In this opinion piece, Dr. James Fieseher explores why problems in America's health care system are undermining our efforts to fight the pandemic. His guest opinion was published in Foster's on January 21.
The pandemic has highlighted some serious flaws in the US Healthcare system. Mislabeled as a “free market” system, Americans have spent more money on combating the pandemic and received fewer benefits per dollar than any other nation.
Our healthcare system has slowly been taking us to the proverbial cleaners, but the pandemic has put us in the fast lane.
Primary care is secondary to for-profit health insurance
The whole point of insurance is to provide funds in the event of an emergency or life-altering occurrence. Health insurance was and still is designed to cover the cost of catastrophic health care. This is the inherent problem of basing the nation’s healthcare on a system designed to only cover catastrophes, it was never intended for routine care.
Health maintenance, such as routine visits to a primary care provider is a secondary issue to health insurance companies. Primary care appointments will cost you an extra co-pay which may or may not be a part of your deductible. As a result of these extra costs, Americans tend to see their primary care providers less frequently than citizens of other industrialized countries. If you have no insurance, many practices will not even schedule an appointment.
One of the reasons that Americans are particularly vulnerable to the ravages of coronavirus is the high number of people with health risk factors such as obesity, diabetes and hypertension. All of these risk factors are reduced with routine check-ups with primary care providers.
But costs alone are not the only reason Americans have fewer preventive visits. The lack of availability of primary care providers is also a byproduct of for-profit healthcare. Insurance companies reimburse (pay) primary care providers less than they pay specialists. More US medical school graduates become specialists in order to pay off their education costs in a timely manner. This also explains why many US primary care providers are either nurse practitioners, physician assistants or a graduate from a non-US medical school.unt
Pandemics require planning and prevention
The US was warned of the coronavirus pandemic as early as December 2019. While it is true that China was slow in announcing details that would have helped to slow the spread of the disease, we can’t control what happens in China, but we could have taken precautions here at home, precautions that never materialized.
Sure, politics and a presidential denial was a major factor in the devastating impact the virus had in the US, but the CDC and other public health agencies could have had more visibility earlier in the process to organize the preventative measures necessary to lessen the early impact of the virus. Given how poorly equipped our healthcare system is in preventing illness and the high number of people with health risk factors, this was a crucial oversight.
You can’t fight an invading army with militias
We have some of the most advanced medical teams and technologies in the world, but without a centralized, coordinating healthcare system, much of this advantage is wasted. The for-profit, “free market” approach to healthcare is based upon the principle of competition and fragmentation. When a strong, unified and swiftly moving invasion force like the coronavirus hits our shores, we have no coordinated system to combat it.
Our fragmented system against a powerful and fast-moving pandemic is akin to fighting an army with amateur militias. This problem was compounded by the President who saw no need to take the necessary precautions recommended by the CDC and his security advisors. “Closing the border to China” except for 40,000 people cannot be considered a serious prevention, as verified by history.
The fragmented system can be subjected to a considerable amount of mixed messaging. One of the reasons that President Trump was able to politicize the virus and the US response was the lack of a central medical voice giving us the facts. Dr. Fauci and to a lesser extent, Dr. Birx symbolized the central response to the virus, but without a system in place to direct the messaging to healthcare providers and facilities, much of that information was delayed or subverted.
There were other people with medical degrees that espoused unproven contrary messages that confused the public and led to unnecessary medical delays and death. Without a central system in place, this type of problem can recur and in even greater numbers.
Vaccination distribution problems
The US had planned to vaccinate 20 million people by the end of December, but only 2.8 million actually received the vaccine. Unsurprisingly, our “free market” healthcare system played a major role in this discrepancy because of it was never designed to treat the country as a whole.
Without a national system in place, pharmaceutical companies were doing their best to get their product to 50 different states each with several vaccine distributors. We came up with an organizational plan about which groups should receive the vaccines and in which order, but with a myriad of competing healthcare systems, there was no way to ensure that the vaccines reached the proper providers.
At the current rate of distribution, the US is projected to reach “herd immunity” in October 2023.
The problem of tying health insurance to employment
You can’t claim that the US has a “free-market” system of healthcare if individual consumers (that’s all of us) don’t pick the product, but our employers do. We wouldn’t tolerate it if our employers determined which grocery stores we could shop in, so why do we want our employers determining our health insurance plans and the doctors associated with those plans? Even if our employers offer a choice of plans, they, not we, get do decide which options are available.
Many people fear “socialized medicine,” where other people direct our healthcare, but that is exactly what we have now. How ironic that the social medicine fear mongers rave against “public options” where the individual members of the public pick their doctors and their health plans.
Here’s the problem: Before the pandemic, ten percent of Americans had no healthcare coverage, and an estimated 30-40% of Americans were said to have inadequate healthcare coverage with high deductibles.
During the pandemic, many thousands of small businesses have closed and millions lost their insurance with their jobs. Now, many more people are without healthcare during the pandemic when they need it the most.
The future of American healthcare
How much we’ve learned from the pandemic depends upon where we go from here.
The private health insurance and pharmaceutical industries are each spending hundreds of millions of dollars in advertising and political funding to convince us that they should be the only option for healthcare. This effort will continue despite having the pandemic expose the inherit problems with our for-profit, fractionated, healthcare system.
There is no ideal healthcare system, but the healthcare system we have now is arguably the least perfect system possible due to its high costs and inefficiencies. We need an affordable, universal, easily accessible system under minimal political influence that can coordinate care in times of national medical emergencies such as a pandemic. This includes the need for basic health insurance that is independent of one’s employment.
Our current Medicare system is an example often cited that comes close to meeting those needs listed above. Expanding that system would be costly and cause an increase in taxes to support it which would be more than offset by not having to pay higher premiums. We would be able to eliminate other government programs that are more expensive (Medicaid, CHIP).
But that is only one possible solution for replacing the present system which costs more money and more paperwork. In other healthcare systems, Americans would actually see an increase in their disposable income and fewer medical bills. We would also see a faster and better coordinated response to future pandemics.
There may be other options to consider as well, but those options might require recreating a whole new system of care.
Most importantly, whatever option we choose, a universal healthcare system would address the need for preventive care which would save Americans sick days, hospitalizations, paperwork, time and money. It would also make us better prepared to weather or even prevent the next pandemic.
Dr. Fieseher would like to acknowledge the assistance of Jessica LaMontagne, a member of Dover Democrats’ Executive Committee and Chair of our Health Care Action Group, who shared ideas helpful to crafting this piece.
About the author
Dr. Fiesher’s article reflects his concerns about American health care in general:
My career as a primary care physician has given me insight into the flaws and inequities of our health care system, inequities that I have fought against with only marginal success. There were too many people suffering and dying needlessly even before the pandemic hit because our healthcare system cannot adequately provide the essential primary care services we need. The seacoast is relatively better off than the rest of New England and the rest of the country, which speaks loudly as to how bad off the rest of the country is, as things are not even adequate here.
Dr. Fieseher has been a primary care physician for 30 years, starting with Dover Family Practice in 1990. He has practiced in Dover and Portsmouth for most of his professional career, but also spent three years in the Veterans Health Administration and two years at Dartmouth-Hitchcock in Manchester. He retired in March, 2020, “but can be coaxed out of retirement if I don't have to travel too far.”