"People are not avoiding health care because of costs in Europe," said Reggie D. Williams II, an international health policy expert at the United States-based Commonwealth Fund. "Unfortunately, Americans have a double burden of worrying about access to care … and then affordability."
Health systems everywhere are stretched by the pandemic. Hundreds of thousands of people around the world suddenly need the same treatment. The problems are just about everywhere: inadequate test capacity, high demand for hospital beds, lack of ventilators, personal protective equipment (PPE) and medical personnel.
The health experts say it is too early to make final judgments about which countries did well and which failed because the pandemic is far from over. But there are lessons to be learned already.
Rifat Atun, professor of Global Health Systems at Harvard University in the United States, said the evidence so far suggests that more centralized, publicly funded systems with universal coverage and a solid chain of command and control have weathered the crisis better. They have been able to scale up the test faster, coordinate response, pool resources and reduce death rates.
"The chain is as strong as the weakest link," he said. "In the United States, there is not only one health system in itself, but several systems in each state, and in each state there are different subsystems, so having a smart, coordinated response has been very difficult – and that has implications because, you know, viruses do not recognize borders from one state to another. "
One place where the United States differs from other countries is how much the pandemic costs people infected by the virus.
Count the cost
Paolone, who is 56 and lives in Monte Silvano in central Eastern Italy, called an ambulance last month after experiencing persistent chest pain. He was sent to an emergency room and later diagnosed with Covid-19 – something he did not expect. He was in an isolation unit with nurses wrapped head to toe in protective gear that reminded him of space suits checking on him through a glass window.
"I had an oxygen mask, but I couldn't breathe … there was a bell next to my bed and I rang the bell," he said. He woke up six days later, at another hospital. "The doctors and nurses clapped when I woke up and they told me I was brought [in] with a helicopter. "
Blomberg's Covid-19 journey sounds worrying. Days of fatigue and pain, a decision to call an ambulance, medically induced coma and a ventilator.
Both Paolone and Blomberg have a long improvement ahead. But unlike Blomberg, Paolone doesn't have to worry about the cost of treatment that saved his life. "I didn't pay for anything. Not a cent," he said. He does not have private health insurance and is currently unemployed, but that does not affect his access to health care. The Italian system is financed through taxes; Primary and 24-hour care is free at the point of use for all residents and residents.
Blomberg, 35, lives in Muskego, Wisconsin. She's lost her job during the pandemic, but has medical insurance through her husband's employer – unlike the 28 million Americans who, according to the U.S. Census Bureau, were uninsured in 2018. But even with the insurance, the bill she's facing for her Covid-19 treatment is eye-catching.
"The ambulance ride was two grand on its own," she said.
Blomberg has so far received bills that cover only some of her treatment and prescriptions. "They were only on the doctor's visit the first few days I was in the hospital, and each doctor's visit cost me between $ 300 [and] $ 400. "
United Healthcare, Blomberg's insurance company, told CNN that it waives cost sharing for Covid-19 treatments for members of Medicare, Medicaid, individual markets and certain employer-sponsored health insurance plans. But others who have United Healthcare policies through their jobs may have to pay for the care.
Blomberg has received no indication that her charges will be waived.
She was too ill to care about the cost of her treatment when she called the ambulance. "My concern kept me alive, it wasn't the bills," she said. "I can take the rest of my life by paying it back."
But study after study shows that money is an important factor for many Americans.
According to the Commonwealth Fund, one in three adults in the United States, even before the Covid-19 crisis, skipped medical treatment because of the cost, compared to one in ten in the United Kingdom, Germany, the Netherlands and Sweden. When the foundation investigated people in the United States about the coronavirus, two-thirds said that costs would be a very important factor in their decision to get care if they had symptoms.
The fact that I look at the United States is a large majority of those who die, those from underprivileged groups, says that costs have been a deterrent to many people accessing services. "This suggests to me that these people usually do not have access to services, probably postpone the decisions and present late."
This is a dangerous approach, especially when dealing with a highly contagious virus. "It makes it very difficult to mitigate and control the pandemic … if people do not go and test, we do not know if they are infected, and it has consequences for politics," said Liina-Kaisa Tynkkynen, an assistant professor of health science at Tampere University in Finland.
"The crisis underlines the value of having a universal public health system as well as a broader social security system," Tynkkynen said. "When these kinds of crises happen, it affects not only people's health, but also their social well-being, their employment, their financial situation," she added.
For many experts, the pandemic is just the reason for major health reforms in the United States.
"There are many healthcare resources in the United States that can be channeled to achieve the universal coverage goal," Williams said. "Yes, there are the political barriers. Yes, there are barriers to taxation and trusting government, but I think this pandemic has shown that lack of universal coverage really lets a lot of people fall in between the cracks."
Blomberg said she prefers a universal coverage system over private health insurance. "I think it would be much, much better for everyone," she said, quickly adding that she is pretty sure the system will not change soon. "I don't see universal health care being an actual alternative right now," she said.
"Part of the problem is, you know, people who make these decisions, they don't have to worry about it. Because they're completely covered by government jobs. They make a ridiculous amount of money. And if people aren't?" Don't be influenced by anything, it's not going to change your opinions about things, "she said.