Eclinicalmedicine 23 2020 100380contents Lists Available At Scienced ✓ Solved

EClinicalMedicine Contents lists available at ScienceDirect EClinicalMedicine journal homepage: Commentary The imperative for universal healthcare to curtail the COVID-19 outbreak in the USA Alison P. Galvania,*, Alyssa S. Parpiaa, Abhishek Pandeya, Charlotte Zimmera, James G. Kahnb, Meagan C. Fitzpatricka,c a Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, CT, United States b Department of Epidemiology and Biostatistics, School of Medicine, The University of California, San Francisco, United States c Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States A R T I C L E I N F O Article History: Received 28 April 2020 Revised 29 April 2020 Accepted 30 April 2020 Available online 17 May 2020 The COVID-19 outbreak in the United States is growing steeply and spreading widely.

As of March 26, national incidence surpassed every other country, and as of April 28 has reported over a million cases. The COVID-19 crisis is exposing the systemic frailties in our healthcare system. More than 78 million people in America do not have access to adequate health insurance [1]. Given that health insur- ance in the US is typically provided by employers, millions more are at risk of losing their healthcare coverage as unemployment surges. Here we discuss how the pervasive healthcare insecurity in the US hampers control of COVID-19.

Further, we argue that universal healthcare would alleviate the cost barriers that are impeding control of this pandemic. Outbreak mitigation relies on prompt diagnosis and case-isolation, in which mild cases are quarantined at home and more severe cases are hospitalized. These measures must be implemented rapidly in order to be effective. However, for the millions of people who are either uninsured or underinsured, concern about the medical expenses that could be incurred delays diagnosis and treatment. While the Fam- ilies First Coronavirus Response Act recently approved by Congress stipulates that COVID-19 diagnostic testing is nominally free for every- one, treatment is not covered.

Those who are hospitalized may face major medical expenses. For instance, the cost of 12 days in the ICU on ventilation would likely exceed US ,000 [2,3], even without consid- ering the additional hospital care before and after ICU admission. In addition to the burden on the uninsured, the under-insured are obli- gated to pay substantial out-of-pocket sums, including thousands of dollars in deductibles and copays. Although the Coronavirus Aid, Relief, and Economic Security Act has invested 0 billion into the Public * Corresponding author. E-mail address: [email protected] (A.P.

Galvani). 2020 The Authors. Published by Elsevier Ltd. This is an open access article unde Health and Social Service Emergency Fund for healthcare providers, less than one third of this sum can be used to fund the treatment of uninsured COVID-19 patients. Compounding the crisis, legal action being pursued by the current Administration is jeopardizing the Affordable Care Act, which would lead to the loss of health insurance for as many as 30 million people [4].

The COVID-19 pandemic also underscores the precariousness of a system in which insurance is linked to employment. Initial unem- ployment claims rose from 282,000 for the week ending March 14 to 6.6 million, 5.2 million and 4.4 million, for the weeks ending April 4, April 11, and April 18, respectively, compared with a previous record high of 695,000 from 1982 [5]. Many of these newly unemployed individuals will lose their health insurance. Although they are per- mitted to purchase insurance on the federal exchange, switching net- works disrupts continuity of care, which is particularly detrimental for those living with chronic health conditions. Furthermore, the majority of families are unable to afford health insurance upon becoming unemployed, given that more than half of American fami- lies live paycheck to paycheck [6].

Racial and economic disparities in the US healthcare system are being magnified by the pandemic. Rates of adequate health insurance coverage are much lower among people of color [7]. With less access to preventative healthcare, people of color are disproportionately affected by comorbidities, such as diabetes, obesity, asthma, and car- diovascular disease. These comorbidities exacerbate the severity of COVID-19 clinical outcomes, including death [8], as does delay in seeking care due to concerns about medical bills. COVID-19 is widen- ing socioeconomic fissures facing people of color as well.

Since the start of the outbreak, Latino populations have reported much higher rates of job and wage loss than Americans at large [9]. The solution to these challenges is the provision of comprehensive healthcare as a human right. Further, universal healthcare will be most cost-effectively achieved by a single-payer system, such as that proposed in the Medicare for All Act [1]. Not only would Medicare- for-All save lives, it would resolve costly inefficiencies that currently make our healthcare system the most expensive in the world. Among the major sources of savings, a single-payer system would consoli- date administrative costs, reduce overhead, empower pharmaceuti- cal price negotiations, and truncate executive pay.

A single-payer system is also incentivized to invest in cost-effective preventative r the CC BY-NC-ND license. ( mailto: [email protected] 2 A.P. Galvani et al. / EClinicalMedicine services that can avert life-threatening clinical outcomes and expen- sive downstream treatment. Another advantage of Medicare-for-All during this pandemic would be its implementation of a standard billing and payment system, which would accelerate COVID-19 case reporting. Billing procedures currently vary across dozens of insurers, and for private insurance is proprietary. Within a consolidated system, patterns in the billing data can signal out- break hotspots to public health surveillance officials.

This consideration is not hypothetical the single-payer system in Taiwan has facilitated exhaustive COVID-19 data collection and reporting [10]. Universal healthcare is fundamental to the continued prosperity of our country in the wake of this and future infectious disease threats. Obstacles to prompt diagnosis and case isolation not only impact the individual, but pose a broader societal risk. A pandemic illustrates an omnipresent truth: that we are each only as safe as the most vulnerable member of our society. We urge investment now in the common good of healthcare security, by extending comprehen- sive insurance to all who currently lack it.

Then, we should move swiftly to create a single-payer system, such as Medicare for All, which is the more efficient way to provide universal coverage [1]. By eliminating financial obstacles to healthcare, we can pave the way for more efficient outbreak control, in both this pandemic and the next. Declaration of Competing Interest None. References [1] Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prog- nosis of health care in the USA.

Lancet 2020;395:524–33. [2] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpa- tients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. [3] Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005;33:1266–71. [4] How would repealing the Affordable Care Act affect health care and jobs in your state?

Economic Policy Institute. impact/ (accessed April 3, 2020). [5] Office of Workforce Security, Employment & Training Administration (ETA) - U.S. Department of Labor. (accessed April 29, 2020). [6] First National Bank of Omaha. FNBO Releases Data from 2020 ‘Financial Planning’ Survey. financial-planning-survey/index.html (accessed April 9, 2020). [7] Buchmueller TC, Levy HG. The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care: an examination of how the insur- ance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Aff 2020;39:395–402. [8] Guo T, Fan Y, Chen M, et al.

Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020 published online March 27. doi: 10.1001/jamacardio.2020.1017. [9] Krogstad JM, Gonzalez-Barrera A, Noe-Bustamante L. U.S. Latinos among hardest hit by pay cuts, job losses due to coronavirus. Pew Research Center; 2020. pub- lished online April 3 latinos-among-hardest-hit-by-pay-cuts-job-losses-due-to-coronavirus/ accessed April 10, 2020. [10] Wang CJ, Ng CY, Brook RH.

Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. JAMA 2020 published online March 3. doi: 10.1001/jama.2020.3151. The imperative for universal healthcare to curtail the COVID-19 outbreak in the USA Declaration of Competing Interest References Annotated Bibliography Worksheet Student Name: A. Bibliographical Information: Author(s) Name: Title of Article: Date of Article: Journal Name: B. Summary of Article: C.

Evaluation of Article: D. Reflection on Application to Practice: Annotated Bibliography Rubric 50 Pts Exemplary Developing Needs Improvement Written Criteria 10 Points 7 Points 4 Points Faculty Comments Bibliographical Information Bibliographical information is accurately stated and formatted. Bibliographical information contains 2-3 errors. Bibliographical information contains more than 3 errors. Summary of Article Article is concisely summarized in one paragraph with no more than one error Article is more than one paragraph with one error Article exceeds one paragraph and has more than 2 errors.

Evaluation of Article Article is evaluated in light of its purpose and credibility Evaluation is loosely based on evidence but well organized Evaluation does not relate to purpose of article and is not evidence-based. Reflection on Application to Practice Reflection contains reference to application to current of future practice merits or lack of merit. Reflection is vague and only loosely related to current or future practice. Reflection does not connect merit or lack of merit to practice. Grammar, Syntax, APA Format APA format, grammar, spelling, and/or punctuation are accurate, or with zero to three errors.

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The Necessity of Universal Healthcare to Address the COVID-19 Crisis in the United States

Introduction

The COVID-19 pandemic has exposed the systemic vulnerabilities within the United States healthcare system, emphasizing the urgent need for reform. As noted by Galvani et al. (2020), millions of Americans are uninsured or underinsured, significantly hampering efforts to contain the outbreak (Galvani et al., 2020). This paper will explore the ramifications of inadequate healthcare access during the pandemic, the potential benefits of universal healthcare, and an analysis of the recommended single-payer system.

Summary of Key Issues

As highlighted, the crisis has exacerbated existing inequities in healthcare access, particularly for marginalized communities. The researchers note that more than 78 million Americans lack adequate health insurance, and many will risk financial ruin due to medical expenses during the pandemic (Galvani et al., 2020).
The discussion focuses on the current public health policies, such as the Families First Coronavirus Response Act, which attempts to address testing costs. Nevertheless, the act does not provide coverage for treatment, leaving those without insurance at significant risk of devastating financial burdens if hospitalization is required (Galvani et al., 2020).
One critical aspect that the authors expound upon is the impact of unemployment on healthcare access and continuity. As job losses surged during the pandemic, many Americans also lost their employer-sponsored health insurance (Galvani et al., 2020). Transitioning to federal exchanges is often impractical for many families, especially when they are already struggling financially.

Evaluation of the Article

The article is imperative in scrutinizing the current healthcare framework as it relates to the ongoing pandemic and advocating for universal healthcare as a viable solution. The authors use statistical evidence to underscore the inadequacies and financial burdens faced by uninsured individuals (Buchmueller & Levy, 2020).
From a credibility standpoint, the article comes from a reputable source—EClinicalMedicine, a respected peer-reviewed journal that specializes in healthcare discussions, particularly issues surrounding infectious diseases (EClinicalMedicine, 2020). The diversity of perspectives from authors affiliated with prestigious institutions, including Yale and the University of California, strengthens the article's validity (Galvani et al., 2020).
Additionally, the evidence presented supports the argument that healthcare access is paramount to effectively managing public health crises, evidenced by the recent outcomes of COVID-19 (Wang et al., 2020). Quoting costly statistics surrounding hospitalization and intensive care unit (ICU) stays underlines the financial consequences of ineffective healthcare access during emergencies (Dasta et al., 2005).

The Role of Comprehensive Healthcare

The critical argument made by the authors centers around the notion that universal healthcare is not just a social good but a necessity for effective pandemic control. In emphasizing the need for a single-payer system, they argue that it would reduce administrative costs, streamline care processes, and mitigate barriers related to out-of-pocket expenses (Galvani et al., 2020).
Moreover, the implementation of a standard billing and payment system would facilitate more efficient case reporting, ultimately allowing public health monitors to identify outbreak hotspots in real-time (Galvani et al., 2020). This aligns with evidence from Taiwan, which successfully utilized its single-payer system to manage COVID-19 effectively (Wang et al., 2020).

Connection to Racial and Economic Disparities

The emphasis on racial and economic disparities portrayed in this document cannot be overlooked. Galvani et al. (2020) elucidate the urgent care disparity that individuals of color face during health crises, and abundant literature confirms the correlation between lack of healthcare access and higher incidences of chronic conditions such as diabetes and cardiovascular diseases (Guo et al., 2020).
The authors also take into account socioeconomic challenges, wherein families living paycheck to paycheck often find themselves unable to afford healthcare post-unemployment, as described by the Pew Research Center (Krogstad et al., 2020). Addressing these disparities through universal healthcare not only serves as a moral imperative but as a public health strategy to minimize the broader impact of future health emergencies.

Reflection on Application to Practice

The implications of universal healthcare extend into numerous practice settings, requiring healthcare professionals to adapt to comprehensive, nuanced frameworks around patient care. Advocating for a system that transcends financial barriers allows providers to concentrate on clinical essentials rather than navigating the complexities of insurance systems. Moreover, knowledge of the underlying socioeconomic factors allows practitioners to guide patients more effectively through systemic barriers attached to healthcare access.
In conclusion, the call for universal healthcare as a response to the COVID-19 pandemic is grounded in both ethical and practical considerations. The COVID-19 crisis has revealed the critical need for reform within an often inaccessible healthcare framework, with the existing disparities calling for urgency. The evidence supporting single-payer systems not only points towards a healing and functioning healthcare environment but also demonstrates an essential pathway towards public health efficacy in the face of pandemics.

References

1. Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. Lancet, 395(10226), 524-533.
2. Zhou, F., Yu, T., Du, R., et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 395(10229), 1054-1062.
3. Dasta, J. F., McLaughlin, T. P., Mody, S. H., & Piech, C. T. (2005). Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical Care Medicine, 33(6), 1266-1271.
4. Economic Policy Institute. (2020). How would repealing the Affordable Care Act affect health care and jobs in your state?
5. Office of Workforce Security, Employment & Training Administration (ETA) - U.S. Department of Labor. (2020).
6. First National Bank of Omaha. FNBO Releases Data from 2020 ‘Financial Planning’ Survey.
7. Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care. Health Affairs, 39(3), 395-402.
8. Guo, T., Fan, Y., Chen, M., et al. (2020). Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiology.
9. Krogstad, J. M., Gonzalez-Barrera, A., & Noe-Bustamante, L. (2020). U.S. Latinos among hardest hit by pay cuts, job losses due to coronavirus. Pew Research Center.
10. Wang, C. J., Ng, C. Y., & Brook, R. H. (2020). Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. JAMA.