In the midst of a global pandemic, it’s worth considering how different health care systems are responding to COVID-19. Italy, a country of 60 million people with universal, government-run health care, has been brought to its knees by the overwhelming spread of cases. Government-run health care may provide universal coverage, but that’s an empty promise for those hospitals turn away. Anyone older than 80 isn’t even being considered for treatment at this time.
Here in the United States, a major contender for president, Sen. Bernie Sanders, staked his platform on democratic socialism and the claim that health care is a right government should secure. Understandably, this claim resonates with many, especially those who think the alternative is for health care to be treated like any other commodity. It shouldn’t. Health care is special — often a real life-or-death situation.
But that doesn’t mean health care is free from the market forces of supply and demand. Saying something is a right and saying it should be free for everyone doesn’t make it so.
However, the United States has its own share of problems and limitations restricting its ability to respond to the Wuhan coronavirus effectively. We’ll be better off than some other countries, especially if we succeed in reducing demand for services by slowing the spread of the virus, but we will still face challenges. Let’s look at the good news first.
America is two things: innovative and generous. These two qualities will guide us out of COVID-19, just as they have other crises in the past. We will find creative ways to manage sick patients, develop treatments and cures, and handle the rest of life. This won’t come without a cost, but if any people in the world are prepared to do things a new way, it’s Americans.
American companies and charitable organizations want to be a part of solving problems. Sick of marketing emails from companies telling you how they are combatting coronavirus? Each of these emails represents an agile, private corporation ready to adapt so it can continue to serve customers in the midst of a crisis. It won’t be long before we can test ourselves at home for COVID-19, thanks to investment, research, and logistic expertise from America’s vibrant and generous private sector.
America’s health care system is also better equipped than others around the world in one important way: We are the world leader in ICU beds per capita.
Americans are also pro-individual and value every life, not just what’s best for the collective. The World Health Organization ranks our system No. 1 in “attentiveness to the needs of the individual patient.” Older Americans might particularly appreciate this attribute during a pandemic that puts them at greatest risk.
For example, a medical system only concerned about the collective tends to focus on data, the bottom line, and the “standard” patient rather than the actual patient. Older people are mostly done contributing taxes to support the system and tend to cost more due to their chronic conditions. End-of-life care is some of the most expensive.
Coronavirus will cut short many lives, and for the bottom-line accounting in universal health systems, this may save money. But Americans know expensive health care is sometimes worth it, especially if it’s your grandmother we’re talking about. And pretty much everyone is someone’s most important person.
Some might say the downside of an individualistic health-care system is that individuals also bear a great deal of the costs, in terms of dollars. Fair enough: health care in the United States is very expensive. But Medicare for All has only one means to address that: paying health-care providers less. This is absolutely the wrong approach to expanding the supply of health services, as lower payments will lead to lower supply.
Instead, we should address our cost problem through greater transparency and competition. Of course, it’s hard to say how much a life is worth in dollars or what the value of a particular life-changing treatment might be. But wouldn’t you prefer to make that determination yourself, or for a loved one, rather than watching a government agency do it?
But America’s health sector is hardly a free market, and we lag behind other countries in some ways. A critical early error in our fight against the Wuhan virus was the limited number of tests.
Some point to South Korea as evidence that a socialized medical system is working better. Indeed, South Korea outdid the United States — and most other countries — in its extremely widespread testing for the virus. This made the country’s fatality rate look good because any fraction with a huge denominator is small. With more than 270,000 people tested, South Korea was able to identify many more people who tested positive, not just those with terrible symptoms, giving South Korea a lower fatality rate.
Widespread early testing in the United States would have better alerted virus carriers of their need to self-isolate, reducing the spread. But without tests, this virus — which acts much like other respiratory illnesses, such as the common cold — can lurk around undetected. The fault here lies with the Centers for Disease Control, the government agency tasked with, you guessed it, controlling disease.
The CDC acted like a monopoly on testing, placing too many stringent rules on the process at first, such as allowing only people who had traveled to China to get a test. Additionally, the tests had to be shipped to Atlanta to be read. Now things are getting better: The administration reduced some regulatory roadblocks for new labs, and private industry has been stepping in to offer more accessible testing.
A second problem in our health system is our capacity to treat patients, mostly because of the number of regular hospital beds and medical staff available. In these two areas, the United States is behind other countries per capita. This isn’t a market failure, but a government one.
Thirty-five states have “Certificate of Need” laws limiting the ability of hospitals to expand and restrict the establishment of new medical facilities. These anti-competitive laws were meant to establish a clear “need” for expensive new hospital wings and buildings, but they ended up enabling established hospitals to block competitors from entering the market, making them a favorite of hospital lobbyists and special interests. But these laws limit our ability to grow health care supply.
Additionally, our physician training pipeline is a government-run, Medicare-funded monopoly. The number of acceptances in medical schools is limited, so schools don’t educate doctors who can’t get a slot in a residency training program. The government caps the number of resident doctor positions available, as a function of Medicare funding. Thus, the United States was already experiencing a doctor shortage. A public health crisis like a pandemic only makes matters worse.
Importantly, Medicare for All would exacerbate, not mitigate, all of the above weaknesses in our current system, doubling down on the centralized pieces of our health system that have been slow, inflexible, and antiquated.
Surviving Today, Thriving Tomorrow
This pandemic has the potential to strain our health-care system like nothing else in modern times. But we will get through it. The United States should lean into our strengths and focus on the creative power of our generous and highly adaptive private sector. While hospitals beds, supplies, and staff are limited, we can expect the very best minds and biggest hearts in our country to stretch our resources to save every life possible.
America’s health-care system is not perfect. Like every health system, ours doesn’t have an infinite supply of services and treatments at the ready, especially not when facing the uncertainty of a pandemic. Reformers should focus on making U.S. health care more agile — meaning more free and flexible to respond to changing events — and on increasing the supply of services by addressing the shortage of physicians and other medical professionals. And the United States should focus on transparency and access, so the very best services and treatments are available as widely and affordably as possible.
This bottom-up, entrepreneurial approach is the opposite of a top-down, one-size-fits-all Medicare for All system and would leave us better prepared for whatever other public health emergency may lie in our future.