It’s Time to Expand the COVID-19 Exception to All American Health Care

Yves here. In theory, spending more money on other US health care priorities, as we have with some elements of Covid response, would be desirable. But in a saying attributed to Yogi Berra, “In theory, there is no difference between theory and practice. In practice, there is.”

We have a bloated and fabulously inefficient health care system. There’s every reason to think that more generous funding of health care priorities, like tackling cancer or autoimmune diseases, would largely go to private equity and health care executive pay packages.

The biggest thing the Feds could do is use government buying power to negotiate drug prices, as every country in the world except the US does. Stopping the price gouging on insulin (and tons of other meds like Sovaldi, Zolgensma, Acthar Gel, and Isuprel which saw huge price increases) would do more to help Americans than long-term initiatives to tackle Big Ailments, given not just the uncertainty of results but questions about whether the effort could be sustained and how to prevent it from becoming the medical version of the F-35.

I wish I had a better answer. But the fact that the US has no good data about any aspect of Covid: how many have had it and what variant if so, how many have died and been hospitalized, how many have been vaccinated, and has made messaging more important than results says we aren’t capable of running large projects, even when the health of citizens and the economy depends on them.

And I have to cringe when I hear people who have not encountered Medicare depicting it as a paragon. It’s a public-private program with lots of gaps and insane complexity. Yes, it’s better than not having insurance, but treating it as some sort of nirvana is wildly naive.

By Sonali Kolhatkar, the founder, host and executive producer of “Rising Up With Sonali,” a television and radio show that airs on Free Speech TV and Pacifica stations. She is a writing fellow for the Economy for All project at the Independent Media Institute. Produced by Economy for All, a project of the Independent Media Institute

There has been a Jekyll-and-Hyde quality to American health care over the past two years. The federal government under the previous administration of Donald Trump, as well as the current one of Joe Biden, has carved out what can be characterized as the “COVID-19 exception,” inconsistently intervening to help people avoid the virus or recover from it, while standing by as Americans struggle with other ailments. In doing so, it has exposed the vast fissures of a broken system into which millions of Americans routinely fall, some, never to emerge.

For example, the Biden administration is now taking action—albeit a year late—to ensure that Americans have a small measure of access to COVID-19 rapid antigen at-home test kits. Without requiring congressional approval, the government launched a centralized and straightforward website for people to order free antigen testing kits. The site is stunningly easy to use, does not require any other information besides a name and address, and relies on the U.S. Postal Service for distribution.

That effort came on the heels of an announcement that private health insurance companies would now be required to reimburse their patients for the cost of such tests purchased out-of-pocket.

Although these policies are being enacted nearly two years into the pandemic, they are certainly better late than never. They signal that the federal government tacitly recognizes the prohibitive cost of protecting oneself from a rapidly mutating and increasingly transmissible virus for low-income Americans.

The government is also providing free masks—finally. Experts recently dismissed as insufficient the now-ubiquitous reusable cloth masks, in the face of the Omicron variant. The Centers for Disease Control and Prevention (CDC) has instead recommended high-quality medical disposable masks such as N95 masks, which are very difficult to come by, or similarly protective KN95 masks, which run upward of $1 a mask. In response, the White House has announced a program to make 400 million N95 masks from the strategic national stockpile available to Americans for free through local drug store chains.

Commentators are pointing out that it’s past time that the government offer free at-home tests and masks—as if inaction on health care wasn’t a standard feature. The Washington Post compared the U.S. to other nations that made such protective materials available to their citizens for free far earlier in the pandemic, and pointed out that the United States’ “lack of universal health-care coverage contrasts sharply with other nations.”

In spite of arriving late to offering masks and at-home tests for free, the federal government has adopted more of an interventionist posture on COVID-19 than any other health care front, ensuring that vaccines, most testing, and treatment remain largely free of charge to Americans. Insurance companies are mandated to cover COVID-19-related costs regardless of the contours of individual plans. And, the uninsured have their costs covered by the government.

The flip side of this commendable government approach to the pandemic is that it ignores those who are unlucky enough to be uninsured or underinsured and struck by any other ailment besides COVID-19.

Take cancer, an illness that affects 1.6 million Americans each year and is the second leading cause of death in the nation. Studies show that cancer-related death rates are higher for those who lack private health insurance compared to the insured. Might such disparities vanish if the government considered cancer to be as worthy of intervention as the coronavirus?

Peter Arno and Philip Caper, writing for Physicians for a National Health Program, asked this critical question in another way: “will our first-hand experience of the federal response to the pandemic (delayed though it was) dispel the usual objections to single-payer health care? Or will most Americans conclude that the public health crisis caused by this pandemic is a one-off exception?”

Although the COVID-19 exception is a promising step toward federal intervention in health care, the programs to distribute vaccines, tests, and masks are still woefully insufficient or disorganized—precisely because the United States lacks a centralized universal health care system through which to enact such efforts. Last year’s COVID-19 vaccine rollout was chaotic precisely because the federal government had to rely on a patchwork system of private and public health care, private for-profit drug store chains and smaller nonprofit organizations.

According to Public Citizen, “Countries with a more unified system are better able to roll out testing, track the spread and intervene appropriately, as they aren’t forced to negotiate with numerous private insurers, issue regulations or orders for multiple public insurance programs, or figure out how [to] handle testing and treatment for the uninsured.”

The United States is a global embarrassment when it comes to health care. The Economist magazine once described the U.S. as, “The only large rich country without universal health care.” The U.S. joins extremely poor nations like Afghanistan and Yemen on the list of 10 notable countries without a universal government-run health care system.

According to a recent Federal Reserve report, “[s]eventeen percent of adults had major, unexpected medical expenses in the prior 12 months, with the median amount between $1,000 and $1,999.” The report also found that “[t]wenty-three percent of adults went without medical care due to an inability to pay.” These statistics are startling and yet, not shocking enough for the government to either expand the COVID-19 exception to cover all illnesses, or expand the Medicare program to cover all Americans. Either step would ensure that no Americans would forgo health care due to an inability to pay.

This depressing status quo is the direct outcome of a well-funded propaganda war by corporate profiteers against expanding the existing Medicare program to all Americans. They include health insurance companies, the private hospital industry, and pharmaceutical corporations.

Interestingly, the standard critics of government-funded health care are stunningly silent on the COVID-19 exception—perhaps because they understand just how shameful it is to deny people care for a pandemic that has eclipsed normalcy and claimed over 800,000 American lives. There is a silent acceptance of the government taking responsibility for ensuring protection from COVID-19, but not from cancer, diabetes, or any other illness.

The naysayers against Medicare for All are relying on Americans simply not noticing the COVID-19 exception.

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    1. Katniss Everdeen

      Those of us with experience with the current Medicare program have known all along that if “M4A” meant “Medicare” as currently constructed, it would just be out of the frying pan and into the fire. Bernie should have known that too and not glorified Medicare as the be all and end all.

      1. Copeland

        And of course, since you’ve been reading and commenting here for years, you know that Bernie’s version was not M4A “as currently constructed”, it was vastly better, and I think Pramila’s plan would have been better still.

        We’ve been all over this for years now, Bernie branded his plan very badly, (indeed, he branded himself very badly – “I’m a Socialist!”) but it wasn’t a bad plan.

        1. juno mas

          Yes, Bernie did want to expand Medicare for all, but also expand the services, i.e.; dental and vision care. These are services that help the young and the old engage with life better. However, Bernie likely never engaged with Medicare at all, since as a member of Congress in his senior years, he’s covered by a separate federal medical health plan.

          Those of us who have engaged with Medicare understand it’s better than “work place” insurance, but also requires a high degree of clairvoyance to estimate our future medical needs. And it remunerates primary care physicians relatively poorly (compared to others) which diminishes the supply of front-line improvers of the public health.

          I believe Pramila’s proposal was more on the line of a single payer system.

    2. Carla

      Single-payer advocates SHOULD always refer to what we demand as “Expanded and Improved Medicare4All.”

      You’re onto something, kirk: in many respects Medicaid coverage exceeds that of Medicare. But Medicaid has its own serious problems. It has been widely privatized and cannibalized as well, and as I know from a family member who has pretty good Medicaid coverage thanks to living in Maryland, so few doctors will accept Medicaid patients that its advantages quickly disappear. In most of the country (maybe some very high-wealth zip codes excepted), almost all doctors accept Medicare. Furthermore, Medicaid coverage and benefits vary dramatically from state to state, while basic Medicare coverage is national.

      1. Screwball

        Unless something has changed, in Ohio where I live, you are not eligible for Medicade unless you have next to zero wealth. When I put my dying mother on it, I had to liquidate all her assets until she was almost broke, then she qualified. I had already went through most of her life’s savings and assets paying the doctor, hospital, and supplemental insurance.

        It doesn’t take long once she went in a rest home. 3 grand a month for living there, and they pumped $1200 bucks a month of drugs through a 90 lb women. Amazing.

        She spent 2-3 years in and out of hospitals and rest homes. I told people they were going to milk her of all her money and then let her die. That’s exactly what they did, to make a long story short.

    3. LAS

      One important difference between Medicare and Medicaid is that Medicare is funded/managed exclusively by the federal gov. and offers essentially the same benefits in all states. Whereas Medicaid is mutually funded/managed by federal AND state; its benefits vary by state. In a few states, Medicaid nearly eclipses Medicare for the beneficiaries and their experience, while in others it is a worse experience. This makes it hard to generalize which M4A to advocate for.

  1. Michaelmas

    US ‘healthcare’ now costs about 17-18 percent of GDP and produces about the worst outcomes in the developed world, whereas N. European nations, like Norway, Denmark, and the UK, run at 8-10 percent GDP and produce seriously better outcomes.

    Another, more accurate, term for this than ‘healthcare’ is looting.

    That is, the US for-profit ‘healthcare-insurance industry’ is best understood as a system for annually looting 7 percent of US GDP to give to wealthy asset holders and ‘industry’ executives–the rich.

    The thing is, a small fraction of 7 percent of US annual GDP buys all the American politicians and lobbyists that will ever be necessary to maintain that system of looting. Ninety-nine percent of Americans might be in favor of single-payer healthcare and it still won’t happen because the rich control the government.

    That’s not going to change till the vast mass of Americans wake up and recognize that contrary to the endless propaganda–except for a short interregnum during Roosevelt’s New Deal–this country’s Owners have always operated it as a colonial kleptocracy, much like Brazil.

    Except my bad. Brazil may have favelas, but also public healthcare provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, the Unified Health System (Sistema Único de Saúde, SUS), which is universal and free for everyone.

    Russia has free healthcare for all citizens provided by the state through the Federal Compulsory Medical Insurance Fund, and regulated through the Ministry of Health.

    If Brazil and Russia can have universal healthcare and the US can’t, what does that say about the US today? The answer is, that the US is arguably the most outright example of a kleptocracy in the world today.

    1. jsn

      Nationalize the insurance companies and use their vast staffing and infrastructure to do contact tracing the Japanese way.

      Use the Defense Production act to direct the Med IC to provide actual care with costs for equipment operation and recapitalization along with direct salaries covered by the US. Offer to buy out the private owners, who knows how long it will take “assets” to return to profitability? Treat Phama the same way.

      But, of course, we can’t even agree COVID is a real problem. Our governing class clearly sees it a just another messaging problem.

  2. KD

    Because what comes out of Congress reflects the preferences of mean voters. . . I don’t think so. Not a lot of evidence for that contention.

    Why not just focus on expanding voting rights, since it doesn’t matter anyways and so the lobbyists don’t care?

  3. Code Name D

    I am thinking that if Hillary the Great had won the election, we wouldn’t even have the Covid carve out.

    1. Anthony G Stegman

      The Covid exception would likely have been needs based. Unless you were dirt poor you would get nothing (tests, masks, vaccines) free.

    2. KD

      If Hillary had won, we would have government issued flying carpets and fake IDs so we could travel the UK and pretend to be British citizens and use the NHS. It would end global warming at the same time.

      1. John

        But Hillary’s means testing, id pol category setaside hurdles, Clinton foundation cut of the take would mean that you would only get your flying carpet to the UK three lifetime hence. Therefore die soon and get a start on the multi lifetime part.

  4. jefemt

    “And I have to cringe when I hear people who have not encountered Medicare depicting it as a paragon. It’s a public-private program with lots of gaps and insane complexity. Yes, it’s better than not having insurance, but treating it as some sort of nirvana is wildly naive.”

    So well-said. For any sub-60-somethings, I cannot recommend highly enough attending a year-end Medicare/ Medicaid planning meeting. These are generally hosted by County health officials, to run through what is new coming down the pie at the recipients/ participants of the ‘systems’.

    Byzantine, insulting, and breathtaking. Last one I attended, which also had a Congressional candidate sitting at the presenters dias… I finally in exasperation, piped up to the assembled crowd of Elders:
    why do you put up with this crap?

    We can, and should- do so much better. Cradle to grave, optical and dental, all in.
    Perhaps start with the benefits extended to Congress, the Executive, Judicial branches, Federal Employees, and top brass in the five branches (6?) of the Department of Empire/War.

  5. Telee

    The irony is that under Biden, Medicare, a social, non-profit public health program is now being transformed into a private insurance program to be administered by Direct Contracting Entities ( DCE ) which will be run by private equity groups and Wall Street investors. Biden has appointed Liz Fowler ( remember her ) to head the Medicare and Medicaid Innovation committee which was created as part of the ACA and given the power to make changes without any consideration from Congress. The plan is being implemented as we speak with thousands of trials all over the United States. Unlike traditional Medicare which uses 2% of its money for administration, the DCEs will use 40% of money from Medicare to administer its coverage. Incentives are in place to deny care, limit networks etc. and the DCEs keep the “saved” money. Wall Street views this as an excellent way to make money from its investments.
    Physicians for a National Health policy are actively opposing DCEs. They had a demonstration in Washington and tried to deliver their petition to HHS but they were locked out and didn’t accept the petition.
    Please get up to speed on this issue! I believe NC had one article on this but as far as the comments I haven’t seen evidence of interest in this issue. Even many congressional members seemed to be ignored of this transition although now their was a letter signed by over 50 congressional meber demanding an immediate halt to this privatization.

    1. JTMcPhee

      Wow, a plaintively worded letter from 50 members of Congress! That’s BOUND to insure (bad pun) strong action by the sh!tes in this government, all righty!

      Any actual bills in the hopper to stifle this latest horror? Wonder if the Brits will rise up to defeat the looting of their National Health Service. You can bet the Fokkers at AARP are right on top of this, for the benefit of their members /s.

        1. Telee

          Thank You Carla. Some people in congress still care about the people but not many. There are other bills calling for Medicare for all but the chances of passing are very slim. The republican party as drawn a red line which means they are 100% against doing anything for the people and the corporate democrats are of the same ilk. Everything for the rich, corporations and Wall Street and nothing for anyone else. The privatization of traditional Medicare will be a windfall for Wall Street and it is supported by Biden ( not publicly). People won’t have a choice and congress can do nothing by law. The door for this was opened up by the Obama administration and is part of the ACA. The people can’t get even the smallest reform. For example, nearly every other country has leave after a baby is born. In Germany, it is 14 months paid leave for both parents. Here nothing. Results of a class war since the 1970’s to get rid of everything from the New Deal and LBJ reforms. So dismal.

          1. thymia17

            Why am I not surprised to read this. Is there anything Biden is doing that doesn’t serve the interests of the 135 billionaires who donated to his campaign and their ilk, or those international organizations which shall remain nameless, which want to replace democratic global governance with a biometric technocracy state? Oh yes, free COVID tests. I forgot.

  6. David B Harrison

    I’m so tired of the lie that the people are to blame for not wanting Medicare for All. Legitimate polls show that a majority of Americans want Medicare for All or something like it. The author of this piece insinuates that the people have to ask for Medicare for All(see his 10th paragraph). They already have. It’s the politicians and media that are in the way. They serve their corporate masters well.

    1. Michaelmas

      It’s the politicians and media that are in the way. They serve their corporate masters well.


    2. Anthony G Stegman

      Not entirely. Most voters continue to vote for the people who will maintain the status quo. What keeps them from voting for others? Fear of the unknown? Perhaps. Many in the middle class who complain about things are also most fearful of change, because despite their fears they worry even more of falling down the social ladder. The middle class holds the key to any meaningful change. Unfortunately, they have been unwilling to go for it.

      1. KD

        Are you serious? Most voters continue to vote for people who will maintain the status quo because the status quo makes sure that only politicians who will work to maintain it get nominated for anything. Further, with congressional committees recommending legislation, the filibuster, the executive agencies (the better to water things down) and the federal courts, the whole system is set up to prevent any outsider who wins on freak chance from actually accomplishing anything other than maintain the status quo. Remember Obama? He did not run as a status quo guy, but he sure governed like one.

        The system isn’t broke, the fault is not the voters, the system does what it is intended to do, and voting helps to give it legitimacy. The system is capitalism, and it serves the interest of capital. If voting threatened the interests of capital, it would not be permitted or it would be nullified, either through courts or the army.

      2. DavidP

        Most if not all voters are allowed to vote for preselected candidates chosen by elite members of both private Parties which translates into no choice at all. All candidates offer no change to current status quo.

  7. henry crun

    And I have to cringe when I hear people who have not encountered Medicare depicting it as a paragon. It’s a public-private program with lots of gaps and insane complexity. Yes, it’s better than not having insurance, but treating it as some sort of nirvana is wildly naive.

    i thought that was just my reaction as i transitioned from employer-provided healthcare, especially as friends told me how much better off they were on medicare. my friends had previously had private insurance, so medicare was an improvement for them. for me, no way. i was shocked at how complex medicare was/is and even more shocked by the increase in out-of-pocket costs once i was no longer covered by the firm.

  8. Biden's diaper

    “Yves: And I have to cringe when I hear people who have not encountered Medicare depicting it as a paragon. It’s a public-private program with lots of gaps and insane complexity. Yes, it’s better than not having insurance, but treating it as some sort of nirvana is wildly naive.”

    Death Health Roulette. Pick a Number (that will never be yours).

    I voted for Bernie campaigning for Medicare for All, when he clearly understood the Advantages of Medicaid as a program. He’s fought a great fight. Maybe Trump will be able to expand Medicaid. Eligibility is simply a number.

      1. Anonymous

        It is in the sense it takes paperwork and documents, and maybe luck.

        My experience, 2017, was with XXXXXrum Health. They did not miss a beat. Upon discharge, and medically stable, I was asked to come back and have a sit down about the bill. Trust me, the ticket for ringing the ER and Imaging Department Bells for a kidney stone visit that turned into shock and awe (talk about competence in a Nurse reading labs-small ER no doc gonna goof early with an obvious diagnosis-kidney stone) about my blood work that resulted in scanning my heart, my lungs, my liver and my pancreas, was dear.

        Back I went to parlay about what I assumed was impossible. I had made $17k that year up to admission. I was exhausted. I was in the Lambert deficit, something less than total chaos, with a 19mm kidney stone, a calcium/oxalate devil, red blood cells out of control, and a weird Norwegian iron head heart liver and pancreas thing. It might not kill me, but when it first did its thing I did wish it would.

        And, I thought, because markets. One mucks through until one cannot. Especially true with two children. And then one mucks some more.

        I have to say, the Medicaid system worked. Twice. My daughter is one of four people in the world have undergone a type of surgery. Having gone through genetic testing, she is one of six known to have been born with a type of specific chromosomal dropout. My PCP (I volunteered for a program that gives younger residents access to a complicated presentation-and have demanded and received unlimited email access) is great. He takes the time to, well, talk and observe and communicate with me.

        1. Yves Smith Post author

          I have a friend in NYC who has been on Medicaid. He is HIV positive. Medicaid plus NYC programs to help HIV positive patients have kept him alive and able to work part time.

  9. Earl Erland

    “I wish I had a better answer. But the fact that the US has no good data about any aspect of Covid: how many have had it and what variant if so, how many have died and been hospitalized, how many have been vaccinated, and has made messaging more important than results says we aren’t capable of running large projects, even when the health of citizens and the economy depends on them.

    And I have to cringe when I hear people who have not encountered Medicare depicting it as a paragon. It’s a public-private program with lots of gaps and insane complexity. Yes, it’s better than not having insurance, but treating it as some sort of nirvana is wildly naive. ”

    Medicaid: Very small, vanishingly small deductibles. They send a $ 5.00 statement or something like that occasionally they refer to as a deductible. I and my daughter benefited from the MI Medicaid system. I was self employed, divorced,raising two children (one was in an ISD) and spending the kind of time with my children that my wife and I had discussed, when she decided to not work. My Daughter had the year of pain and medicine (in pain not sleeping Med Center in pain not sleeping Doc Appointment in pain not sleeping – Imaging-surgical appointment-surgeon comes out in 10 minutes advises Ann Arbor for her 14 year old). Ann Arbor Surgery. All covered by Medicaid.

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