The coming epidemic

The American health care system has two problems that virtually guarantee that there will be an epidemic within the next twenty years, a pandemic that will kill several million Americans, make 1/4th of the remainder seriously ill for weeks, and cross all socioeconomic lines to infect insured middle class Americans and the wealthy as well as the lower-class uninsured. These two problems are:

1. Lack of funding for preventive care, and
2. Lack of universal health care.

Let's look at the first. It makes sense that insurance companies would fund preventive care -- that the insurance companies would be the first to push immunizations, exams, early diagnosis for critical illnesses, and so forth upon their customers. After all, a healthier clientelle means less money spent, right?

But such a notion is naive. The goal of pretty much all health insurance companies in the US today is what you’d expect: To pay out as little as possible while taking in as much money in premiums as possible. It’s called “capitalism”. Duh. Now, you’re saying to me “if the insurer doesn’t pay out money, people will get sicker!” But health insurance in the US is tied to the employer rather than to the individual. The health insurance company is betting that, by the time you get sicker, you’ll be with a different employer and thus a different health insurance company. In short, they’re gambling that you’ll be with another insurer by the time their penny pinching catches up with you.

The result is that there is little funding for preventive care. You have lots of smokers where insurance companies won't pay for stop-smoking programs. You have lots of fat people where insurance companies won't pay for weight-loss programs. You have lots of people who don't see the doctor regularly enough to catch diseases such as hypertension which are harmless if caught and treated early, but cause serious illness if allowed to linger. You have lots of people who aren't immunized. You have, in short, a reservoir of unhealthy people who are perfect as the early disease vector for the coming epidemic, since they will catch the bug more easily and there's enough of them to spread it all around. And the insurance companies don't care, because, thanks to the fact that insurance is tied to employers rather than individuals, they're gambling that these people will be with another insurance company by that time. In the meantime, they have their profit. That's all that counts, right?

Now, let's focus on the other factor that makes the coming epidemic inevitable: Lack of universal health care.

Now, you'll say that this is "socialism", perhaps. But this is important. Universal coverage is the only way to prevent reservoirs of disease from lingering in the population, reservoirs which can mutate and explode into epidemics that kill insured as well as uninsured. The 1918 flu epidemic is a classic example, which killed 20 to 40 million people and depressed the average lifespan of Americans by 10 years as well as killing tens of thousands of healthy young American soldiers in Europe (more died of the Spanish Influenza than died of German bullets!), but any serious disease which is allowed to linger in the population due to lack of universal health care can mutate that way.

For example, there is a new strain of TB slowly spreading that is resistant to any known antibiotic. TB is normally easy to treat, but by failing to have universal coverage, a reservoir of TB infection has been allowed to linger in the population, and it is slowly mutating. It will take just one more mutation to make it as virulent as it is antibiotic-resistant and we’ll have a TB epidemic to match any in history—a TB epidemic that will affect rich as well as poor, insured as well as uninsured. That is the cost of lack of universal health care —- epidemics that kill millions of, including those who do have access to health care. Universal health care doesn't just benefit Jose' and Latrice. It benefits me too, because I'm just as likely to get sick and die as Jose' and Latrice if lack of universal health care brings on the coming epidemic.

It’s time to admit that the American experiment in employer-provided health insurance is an utter failure. If we don't fix things, we will have the super-pandemic that I describe above. Even today, my mother (with 40 years of experience as a health care provider) reports that doctors are seeing more and more disease that just doesn't respond to any known treatment. All that needs to happen is one mutation for virulence, and the pandemic is here. I don’t know what needs to replace the current system, but there’s plenty of good systems out there. For example, the #1 and #2 health care systems in the world are the French and Swiss health care systems. They have completely opposite ways of handling things which I won’t go into here, but the important part is that the Swiss system, which is probably the closest to the American system, has insurance purchased by individuals, not by employers, meaning that insurers actually have an incentive to keep their customers healthy. And both systems provide universal coverage, either via a government insurance company similar to Medicare funded by payroll taxes, or via subsidies for those not able to afford full cost of insurance.

Whatever we do, it needs to be done ASAP. Because by having 45.8 million uninsured Americans and skimping on preventive medicine, we insure that there's plenty of unhealthy people to serve as the vector for the coming epidemic... and once it's out there in large numbers, no amount of employer-provided health insurance is going to protect you.

-- Badtux the Healthcare Penguin

Cross-posted to the Mockingbird's place.