COVID19 may kill medicare and ACA

As in my last post, the problem is the government’s response to the COVID19 epidemic that will cause problems. Even at the beginning when it was projected that millions would die from this disease, it would have been better to continue without lock down, closure of non-essential businesses, enforcing arbitrary face-mask and social distancing rules. It would have been sufficient to have a public information campaign reminding people that long-standing advice about staying home when sick, covering mouth when sneezing or coughing, and keeping hands and surfaces clean. Health care establishments may have some similar reminder to be extra diligent but to continue as normal.

Instead, the government imposed some very unusual restrictions on health care systems in particular.

  1. Routine or non-urgent appointments were canceled, these include disease screening and elective treatments or surgeries that normally would be better done earlier rather than postponed.
  2. Longer wait times to schedule a doctor’s visit, and longer wait times to see a doctor on the appointed time due to the extra efforts to clean the rooms and to process the patient.
  3. Emergency paramedic calls for heart attacks or strokes are not as responsive as before and often (in some areas) the arriving medics are discouraged from being as thorough in their resuscitation efforts leading to more dead-on-arrival calls than normal.
  4. Seeing a doctor for a non COVID19 issue will subject the patient to testing that may discover an asymptomatic case, or a false positive that will add quarantine. Alternatively, going to a medical facility involving a lengthy stay will increase the risk of later testing positive for the disease. Both of these discourage patients from making appointments earlier as they normally would.
  5. Reports of people treated for non-COVID19 conditions getting poorer treatment if they test positive for COVID19 resulting in extra isolation and delays to prevent the spread. The treatment would not be as attentive to the condition as normally due to extra concern about the COVID19.
  6. The positive test will place the patient in a COVID19 ward where they have increased risk of picking up the real virus if they previously had a false positive test.
  7. If one does need hospitalization to treat complications from COVID19, they will not get attentive care from their doctors or nurses who will try to minimize their interactions and keep maximum distance compare to other diseases. The practitioners will be more nervous or overworked, and in either case, not providing the level of care normally expected.
  8. COVID19 treatments involved rapid escalation to sedation and invasive ventilation even when those had poor survival rates because other methods had increased risks of spreading the contagion.
  9. Patients being encouraged to sign do not resuscitate agreements, or being left to die without resuscitation when there was still some chance of recovery.
  10. Patients left alone in COVID19 wards with dead patients in neighboring beds for long periods of time.
  11. Having COVID19 condition and dying from it meant the remaining days for the patient were alone (if not sedated under ventilator), not allowed family visits and rarely having medical staff visits.
  12. Practices that relocated hospital patients to nursing homes without prior testing lead to nursing home contagions. Other nursing homes being so neglected that they were later found to have many dead people needing to be removed.

This is not an exhaustive or a well researched list. It is only my impression based on what I have heard about. The general impression is that these are people paying good money in premiums for their Affordable Care Act plans or their Medicare plans and these people are not getting the services they expected to get for those premiums.

There is a good reason for the reduction in value of their plans. There is a condition that the system is having difficulty dealing with, and some of that difficulty is bureaucratically imposed. While these may be understanding, that does not change the fact the expected value of these plans are not being delivered. Given all the information even at this late stage, it does not appear that any of these deficiencies will improve any time soon, maybe not for years.

I am thinking about the people paying premiums into these plans and have not yet had to have medical care including no need for COVID19 treatment. They buy into these premiums with the expectation that some day they will benefit from a certain level of care when it is their turn to need medical attention. Many will see that the care they will receive is not at the level they thought it would be. For example, if they had some early symptom of a major condition such as heart disease or cancer, they may not get access to hospital for early screening and treatment if there is a pandemic occurring. This was explicitly part of the bargain in the first place.

These medical plans rely on a large population paying premiums in order to pay for the much smaller population that actually need health care. The overall performance lately is demonstrating that they may not get the promised care when they do need it. Or they may actually need care and find that they are not getting it because the doctors are not accepting appointments or the patients are reluctant to try to make an appointment.

As new premium payments come due, people may start to opt out of paying. Later this year, there will be a new open season and many people may decide not to sign up for another year. The reason is that they are seeing the value of the plan not being as good as they thought it would. The plan is not going to save them as well as they thought it would if they were to have heart attacks, strokes, get diagnosed with cancer, or some other disease.

We are promised that this pandemic will be around for at least another year, probably longer, until a vaccine is available. During this period, we can expect our health care systems to being distracted from doing anything else that is not COVID19 related. The ACA or medicare premiums are not going to help as much as expected for non-COVID19 conditions, and even the treatment for COVID19 is not as attractive as was once expected.

I can see a substantial number of healthy people opting out of these programs in the coming months and for next year. They will be recognizing that they will not be getting the services that they were led to expect. They may even recognize their own situations where they did not get medical attention as quickly as normal either because of the new difficulties of scheduling an appointment, or their deciding they would rather postpone given all the negative news about health care at present.

There have been a lot of COVID19 patients, but there is a far greater number of people who are paying their premiums while not needing healthcare yet. Those premium payers are paying attention to what they are going to get in return for those payments. The deal does not look as attractive as they did before, and for ACA plans, they were already unattractive in terms of return for the premium payment.

I wrote much earlier about the need to have two different health care systems: one for non-contagious diseases and one for the contagious diseases. The COVID19 situation demonstrated that we had only one of these. All of our premiums are going into the health care that we are most concerned about, the type of care that the medical system is best equipped to deal with: conditions such as cancers, heart disease, strokes, etc. The COVID19 situation hijacked this system and effectively shut it down much like the virus itself hijacks the cell and shuts it down.

We need a parallel medical system for infectious diseases that have their own infrastructure and staffing separate from hospitals. That system would have its own independent source of funding. That way when a contagion happens, there would be no impact on the regular health care system, people will continue to get the care they expect for their premiums.

Instead, we have just a single system and that system inevitably will become devoted to the contagious disease, pushing all other health care services as optional or secondary. This may be inevitable due to the nature of medical practices.

Premium payers are paying attention. The insurance against possible non-contagious conditions may not deliver what was promised if a contagious event occurs, and the medicine for contagious diseases do not promise a very impressive recovery rate. With COVID19, we learned that our health care premiums do not guarantee access to health care when we need it.

The insurance subscribers may start to leave, and they would have good reasons. The health care system is like a computer operating system, it needs an antivirus feature.


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