Public Health, Universal Health Care, and the COVID19 Virus – Part 2

I never thought of Donald Trump and Mike Pence as being advocates for universal health care, but in response to the COVID19 virus, apparently, they are, albeit in different, sordid ways. 

In his address to the nation, Trump stated that representatives of the private insurance industry have assured him they will “wave all copayments for corona virus treatments, extend insurance coverage to these treatments, and prevent surprise medical billing”.  Trump also said he would be taking emergency action to provide financial relief for people who need to stay home from work if it is confirmed they have the virus or need to take care of someone with the virus.  

Trump closed his speech noting, “We are all in this together.  We must put politics aside, stop the partisanship, and unify together as one nation and one family.  Acting with compassion and love, we will heal the sick, care for those in need, help our fellow citizens, and emerge from this challenge stronger and more unified than ever before.”[1]  Sounds like an endorsement for UHC.  Oh, if only this was true.

It was difficult enough to listen to Trump the first time, as his delivery was wooden, speaking with little emphasis or emphasizing words and phrases at the wrong places.  Unfortunately, to quote him accurately, I had to endure listening to his speech several times over.  Trump also snorts when he speaks, which is very distracting.  And, of course, his speech was riddled with falsehoods.[2]

As noted above, Trump said that the private insurance industry would wave copays for corona virus treatment.  Actually, they said they would wave copays for corona virus testing.  Testing is cheap, treatment can be very expensive, especially if you need to be hospitalized in the ICU.  Fortunately, most health insurance plans will cover treatment of viral infections.  However, nothing was said about waving deductibles.  Many Americans have high deductible insurance premiums, where they are on the hook for the first $2,500 or more of their medical costs, so if they need treatment for the virus, they will still have hefty out-of-pocket expenses.

Keep in mind that prior to his address to the nation, Vice President Pence met with representatives of the health insurance industry, so Trump and members of his administration knew exactly what the insurance industry was willing and not willing to do.  Consequently, the assertion that insurers would wave copays for treatment was patently false.

And the lies just keep coming.  Just as I was getting ready to post this article, Trump announced he would not approve a special sign-up period for the uninsured to enroll in Obamacare.  This will provide millions of uninsured Americans coverage if they need it for treatment of COVID19.  So much for “we’re all in this together.”  Trump’s decision is consistent with the Republican view that health care is a commodity and an individual responsibility to obtain.  If you don’t have or can’t afford health care, that’s not my problem or the government’s problem, that’s your problem.

Surprise billing occurs when a medical provider who is not part of your insurance network provides you with treatment.  In that case you are responsible for the amount of the provider’s charge not covered by your health insurance.  For example, suppose you are hospitalized for treatment of COVID19 and the pulmonologist does not participate in your insurance plan.  She bills you $12,500 and your insurance company pays her their standard rate of $7,800.  If she was a member of your insurance plan, she would have to accept that amount as payment in full.  However, because she is not a member of your insurance network, you are responsible for the difference of $4,700.  Consequently, Trump made an empty promise – he lied, again – as insurers only committed to no surprise bills for testing, not treatment.  In fact, insurers have little control over surprise billing as it’s the medical providers and not the insurers who are responsible for out-of-network billing.[3]      

The United States is one of the few developed countries that does not assure its citizens paid sick leave.  This has become more problematic as an increasing number of Americans are employed as hourly wage earners without benefits.  Additionally, many workers with sick leave benefits are only covered for up to ten days a year, which might not be enough time if stricken by the virus.  Trump’s pledge that working Americans would receive pay if sick during the COVID19 crisis delighted Democrats who believe paid sick leave now and after the crisis should be guaranteed through legislation.  So far, this is an empty promise as Trump has yet to get his own party on board. 

At least, Trump ended his speech with a promise to put politics aside in order to work for the benefit of the American people.  A promise he promptly broke when he falsely accused the Obama administration for the delay in COVID19 test kits.[4]

If the purpose of Trump’s speech to the nation was to quell fears and reassure us his administration was in command of the situation, I sure I’m not the only American who came away concerned and disappointed.[5]  Instead, we got the usual series of lies that only undermined confidence in his abilities and the capabilities of his administration.  This probably contributed to the drop in the stock market, as investors are not stupid and know that Trump can’t be depended upon to carry through with his promises.  Instead, Wall Street was left with a bunch of broad guarantees with no evidence that any of them would come to fruition, not to mention the continued contradictions between Trump’s pronouncements and statements compared to comments from administration medical officials, such as NIAID Director Anthony Fauci, M.D.

And as bad as things are, Trump added insult to injury by suggesting that health providers are profiteering from the pandemic.  Hospitals are reporting shortages of personal protective equipment, such as gloves and face masks, which should be replaced frequently to reduce spread of the virus to doctors and nurses.  However, Trump noted said he couldn’t understand how a supplier who delivered 10-20,000 face masks for years now needed to increase the supply to 300,000, unless some unscrupulous was happening: “Where are the masks going?  Are they going out the back door?”[6]    

We are in the midst of a public health emergency, which should remind us of the importance of ensuring all Americans have access to the medical care they need regardless of ability to pay.  As a nation we engage in public health practices to protect all members of society from illness and disease.  For example, as a result of public health initiatives Americans no longer worry about getting cholera, diphtheria, tuberculosis, polio, malaria, and myriad other diseases.  We have access to clean water and don’t pollute our rivers by dumping raw sewage into them.  And we trust our public health agencies because they’re created to serve society rather than profit from it.  Ultimately, the health of our nation depends on the health of its people.  Trump was correct when he said we do these things out of compassion for the wellbeing of each other and in doing so we are a better society for it.  Unfortunately, he doesn’t believe those words.

Finally, in regard to my opening comment that VP Pence demonstrated support for UHC, he did indeed do so, but not in a positive way.  When asked at a news conference about protecting the health of the millions of Americans without health insurance during the corona virus crisis, Pence responded by turning his back on the reporter and walking away.  A powerful statement for why we need UHC.


[1] https://www.youtube.com/watch?v=I09RkjLcFpU

[2] Despite these distractions a recent poll found that the majority of Americans believe Trump is doing a good job leading the country during this health crisis.  Oy vey!

[3] https://www.mcclatchydc.com/news/politics-government/white-house/article241059031.html

[4] https://www.factcheck.org/2020/03/trumps-misplaced-blame-on-obama-for-coronavirus-tests/

[5] Trump’s exaggerations and lies don’t tend to concern his supporters because, as Newt Gingrich has observed about conservative supporters of the Republican Party, the truth doesn’t matter, only what people want to believe.

[6] https://www.newsweek.com/trump-cuomo-masks-hospital-doctors-stealing-new-york-1494949

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