Like all of you, I’m closely following the news of the COVID-19 coronavirus. Right now, my best advice is what you’ve likely already heard: wash your hands frequently for 20 seconds at a time, stay home when you’re feeling sick, and call a doctor if you experience symptoms of a fever, coughing and shortness of breath. And avoid large gatherings if you are elderly or have significant chronic illnesses.
If Coronavirus is teaching us anything, it’s that our nation needs a better system of health care.
All the things that were already broken – the cost of care, access to care – are being cast in an even harsher spotlight as health systems across the nation scramble to respond to the outbreak.
Last week Gov. Gavin Newsom and State Health Officials announced that millions of Californians are now eligible for free medically necessary coronavirus (COVID-19) testing. Commendably, the insurance industry as a whole seems to be following suite by waiving deductibles for testing.
But what about treatment? The cost of medical care for a coronavirus patient who requires isolation and respiratory assistance could cost thousands, if not tens of thousands of dollars.
Now consider that more than one-quarter of Americans have high-deductible health insurance, plans that put them on the hook for hundreds, if not thousands, of out-of-pocket costs before their insurance kicks in. According to a 2019 Kaiser Family Foundation report[1], the percentage of workers with an annual deductible of $2,000 or more for single coverage has grown from 18% to 28% over the past five years.
Deductibles in general are on the rise. The number of people with employer-sponsored insurance who have deductibles has increased from 63% to 82% in the past 10 years, and the deductibles have risen from $826 to $1,655, on average.
The sad fact is, we are living in a high-deductible nation. As the cost of coverage rises, more and more Americans are covered by plans that may cost them less on a monthly basis – but a lot when disaster strikes.
Which means if coronavirus spreads, a lot of us will be on the hook for a lot of money.
That’s a problem because half of Americans also say they don’t have enough savings to cover an unexpected $500 medical bill. 84% of Californians say the affordability of health care is an extremely or very important policy issue—a point of view that people share regardless of political party, race, or income level.
In our country, illness isn’t just something that threatens your life; it threatens your financial survival.
But it’s not just affordability, or lack thereof, that’s holding us back. Finding treatment is also a huge issue, whether you’re fighting global pandemic or getting a yearly checkup.
Approximately 70% of the people we serve at my hospital have Medi-Cal, the public insurance program for the poor. Medi-Cal reimburses doctors poorly per patient, and California has one of the lowest reimbursement rates in the nation. (We’re 48th.)
Unsurprisingly, not a lot of doctors want to work here, which is why a study we commissioned found a doctor deficit of 1,200 practitioners in South LA relative to more affluent areas. And across California, the number of physicians willing to treat Medi-Cal patients has dropped.
As a result, twice the number of Medi-Cal enrollees report having trouble finding a doctor, compared to those with private insurance, according to a California HealthCare Foundation report. This same report showed that only 48% of Medi-Cal enrollees were able to get timely care – i.e. an appointment with their doctor within two days – compared to 70% of those with employer coverage.
So, say you’ve been exposed to someone with COVID-19, or are experiencing fever, cough or trouble breathing – and you have Medi-Cal? Who you gonna call?
Your doctor – if you’re lucky enough to have one who will see you, and if you can pay the deductible.
If you can’t afford it, or can’t find a doctor at all – and 8% of Medi-Cal enrollees say they cannot – you’ve got a problem. We, as a society, also have a problem, because the more sick people are out there, the greater the chances this pandemic will grow.
Adding insult to injury is the current administration’s efforts to rollback funding for Medi-Cal. Earlier this month the Trump administration proposed billions of dollars in cuts to social safety-net programs, including Medi-Cal. (While keeping Medicare, the public insurance that serves much of the electorate that voted for Trump) intact.
Now put together high medical costs, poor physician accessibility, and a low-income population who may not be able to afford to stay home from work, with a highly-infectious disease like coronavirus, and what do you get? You get a recipe for the spread of disease.
It’s time for healthcare in this country to change. All our lives depend on it.
[1] https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey/
