10 million jobs lost, health insurance as well?

As I start to write this OpEd, on April 2, the headlines state that another 6.6 million Americans have filed for unemployment insurance. Add that to the 3.3 million that filed last week for a total of nearly 10 million Americans. A very likely result is this loss of jobs will lead to many of these same Americans losing their health insurance possibly at their greatest time of need. The most recent literature suggests that about 50 percent of Americans have their health insurance through their employers.

In the last major recession of 2007-2009, 9.3 million Americans lost their health insurance due to their loss of job. 57 percent of those who lost their job lost their health insurance. The other 43 percent were able to piggy-back onto their spouse’s insurance or were able to afford extending their health insurance through COBRA.

Recent news suggests that the average price tag for a hospitalized patient with COVID-19 is $35,000. Therefore, in a worst-case scenario, a person is hit with the catastrophe of losing their income, losing their health insurance, and then dealing with a severe case of COVID-19 to the tune of $35,000. Hopefully they survive. A footnote here. In the presidential press conference of 4/3/20, Vice President Pence promised that no American would pay for COVID-19 related care. He claims these expenses will be covered through the CARES Economic Relief Act.

Wendell Potter, a previous executive for Aetna, states in a recent article in The Guardian, “When will we Americans realize how irrational and irresponsible it is for so many to be dependent on employers for health insurance. Take it from me. I’m a former health insurance executive who once profited from this system. It’s time for it to stop.”

Health insurance’s linkage to employment since the 1930s has always included a major flaw. If an individual loses their job, they lose their health insurance, thus causing “job-lock”. Americans often stay in a job they despise so they can maintain their health insurance. When one loses their job, even if one can keep the ex-employer’s insurance temporarily through COBRA, the cost of maintaining this insurance is prohibitive.

Our pundits and politicians tell us that we need to maintain our present system of paying healthcare bills. We are told that many of us are very happy with our present health insurance. We do not want that to be taken from us. But is this true? How many of us love what we have? How many of us still have the same health insurance we had 3 years ago, much less 20 years ago? We really don’t understand what we have until we have to use it.

In my previous role as an independent family physician in partnership with four other physicians, as owners of the practice we needed to change our health insurance every year just to be able to afford it for ourselves and our staff. As we did this, year after year the premiums, deductibles, and co-pays continued to climb. We were to be relatively pleased that our premiums only climbed 16-20% annually as opposed to up to 60% if we stuck with the previous year’s plan. We rarely were able to afford the previous year’s plan due to the predictable increase in premiums.

In the Pre-COVID-19 era, about 60 million Americans change jobs on an annual basis. Therefore, their health insurance must change, or they lose it. If affordable, this new insurance is provided by a new employer, the ACA exchanges, medical assistance due to limited income, or Medicare due to age. The new health insurance nearly always includes different networks of providers and hospitals, and different cost-sharing, meaning deductibles and co-pays. It is not the same. This individual cannot “keep what they have”.

Our nation’s people now face a time of job insecurity that has not been faced since the 1930s. For those who have lost their jobs, the loss of a living wage is compounded by the risk of losing one’s health insurance.

COVID-19 has caused catastrophic upheaval to our world in the short-term. First and foremost, we are losing loved ones that would otherwise still be with us. Our necessary response to this threat has caused dramatic change in our lives. With the loss of nearly 10 million jobs thus far, it has exposed employer-sponsored health insurance’s inherent weakness. Now more than ever, our nation needs to have a very serious conversation regarding how we pay for healthcare. An Improved Medicare for All Plan would continue to cover workers and their families who have lost their jobs. It would eliminate “job-lock”. Improved Medicare For All would be affordable as it would markedly reduce the tremendous excessive administrative costs of our present system and would prevent Americans from paying 60% more than the rest of the world for our medications. It would allow us to keep the physicians and hospitals we choose to care for us year in and year out. Improved Medicare for All would be paid for by progressive taxes that would replace what we are now paying for premiums, deductibles, and co-pays. Almost all of us ultimately would pay less for our healthcare then we are paying now.

COVID-19 is causing tremendous turmoil in our local communities, states, country and world. I pray that despite our present sacrifice and suffering, eventual good will come of this horrible chapter in our lives. Improved Medicare for All can be part of that gain after our society survives this horrible storm.

Dr. Dwight Michael is a member of the Gettysburg Democracy for America Healthcare Task Force.