Single-Payer System Would Be More Effective in Managing Pandemics

Interview with Dr. James G. Kahn, emeritus professor, Philip R. Lee Institute for Health Policy Studies at the University of Southern California at  San Francisco, conducted by Scott Harris

Since first being identified in Wuhan, China in December 2019, the coronavirus, COVID-19 has spread quickly around the world, hitting the nations of South Korea, Italy and Iran the hardest. As of March 10, more than 113,000 people have reportedly contracted the virus and 4,000 have died worldwide. In the U.S., at least 973 people in 37 states and Washington, D.C., have tested positive for coronavirus, according to a New York Times database, and at least 30 patients with the virus have died.

In the midst of growing fear about the spread of the virus, the Trump regime has spread irresponsible and dangerous misinformation about the numbers of people in the U.S. who have been infected, the availability of test kits, with the president even recklessly advising people with the virus to go to work. With the U.S. stock market experiencing wild coronavirus triggered gyrations and plunging to its largest single-day point drop in its history, the administration is fighting a two-front war, incompetently attempting to address both the spread of the disease and the economic meltdown.

Between The Lines’ Scott Harris spoke with Dr. James G. Kahn, emeritus professor at the Philip R. Lee Institute for Health Policy Studies, at the Department of Epidemiology and Biostatistics at the University of California, San Francisco. Here, Dr. Khan examines the Trump administration’s deficient handling of the coronavirus pandemic and the benefits of universal health care – also known as “single-payer” – such as the proposed Medicare For All legislation, in protecting communities from contagious disease.

DR. JAMES G. KAHN: My understanding is there are some well-established best practices that require isolating people with known or suspected infection. That means keeping them away from other individuals, but also when there is an interaction between the healthcare workers who are providing the early care and the people who are infected, that needs to be done in an extremely careful way to avoid exposure. And there was an incident there that I read about it in the paper about a week ago when the experts from the Centers for Disease Control said, “This is how we do this.” And they were overruled by a political appointee from the Trump administration. And I just think that’s a terrible way to apply the best science. It’s a scientific decision and medical decision. It shouldn’t be based on some political calculus. And I think what we’re seeing also with the president at his press conference is that he is focused on trying to reassure people that this is really not so bad and we shouldn’t worry about it so much and it’s going to go away, when really what we should be doing is giving people information that will allow us to make that true, to allow us to control the spread. So there’s quite a bit of concern that this is still not optimal, but it’s headed more in the right direction.

SCOTT HARRIS: At a certain point, the president advised people who are sick with coronavirus to go to work, which was certainly a piece of very harmful misinformation that was put out there. And that’s among many comments that the president has said off the cuff that seemed to really damage the government’s credibility here in handling this situation. Dr. Khan, what’s the best way for the medical community to combat that type of misinformation?

DR. JAMES G. KAHN: Well, I think what you’re seeing is that there are a lot of knowledgeable and experienced public health professionals who are putting out correct information. For example, such as you shouldn’t go to work if you suspect that you may be infected or if you’re sick. in fact, many, states, municipalities, universities are making decisions to reduce exposure at work or in classes. For example, Stanford University is no longer holding classes in person. At University of California, San Francisco where I’m based, the major teaching building at our new campus has been – everyone’s been told – that the classes will happen through Zoom and other technology online and not to come in. So I think there are many good decisions being made because a lot of experts, public health officials are weighing in and ignoring the White House press conferences.

SCOTT HARRIS: Dr. Khan, as a supporter of Medicare For All and universal healthcare, what are the major advantages of a system that covers everyone in the country when it comes to combating a disease pandemics like the coronavirus?

DR. JAMES G. KAHN: Well, there are three major advantages. The first is, of course, that everyone who needs care — and coronavirus can be quite serious — knows that they can get care and it will be paid for. So that’s in general a huge advantage of Medicare For All is that people can get the care that they need.

The second is related to tracking the epidemic. If people have access to care without financial barriers so they’re both insured and they don’t have big deductibles or cost-sharing or ideally no cost barrier at all, as would be true with Medicare For All, then if they get sick, they will go to the doctor and get diagnosed. And those reports can then be used to supplement other kinds of reports to help track what’s happening with the epidemic.

And then the third thing is a little geeky and I apologize for that, but the quality of data that we get from clinical interactions right now is really quite bad because we have so many different insurance companies and so many different electronic health records that it’s all a mashup and it’s impossible to get the data and making use of it in real time.

But under Medicare For All, we would have a single electronic health record and a single billing system that’s one of the great appeals of Medicare For All – it saves a lot of money on paperwork. And by having that single data system, we could very quickly detect, “Oh look, there are a lot of people seeking care for fevers in this jurisdiction and that may tell us that’s where the epidemic is going.” So it, it serves a disease surveillance purpose if you have really good data, which right now we don’t.

I spend a lot of time writing both scientific papers and opinion pieces that go online or into newspapers. And I have certainly listed out many reasons that we should support Medicare For All. One of them is that it will save money. Another one is that it is great for everyone who can care for themselves without financial barriers. And there are quite a few other reasons, but once coronavirus hit, it reminded me that we all have an interest, a distinct medical interest in having everyone in our community have access to care, to be diagnosed and treated. So yes, chalk it up as another reason to push for Medicare For All.


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