A Personal Perspective on American Healthcare Before and During Covid-19

My family immigrated to the United States from the Soviet Union three decades ago. My entire adult life was spent in the US, mostly in Connecticut, which has been my home. After college, I became a graphic designer, and spent several years at Anthem Blue Cross and Blue Shield’s marketing and communication department, where I first learned about employee wellness programs, Medicaid, PPO, HMO, and HSA plans. Designing collateral allowed me to understand healthcare products and inspired me to study business and advance my position in the field of the healthcare industry.

As I’m writing this blog, I’ve spent over two decades in the field of healthcare, mostly from the insurer and broker’s side, and also from IT systems, non-profit, and public health perspective, and am both fascinated and frustrated with healthcare in America, a massive, multi-dimensional, dynamic and ever-changing enterprise.

Is healthcare equality possible?  

The creation of consumer-directed healthcare plans, health savings accounts, and the never-ending argument that “healthcare in America should be a right, not a privilege”, struck a nerve with me long ago. As a former citizen of the USSR, where healthcare was available to everyone, I could appreciate the ability to get a homecare visit when I was a sick child. When I needed medication, there was not a question about whether I could afford it or not, it was more of a philosophical discussion, focused on advantages of herbs and natural healing methods vs. antibiotics or other synthetic medications.

I also saw healthcare from a perspective of privacy and government interference. What would seem appalling to many western countries, seemed perfectly acceptable to me as a child. For example, the method of vaccination and disease testing, which was often done right in school at our students’ desks and during class. We had regular annual medical exams at school and parents didn’t think of protesting such practices.

I also saw the difficulties of the Soviet system in its limitations. The scarcity of equipment, the lack of innovation or investment in the future, the decisions as to whether or not surgery was justified no matter how you, as an individual, felt about it. 

In America my ailing, diabetic and heart disease-stricken grandparents got a new lease on life through Medicare eligibility and American innovation; they both had quadruple bypasses and lived at least 10 years longer than if they never left the USSR.

I always worked for large corporations to make sure that I carried health insurance for my family. I consider myself lucky to understand the ins and outs of insurance policies, costs, and limitations. For the past 20 years, my family fully utilized my medical coverage for a variety of ailments and feel fortunate and grateful to have had the means and wonderful clinicians and hospitals who have taken care of us when we needed it.

The truth is told, but are enough paying attention? 

As a health insurance professional, business and technology savvy individual, I’ve learned that my relationship with the healthcare industry is very personal and greatly intertwined with my everyday life. I don’t have the silver bullet that will solve our healthcare equity, quality, access, and cost issue, but I know that I care deeply enough to try. Reading books like Wendel Potter’s Deadly Spin, Elizabeth Rosenthal’s An American Sickness, and Stephen Brill’s The Bitter Pill, opened my eyes to a whole new perspective of the healthcare industry that I didn’t fully understand. I connected the dots I didn’t even know existed. I highly recommend the above-mentioned books as a primer into the realm of American healthcare.

Wendel Potter was a tenured healthcare PR executive who spent 20 years at the two major health insurance companies in the US. His book, Deadly Spin, is akin to a biographical account of his experience as a PR/spin leader for the companies he worked for. The insurance business is heavily regulated and dependent on careful risk management. Like many businesses, once it becomes public, the focus of the company shifts to shareholder profits, but unlike Googles and Facebooks of the world, insurers get a bad reputation for being profitable. This comes back to the ever-present question, “should healthcare be a right or a privilege?” And, given the history and Potter’s account, the answer is not straight-forward.

Elizabeth Rosenthal’s An American Sickness is an equal opportunity critique of all the healthcare industry players: from hospitals, specialists, insurance companies, to supply chain of durable medical devices, laboratories and diagnostic centers, big Pharma and employers who provide employee/family health care coverage. Ms. Rosenthal’s overview of all the dysfunction in the industry is palpable and can make you angry and discouraged… why does a hospital sport marble floors and large screen TVs? Therefore, understanding the complicity of all the parties involved isn’t painting the full picture. Social determinants of health are not discussed in the book and addressing the issues of rising costs and unreasonable profits cannot be explored without the underlying issues of social economics, health equity, race, demographics, nutrition, addiction, and genetic diseases.

Healthcare is personal, until it becomes political

The Bitter Pill was an eye-opener. If you paid any attention to politics before 2016, you’d be aware of the fight for the Affordable Care Act (ACA or “Obamacare”) and its rough start via healthcare.gov. The complexity of healthcare laws, special interests, unwillingness to compromise on Capitol Hill led to an ongoing barrage of misinformation and blame. The law passed with a narrow partisan margin and its initial implementation should be documented in the annals of project management history, as an example of a disorganized and poorly designed plan that was destined to fail. Ironically, it was Optum, a UnitedHealthcare company, which came to save the day with other talented and driven individuals from the public and private sector, who were able to bring healthcare insurance to millions of our country’s uninsured. The law became most widely popular when the Republican party began talking about its repeal. Steven Brill emphasized the flawed issues in the law that have to be addressed but getting rid of it proved extremely unpopular and damaging to our nation. Critical core tenants of the law, like pre-existing conditions, the mandate and the ability to keep children on their parent’s coverage until the age of 26 are critical and essential.

Alaa Elassar, CNN correspondent, in his article A Nurse Revealed The Tragic Last Words Of His Coronavirus Patient: ‘Who’s Going To Pay For It?’ on April 11, 2020, writes: “Smith, who is predominantly treating COVID-19 patients at a hospital in New York City, revealed the tragic last words of a dying man he was about to place on a ventilator: “Who’s going to pay for it?” the coronavirus patient asked Smith in between labored breaths. “They were last words I’ll never forget,” Smith told CNN…Smith called the incident “by far the worst thing” he has witnessed in his 12 years of critical care and anesthesia and said the moment shed light on a health care system that he says has been and still is failing its people. “I was very sad and honestly, a little horrified. This demonstrates that we have a profound failure when one has to worry about their finances when they’re dealing with much bigger issues that have to do with life or death.” 

Must it take a pandemic or global proportion to awaken the sleeping truth?

Today, with COVID-19 imposed restrictions and guidelines that change the core of our lifestyles, the pain of not having healthcare coverage is very real, ominous and devastating. Now, more than ever, the inequities, inequalities and lack of preparedness for this reveals an opportunity to rethink how we disentangle ourselves from the current system and prepare ourselves for the future.

The idea that “we’re only as healthy as the unhealthiest person” never rang truer than now. Closing borders, defunding the World Health Organization, denying aid to less fortunate countries and playing a blame game instead of solving the issues, won’t bring us any closer to a solution and further increase the prospect of these problems’ reoccurrence. This coronavirus has killed over 100,000 people in the US, number greater than any recent wars, including Vietnam. And no one is immune to it, regardless of political connections, wealth, status, gender or race. That said, the pandemic is not “the great equalizer” as it has shown that the poor are more likely to die of the disease and are less likely to get appropriate medical treatment.

What I hope we can do is try to heal the wounds of our generation by working together and solving the problems of social dissonance we are experiencing so vividly today. While we’re outraged by China’s human rights and individual privacy violations, they have been able to ‘collectively’ curb the virus spread and seemingly slowed the spread and stopped the pandemic. The same is happening in other authoritarian regimes and while I strongly oppose these brutal methods, what appeals to me is the idea of social accountability: “One for All and All for One.” Proper public health management has the potential of helping us solve the issue of the current pandemic but also healthcare in America, in general. Countries like New Zealand, Thailand and Taiwan have been the best at curbing the spread of coronavirus. Their example is swift, steady and unwavering leadership at the top.

Are we brave enough to create a new and improved path forward?

I seek to find a holistic approach that includes, not only, determining how to pay for healthcare and save money, but also promoting innovation, sustainability, self-awareness/accountability and reducing fraud and waste. I’m looking for a solution that requires broad and systematic changes in the system that approves our dependence on sugar and other comfort foods, our sedentary lifestyles and our addiction to all things media. Medicare for All sounds like a wonderful idea, and it may be, but it will not solve ALL the issues of cost, poor diet, lack of exercise, empathy, kindness, and self-discipline. Medicare for all is just a beginning. There is no need to ban private insurance, but there is a bigger issue to solve about our diet, lack of exercise, and constant stress.

Every crisis identifies our weaknesses and allows us the opportunity to learn from our mistakes or trials and tribulations. Many talented people, like Bill Gates, Dr. Ali Khan, President Obama, and other various virologists and scientists have predicted the COVID-19 epidemic and warned us that there may be one far worse in the future. How well we’re prepared from public health and human-centric perspective is crucial. Coronavirus pandemic has already proven great gaps and ineffectiveness of our system, our reliance on what we know, and unwillingness to change for selfish or cynical reasons. A lot is still ahead for us and how we manage this epidemic and the future health of our society as a whole depends on innovative, collaborative and humanistic approaches… and that is why I choose to be involved.