The U.S. Health Care System on the Eve of the Covid-19 Epidemic: A Summary of Recent Evidence on Its Impaired Performance

Abstract

<jats:p> Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians’ practices; and insurers’ profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model. </jats:p>

The Impact of the COVID-19 Pandemic and Policy Response on Health Care Utilization: Evidence from County-level Medical Claims and Cellphone data

“…The decline in health care utilization also seems to be impacting employment in the health care industry. Himmelstein and Woolhander (2020) using the Bureau of Labor Statistics data found that the number of ambulatory workforce fell by 1.19 million persons, a 14.9% drop and the number of hospital employees decreased by 135, 000 (2.6% decline) (Himmelstein and Woolhandler 2020). Finally, we use real time cellphone mobility data on weekly visits to offices of physicians and hospitals to confirm the results of the detailed claims data.…”

Evaluation of China's public health system response to COVID-19

“…In the early stage of pandemic prevention, the public health system should have sufficient alerts [ 7 ]. Its main task is to find out the pandemic situation in a timely manner, understand relevant information through corresponding medical tests, and make an objective assessment of the spread speed and magnitude of the pandemic accordingly [ 8 ]. Sufficient alerts of pandemic are the starting point of the public health system, and the pandemic information captured is an important reference for pandemic prevention [ 9 ].…”

Universal Health Care for the United States: A Primer for Health Care Providers

“…For those workers who choose not to take offered coverage, 9 out of 10 report that the out‐of‐pocket cost is the main reason for their declination 39 . Families below 200% of the federal poverty level who do use employer‐based coverage spend a significantly higher share of their overall income on premiums and out‐of‐pocket expenses compared with families at 400% or more of the federal poverty level; these expenses equate to more than a third of their income for those in the poorest fifth of the population 53,58 . In comparison, out‐of‐pocket spending in countries with universal health care is half that of their peers in the United States 52 .…”

“…39 Families below 200% of the federal poverty level who do use employer-based coverage spend a significantly higher share of their overall income on premiums and out-of-pocket expenses compared with families at 400% or more of the federal poverty level; these expenses equate to more than a third of their income for those in the poorest fifth of the population. 53,58 In comparison, out-of-pocket spending in countries with universal health care is half that of their peers in the United States. 52 Consumer satisfaction also differs between the US system and countries with universal health care, with Americans 4 times as likely to report major dissatisfaction with their health insurance.…”