In mid-March, American comedian Baten Phillips, also known as Baldhead Phillips, had an itch in his throat and a flight to catch.
When his plane landed in Atlanta, where he lives, he was drenched in sweat, felt dizzy, and had difficulty breathing. His wife took him to the nearest emergency room.
The public hospital diagnosed him with a sore throat and sent him home. He returned two days later and tested positive for COVID-19. He fought for his life in intensive care for six weeks. At that point, the hospital gave him a choice: stay longer and top up his bill, or leave and pay for oxygen at a lower cost.
Phillips has diabetes, which makes his COVID-19 infection more severe. Without health insurance, he pays medication and hospital costs out of pocket. He decided to go.
To date, Phillips has $ 14,000 in medical bills. His hospital received $ 145 million through the CARES bill that was designed to help hospitals severely affected by COVID-19. However, the hospital told Al Jazeera that the aid did not cover the entire financial gap.
American comedian Baten Phillips spent six weeks in the intensive care unit of a U.S. hospital after testing positive for COVID-19. [Courtesy Baten Phillips]”The cost of medical care is ridiculous, especially for a disease like this,” said Phillips, who launched a GoFundMe to help cover the cost.
“People are going into more debt just to fight that.”
While Phillips said he was grateful for the care he received, he urged the United States to take some cues from countries with universal health coverage – a system that experts and public health doctors say is during one Pandemic saves lives.
For example, the COVID-19 death rate in Canada, where there is a single-payer healthcare system, is less than half that of the US, where a for-profit, private-public model often allows people to fall through the cracks.
While COVID-19 arrived in neighboring countries around the same time in late January, Canada had 282 deaths per million people on November 10, while the US had 722 deaths per million people.
A universal health system “makes a huge difference in many ways,” said Dr. Danielle Martin, a Canadian medical doctor who testified before a U.S. Senate committee investigating health care.
Free tests, treatment
Lives are mostly saved in a pandemic through political and public health decisions, Martin explained.
These include imposing travel restrictions, encouraging the use of masks and physical distancing, conducting tests and tracing contacts, closing down non-essential services, providing a basic income so people can stay at home, and being arrested resolute action at all levels of government.
“When people contract COVID-19, there is no doubt that access to quality health care – testing and treatment – can save their lives. Therefore, universal access to COVID-19 is a crucial part of a comprehensive pandemic response,” so Martin said Al Jazeera.
People wait in line at a COVID-19 testing center in Toronto, Canada [File: Carlos Osorio/Reuters]Canada has a publicly funded system that is provided by the provinces. Under the Canada Health Act, everyone is entitled to medically necessary benefits with no additional payments. As part of this system, Canada is offering free COVID-19 treatment and testing.
In comparison, the cost of treating and testing COVID-19 in hospitals across the United States can vary widely. A survivor of COVID-19 is billed $ 1.1 million by a Seattle hospital – a sum that was later covered by Medicare.
The Kaiser Family Foundation, a nonprofit health research organization, found that U.S. testing facilities charged $ 20 to $ 850 per test. In many cases, the cost of testing has exceeded Medicare coverage, which ranges from $ 51 to $ 100.
When people contract COVID-19, there is no doubt that access to quality health care – testing and treatment – can save their lives
Martin said if someone knows they don’t have to pay out of pocket for a hospital stay or test, they are more likely to declare their symptoms and seek help, or stay in the hospital longer and do whatever care they need, whatever gives a better health result.
That is gaining urgency today as the U.S. recorded its highest daily infection rate on Nov. 13, adding around 153,500 new cases to its total of nearly 10.6 million infections, according to Johns Hopkins University.
On November 10, the U.S. beat its record for COVID-19 hospital stays, the AP news agency reported.
In Canada, COVID-19 deaths were mostly recorded in nursing homes. While medically necessary medical and hospital services are covered by Canada’s Health Act, personal assistance and care are not provided in these homes, so residents pay an additional fee.
Basic health conditions
Health outcomes from COVID-19 are also worse for people with underlying illnesses who don’t have health insurance, as having no insurance means they have to pay out of pocket for the medications and doctor visits they need, so many forego it.
Nearly 33 million Americans under 65 are uninsured, according to the latest estimates from the Centers for Disease Control and Prevention (CDC).
Ahmer Rehman, an intensive care doctor in Michigan, said he saw this dichotomy in insured and uninsured diabetes patients who also tested positive for COVID-19. “These uninsured people have uncontrolled diabetes, so their COVID symptoms were much worse and they died much faster,” he told Al Jazeera.
A patient is being tested for COVID-19 this week in East Los Angeles, California [File: Lucy Nicholson/Reuters]Rehman said in his experience that the US system pressures hospitals to discharge patients quickly because insurance companies give hospitals money for a set number of days based on the initial diagnosis.
The administrators of the hospital he works at encourage doctors to discharge patients earlier so the hospital can make a profit, he said, although the company will not pay the hospital if the patient returns with complications.
He said his hospital ranks doctors based on the number of days their patients stay and posts their rankings on a bulletin board in the doctor’s lounge – putting pressure on doctors with poorly rankings.
“You just feel the stress of getting them out faster. It tarnishes your judgment a little. “
Public and private hospitals
Phillips, who is black, said the virus “spread like wildfire” in his Atlanta community.
African Americans had the highest COVID-19 death rate of any racial group in the US, according to the CDC, and the death rate for black Americans was 2.1 times higher than that of white Americans.
General health care could have improved Phillips’ outcome, Rehman said: “With subsidized diabetes medication and regular doctor visits, his body may have been more resistant to COVID-19, and free and accessible tests might have allowed him to diagnose faster.
Phillips also said he likely would have stayed in the hospital longer if he had known he wouldn’t have to pay for it.
In New York City, which has the highest death rate in the United States, the virus hit low-income, racial communities hardest. Patients from these communities ended up according to the New York Times, which reported that patients in public hospitals were three times more likely to die than patients in private hospitals, mostly in public hospitals.
Public hospitals in the city also had difficulty moving patients to private hospitals, which would have eased the pressure. Rehman said if a patient is uninsured, a private hospital could refuse an application to admit a patient because the hospital fears they may not get paid. “It’s a flip of the coin for private hospitals in many situations,” he said.
COVID-19 also hit racial communities hardest in Canada.
“In the Canadian context, it’s easier to balance this out because these hospitals are expected to work together,” said Martin, who added that transfers are made without question as all Canadian hospitals are government paid.
“This enables hospitals to compensate for the high variability between districts that occurs due to social factors such as systemic racism.”