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This is how the US healthcare system makes it hard to stop the coronavirus

Everyone has a trap in the American healthcare system. But now that the United States faces the coronavirus pandemic, the blemishes have bigger - and even fatal - ramifications.

The problems overlook early hurdles from federal officials, such as delays in the distribution of test kits.
As countries around the world struggle to deal with the coronavirus, people in the United States must contend with a fragmented healthcare system in which just getting tested can mean hundreds or thousands of dollars in medical bills - a risk that other developed countries do not face. .
"When you contract a highly contagious disease, we all suffer the consequences," said Alan Weil, editor of Health Affairs, Health Policy magazine. "My destiny is closely linked to that of others."

Here are three issues the United States must grapple with:

Lack of coverage and high costs

The United States is the only developed country that does not have universal health care. Nearly 28 million non-elderly Americans, or 10.4%, were uninsured in 2018, according to the most recent data available from the Census Bureau.

This is an improvement over what it was before the Affordable Care Act was passed in 2010. That year, 46.5 million people without the elderly, or 17.8%, lacked coverage. But the uninsured rate has started to rise again in the last two years.
The uninsured rely heavily on a combination of community clinics and hospital emergency rooms for care. This means that they often wait until their condition worsens before seeking medical help, which could result in them infecting many other people during an outbreak such as the coronavirus.

But even those with insurance may not seek care as quickly, in large part because they face deep discounts and out-of-pocket costs for doctor visits, trips to the emergency room, and treatment.

The nearly 153 million Americans who have insurance through their jobs have seen their deductions double over the past decade, according to the Kaiser Family Foundation's 2019 Employer Health Benefits Survey. A worker now has to pay about $ 1,655 a year, on average, before coverage begins.

Additionally, more than a quarter of covered workers, including 45% of small business workers, have an average deduction of at least $ 2,000 a year.

"Addressing the coronavirus with tens of millions of unhealthy or underinsured people will be a unique American challenge among developed countries," Larry Levitt, Kaiser's executive vice president of health policy, said on Twitter. "It will take money to treat people and address the unpaid care that service providers are absorbing."

Concerned that high costs could discourage people from getting tested if they feel ill, many insurance companies and many states are waiving copayments for coronavirus tests for certain policyholders. But patients still have to pay for visits, other tests and any treatment for the coronavirus or any other illness they may contract.

No paid sick leave

Another weakness in the nation's battle against the spread of the coronavirus is the lack of national standards for paid sick leave, which is rare among industrialized countries.
Federal and state officials are asking those feeling sick to stay home from work, but for many this is not an easy thing if it means giving up a paycheck or being caught off guard by the bad side of a manager. .
Nearly a quarter of workers do not have paid sick leave, according to federal data. Among those in the leisure and hospitality industries, who often interact with the public in places like restaurants and hotels, less than half are able to take paid sick leave.
Among the lowest paid employees, only half of them take sick leave.
And many workers in the gig economy, like those who drive Uber and Lyft and provide food, are considered independent contractors and do not receive benefits such as sick days.

Dean Baker, chief economist at the Left Leaning Center for Economic and Policy Research, wrote: "Of course, another effect of not having paid sick leave is that many people will go to work sick, which will make the virus spread more widely." . In a blog post.

Over the years, some states and municipalities have stepped in to fill the void: A dozen states plus the District of Columbia require employers to provide paid sick leave to some workers. At least 18 cities and counties have done the same.

However, some state legislatures have prevented municipalities from enacting paid sick leave laws.

Meanwhile, less than 30% of workers are able to work from home, according to the Bureau of Labor Statistics. Those who might be more likely to work in higher paying industries, such as finance or professional services. But in the entertainment and hospitality industry, fewer than 1 in 10 are able to work from home.

Democratic leaders in Congress are pushing to expand paid sick leave to try to contain the virus, a move the White House is also considering. President Donald Trump also said Monday that he will pressure lawmakers to ensure that aid is available to workers every hour.

Shortage of primary care physicians, intensive care beds and respirators

Federal officials advise that instead of rushing to the emergency room or receiving urgent care, those with a fever or shortness of breath should call their doctor. This will reduce the chances of the coronavirus spreading and avoid overloading hospitals and clinics.
Dr. David Blumenthal, a primary care physician and president of the Commonwealth Fund, is a researcher in health care and policy regulation.
The country's medical system is geared towards specialized care. He said primary care physicians are often less paid and the field is gaining ground.

In the United States, there are roughly 3 general or family practitioners for every 10,000 people, compared with 7.5 in the UK, 9 in France and 13 in Canada, according to the Commonwealth Fund analysis.
"We lack the first line of screening and counseling that primary care can provide," Blumenthal said, adding that these doctors are in a better position to decide whether their patients have pre-existing conditions that require additional treatment.
While health officials say the vast majority of those diagnosed with the coronavirus, officially known as Covid-19, will be able to recover at home, some will need to be hospitalized. If these numbers increase dramatically, hospitals may have a difficult time absorbing them.

Eric Toner, principal investigator at the Johns Hopkins Center for Health Security, said that many hospitals have a limited number of ICU wards and staff trained to care for patients in them.
"ICU beds are very expensive to build and maintain. We don't have many of them that we need on average daily. So when we have an unexpected increase as we would expect with COVID-19, we will exceed that capacity," Toner said.
This is a major concern for John Hick, medical director of emergency preparedness for Minneapolis-based Hennepin Healthcare, which is already facing flu season. He said last week that of the more than 400 ICU beds in the metropolitan area, there were only a few.

Toner said that if a lot of coronavirus patients emerge, some hospitals may have to take over other rooms that contain a lot of technology, such as surgical recovery or cardiac units, that require other patients' procedures to be postponed.
"Unlike the Chinese, we cannot build hospitals in three days," Blumenthal said.
Heck said having adequate supplies, especially N95 respirators, is also a concern. Although Hennepin did not see any coronavirus patients until the end of last week, dozens of people are coming for tests. Employees use ventilators if they suspect someone has the disease.

There has been a shortage of N95 respirators globally as countries treat coronavirus patients. Last week, the federal government placed an order for 500 million devices over the next 18 months to recharge the supply from the US Reserve.
Meanwhile, hospitals like Hennepin that are not in hotspots must.
"The rest of us get a percentage of what we normally ask for, but that doesn't start to keep up with what is needed," Heck said. "So we are stuck."