other medical procedures resulted in a bill for $34,927. Askini is uninsured. “I was pretty sticker-shocked,” she said. “I personally don’t know anybody who has that kind of money.”
This kind of medical debt often leads to bankruptcy. According to a study published last year, about 530,000 bankruptcies are filed annually because of debt accrued due to illness. The majority had insurance when they filed for bankruptcy. Outrageous bills and the threat of bankruptcy are just two reasons why hundreds of thousands of people are afraid to go to the doctor or delay care until their symptoms become severe.
It is time to join the civilized world and guarantee healthcare to everyone.
This delay makes prevention impossible, reduces the effectiveness of treatment and contributes to the lower life expectancies of Americans compared with many other countries, rich or not. Life expectancies stay lower despite far higher per capita US spending on healthcare—as opposed to spending on public health infrastructure—compared with any other country. It’s a stark illustration of the impact of a profit-driven healthcare marketplace.
The COVID-19 pandemic has put on full display the extreme injustices and inequality at the core of the American healthcare system. If it teaches this country anything, it should be that it is time to join the civilized world and guarantee healthcare to everyone.
So that a critically ill patient never again asks a nurse anesthetist, right before he inserts a tube down his throat to help him breathe, “Who’s going to pay for it?”
Image via Derrick Smit/Facebook
This is America.
Top photo by Helen Redmond