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U.S. differentiation: Pandemic intensifies “medical gap between rich and poor”

U.S. differentiation: Pandemic intensifies "medical gap between rich and poor"

As of the 27th, the number of confirmed cases of new Coronavirus in the United States has accumulated to nearly 8.8 million and 226,000 have died. The US media pointed out that during the pandemic, many problems in the US medical system have been exposed, leading to a further increase in the “medical gap between the rich and the poor”.

In the current United States, contracting new Coronavirus may not only be fatal, but it also means a disease of “richness”. Take virus testing as an example. In some places, free testing is in short supply, and some people who urgently need testing reports have to spend their own money. The cost ranges from hundreds to thousands of dollars. The highest record is an emergency room in Texas. Bills up to $6,408.

There are currently 440,000 people in the United States who are hospitalized for new Coronavirus, and hospitalization is even more costly. According to a study by the American insurance industry organization, the median cost of hospitalized patients with Coronavirus ranges from US$30,000 to US$60,000 (about 200,000 to 400,000 yuan). For tens of millions of people with insufficient or uninsured medical insurance Said that this may mean bankruptcy once. The U.S. government launched a temporary program in April to subsidize the cost of treatment of Coronavirus for uninsured patients, but in practice, many people do not enjoy it. Because many patients admitted to the hospital have complications, if the Coronavirus cannot be the main diagnosis, they cannot enjoy free treatment, and some of the first aid items are not in the scope of reimbursement.

△ Bills for uninsured patients, out-of-pocket expenses are as high as 70,000 U.S. dollars. Picture from The New York Times

To make matters worse, because most Americans rely on employers to provide medical insurance, at least 6 million Americans have lost their insurance since the pandemic. If their spouses and children are taken into account, more than 12 million people will be affected.

This kind of blow is even more obvious to minorities. According to a national survey (KFF) published in October, the health care conditions of African Americans have worsened due to the pandemic. Forty percent of black adults said that someone they knew had died of COVID-19, almost twice the rate of whites. One-third of black adults and nearly half of black parents have difficulty paying bills due to the pandemic.

·Deformed medical system

The medical system in the United States is often criticized. The most direct manifestation is that the cost of medical care is extremely high. It feeds medical institutions, pharmaceutical factories, and insurance companies, but it places a heavy burden on patients and society.

△The production line of Redcivir is from the Associated Press

There are a lot of unexplainable costs behind consumers’ sky-high medical bills. Take the Corona treatment drug remdesivir newly approved by the US Food and Drug Administration as an example. The drug will be sold to hospitals at a price of US$520 per vial or US$3,120 per course of treatment (approximately 20,000 yuan) for the treatment of private medical care. Insured patients. For patients with government-funded medical insurance, the price is US$390 per bottle or US$2340 per course of treatment.

It is not uncommon for American medical institutions to charge indiscriminately. The American media previously reported a typical case: Two people went to a medical machine in Texas for a virus test, but they received a bill that was 32 times different. One person paid only US$199 with cash, while the other paid US$6,408 (approximately 42,000 yuan) for insurance. Despite the negotiation between the insurance company and the medical institution, the sky-high test fee has dropped to US$1,128, and individuals still have to bear US$928. Insurance companies negotiate price discounts with medical institutions. This is also a characteristic of the American medical system. The larger the insurance company, the stronger the bargaining power.

The root of the “whatever you want” pricing is that the US medical system is completely market-oriented, with the upstream and downstream controlled by interest groups such as medical institutions, pharmaceutical companies, and insurance companies. The pricing is not transparent, and the government does not regulate medical prices. In the United States, most medical expenses are two or three times that of other developed countries. For example, the cost of appendectomy in the United Kingdom is US$3,050, New Zealand is US$6,710, and in the United States, the average price is US$13,000 (according to the 2017 International Medical Price Comparison Report). In the end, these costs will be transformed into a heavy social burden. The per capita health care expenditure in the United States in 2018 was US$11,000, and health expenditure accounted for 17.7% of the GDP.

Large companies can provide expensive insurance to executives, making it difficult for most working-class, self-employed or unemployed people to reach, creating a de facto medical gap between the rich and the poor. According to statistics, before the outbreak of the CORONA pandemic, 87 million Americans had insufficient or no insurance. Every year, more than half a million families declare bankruptcy due to medical-related debts. According to a recent study, the risk of cardiovascular disease among high-income people in the United States is one-third to half that of low- and middle-income people.

·Medical reform has become the most difficult bone

Establishing a medical insurance funded by the U.S. government and covering the entire population is a goal pursued by many people, and the benefits are obvious. One is to benefit everyone regardless of whether the rich or the poor; the other is to significantly reduce costs, especially to reduce incidental charges for private insurance companies and medical institutions. The third is to regulate the charges in the medical chain. However, doing so will affect the income of doctors and the interests of insurance companies. Therefore, since the beginning of the last century, this goal has never been able to break through the obstruction of interest groups.

Due to protests and lobbying by the American Medical Association (AMA), the largest medical organization in the United States, President Roosevelt was forced to abandon the publicly funded universal health insurance plan when he enacted the Social Security Act in 1935. With the development of medicine, the cost of hospitals and doctors began to rise, and the involvement of third-party insurance companies in this lucrative market established the basic pattern of today’s American medical system.

Many presidents after Roosevelt tried to establish government-funded universal health insurance. However, due to the intertwined interest groups, health care reform has become the most difficult piece of bone in Washington. Most presidents can only repair this system, not shake its roots. For example, during the 1992 Clinton campaign, he expressed his support for universal health insurance, but after he was elected, he turned to a reform plan to expand employers’ insurance provision. Despite the “additional” attitude, it still failed to be voted on by Congress.

It was not until the promulgation of the “Affordable Care Act” (commonly known as the “Obama Health Insurance Act”) in the Obama era that there was a major progress in health care reform, but Medicare (for the elderly over 65) and Medicaid (for low-income groups) were still retained. The existing structure of purchasing medical insurance for employees with employers has been reformed mainly in terms of expanding coverage, reducing discrimination, and standardizing.

However, the effectiveness of this reform has also been questioned. According to surveys by relevant agencies, in recent years, the proportion of American adults who have no medical insurance at all has been declining, but the proportion of underinsured persons has increased. The proportion of household income is too high).

△Gray represents the proportion of uninsured population; yellow represents the proportion of underinsured population. The graph is from The Commonwealth Fund

It is conceivable that in order to truly realize the equality of medical care, it is necessary to reform the American medical system. However, this is obviously a distant goal for the medical reform controversy that has lasted for nearly a century.

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