By Beatrix Hoffman* – Newsweek
Even as they put their own lives on the line, health care workers are confronted with another, agonizing fear: that they will have to make choices about who lives and who dies. Rationing of masks and ventilators has become an increasing reality during this worldwide pandemic.
We can prevent or at least reduce the possibility of this happening again in the future by stockpiling lifesaving medical equipment and redirecting national and global resources toward public health preparedness. During the reckoning that will come, we must also take a hard look at how the U.S. already rations health care, and rations in ways that made us more vulnerable to disaster.
Rationing is the systematic allocation of a limited resource. Since resources are not infinite, all health care systems ration in one way or another. We are used to hearing about how other countries ration by putting people on waiting lists, for example. The U.S. health care system rations by putting up economic barriers to care and excluding millions from stable health coverage.
Even before the pandemic, 27.9 million people in the United States had no health insurance at all. We are the only industrialized nation that tolerates leaving any of our citizens uninsured. While being uninsured keeps many from getting the care they need, even Americans with health insurance face the financial barriers of premiums, copayments and deductibles, and the fear of medical bankruptcy. The high price of essential drugs like insulin (costing many times more than in other countries) means that people ration their own medications or go without.
And Americans with health insurance also face losing that insurance if they lose their jobs—a fear that is becoming devastatingly real. On March 20, my sister was laid off due to the coronavirus pandemic. Less than a day later, she received the notice that her health coverage would stop at the end of the month. As a historian of the U.S. health system, I was infuriated to hear this, but not surprised. Millions are now in the same position: no job, no health care.
Besides the economic barriers faced by individuals, the U.S. health care system also rations by allocating resources based on financial and political considerations, rather than medical need. Hospitals that are not profitable close down. Politicians in 14 states have refused to expand Medicaid to more residents, even though Medicaid expansion improves both access to care and health outcomes. The annual health expenditures in the U.S. per person is $10,000, and one-third of that money is spent on paperwork and billing, not on providing medical care.
This American way of rationing has made us more vulnerable to the coronavirus disaster. We are already paying the highest health costs in the world, but get far less for our money. Compared to other affluent countries, we have fewer doctors and fewer hospital beds per capita, and Americans have higher rates of chronic health problems. The lack of coordination between our public and private health systems meant we were not prepared to make and distribute enough tests or to trace the contacts of sick people. People everywhere are afraid of getting the virus; in the U.S., this terror is compounded by fear of what the treatment will cost.
Health care rationing already exists in the United States. It’s done by ability to pay, and now it’s making us all more vulnerable, writes Beatrix Hoffman, professor of history at Northern Illinois University. Illustration by Alex Fine; Photo By Thomas Barwick/Getty
Our health care system will also make it harder for us to recover from this disaster and to plan for the future. The current number of about 30 million uninsured will go much higher. Even when a vaccine is developed, our fragmented, inequitable system will make it harder to ensure that everyone will get it without charge. In many other countries, medical school is free or highly subsidized, but our heroic health professionals will still face the burden of paying off crushing student loans. How will we encourage more young people to enter these essential fields and help us prepare for future pandemics?
We cannot wait any longer to fix our broken health care system. The United States must stop rationing health care by income and insurance coverage. Health coverage for all will not end pandemics, but will prevent a great deal of the economic pain and fear they engender, and will improve our ability to respond as a society. We can afford to cover everyone, and today’s public health emergency shows us that we can’t afford not to.
I can’t stop thinking about the nurses, EMTs, doctors, and others who are putting themselves at grave risk, while also having to potentially make terrible choices for their patients. At the very least, let’s never again force them to have to think about whether their patients can pay for their care.
*Beatrix Hoffman, Ph.D., is professor of history at Northern Illinois University and the author of Health Care for Some: Rights and Rationing in the United States Since 1930.
The views expressed in this article are the writer’s own.