Episode 083: Making it Through Coronavirus without Health Insurance

Once again, the coronavirus outbreak is dominating the news. Government officials at the federal, state, and local levels have closed down most businesses in the hopes of preventing our health systems from being flooded with patients needing ICU beds and ventilators. Aside from the details about the virus which we still don't understand well enough at this point, what are the reasons that the US response has felt so inadequate?

I answer that question and also discuss what it's like living without health insurance during this pandemic. My family recently switched to a health sharing ministry and have been without insurance for five months now. Overall, the experience has been very good. We have had to hire a DPC doc which has provided us better and more personalized care than we had before. Also, through her we have gained significant cost savings through the purchase of medications because she dispenses medications from her office. To date, I estimate that we have saved over $2000 in five months versus if we'd have had our prior insurance plan.

Finally, the list of reasons this pandemic has been worse for the US than it needed to be (in no particular order and this list is in no way exhaustive):

1. Certificate of Need Laws - These anti-competitive laws are ways players in the market keep out competitors which in turn reduces the capacity of the system to respond to surges in demand. Hospitals through these state boards restricted the amount of hospital beds, ICU, imaging, and laboratory testing that are available for patients.
2. Tariffs - The tariffs the Trump administration imposed on China hurt our supply chains by about 16% prior to this outbreak by increasing costs and limiting supplies. This put an already tenuous supply chain at more risk for a break when a surge in demand occurred. These were a mistake and might cost the lives of health care workers who are forced to work with used, homemade, or no personal protection equipment.
3. Certificate of Need Laws - The maintenance of certification rules that force physicians to continually test and pay for modules that oftentimes have no relation to their practice have caused many to retire early. Rather than start a new expensive and time exhaustive five or ten year cycle, many doctors instead choose to retire a year or two early. Those doctors are now not out there to help treat this surge of patients. The lack of importance of the certification process has been unintentionally admitted to by the boards themselves as many are waiving the requirements for this year because they see the financial and time impact that the virus will have on practicing docs.
4. FDA regulations - The FDA moved from an organization that focused on safety to one that now spends most of its time on whether laboratory tests and medications work. This requires massive studies and testing delaying the time for life saving drugs or test from being put to work. This is seen most obviously by the FDA preventing the introduction of coronavirus tests in time to actually help policy makers make decisions. By not having adequate testing, people have had to make decisions on whether to shut down businesses and schools without any idea how prevalent the virus is in the community.
5. Group Purchasing Organizations (GPOs) - Through cartelizing the hospital supply chain through regulations, Congress has left us with a very weak supply chain and producers of equipment necessary to fight the outbreak.
6. Information Control - The pandemic started because the first doctors to recognize a novel disease in their hospitals were prevented from warning others by the Chinese government. For weeks, potentially critical information about a virus outbreak was not given to the public so they were not taking basic preventative measures that those in Asia are so used to. The same information throttling was attempted in the US by our regulators on doctors in Washington. Eventually, those doctors got the word out on social media that there was a problem and people began acting appropriately. The free flow of information (even incorrect) is critical to getting people to eventually make the right decisions about their health.