Commentary: Pandemic Highlights Flawed U.S. Health Care System

A lot of inconvenient truths have emerged from the COVID-19 outbreak in the United States, and one of the most obvious is our nation's health care inequities.

We Americans live in the richest country ever known to humankind but also one in which the population of have-nots has grown to be the majority, as the middle class, so robust in the two or three decades after World War II, has shrunk and wealth is concentrated among a few.

The 1950s and '60s glory days of the single breadwinner household, the days of Ike Eisenhower, JFK and LBJ, are ancient history. Also, about one in 10 American families lived in poverty in 2018, with some 25 percent of them headed by women, according to the U.S. Census Bureau. About half of us live from paycheck to paycheck, and some 90 million are uninsured or underinsured. And more than 500,000 Americans were homeless in 2018, according to data compiled by the National Alliance to End Homelessness.

Some scream when a national leader or leaders, such as Sen. Bernie Sanders of Vermont, propose a single-payer, Medicare For All program, but the pandemic has exposed the gross unfairness of our current health care structure, the employer-based, private health insurance system, as tens of millions of Americans queue up electronically in jobless lines and also have lost their health insurance. Consider that the newly jobless face the grim reality of meeting their primary needs - food, clothing and shelter (rent or mortgage) - rather than doling out dollars to buy medical insurance, and, thus, remain vulnerable amid our health care crisis.

As the total number of U.S. COVID-19 cases begins to near 1.3 million and the death toll 75,000, affecting all, rich or poor - but at the highest rates especially the poor and minorities with pre-existing medical conditions - Sanders' plan seems more palatable: We need a law that finally guarantees healthcare to everyone, employed or unemployed, cradle to grave, as most developed Western nations have.

Those who argue that a single-payer health care system would be the end of America as we know it, what they contend the Commie pinkos and fellow travelers who believe in FDR's Four Freedoms are itching for, also say that the poor or uninsured suffering a medical crisis can always get treated at a county hospital emergency room. They are correct.

However, they need to remember that the pandemic has so financially burdened hospitals that some are on the brink of bankruptcy and will need additional funds to keep their doors open, the lights on, the ventilators humming. And that affects all of us and augurs well for a revamping of our medical institutions that are in the grip of profit-making insurance companies and drug companies whose services and products take significant bites out of monthly paychecks from employers who offer medical benefits.

Access to comprehensive health services is part of the problem, too, of course, whether the poor or uninsured live in large cities or rural areas.

A particularly striking example of our crisis in health care inequity are American Indians, despite a legal obligation of the United States to provide healthcare to them and Alaska natives.

For a number of reasons, including a poor diet high in salt, sugar and fat, American Indians and Alaska natives have a shorter life expectancy than all other U.S. residents and continue to die at higher rates than other Americans in many categories of preventable illness, including chronic liver disease and cirrhosis, diabetes, and chronic lower respiratory diseases.

The Indian Health Service - an agency within the Department of Health and Human Services - offers care to more than 2.2 million Indians in 560 recognized tribes across the country. However, Congress has consistently underfunded the service, forcing hospital administrators to limit services, according to a report by Mary Smith, a member of the Cherokee Nation, an attorney, and former principal deputy director (and chief executive) of the IHS.

So for the U.S. citizens whose ancestors were the first to settle in North America, their health care reality is much different than most other Americans.

To match the level of care provided to federal prisoners, funding for the IHS would have to nearly double, noted Smith, citing an analysis by the National Congress of American Indians. Additionally, according to the analysis, funding would need to be even higher to match the benefits guaranteed by programs such as Medicaid, the federal-state program that helps pay for heath care for the needy, aged, blind and disabled, and for poor families with children.

Is it any surprise, then, that we hear news that COVID-19, the disease brought on by the coronavirus, has killed Navajo Nation residents at rates that are above U.S. averages? Navajos, the nation's largest tribe, are an especially vulnerable population, because members suffer high rates of underlying diseases, a lack of medical infrastructure, and limited access to care and supplies.

Clearly, where people live makes a difference and determines whether or not they receive the health care they need to live a full, healthy, and prosperous life, a human right.

But the same also would be true if Americans demanded collective leadership - a coordination among county, state, tribal and federal governments - committed to forging a new national health care system that would mitigate health inequities for all everywhere.

Contact reporter Richard Bammer at (707) 453-8164.