Biography/Disclosures
Biography:

Edmonds is a senior medical advisor and chief eye care officer at United Healthcare, co-director of the Low Vision/Contact Lens Service at Wills Eye Hospital in Philadelphia and a member of the PCON Editorial Board.

May 19, 2020
3 min read
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BLOG: The pandemic fuels the flames of health care reform

Biography/Disclosures
Biography:

Edmonds is a senior medical advisor and chief eye care officer at United Healthcare, co-director of the Low Vision/Contact Lens Service at Wills Eye Hospital in Philadelphia and a member of the PCON Editorial Board.

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Never in the history of American health care has there been such chaos, confusion and concern for the welfare of our citizens. Although often criticized for our high cost, limited access and our emphasis on treatment rather than prevention, Americans have been confident in our quality of care and successful outcomes.

But along comes the novel coronavirus from the other side of the world and, even with plenty of notice, our health care system was not up to the challenge.

It was really no surprise to the world that our health care system was not able to cope with this type of health emergency. In a commentary on March 3, 2020, for The Week, Ryan Cooper wrote, “Why America is so vulnerable to coronavirus.” He predicted that America would fare among the worst of any affected county due to the capitalist nature of our health care system with 30 million people uninsured, another 44 million underinsured and many more with high deductible plans that make treatment or hospitalization impractical.

Mr. Cooper was spot on. Despite efforts to close our borders, SARS-CoV-2 arrived from various vectors and kicked off the COVID-19 pandemic. We were unprepared for testing or to manage people who were found to test positive. Citizens without insurance or with high deductibles where hesitant to seek medical care and instead spread the virus. Shelter-at-home orders were issued late, on a state-by-state basis without any type of national authority. The first stay-at-home order did not happen until California started the trend on March 19. Other states followed but with more concern for politics than public health. Some states never made such orders.

As the pandemic evolved, we were barraged with a series of conflicting informational updates and recommendations from local, state and federal sources. On March 12, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted that “... the system is not set up for what we need right now, it is a failure ... the idea of anybody getting tested, as they do in other countries; we are not set up that way. Do I think that we should be? Yes.” Dr. Fauci went on to become the leading voice for federal recommendations on managing the pandemic. It is important to note again, with the American health care system, that Dr. Fauci and other national public health leaders can only make recommendations, as the authority for action belongs to the states and is implemented by each governor. The governors all have different backgrounds, political connections and access to public expertise in their respective states. The results have been a hodgepodge of grandstanding, pontificating and ongoing controversy.

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The current mitigation model of stay-at-home orders and social distancing is a social experimental model that has never been tested. The natural course of viral disease can be plotted on a curve that shows a steep upward phase with a rapid number of new cases followed by a peak with a rapid downward phase. As a population reaches “herd immunity” — a state where enough people have been infected and recovered and are immune or have died, the spread of the infection stops, and the pandemic is done. There is now evidence that the mitigation has flattened the curve and prevented overwhelming our hospital system. This was required because our for-profit hospitals are not designed for an unprofitable public health crisis despite the lessons of the 2009 H1N1 pandemic. By flattening the curve, however, we have interfered with the natural progression of an infectious viral disease and have slowed the herd immunity process. The curve, although flattened, will also be lengthened. The remaining question is how long it will be lengthened and if the ultimate number of infected citizens, the area under the curve, will be greater than if we had not implemented this aggressive mitigation strategy.

Now, more than ever, the weakness of our health care system has been exposed. We must fix the problems of the Affordable Care Act, now exposed with 10 years of experience, or replace it with a more socialized plan built on the experience of most of the other modern societies of the world. Like the military and the highway system, some aspects of modern society need centralized, federal programs with the power to protect the general welfare of the population. Since we now can better understand how the health of the individual can affect the health of the society, we need to make health care a fundamental right of American citizenship rather than a privilege for those who can afford it.

Reference:

Cooper R. The Week. Why America is so vulnerable to coronavirus. Posted March 3, 2020. Accessed May 15, 2020.