US needs to provide affordable comprehensive health services
Posted on April 12th, 2020

By P.K. Balachandran courtesy Ceylon Today

The US now accounts for a third of the “active” COVID-19 cases in the world. According to the latest figures put out by the WHO, there were 1,101,497 active cases in the world as a whole on Thursday April 9. Out of this, 397,472 were in the US. In contrast, China had only 1,160 active cases.

Of the 88,565 deaths due to COVID-19 in the world as a whole, the US accounted for 14,797 and China 3,335. The US stood at the top of the pile in terms of active and critical cases, though in terms of the number of deaths, the toll was more in Spain and Italy.

Experts say that while the US is rich and has a sophisticated health infrastructure, its healthcare facilities are expensive and out of reach for millions. It is not State-backed to the extent it is in the UK. When Barack Obama was President, he introduced the “Patient Protection and Affordable Care Act (ACA)” in 2010, which came to be known as “Obamacare”.

Obamacare based on the insurance system

But Obamacare is still based on the insurance system, unlike the National Health Service (NHS) in the UK, which is entirely free and available to all irrespective of class. No wonder, the US was topping the list in coronavirus infection on April 9, while the UK was eighth.

According to available literature on the subject, Obamacare mandated that everyone buy insurance. As a result, healthier young people paid premiums even though they didn’t use their insurance as much as older people did. That offset insurance companies’ cost of insuring even the most sick.

The ACA prevented companies from excluding anyone. As a result, everyone could afford to see a doctor before their symptoms turned into a crisis. Prior to the ACA, the uninsured used expensive hospital emergency rooms as their primary care provider.

Obamacare expanded subsidies for middle-income families. That allowed more people to afford better insurance packages. Prior to the ACA, only families with corporate-sponsored insurance could afford comprehensive plans.

Obamacare tax increase resented

To pay for the subsidies, Obamacare increased taxes on health care providers and high-income earners. People making US$ 200,000 a year (US $250,000 for married couples) paid higher income and investment taxes. To enforce the mandate, a tax penalty was levied on those without insurance. The US Congress repealed the tax penalty with the Tax Cuts and Jobs Act. It went into effect in 2019.

But the increased tax burden generated opposition from conservatives. This led President Donald Trump to declare that he will repeal Obamacare. However, it is still there benefiting about 4.1 million people.

UK’s NHS  

The NHS of the UK is completely state-funded and is comprehensive. It is also cheaper than Obamacare. The NHS spends much less per person than the American health-care system does, yet it achieves better outcomes, according to the Commonwealth Fund  which monitors health management in select Western countries.

The Netherlands’ system is not based on a single-payer of the bill (unlike the NHS). But like the NHS, it also achieves near-universal coverage through close government regulation. The US system is also too expensive by European standards. Despite Obamacare, which made health insurance somewhat affordable, insurance is still expensive as per European standards. No wonder 26 million Americans did not have health insurance as recently as in 2016.  

The US doesn’t invest in social services. Things like home visiting, better housing, and subsidised healthy food which could improve chronic disease outcomes don’t exist there. It is because of all these factors that life expectancy has been going down in the US as compared to the 1960s.

Choosing guns over butter  

The US spends more on weapons of war than public health. It downsizes budgets of health institutions for the sake of spending more on weapons programs, says  Gregory D. Koblentz and Michael Hunzeker of George Mason University who are experts in biological threats to National Security.  

They wrote in The Atlantic that the US Establishment has been consistently ignoring threats from viruses and has been spending heavily on weapon systems.  

The American Establishment had forgotten that viruses could kill more Americans than weapons in war. The 1918 Spanish flu pandemic killed at least 40 million people and among the dead were 195,000 Americans.

Koblentz and Hunzeker point out that the Trump administration was not interested in fighting threats from viruses. “It raided the Defense Threat Reduction Agency’s budget for working with other countries on biosecurity threats to pay for more research on hypersonic missiles. 

The National Nuclear Security Administration saw its budget increased by 20 percent to pay for new nuclear weapons, even as the administration slashed the budget for the Center for Disease Control and Prevention (CDC) by 15 percent,” they say.

The entire 2019 federal budget for all health security-related programs was about US$ 13.6 billion. In contrast, the Trump administration has requested almost US$ 46 billion in funding for nuclear weapons programs in its 2021 budget proposal, the authors point out.

Koblentz and Hunzeker quote Nobel laureate Joshua Lederberg who said that the single biggest threat to humanity’s continued dominance on this planet is the virus. Biomedical research, public health preparedness, and international cooperation are the keys to global health security, the laureate said.

But what President Trump is doing is just the opposite. He is going to cut funding for WHO because it allegedly prevented him from clamping a ban on travel when the COVID-19 threat was spotted on the horizon. He charged that WHO was working behind the scenes for China.

If indeed US funding for WHO ceases, the only world organisation working for disease control and health across the globe will go kaput.

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