Saturday, 6 June 2020

Commentary: Why universal health care would especially help blacks, Latinos and Arab Americans - The San Diego Union-Tribune



Commentary: Why universal health care would especially help blacks, Latinos and Arab Americans

In April, a New York City nurse anesthetist posted on Facebook that the last words of an American patient dying of COVID-19, before he was intubated, were, “Who’s going to pay for it?” This captures the crisis of our health care system. Knowing of the bad number of deaths that had already occurred in Italy by that time, the first thing that came to my mind was that these would not be the last words of any Italian patient.
I have lived and worked in six countries on three continents. My job has been to explain clinical and economic value to those countries, payers and health care systems so health care innovations like new drugs and advanced diagnostic tests can be permanently funded by health insurance. This process can take years but is critical to improving care.


Through my work, I have experienced different health care systems firsthand and in-depth. While France’s health care funding is federal in the majority of cases and Canada has a provincially funded health care system, both countries offer supplemental private insurance for additional benefits. China and Brazil have significant out-of-pocket components, especially for new innovations. The United States has a mixed funding model.
When I moved to the United States, my employer at the time thought the Affordable Care Act (also known as ACA or Obamacare) would change perceptions of payers and health care systems, because we were inching closer to universal health care. A decade later, universal health care seems further out of reach.
The coronavirus pandemic has exposed somber realities.
A mid-April analysis from Kaiser Family Foundation showed that in the majority of states, African Americans account for a higher share of confirmed cases and deaths than their share of the total population. A report by the Centers for Disease Control and Prevention found that African-Americans are hospitalized at higher rates than whites for COVID-19. In New York City, the U.S. community hardest hit by the virus, more Hispanics per capita are succumbing to the illness than any other ethnic group. In San Diego, the East County COVID-19 numbers show proportionally higher numbers of “unknown” ethnicity, which could be Middle Eastern because of East County’s large Chaldean population.
People within the above-mentioned communities tend to have higher numbers of uninsured or underinsured. That means they normally have less access to health care, whether for prevention or for treatment when needed. That also could mean higher prevalence of underlying medical conditions that are contributing to mortality in those groups. People with no insurance or underinsurance might delay seeking urgent care until it is too late.
Encouraging people to seek needed treatment during the novel pandemic must be tied to reduction of out-of-pocket costs. In a recent survey by Real Endpoints, most insurance companies reduced or eliminated different types of out-of-pocket costs for COVID-19 patients. That is a step in the right direction, but it does not address the broader shortfalls of our medical insurance system.
There are now about 90,000 deaths related to COVID-19 in the United States. Our hope is that all the public health measures and the evolving treatments and vaccines will slow and eventually stop these deaths. But remember that we have almost 600,000 deaths every year related to cancer and another 600,000 deaths related to heart disease. The impact of those diseases on patients is devastating in many ways, including financial. In one study, 42% of cancer patients had financial hardships, despite being insured.
Health care costs are the second leading cause of bankruptcy in the United States. Adding insult to injury, our employer-based medical insurance system ensures that people lose their benefits when they lose their jobs. Recent proposals have focused either on extending COBRA benefits or expanding the ACA base. Unfortunately, for many people neither of these solutions is affordable. Even when people buy Obamacare, they tend to buy lower-premium plans that have significantly higher upfront out-of-pocket costs.
Coping with coronavirus
The pandemic sweeping the globe has changed everyone’s lives, and we want to hear how it’s changed yours. If you’d like to write an op-ed for us on a subject related to the virus, make it 700-750 words and send it to us with your name and a phone number so we can reach you.
Access to health care is a basic human right. It is time for a real change in our health care system and it is not difficult. Having universal health care does not mean that there should not be an employer-based private insurance system. Universal health care will have a positive impact on our lives, and for those most fragile and marginalized among us it could mean the difference between life and death.
Qadan is a biopharmacist and medical technology executive at Illumina in San Diego. He lives in Carmel Valley.
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SRC: https://www.sandiegouniontribune.com/opinion/story/2020-05-19/commentary-covid-19-crisis-shows-need-for-universal-health-care-for-arab

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