In her five-minute video-log, Dr. Ashley Bray, a general medicine resident, records her average day in a New York City hospital overburdened by new patients who have contracted COVID-19, a virus which has infected nearly 109 million people globally and has been responsible for the death of over 485,000 people in the United States alone [6,2]. In the video, we hear repeated calls over a loudspeaker of “Team 700,” which is the code for when a patient is on the verge of death. The final shots in this video-log show the dozens of refrigerated trucks stationed outside the hospital to hold the bodies of the dead. Dr. Bray ends her video by describing the overall situation as “apocalyptic.”
As America continues to lose the battle against COVID-19, it would be all too easy to assert that the effects of COVID-19 have been indiscriminately felt, and that the healthcare system is “managing” the virus. Going beyond a rudimentary analysis, it is evident that 1) specific populations, namely minority groups, are disproportionately affected by COVID-19 due in part to the healthcare system’s reactionary, late-stage approach to illness ; 2) an exorbitant amount of money is wasted in the healthcare system, which diverts resources away from other areas that require improvement ; and 3) significant legal loopholes exist that allow health insurance companies to deny people insurance, which has resulted in millions being uninsured during the pandemic . Given these realities, America moving forward must create a more financially efficient and encompassing system that guarantees everyone high-quality healthcare. By adopting a single-payer healthcare model that is more standardized and efficient, more resources would be available to readjust the public health approach from reactionary to preventative, which, in turn, would mitigate health disparities.
The chaos ensuing from the COVID-19 pandemic has shed light on a system that is both inefficient and exclusionary, and this system has played a significant role in minority communities being so heavily affected by coronavirus. So, how can we create a health care system that is both efficient and accessible while allowing for a redistribution of wealth toward creating a more preventative approach to public health? A potential answer lies in adopting a single-payer healthcare model. This model is a tax-funded system operated by the government that takes responsibility for financing healthcare for all residents. Under this system, everyone in America would have health insurance under one standardized plan, and access to necessary services, including doctors, hospitals, long-term care, prescription drugs, dentists and vision care. Furthermore, individuals would still be able choose where they receive care to ensure that everyone has the opportunity to make an informed decision about their healthcare plan. The single payer model starkly contrasts with the current system, in which healthcare is mainly funded by private companies that vary in benefit structures depending on their employees’ premiums and rules for paying medical care providers. In addition, while the current system does not have an aligned plan for providing healthcare on a local, state and federal level, a single-payer system would create uniformity in healthcare delivery, which would significantly reduce inefficiencies due to administrative complexity.
Under a single-payer model, no American would needlessly suffer due to a lack of medical insurance. Given the thousands of people who were more prone to suffer from COVID-19-related issues due to a lack of an insurance backbone, in addition to the fact that an estimated 68,000 patients die annually due to lack of insurance, the system’s benefits are extremely relevant . Furthermore, according to Dr. Andrea Christopher from the Harvard Medical School, a single-payer system would incentivize more to direct healthcare spending toward public health measures. For example, targeting funding towards childhood obesity prevention programs in elementary schools and daycares could reduce the rates and complications of obesity more effectively and at lower costs than paying for doctor visits to recommend healthier diets and increased physical activity.
With respect to the association between government-run insurance and preventative care, there are some relevant studies that challenge this projection. One such study sought to assess the impact of Medicaid expansion on the receipt of 15 different measures of preventive care including cancer screening, cardiovascular risk reduction, diabetes care and other primary care measures. After comparing 24 states which expanded their Medicaid and 19 states which did not, the study found that Medicaid expansion was not associated with improvements in cancer screening, cholesterol monitoring, diabetes care, or alcohol use screening . Despite these findings, however, the level of relevance or applicability of a state-by-state study toward a national expansion of Medicaid/Medicare may not be as high. This is because under a single-payer system, all fifty states would be required to uphold standardized criteria of quality healthcare that includes preventative and corrective treatment. Another study illustrates how hospitals in both Maryland and Pennsylvania that replaced the fee-for-service system with a Medicare/Medicaid global budget system were able to acquire a reliable and substantial revenue source, allowing them to reinvest in community health care delivery; as such, there is a notable relationship between the revenue acquired by hospitals and the reinvestment into community-based public health . Furthermore, an additional study on the effects of Medicare for All finds that rural hospitals specifically would see their revenue increase largely due to the elimination of financial burdens that uncompensated care places on hospitals. Under the implementation of a single-payer system with Medicare expansion, the alignment of all fees to the Medicare schedule would result in a mean projected revenue of 103% for rural hospitals for the same level of service provision and, therefore, operating costs. Notably, the magnitude of the shift would be largest for hospitals serving the least affluent communities, which tend to have substantial balances for uncompensated care and receive much of their revenue from Medicaid . As such, a single payer system is not only encompassing and cost-effective, but has significant revenue space to reinvest in developing a more preventative public health approach, wherein money could be invested in better public transportation systems, community-based health systems and better access to higher quality food.
While the needs and challenges of revitalizing the American healthcare system can sound daunting, it is important to reiterate the scale of the problem. The ongoing COVID-19 pandemic has exposed and exacerbated pervasive systemic inequities and has already begun to reshape medical care. Despite the inevitable political and legislative pushback against top-down reform, the tragedies of the pandemic — from hospitals being severely overburdened to millions of people being debilitated from this virus — can provide the impetus for a powerful call for action that can serve to break down these barriers. Creating a uniform single-payer healthcare plan can legitimately save thousands of lives that would be needlessly lost to a lack of adequate healthcare. Furthermore, eliminating or even substantially reducing wasteful medical care spending could be an opportunity to fundamentally reshape our nation’s medical care system through investing in a more preventative public health approach, thereby igniting a movement against the obesity and diabetes crises. Overall, a single-payer healthcare system can move our public health approach in a positive, more equitable direction and could thus shape a healthier, safer and prepared America.
Edited by: Sophia Xiao
Illustrated by: Shubhanjali Minhas