Ebola, Epidemics and the Need for Change

From Healthcare4AllPA Newsletter, November 2014


The disputes and panic over Ebola bring into focus the need for fundamental changes in our health care system.  We are heading for disaster if our profit-driven health care system continues to drain our financial resources and skew our priorities in health care research and delivery.  The current complex array of expensive insurance middlemen creates dysfunctional competition between different components of the health care system.   The health insurance industry routinely lobbies against government involvement in insurance to protect the profits they make, but when a public health crisis looms, all eyes turn toward the government, expecting our tax dollars to fill the gaps in paying for the necessary resources to avert the crisis. This system is neither financially nor ethically responsible.  When facing a crisis such as an epidemic, a successful strategy must be founded on long term planning, cooperation and a dedication above all to the public good.  A reliance on competition, market forces and purely financial incentives will lead to disaster.


As physician and public health expert Dr. Walter Tsou told Amitabh Pal in a recent interview:  “We have known about Ebola since 1976 and yet we still have no vaccine or treatment…In the cruel economics of the pharmaceutical industry, unless a drug promises a significant return on investment, [drug companies] are unwilling to invest in it.” ( http://www.healthcare4allpa.org/top-doc-says-ebola-shows-skewed-priorities/)


An Ebola epidemic in our country is unlikely, but we are currently struggling to control other infectious diseases in the U.S. (http://www.pbs.org/newshour/updates/six-diseases-actually-worry/).  MRSA – an infection that is easily spread – is one example.  The high deductibles of the most affordable health insurance plans encourage people to self-treat what would first appear to be a painful spider bite, seeking medical treatment only when the infection is advanced. The delay in seeking medical treatment allows the infection to be spread to others, and MRSA is much more expensive to treat in the advanced stages.  Thus, high deductible and/or high co-pay insurance exponentially worsens the public health consequences, both human and financial.


If the U.S. were hit with an epidemic caused by an airborne pathogen, such as SARS, those least likely to afford a medical check-up will be in the position to infect the most people: our minimum-wage service personnel who each literally contact hundreds of people daily in the food service and retail industries.  Daily care of small children and the elderly, the most vulnerable people in our population, also often only pays minimum wage.  Full time minimum wage does not afford a low deductible comprehensive health insurance policy.  According to Dr. Tsou, (http://www.healthcare4allpa.org/health-justice-the-best-cure-for-ebola/) the 2003 SARS epidemic in China was brought under control only after the government announced that individuals with SARS symptoms would be treated regardless of ability to pay.


Under the terms of the Affordable Care Act (ACA), states are allowed to innovate starting in 2017; i.e., state-based health plans can be created as long as the plan meets the standards set forth in the ACA.  There is a plan for Pennsylvania, complete with specific legislation (http://www.legis.state.pa.us/cfdocs/billinfo/billinfo.cfm?syear=2013&sind=0&body=S&type=B&BN=0400), that would provide comprehensive coverage for all Pennsylvanians.  The savings to individuals and the state would be immense: 18 billion per year according to the recently completed economic impact study.  (http://healthcare4allpa.org/temp/wp-content/uploads/2013/03/EconomicImpactStudy3513.pdf).


Our tax dollars and health insurance premiums must be put to more efficient use than the counterproductive expenditures endemic of our current profit-driven commercial health insurance system. When the focus of insurance is on maintaining individual and public health, then cooperation among providers will lead to the greatest public good.  If the direction of our health care is bound by a reliance on market forces and financial incentives, the public good cannot be assured.  We should not be waiting until disaster strikes to verify what is already clear: none of us is safe from disease unless all of us are safe from disease.  Profit driven commercial health insurance puts us all at risk!