Could Covid-19 Be Leveraged As A Change Agent?

Posted on | April 21, 2020 | 4 Comments

Mike Magee

As the weeks and months of the Covid-19 pandemic pass by, it is increasingly obvious that it is both an economic and a public health crisis. These two major forces appear on the surface to be opposing each other. But the reality is that solutions for both could be harmonized by movement toward a national health care system.

The failure of our health care system should, by now, be patently obvious to all.

Our faith in free enterprise and capitalism to “win the war” on disease (and supposedly leave “health” in its wake) dates back to the immediate post – WWII era. Over the years we’ve doubled down on this historically poor decision again and again, breeding profiteers, colluders, and promoters – but not much health for America.

Covid-19 has revealed that American health care is rigid and inflexible when confronted with an unexpected crisis. The historic intermingling of health and business has yielded a long list of side-effects including: academic medicine’s rush for NIH grants, sellable patents, DTC advertising and AMA profiteering database sales, industry’s relentless assault on checks and balances engineered by ever expanding government relations programs, and government’s open door policy toward scientists with well known conflicts of interest.

All spell success for the Medical-Industrial Complex, but treat patients as pawns. The winning argument for a restructuring of our healthcare system and the movement toward public health insurance options is both economic and ethical. Universal coverage is necessary not simply because it’s a human right (which it is), but because risk must be shared by all equitably to make insurance work.

A healthy population is more productive, more likely to be educated, more mobile and willing to take risk, more likely to get married and have children, less likely to be involved in crime, violence, or injury, and less likely to panic during a health care crisis. And all of this saves money.

When Warren Buffett said that “Medical costs are the tapeworm of American economic competitiveness”, he knew what he was talking about. But to responsibly transition ourselves out of this mess requires two things: 1) a vision/strategic plan, 2) the capacity to retrain and redirect excess non-clinical health care workers from reactive health delivery to proactive and preventive social services.

On the vision front, studies clearly indicate that consolidating administrative back-office management of insurance sales, benefit management, and claims payments could immediately shave 15% off our national health care bill. But getting there is not as easy as uttering the magic phrase, “Medicare-for-all”. But opening up coverage now, with so many suddenly unemployed and without insurance, is a no-brainer. The American public in large majorities already favored moving in this direction, and that was before paychecks and health coverage began to disappear en masse in tandem.

Clearly, we are facing worker displacement on a scale similar to the Great Depression. Why not seize this as an opportunity to embrace workforce transitioning? Currently, there are 16 additional health care workers for every one physician in America.  Approximately half of these are non-clinicians uninvolved in any direct patient care. You can find a list of some the jobs, along with average salary and educational requirements HERE. The American Academy of Professional Coders is now nearly 200,000 strong with average salary approaching $50,000 a year.

Health care now includes 11% of all workers compared to 8% in 2000. Since the country’s near financial collapse in 2007, 35% of the job growth has been in health care, fueled by aging demographics and the expansion of Medicaid under the ACA. More than 1/2 of the nearly $4 trillion spent on health care in the U.S. goes to wages.

Opening up a public option to all would trigger a shift toward prevention, public health planning, and investment in expanding our societal safety net including social health determinats like safety and security, nutrition, education, clean environments, and transportation.

Where might we begin. A logical starting point would be to deconstruct enterprises which primarily service direct patient care needs from those engaged in speculative scientific discovery for profit. These are radically different entities. Step two would be to integrate direct patient care with the continuum of social services. Plan for health, not disease.

Finally, we need to reposition this pandemic as an economic and public health opportunity. We need to be bold. We need to make change our friend.

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