October 2020, Volume XXXIV, Number 7

cover story One

Keeping Politics Out of Science and Public Health

COVID-19 Shines a Light

OVID-19 has magnified the critical problems in our health care system, heightened people’s awareness of its flaws, as well as the need to improve it. One needn’t look further than the fact that the United States accounts for 22 percent of global COVID-19 deaths despite making up 4 percent of the global population.

Amid this great resetting, we must take every opportunity to rethink the parts of the health care system that are not serving people and build a more reliable and robust health care system for the future.

Public trust and faith in science are critical when it comes to population health, especially during a pandemic. Unfortunately, however, we have seen an unprecedented amount of politics injected into our health care delivery system. So much so that even masks and physical distancing have become political issues. Unlike previous national emergencies, such as 9/11 that brought the country together, the COVID-19 pandemic has only fueled our nation’s political divide.

An example is the deluge of misinformation about the pandemic — whether it’s the constant downplaying of the dangers of COVID-19, attacks on public health institutions, or amplification of false medical treatments — spreading on social media and elsewhere, which we’ve seen create real-life consequences.

Every day we are confronted with headlines that remind us of the reality that COVID-19 does not care if you’re a Republican or Democrat. It also doesn’t care if you, or your patients, are tired of it or think the threat is overblown.

Our nation has a dire need for science-based, nonpartisan information.

Building trust is enormously important in neutralizing misinformation and overcoming increasing skepticism around an eventual COVID-19 vaccine, and we all share a responsibility in this critical work. Health officials are doubling down on calls for flu shots to prevent systems from being overrun in the coming months.

Our nation has a dire need for science-based, nonpartisan information about the pandemic and the critical nature of public health preparedness in general.

COVID-19 Magnifies Existing Problems in Our Health Care System

Now more than ever, it’s time to put science and health care above politics by redefining the goal in human, not political terms and supporting a positive, practical, and lasting approach.

United States of Care is a nonpartisan nonprofit co-headquartered in Minneapolis and founded in 2018 by Minnesotan Andy Slavitt, a former Acting Administrator of the Centers for Medicare and Medicaid Services. Its mission is to ensure that every American has access to quality, affordable health care regardless of health status, social need, or income.

Since March 2020, our work has been oriented around COVID-19. Specifically, the need for practical solutions that address both the immediate challenges of the crisis and long-term gaps in our health care systems — laid bare by COVID-19 — to ensure people can access affordable, high-quality care.

Looking ahead, the pandemic, economic recession, and national discussion on race have created a renewed call for action in America. It simply isn’t enough to get “through the crisis” and go back to the system we had before. We believe this moment is an opportunity to work together to build a health care system that serves all of us better.

That starts by understanding and addressing health care disparities, examining the role of virtual care, investing in communities to improve health, and reimagining job-connected health care. The invaluable perspectives of physicians on the frontlines of COVID-19  are especially important in the larger policy conversations to come, post-election.

Health Disparities

Sadly, it isn’t a surprise that people of color have disproportionately experienced the pandemic’s burden. Despite some perceptions that systemic racism is not a public health issue, overwhelming facts prove otherwise.  COVID-19 simply magnified the problem that already existed.

Two years ago, USofCare launched an initiative with Minnesota health systems, community leaders, and Wilder Research to develop a roadmap to end disparities in health outcomes throughout the state. The goal was to listen to individuals and communities facing structural barriers and to put forth policy solutions aimed at better addressing racial disparities in the short-term and ultimately eliminating them in the future. The work resulted in a Feasibility Study, The Role of Health Care in Eliminating Health Inequities in Minnesota, and a Systems Transformation Framework.  We urge institutions to utilize this tool to ensure all people — particularly those most underserved — can live the healthiest life possible.

As physicians we must ask questions like what more can we all be doing to advocate for change in the systems where we serve? How can providers check our own biases to provide the highest level of care to all our patients?

Looking at Virtual Care in the Right Way

From the moment the pandemic forced providers to reimagine the way they care for patients, and regulatory flexibilities were granted — COVID-19 unleashed a revolution in virtual care.

While there’s no denying that virtual care has filled a critical gap in the system left by the sudden restrictions on physical visits, serious questions remain surrounding the future of virtual care post-COVID.

We recently launched a new initiative to explore how virtual care can best function as an innovative tool to help groups — disproportionately impacted by health inequities — access care in a whole new way.

We are starting our work with a listening tour to connect with people throughout the US and better understand their experience with virtual care. We’ll be pairing what we hear with research, evidence, and input from experts on how virtual care has helped to break down barriers to accessing care - or in some instances, create new ones. We’ll use this information to produce tools and resources policymakers and health systems can use to create a virtual care system that works for all of us. We then plan to bring together expert leaders to support the implementation of these resources and evaluate their impact over time. We also especially want to hear the perspective of physicians. Our questions include: How have you embraced virtual care since COVID-19 started to take hold in the US? How can we think about virtual care as a tool towards achieving more equitable access?

We must rethink our 75-year-old system of job-connected health insurance.

Investing in Communities to Improve Health

The interlocking economic and public health crises have created the imperative to reframe what constitutes health as more inclusive of mind, body, spirit, and community. Providers are increasingly partnering with patients to gain a better understanding of their comprehensive health-related social needs.

As one example, Allina Health is part of the Accountable Health Communities cooperative agreement with the Centers for Medicare and Medicaid (CMS). It has been screening its patients for basic needs such as food, housing, transportation, and interpersonal safety, then supporting patients with unmet needs to connect to community resources.

We need to continue to accelerate approaches that support this type of multidimensional health care delivery.

Rethinking  Job-Connected Health Insurance

During the past seven months, the pandemic has magnified the risks to the more than 160 million people who have their health security connected to their jobs. In fact, it’s estimated that as many as 14.6 million people may have lost their job-connected health insurance benefits. These compounding effects of the pandemic have helped people see that one individual’s health is linked to the health of all, and we need to re-examine the precarious state of job-connected health insurance for people, employers, and our economy. We must rethink our 75-year-old system of job-connected health insurance, which can leave half the US population vulnerable to losing both their job and health security at the same time.

Here again the voice of physicians is crucial.  How does the system of job-connected health insurance help or hinder your patients’ ability to access the care they need?

Reflections on 2020 and Looking Ahead

For the overwhelming majority of Americans, 2020 has been a year filled with enormous anxiety, uncertainty, and frustration. Although we do not know when the pandemic will end, for many, the psychological, physical, and mental scars may never go away. Our nation finds itself at a crossroads. The lessons we choose to learn from COVID-19 will  shape policy and decision-making for generations to come.

While the pandemic has highlighted so much of what’s wrong with our national health care system, it’s also highlighted what’s right – the people.  Americans are finding hope amid the crisis – in religion, their families, and stories of people helping others. They are forever grateful and inspired by the extraordinary efforts of our nation’s physicians, nurses, and other medical workers on the front lines.  We are faced with a unique opportunity to build a stronger health care system for the future — one that truly serves all – and we must do everything we can to that end.

Emily Barson is the Executive Director of United States of Care.

Penny Wheeler, M.D., is the CEO of Allina Health and a Founder’s Council Member of United States of Care.

Please visit us online, we’d love to hear for you. (https://unitedstatesofcare.org/) for updates and the latest resources. 

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