Letter to Editor | The pandemic may reshuffle US healthcare deck

— from Tom Eversole —

The difference in charges for COVID-19 testing for self-pay versus insured patients can be huge.  In our current business model, health systems need to inflate prices so that insured patient revenue compensates for not collecting from uninsured (self-pay) folks who often don’t/can’t pay.

Some jurisdictions have assigned contact tracing to hospital systems. As currently financed, hospitals do not have the capacity or incentive to do the “gum shoe detective” work that is the established specialty of Public Health (PH). Furthermore, hospitals do not assure that quarantined people actually can/do self-isolate.

The current medical industry is not adequate to serve an entire population uniformly, effectively or fairly. If healthcare systems cherry pick business, then PH is maintained insufficient to magically compensate when commerce fails. The root problem is our patchwork healthcare system, not hospital/clinic staff or providers.

Unfortunately, our current chief executive sidelined CDC and its FEMA-coordinated, PH emergency response network in favor of familiar tactics that served him well as a real estate developer. As a result, America’s pandemic response fell to uncoordinated state governors, some of whom did the same. 

State and local officials who allowed their PH agencies to lead made better progress in stemming local outbreaks than those who relied on politicians to make complex, population-level health protection decisions. The latter group had little training, experience or will to undertake severe and unpopular directives.  As bridge players say, “Don’t send a boy out to do a man’s job.”  The next bid might be “Two no trump.”