As a neuro-immunology specialist in Portland, I get a front row seat to witness the devastating effects on COVID-19 on my patients. And no, I don’t mean the effects of the virus on their neurological health. My clinics where I care for people with multiple sclerosis are dotted with last minute cancelations. Remaining patients often anticipate losing their insurance either from their own job loss or their partner’s job loss. I fill multi-month prescriptions and point them to charity arms of pharmaceuticals. The anxiety and depression is palpable and wreaks havoc on their health and ability to function in their families and relationships.
Interruptions in health insurance are always damaging to health, even without a pandemic, but COVID-19 shines a spotlight on the faulty logic of our employer-based health insurance system. For years I’ve watched my patients bounce from plan to plan as they (or their partners) change jobs, as employer options change, or as the plan coverage dwindles. They are forced to switch providers and switch medications even if they were responding well to their regimens. Enrollment processing time, transferring records, prescriptions at new pharmacies, and duplications of laboratory and imaging tests all result in worse disability and wasted time and money. COVID-19 shows all too clearly how our personal health is dependent on everyone else’s health. Ironically, public health is now the most vital, personal health issue.
Many unemployed from COVID-19 will qualify for Oregon’s Medicaid program, and the Oregon Health Authority is busy helping the over 14% unemployed Oregonians sign up on the marketplace and navigate options. However, Medicaid means yet more plan changes, more delays and inevitably worse health outcomes. Medicaid is a Band-Aid fix for a patchwork health insurance system that needs major surgery. Oregon is beginning the long slow process of returning to “normal.” Crucial to our long-term economic recovery must include healing our health insurance.
Fortunately there is a cure, and one that already works in our country. In my other job at the Portland VA hospital, the veterans I serve have more stability, more predictability and even more choice in their health care than their private pay counterparts. Not surprisingly, the levels of anxiety even during this pandemic are correspondingly lower. While not perfect, the VA is a cost effective and successful health care system preferred by veterans even when given the choice to use civilian options.
Health insurance done right is a federal concern. As U.S. citizens, we are free to work, travel and play in every state. Our health insurance should travel with us. West Coast neighbors Seattle, Washington and San Francisco, California passed Medicare for All resolutions. Oregon should do the same.
Economic recovery is a top priority for everyone these days. As a doctor, I am convinced that a healthy economic recovery relies on a healthy public. A national health insurance system tied to humanity, not jobs, will provide the most cost effective and high quality care.
Dr. Rebecca Spain is a neurologist at Oregon Health & Science University and the VA Portland Health Care System. She can be reached at [email protected].
