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The coronavirus reveals all the weaknesses of the American healthcare system

The international response to the new coronavirus revealed the following: The United States has been less prepared for a pandemic than countries with universal health systems.

There is a real concern that Americans, with their higher uninsured rate and higher out-of-pocket costs compared to the rest of the world, will not seek care because of costs. Even before the crisis began, the United States had fewer doctors and hospital beds per capita than most other developed countries. The launch of the Covid-19 test has been erratic, relying on a combination of government and private labs to expand capacity to run the tens of thousands of tests that will be required.

"Everyone who works in this field agrees that regardless of how you measure it, the United States is far behind on this," says Jane Keats, director of global health and HIV policy for the Kaiser Family Foundation.

People should go to the doctor and get tested if they have Covid-19 symptoms, however, Americans can avoid medical care, even in severe cases, due to cost. Hospitals will need rooms for people who need close follow-up in a clinical setting, and ICU beds and ventilation units for patients who get worse and need mechanical support to keep their bodies functioning.

But none of these units remains empty at the moment: they already have coronavirus-free patients who need them and will continue to need them during the crisis. New York Governor Andrew Cuomo said Sunday that nearly 80 percent of intensive care units in New York City are already full, even as the Covid-19 outbreak continues.

By any of these pandemic preparedness measures, the United States lags behind most of the rest of the developed world.

"The United States is doing worse than the average for equally rich and large countries in almost all pandemic preparedness measures," Cynthia Cox, director of the Health System Tracking System, Peterson Kaiser, told me. "The coronavirus outbreak is already revealing the deficiencies and inequalities in our healthcare system and is likely to put more pressure on the system in the coming weeks."

The slow start of testing in the United States will exacerbate these problems.

Testing is important not just because it diagnoses people and undergoes proper treatment if they have an infection. It also determines how far the virus actually spreads. Experts know the scale of the problem, they know the speed at which people will be hospitalized or die, and they can follow their movements. This leads to a more informed response.

But the United States has failed to implement coronavirus testing, putting us far behind our economic counterparts in tracking the outbreak. A manufacturing issue with test kits initially shipped to the field and delays in approval of commercial tests led the nation to stop or slow down Covid-19.

"Failing a test puts additional pressure on our already challenging healthcare system," Cox said. "The combination of all these factors will make the United States worse than similar countries."

Comprehensive health care is not an ideal treatment for emergencies like this. Italy has a universal health care system, which is a federal national health insurance program similar to Canada's, but an inevitable outbreak of the disease has forced the country into lockdown as cases and deaths continue to pile up.

However, other countries are still generally more prepared for the pandemic than the United States, and we are now seeing the consequences of this gap.

For now, American politicians are proposing to make American health care like these other countries: make care free or cheap at the point of service, either by having the government cover more of the cost or by forcing private insurers to cover services related to the outbreak.

However, it is only a temporary patch for these structural problems.

Why the United States is Less Prepared for a Pandemic Than Other Countries

By many measures, the United States has one of the worst healthcare systems among advanced economies. A higher percentage of the population lacks health insurance. We have more medical debts. We die more often from preventable causes. The weaknesses of this system, which already places the United States behind its peers in many health outcomes, are exposed in the event of an outbreak.

The biggest and one of the most unique problem in the American system is cost.

Americans face higher costs for their own health care than do citizens of almost any other country, and research shows that people are forgoing the care they need, including severe cases, due to cost barriers. Patients here are more likely than those in most other countries to say they have a cost barrier to accessing healthcare: 33 percent in the United States versus between 7 percent (Germany) and 22 percent (Switzerland ) in other advanced economies. Americans are likely to say that they have struggled to pay or cannot pay their medical bills and that their insurance plan refused to cover some of their medical claims.

We teach Americans to delay care as a result of these cost barriers: In 2019, 33 percent of Americans said they postponed treatment for a medical condition due to cost. 25% said they postponed care for a serious illness. A 2018 study found that even women diagnosed with breast cancer, a life-threatening diagnosis, can delay care due to high deductibles in their insurance plan, even for basic services like imaging.

These cost barriers affected patients at various points in a pandemic situation. First of all, they may be wary of going to the doctor because they fear that they will not be able to pay for an exam or any test. But then if they receive a Covid-19 diagnosis and require hospitalization, they receive the hospital bills, the doctors they see, and any treatment they receive for anxiety.

In the United States, and only in the United States among developed countries, patients risk thousands of dollars in medical bills seeking help in the event of a crisis. Some Americans have already been paid around $ 4,000 due to government-imposed quarantines, the New York Times reports.

To make matters worse, there is the health care infrastructure of our system, which has been built on a shattered powertrain. There is a lack of capacity that puts us at an even greater disadvantage at a time when the pandemic is spreading, when it is most needed.

Hospital beds, for example, will be essential for Covid-19 patients who have more severe symptoms. The United States has fewer hospital beds per capita than most other countries in the developed world.

The potential shortage of hospital beds is compounded by the fact that the United States has higher rates of hospital admissions for chronic diseases that, with proper management, should not require a patient to go to the hospital. These conditions include congestive heart failure, diabetes, and asthma. Researchers believe that the lack of access to primary care and the higher costs of obtaining this routine care compared to other countries, lead to preventable hospital admissions in the United States.

This means that our hospitals are already receiving patients who would not have to if the system worked better, and now they would have to adapt to the influx of Covid-19 patients.

We also have fewer doctors per capita: 2.6 per 1,000 people, which is much lower than the comparable country's average of 3.5 and less than all Peterson-Kaiser countries with the exception of Japan. Experts blame much of this shortfall on the high cost of medical education in the United States, which is closely related to the world's leading US health care prices.

As a result, Americans have more trouble getting an appointment with their doctor on the same day or the next day than people in most other places.

Take these structural issues along with the slow start of coronavirus testing in the United States, and we are way behind than we should be.

"If we don't test for widespread disease and it slows down, we can have huge spikes in the number of people needing medical care at one time, putting extraordinary pressure on our healthcare system," Cox told me. "By not acting fast enough to prevent the spread, our healthcare system will come under more pressure and more attention."