The Journal Gazette
Thursday, June 25, 2020 1:00 am

Pandemic response shows glaring health care finance inequities

Dr. Robert Stone

Follow the money.

The coronavirus spread like wildfire across the United States. New York City hospitals were quickly overwhelmed with sick and dying patients. Everywhere, hospitals scrambled to create more ICU beds and find more ventilators, to protect non-COVID-19 patients and staff from getting infected, and to provide enough personal protective gear.

Right away we realized that “elective” surgeries such as joint replacements and hernia repairs, as well as procedures such as colonoscopies, would need to be postponed to preserve the hospital resources being mobilized for the pandemic surge and to reduce exposure of patients coming to the hospital.

IU Health began postponing “nonessential” surgeries on March 15, and its most recent financial report showed income down 50% from the same period last year, while at the same time costs were up from taking care of very sick, very expensive COVID-19 patients. Price gouging for products such as masks and gloves made it worse.

Across this country, hospitals' bottom lines bled billions as we rose to meet this challenge. Congress responded by allocating more than $100 billion of aid to hospitals.

Meanwhile, health insurers reaped a windfall as premiums kept rolling in while they didn't have to pay out for all those postponed procedures. The independent watchdog ProPublica on April 28 reported: “Executives at Cigna, the health insurance giant, have signaled to investors that the coronavirus pandemic isn't hurting the company's business and might actually be a boon.” United Health, the largest in the industry, reported revenue of $64 billion in the first quarter of this year, $5 billion more than last year's first quarter.

The income the hospitals lost became the insurance companies' gain. It's as if the taxpayer bailout for the hospitals went straight to the coffers of the insurers, a massive transfer of wealth.

People around the world are celebrating the dedication and courage of hospital workers. I have been proud to be a practicing physician. But while hospitals received congressional relief, they also resorted to layoffs, pay cuts and furloughs for tens of thousands of health care workers.

As we continue to follow the money, the headline of this June 8 article from the New York Times says it all: “Hospitals got bailouts and furloughed thousands while paying CEOs millions.”

Hospital workers and patients are not on this gravy train. And with millions of Americans losing their jobs, many will soon be losing their health insurance. There will be a tsunami of medical debt and bankruptcy hitting over the next few months.

We have the most expensive health care, but nowhere near the best care in the world by any objective measure. Our complicated, market-based system is fantastic at creating profits but not at creating health. In other developed countries, hospitals are financed like public schools and fire departments with annual budgets, not dependent on elective surgeries and colonoscopies for their financial survival.

The pandemic brought out the best in us as we improvised and adapted to meet the initial surge of cases, but it also revealed the glaring weaknesses in our system. The virus has exposed the inadequate care available for African Americans and American Indians, among others, starkly illustrating the concept of “structural racism.”

To fix this we need to fundamentally change the way we pay for health care, and in that process expand care to include absolutely everyone.

Public opinion polls consistently show a majority of Americans want universal health care, but not a majority of politicians. What do you find when you follow the money to the end of the trail? Money in politics. It's enough to make you sick. It's time for a change.

Dr. Robert Stone, a Bloomington resident, is the director and founder of Medicare for All Indiana.

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