Lessons Learned, And Not Learned, From The Pandemic


The COVID-19 pandemic lies at the intersection of healthcare delivery and public policy. Deborah Freund and Terry McGann have spent a lot of their professional lives at that crossroads, studying and steeping themselves within the issues.

Freund, a school professor and former CGU president whose academic expertise is in health economics and health policy, recently co-authored a significant study of the Affordable Care Act and its effect on insurance coverage in the last decade. McGann earned his PhD in political philosophy and government from CGU ('75) and it has taught in the university. He started his career in healthcare economics and policy within the 1970s, served elected officials, and developed a reputation like a dean of Sacramento lobbyists.

Freund and McGann recently shared their opinion of the pandemic and it is ramifications within the following Q & A.

Should more have been done to get ready for a pandemic? Did politics get in the way?

Terry McGann: In 2021 the Smithsonian were built with a dramatic article predicting that the next pandemic would come from China, so it's nothing like there wasn't attorney at law about this possibility. But you will find pressures have a tendency to confront government. It is sometimes complicated to choose and choose which crisis you are going to prepare for because it involves money, time, energy, and risk. If you start spending vast sums of dollars on something that might not take place in your daily life, you open yourself up to a lot of criticism.

Though we were hopelessly unprepared for COVID-19, we've moved toward something that might hopefully lessen the horror of the pandemic, thanks to the resilience from the American economy and the kind of talent we have within the private and public sectors.

There's no question that within the new world of politics, a high level Democrat, along with a Republican includes a bill that will provide infrastructure, for example, it is good for you personally when they can't win-even if the country loses. Once the GOP controlled the Senate during President Obama's administration, they basically didn't approve the bills that left the home. This sort of thing shows that our leaders have not been good stewards, and that we need individuals politics to be stewards. Maybe this crisis will create a real chance of better thinking about that responsibility. Without them, the political system is hopelessly compromised.

What has got the pandemic revealed about the state of our nation's healthcare system?

Deborah Freund: The pandemic has really highlighted disparities in health outcomes and use of care. For a number of reasons, people who are Black as well as Mexican or Latin American descent, and other at-risk populations such as those people who are incarcerated or homeless have been in worse health than anyone else. And they are more likely to die of COVID-19. Some problems go back to the Tuskegee experiment-you possess a degree of distrust among some groups about likely to doctors once they aren't exactly the same race. As a result, they don't go.

Unlike other developed countries, there exists a significant quantity of people–8 percent of the population-not covered by health insurance, which may be keeping them from seeking care even when they need it. There is also a large amount of evidence that individuals who are having strokes and heart attacks might not be going to the er or hospitals for care. If you're really sick-if you tested positive for COVID-19-you may go for an er and get admitted to a hospital, but the bills would follow you later. When you have no insurance there are high costs, there are problems.

Something that isn't being discussed very much-I take a seat on several health system boards-is the way hospitals are accommodating COVID-19 by planning for surges in intensive care. Hospitals are running at low occupancy because they are awaiting surges, and they are taking a loss just because a large amount of other types of care are being deferred. They're getting money through the CARES Act, however i don't think that is going to counterbalance the extent from the financial harm to most of them. What that does to the way forward for healthcare and innovation remains to be seen.

How much harm to the economy will the pandemic cause, and just how much is going to be long-term?

McGann: This virus is extremely likely likely to return in the fall, there hasn't been a lot of discussion about that except from the experts. It's difficult predicting exactly what the endgame is going to be. We already have a significant national debt. Thanks to the Fed's capability to print money-let's hope that doesn't go away-we could obtain a lifejacket and stop a depression. But we will be up to $25 trillion indebted, and there's a formula on the relationship of the national debt to GDP. It isn't an irrelevant number. It's something that policymakers need to focus on, and they've to really make it part of their decision-making.

Freund: The economists agree we will have a transformation. It won't look like it did before the pandemic. Forecasts indicate that the unemployment rate and national debt will exceed anything we have experienced before, like the recession that began in 2008. So, regrettably, I fear that things will not be normal again in the near future.

How will the pandemic inform discussion about national health policy?

McGann: Administrations returning to Teddy Roosevelt have talked about universal medical health insurance. In 1954, the government ruled that pensions and medical health insurance could be tax deductible, which incentivized employers. When Medicare and Medicaid came along in 1965, millions more came onboard. Now, healthcare providers are subcontractors towards the four big insurance providers, which control an overwhelming majority of the market. They're permitted to measure their very own risk and therefore are not obliged to insure who they do not wish to insure. Health insurance companies aren't evil. They are not villains, but they have to do what life insurers have done, which would be to not cherry-pick a region inside a state.

About 75 years ago life insurance companies were prohibited from establishing different rates for particular regions within a state. A single rate for the entire state was required. They might, of course, establish different rates based upon age an individual. In healthcare insurance today, companies ought to be necessary to create \”community rating\” price calculations and be barred from \”experience rating,\” meaning cherry-picking various policies would not be permitted. The Kaiser Health Plan was originally dedicated to this principle.

Since medical health insurance is so complicated, I would not be opposed to a large state like California being divided up into several regions, but each could be required to have a singular community rate. As it stands now, it's almost impossible for the large insurance providers to fail. They increase their rates each year and they pick who they want to serve. Their ability to control costs and risks is non-sustainable.

I accustomed to represent Hospital Corporation of the usa for twenty-four years as a lobbyist in California. I attempted to convince them that their future could be compromised forever if they didn't adopt universal healthcare. If everyone is insured, you don't have this uncompensated care gestalt of monetary accounting that makes no sense. That structural issue will come front and center as a result of COVID-19. It will be clear by the end of the year that a lot of people who died because they didn't have access to healthcare shouldn't have died.

If the health insurers can't figure it out, we will possess a single-payer system in this country-and I do not think this is a good idea. I believe the public-private partnership is much better, but when they do not get going, they're going to get crushed.

Freund: We've identified many weaknesses in providing use of care and coordination of care, of providers not ready, along with a shortage of doctors and other health practitioners. Special provisions are allowing people from one state to practice in another in which they aren't licensed, and new graduates who have been supposed to start residencies are now around the front lines. I'd hope that we will make use of the science and data to go forward with greater collaboration so that we're able to work together to do the things we have to do. It's a very complex business, and shortcuts are doomed to fail.

McGann: All these people who are uninsured are now a large risk to folks who're insured. They've never had this kind of exposure to this side of the issue-direct health risks. To me, that's one of the seminal stuff that is going on at this time.

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