COVID-19 has exposed the best and worst in U.S. health care. The private sector has responded effectively—and at times heroically—to the challenge. Frontline medical workers have labored sacrificially to treat influxes of patients; hospitals have improvised to add beds and medical equipment, and pharmaceutical companies have moved rapidly to develop treatments and vaccines.
The response of government public health officials, by contrast, has been largely clumsy and often ineffective.
Despite years of planning and tens of billions in spending on pandemic preparedness, the public health establishment was unprepared.
The CDC failed to recognize the seriousness of the contagion early on and developed a defective test for the virus. The FDA exacerbated the error by initially blocking tests developed by private laboratories from the marketplace.
Public trust in the government’s vaunted capacity to prepare for disaster eroded further with news that it had failed to stockpile adequate supplies of personal protective equipment.
The public health establishment also failed to provide accurate and timely data about the spread of the pandemic, blinding state and local officials, doctors and others to the state of the contagion in their communities. CDC defied four laws, dating as far back as 2006, directing it to create a modernized, real-time data collection system. Instead, the government in many cases still collects COVID-19 data by phone and fax.
Government lockdowns exacerbated economic and racial disparities by destroying millions of jobs deemed “non-essential” by public officials.
Those fortunate enough to work remotely saw their disposable incomes and savings rise, even as millions of city-dwellers with lower-paying jobs—disproportionately minorities—were consigned to unemployment lines and food banks.
People of means shunned cities, while lower-income residents were often confined in multi-family units and in multi-generational households where the contagion easily spread.
Those same lockdowns banned non-emergent care, leading to a rise in deaths unrelated to COVID-19, especially among people with chronic illnesses.
And while government lockdowns shuttered businesses, churches and schools, they neglected to protect the population that accounts for nearly half of COVID-19 deaths—nursing home residents.
These are just some of the human, economic and social consequences of putting government in charge of health care.
And yet some insist that the results of government’s failed COVID-19 interventions argues for yet more government intervention, this time to achieve “universal coverage.”
The fact is that we are closer to universal coverage than most imagine. The Census Bureau last week released two surveys that estimate the percentage of U.S. residents with health coverage during 2019. One showed a slight increase in the number of uninsured, the other a small decrease. One survey estimates that 91 percent of the population had coverage, while the other estimated 92 percent.
A deeper dive into earlier Census Bureau surveys reveals this startling fact: 99 percent of people lawfully present in the United States have access to affordable health coverage, regardless of their income or medical condition.
People not lawfully present in the U.S. constitute the largest bloc of the uninsured. The vast majority of the uninsured people with lawful immigration status are eligible to enroll in free coverage under Medicaid or subsidized health insurance in the exchanges, and millions of others have declined the offer of employer-sponsored insurance. Affordable coverage is available; millions haven’t enrolled.
It is too soon to know how COVID-19 may have changed the insured numbers. Government-ordered lockdowns have destroyed many jobs. But most jobs the government deemed “non-essential” are in sectors where employer-sponsored coverage is not the norm. Many of these unemployed workers may already have been enrolled in Medicaid or subsidized health insurance, so their coverage is uninterrupted. If they weren’t enrolled while working, they likely became eligible when they became unemployed.
The best way to move closer to universal coverage is to empower patients and their doctors, not politicians and bureaucrats. Choice and competition, not government regulation, will force high health care prices down and make coverage more affordable.
The Trump administration has given us a partial glimpse of what this might look like with a rule that allows employers to contribute to tax-favored accounts that employees can use to purchase their own health insurance. Such coverage is more secure because the worker, not the employer, owns the policy even if she changes or loses her job. By drawing healthy workers into the individual health insurance market, these accounts also can repair some of the damage ObamaCare inflicted on those markets.
The failure of government experts to respond effectively to COVID-19 shows the folly of granting government more control over health care. Relaxing regulations to maximize health care choice and competition is the best way to progress toward universal coverage.
This piece originally appeared in the Hill on 9/22/20