Thread by @ASlavitt

COVID Update August 5: Without universal coverage, COVID-19 might never end.

Worse, without it, the US would become the magnet for all future pandemics. 1/

Americans didn’t get what they needed from the health care system before the pandemic. It’s too expensive, too inequitable & driven more by profits than patient care.

What’s bad without a pandemic completely fell apart in a crisis. 2/

Our health care system actually made the pandemic worse.
-5 million losing insurance coverage
-Small practices running out of cash
-Nursing homes infection disasters
-Care unavailable to many communities— rural, Black/Brown, poor
-Shortages of key professions 3/

We WANT people to get care. We WANT infected people to get treated. We WANT people to deal with underlying conditions. We want people to get testing.

Otherwise they get sicker & they increase the spread.

But without access to care they get sicker & we do too. 4/

We had some mechanisms in place Trump decided to ignore.

The ACA created insurance exchanges & Medicaid expansion to cushion the blow for people losing converge.

The Trump Admin refused to allow them to be used & GOP governors refused to expand Medicaid. 5/

Medical costs from COVID are significant for people who get hospitalized.

And afterwards, as people who are sure to have ongoing chronic issues, people will see both higher costs & pre-existing conditions.

Everyone should have care free from worry about cost. 6/

What about the money you say? The money is there. It is just going to the wrong place.

The insurance companies we pay to pay claims when we’re sick made billions of EXTRA dollars as we’ve gotten sicker and sicker. 7/

nytimes.com/2020/08/05/hea…

That is not a good system. It’s a system designed for & by insurance companies & pharma conpanies. Not us. Not doctors & nurses.

@Farzad_MD and I wrote this piece about how small health care practices are getting battered— just like patients. 8/

statnews.com/2020/05/28/cov…

These profits don’t add to our system. They don’t make us healthier. They actually make middlemen more & more powerful, allow them to buy the status quo in Washington, buy other insurance companies, and even medical practices. 9/

We’ve now spent several trillion dollars cleaning up a problem, much of which could have been spent keeping us healthier.

We have the money. We have to invest it differently. 10/

.@AndrewYang and I discussed how much better we can support people if we restructure the income and health based systems.

@BernieSanders and I also discussed how the times make his vision more real. 11/

Smarturl.it/inthebubble

What isn’t working is the vision of cutting taxes & shrinking Medicaid and Medicare that Trump and McConnell and McCarthy push.

Trump is hoping the ACA will be overturned in the courts in which case 23 million more lose coverage & pre-ex conditions aren’t covered. 12/

Viruses go where they can spread.

Places where people congregate, indoor places, bigger cities.

They will also spread $ do damage where people aren’t getting vaccinated and routine basic care. 13/

Airtight systems with universal care, universal vaccinations, affordable medicines and good public health infrastructure will do much better warding off pandemics.

In other words, not the U.S. 14/

I wrote this piece with this very catchy headline in @JAMA_current.

(I’ve no idea what the photograph is either— why are miniature men from the 60s standing on a notebook?) 15/

jamanetwork.com/channels/healt…

I call for three changes:
-stop making health care based on employment, but make it on existence
-make the system one between patients & medical teams, not between “consumers” & insurers & health care providers
-one by one remove the racism & inequality in health care 16/

Will there be resistance?

Yes. But not from the public.

More so from the electoral system which shapes Congressional districts to be unrepresentative & money in politics which cheapens your opinion & your vote 17/

When Americans vote directly— in Oklahoma, Missouri, Utah & Nebraska— you know, beacons of progressive politics— Medicaid expansion passes every single time.

As it just did this week in Missouri. 18/

For all we lose we have to come out of this crisis with something better. Going back to the same way after all this this will feel hollow.

@USofCare exists for that simple reason.
19/

What if in memory of the people we lost we made the country better?

What if in memory of the people we lost we reduced the lethal spread & damage of the next pandemic. 20/

Here’s a sad truth. The risk we feel we’ve been living with these past few months, many people have been feeling that their entire lives.
21/

People with disabilities. At constant risk that an infection can take their independence.

People of color. That worse treatment will shorten their lives.

People without access to insurance. That any illness will advance unchecked & leave them penniless. 22/

The most popular reason for a newly diagnosed cancer patient to call the American Cancer Society hotline is not to ask about the disease, treatment, or side effects.

It’s to say they can’t afford to have cancer.

23/

Whatever complications come from COVID, the treatments, tests & vaccines need to be be there for everyone. Or they may as well not be there for anyone.

Not just in crisis but afterwards. 24/

Let’s leave our kids a legacy we can be proud of. Just like a generation gave us Medicare and Medicaid, let’s make worrying about health care costs something our kids never have to experience. /end