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We need a centralized medical system, too

Ted Rall on

The coronavirus pandemic has laid bare two fundamental flaws in the American health care system.

No. 1: There's a reason that other rich countries treat health care as a taxpayer-financed social program. Employer-based health insurance was stupid pre-COVID-19 because our economy was already steadily transitioning from traditional full-time W-2 jobs to self-employment, freelance and gig work. The virus has exposed the insanity of this arrangement. Millions of people have been fired over the last two months; now they find themselves uninsured during a global health emergency. The unemployed theoretically face fines for the crime of no longer being able to afford private health care.

The second inherent flaw in the U.S. approach is that it's for profit. Greed creates an inherent incentive against paying for preventative and emergency care. Even people who are desperately ill with chronic conditions see 24% of legitimate claims denied.

When your insurance company issues a denial, it doesn't merely pocket that payment. It also adds to future profits. Even if you're insured, the hassle of knowing that you might get hit by a surprise bill for uncovered/out-of-network charges makes you more likely to stay home rather than to risk seeing a doctor or filling a prescription and going broke. "Visits to primary care providers made by adults under the age of 65 ... dropped by nearly 25% from 2008 to 2016" due to routine denials by insurers, reports NPR.

Denials also create a societal effect: News stories about patients with insurance receiving bills for thousands of dollars after being treated for COVID-19, even just to be tested, prompt people to stay away from hospitals and try to ride out the disease at home. Some of those people die.

There's a third structural problem exposed by the pandemic, but it's not receiving attention from public policy experts or the media. I'm talking about America's lack of a centralized health care system.

 

A centralized health care system has nothing to do with who pays the doctor. A centralized system can be fully socialized, government-subsidized or fully for profit. In such a scheme, all patient records are stored in a central online database accessible to physicians, pharmacists and other caregivers regardless of where you are when you need care. If you fall ill while you're on a trip away from home, the admitting nurse at a walk-in clinic or hospital has instantaneous access to your complete medical history.

The current system is primitive. Data is not transferable between doctors or medical systems without a patient's directive, which is often required by the obsolete technology of sending a fax. That assumes the sick person is sharp enough to remember which of his previous doctors did what when. And that's it's not a weekend or a national holiday or a Wednesday, when some doctors like to golf.

Unless an unconscious patient happens to be wearing a medical alert bracelet, there is currently no way to determine whether the person is allergic to a drug or has a chronic illness, or whether there's a treatment regimen proven to be more effective. Even if the patient is alert and conscious, a new doctor may ignore her request for a specific medication in favor of cookie-cutter, one-size-fits-all treatment.

A few months ago, I developed the classic symptoms of what we now know to be COVID-19. I live in New York. I succumbed while on business in Los Angeles. Trying in vain to fight off a relentless dry cough, difficulty breathing and day after day of brutal aches and fever, I visited a CVS walk-in clinic. I have a long history of respiratory illnesses: asthma, bronchitis, pneumonia, swine flu. I requested a third- or fourth-generation antibiotic since I knew from experience that I would inevitably decline with anything less. "We do not treat viral infections with antibiotics," the nurse, a charmless Pete Buttigieg type, pompously declaimed. I pointed out that viral lung infections usually have a bacterial component that should be treated with antibiotics.

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