Editor’s Note: This roundup is part of the CNN Opinion series “America’s Future Starts Now,” in which people share how they have been affected by the biggest issues facing the nation and experts offer their proposed solutions. The views expressed in these commentaries are the authors’ own. Read more opinion at CNN.
With over 1 million deaths in the US from Covid-19, and close to 100 million cases of infection since the pandemic began, almost everyone in the nation has been touched by the disease in some way.
For Chimére Smith, who has suffered from long Covid since 2020, the last two years have laid bare the myriad problems with the American health care system. To advocate for her own health, “I became who I never wanted to be: a confrontational, complaining Black woman,” she writes.
“[M]y new life, which includes days of pain, brain fog, exhaustion and persistent eye issues, has left me unable to teach the students I cherished. I laugh at the money playing peekaboo in my bank account after exhausting all my leave benefits. And, some days, crying is all I can do.”
CNN Opinion asked health care and policy experts about their proposed solutions to refine our health care system so that it best serves all Americans.
Theresa Brown: As nurses fare, so fare patients
When too few nurses work on a hospital floor, patients die who would likely otherwise have survived. That is not hyperbole, but a fact well established by research.
Despite this, many hospitals have been understaffing their wards for years. Then, Covid-19 came, confronting overworked nurses with extremely ill patients who were dangerously contagious. Many patients died, and many nurses quit. Of those who remain on the job, many are considering leaving.
The crisis in nurse staffing arose largely because many health care entities prioritize profits over healing. Nurses comprise the biggest labor pool of any hospital, and are therefore viewed in corporate terms as a cost center rather than a profit generator. Eliminating nursing positions gives hospitals an easy way to cut their labor costs. The problem is that that no nurse can do the job of two nurses well, so care managed within such a rigid capitalist framework will inevitably be less safe.
To save nursing, and patient care, we need federally mandated staffing ratios of nurses to patients in the hospital. Ratios were implemented in California in 2004 without putting big hospital systems out of business. And the Center for Medicare and Medicaid recently imposed nurse staffing requirements in skilled nursing facilities, which are specialized nursing homes. Economic support from the government for financially struggling hospitals could help them staff appropriately.
As nurses fare, so fare patients, because nurses are the canary in the coal mine for patient health. Patients deserve to have safe curative care prioritized over excessive health care profits.
Theresa Brown, nurse and New York Times bestselling writer, is the author of “Healing: When a Nurse Becomes a Patient,” and “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.”
Brian Miller: Allow competition in hospital markets
According to the Kaiser Family Foundation (KFF), over 91% of Americans possess insurance coverage, yet according to data from the US Census Bureau nearly one in five still struggle to afford medical care. With the federal government’s deficit totaling $217 billion in the month of August 2022 alone, and economy-wide inflation at 8.2% in September, policymakers can lower health care costs for patients and increase access without increasing governmental spending by injecting a dose of competition into hospital markets.
With the recent political focus on corporate power and the ills of monopoly, the hospital industry is no exception and has come under the policy microscope. Ninety percent of metropolitan statistical areas are considered highly concentrated for hospital care, according to KFF, with hospitals buying up physician practices and driving further consolidation.
Researchers have demonstrated the harms of this lack of competition, with hospital consolidation leading to higher insurance premiums, higher prices and consumer cost-sharing, and decline in patient experience. Given that hospital and outpatient care comprise 50.4% of national health expenditures, according to research published in Health Affairs, it is no wonder that affordability remains an issue.
Policymakers could drive down hospital costs by repealing the ban on physician-owned hospitals from participating in the Medicare program, paving the way for physicians to open both new community hospitals and develop more specialty hospitals, which would increase hospital market competition.
With robust evidence demonstrating that competition in outpatient care markets lower costs, policymakers could reform Stark Law, which prohibits physician referral for designated health services to facilities in which the physician or a family member has a financial interest. Ironically, corporate self-referral is not subject to these restrictions, and corporate health systems frequently mandate internal referrals.
By lifting the physician self-referral ban in managed Medicare or managed Medicaid settings that have checks and balances to avoid waste and abuse, physician-owned and operated enterprises would be in a position to compete with corporate enterprises. Corporate monopolies would face increased competition from new physician-owned hospitals and clinics. And with consolidation tied to outcomes such as mortality, addressing hospital monopoly power is not just an issue of finances: It could be a matter of life or death.
Brian J. Miller, MD, MBA, MPH is a nonresident fellow at the American Enterprise Institute and an assistant professor of medicine at the Johns Hopkins University School of Medicine. He served as a Special Advisor to the Federal Trade Commission in 2015.
Syra Madad: Rebuild trust in science
Trust in science has taken a major blow recently. A Pew Research Center survey found that Americans’ trust in scientists is lower now than it was pre-pandemic.
This couldn’t come at a worse moment. We’re living in a time when disease outbreaks are rampant, and the need for communities to heed public health officials’ guidance is more important than ever – whether it’s asking people to mask up to help mitigate the spread of an airborne-virus like SARS-CoV-2 or to remain up-to-date with vaccinations.
But Americans are often struggling to discern between fact and fiction in an increasingly polarized nation, causing an unprecedented epidemic of misinformation that can often spread faster and further than the truth.
There are two things we must do immediately to jump start the slow and continuous process of regaining trust in science.
First, building trust in science requires a human connection. We must leverage trusted messengers in all communities and start from a place of dialogue as opposed to just fact-sharing. Even with a fancy health official title, you’re doomed to fail if you can’t make a personal connection with the people you’re trying to keep healthy. This is where local health departments play a significant role. They know their respective communities better than federal entities do.
Second, building trust in science is a year-round job – not something that can be done acutely during emergencies. Our cycle of panic and public health guidance during outbreaks, followed by neglect, erodes the relationships public health officials build with communities. We need to hear the voices of our public health officials, and see their faces, often and in times of non-emergency to establish trust for when crises strike.
Syra Madad, DHSc, MSc, MCP, is an infectious disease epidemiologist, faculty at Boston University’s Center for Emerging Infectious Diseases Policy and Research, senior director of the system-wide special pathogens program at NYC Health + Hospitals. She is also a fellow at the Belfer Center for Science and International Affairs. She tweets @syramadad.
Max Richtman: Expand Medicaid
It’s no secret that it can be hard to get things done in Washington. Health care reform is no exception. President Joe Biden’s administration and Congress have made some noteworthy progress, with the passage of legislation to lower prescription drug prices in the face of fierce opposition from the GOP and Big Pharma. Unfortunately, efforts to expand Medicare to include dental, hearing and vision benefits perished with the failure of Biden’s Build Back Better Plan, which lacked unanimous support among Senate Democrats and got none from Republicans.
With so little agreement between the parties on health policy, there is some lower-hanging fruit that can improve coverage for millions of Americans right now: Medicaid expansion.
The Affordable Care Act empowered states to expand Medicaid to cover almost all adults with incomes up to 138% of the federal poverty line. It has been an unmitigated success in both red and blue states. Medicaid expansion has radically reduced the number of uninsured Americans and boosted health outcomes, including fewer premature deaths, among older adults. It has also contributed to a reduction in health disparities for women and people of color, according to research from the Kaiser Family Foundation.
So far, 38 states and the District of Columbia have expanded Medicaid – including 16 traditionally red or purple states. More than 4 million uninsured Americans would gain coverage if the remaining states followed suit, according to Kaiser Health News.
It’s a turnkey option that the Biden administration has made easier to implement through special waivers. Voters in the holdout states that have yet to expand Medicaid should push their legislatures to join with the majority of states that have expanded the program. And they should keep this issue front of mind at the ballot box.
Max Richtman is president and CEO of the National Committee to Preserve Social Security and Medicare. He is former staff director of the US Senate Special Committee on Aging.
Lala Tanmoy Das: Diversify the pool of doctors
One of the biggest issues facing the American health care system are the disparities that keep many from accessing quality care. Medical education has a huge role to play in eliminating those disparities.
The end goal is this: There should be a diverse community of doctors that represents the populations they serve. Studies show that minority patients benefit from having minority doctors, yet the current makeup of the US physician workforce is not representative of population estimates. For example, African Americans constitute about 14% of the US population, yet only 5% of physicians are Black, according to 2018 data from the Association of American Medical Colleges.
To encourage more minority students to pursue medical school, there needs to be a systemic overhaul in admissions policies for undergraduate and graduate medical education, commitment to debt reduction and forgiveness, institutional policies that explicitly protect minority physicians from racism encountered on the job and pipeline programs that give students of color opportunities to bridge to medicine, which some schools have already adopted.
While investing in these long-term solutions, we must simultaneously reform the culture of medical education to be less biased and more understanding of our patients’ individual needs. We should continue to invest in implicit bias training and create safe spaces for students and trainees to engage in conversation to debunk stereotypes and prejudices that interfere with patient care.
Then, the next generation of doctors will be able to recognize inequities and the elements of our health care system that encourages them – like racist guidelines or medications and biometric calculators that inappropriately adjust for race – and dismantle them.
Lala Tanmoy (Tom) Das is an MD-PhD student in New York City. He tweets @TanmoyDasLala.
Jennifer Lee: Make sure Americans are covered when Covid-19 is no longer a public health emergency
With US inflation hitting a record high this summer and the increased cost of everyday necessities straining American families, especially in communities of color, ensuring affordable access to health services is more important than ever.
The Inflation Reduction Act takes a vital step by extending the premium tax credits for those who buy their own coverage on the Affordable Care Act marketplace, enabling 13 million individuals to continue to afford their coverage, according to the Kaiser Family Foundation. Congress would do well to make these tax credits permanent.
In addition, when the Covid-19 public health emergency (PHE) ends, an estimated 15 million Americans, including over 5 million children, could lose their coverage through Medicaid, according to estimates from the Department of Health and Human Services.
As the Georgetown University Health Policy Institute points out, as of September 30, only 27 states and the District of Columbia have publicly shared their plan to prepare for the end of the PHE. State leaders should act now to ensure every Medicaid enrollee knows how to stay covered and should work to simplify renewal processes, such as using electronic data sources to verify eligibility.
This is particularly urgent for those 12 states that have yet to expand Medicaid. In these states, the end of the PHE could leave 383,000 adults with no other options for affordable coverage, while expanding Medicaid would provide financial security and access to health care to millions of mostly working adults and parents.
As federal procurement for Covid-19 vaccines and treatments ends, the government will transition these costs to insurers and consumers, including for vaccines, which can be costly.
So, it is essential that policymakers continue to explore policies to mitigate the high prices of drugs and therapeutics, such as prohibiting drugmakers from shifting costs to non-Medicare consumers and establishing a federal reinsurance program for high-cost drugs.
Jennifer Lee, MD, is chief medical officer at the Alliance of Community Health Plans and former Medicaid director for Virginia.