Guest Post: Why Are We Waiting for the Federal Goverment to Offer Comprehensive Testing and Contact Tracing?
Note: This is a guest post by Miranda Wilgus, Executive Director and Co-Founder of ACA Consumer Advocacy (disclosure: I'm on the ACACA board of directors).
In the middle of June 2020, with over three months of an international pandemic behind us, over 100,000 Americans and more around the world dead from Covid19 and its complications, what are we waiting for? We know that our administration has done everything possible to impede the facilitation of needs and resources to our country. Special interests are running rampant, price gouging is the norm, government agencies have been scooping up supplies from states that are desperately needed, and the GOP controlled Senate is more focused on packing courts with unqualified idealogues than with passing bills to assist Americans financially affected by the pandemic.
It feels like much of the progress we’ve made as a society, the labor reforms people fought and died for, the governmental regulations meant to ensure our safety and our ability to trust that the medicine we take or the food we eat is safe, it feels like those hard fought battles are being rolled back faster than we can even register our outrage. Companies are still selling unreliable coronavirus test kits with no real oversight, and untrustworthy results. After years of fighting for better pay, suddenly minimum and low-wage workers have been deemed “essential,” yet have seen no pay raise, while many of their employers dragged their feet on creating safer conditions for workers, only acting when strikes and public outrage forced their hands. Many of these workers, due to delayed and insufficient economic assistance are forced to make a choice: work, and face the possibility of becoming sick and spreading infection to their family, or potentially losing their income and home. Millions of others have lost their jobs, with unemployment higher than any time since the Great Depression. In Texas, Ohio, and across the country, lines for food banks have stretched for miles as many Americans can no longer afford to feed their families. All while the president tweets increasingly incoherent and dangerous tirades, and those in his administration find ways to profit from a disaster, if not of their own doing, then one greatly magnified by their greed and incompetence.
Because of our continued insistence in linking healthcare to our employment status, millions of Americans find themselves not only out of work, but now without insurance in the middle of a pandemic.. Those in states that refused to expand Medicaid have essentially three choices: see if they qualify for an expensive COBRA plan to continue their existing plan, especially if they have already met their deductibles for the year, attempt to navigate the complicated maze of enrolling in an ACA exchange, or simply go without insurance at all. These millions of Americans must make this complicated choice while the administration works to overturn the Patient Protection & Affordable Care Act (ACA) - their opening arguments before the Supreme Court are due in mere weeks.
So - what are we waiting for? Seriously. Why are we still waiting for the federal government to fix this? To guarantee enough testing, to make sure there are enough treatment centers, especially in rural areas of our country. Why are we waiting for a cohesive contact tracing system, for more PPE, for anything else to trickle down from the top, especially when it seems the administration has moved on from talking about the current healthcare crisis? We have seen some modest improvements in some areas of the country, but it is not enough, it is not comprehensive, and we are starting to see more outbreaks due to states easing their lockdown rules.
The fact is, we can do this together. States are already working together in regional coalitions. Nonprofits and grassroots organizations are doing their best to fill in gaps. Imagine if we all worked together to address the issues we now face with this pandemic.
Every county in this nation has a health department. Many of these are stretched now - and frankly most of the time - but the fact remains that they represent the best place to build a nationwide effort focused on using local programs to do the contact tracing that is needed to open our country. They remain the best central base to make sure testing can be done in rural and underserved urban neighborhoods. A partnership made up of local county health departments, states, federal funds, and private funds and donations can be made to work. County health departments make the most logical place to create dedicated mobile health units that can function for contact tracing, testing, as well as primary care. Rather than inefficient and slapdash responses to a crisis, we could take this time to build a method of delivering dedicated, routine, regular primary care to those who need it, but can’t get it. Dedicated, routine, regular primary care.
What about the tech answers being bandied about - why not wait for the next cell phone app to do the tracing for us? In too much of this country, cellular networks are insufficient, and internet connections are spotty at best. Many of the communities most in need are comprised of people without the money to buy a smartphone. Once again, those most in need would be left behind.
This must be done in a non-profit, non-private, non-profit motivated manner. This is not something that we, as a nation, can afford to rely on private medical conglomerates to do, or to abdicate our responsibilities to private equity firms looking for the next quick profit venture. We cannot afford to exclude anyone based on insurance networks or being uninsured. These clinics must be available to everyone regardless of their insurance status. Medicare, Medicaid, private insurance, ACA exchange plans, underinsured, uninsured - everybody must have access.
Who will staff them? We have millions of healthcare professionals - from doctors to nurses, technicians, administrators and more - currently out of work, at the height of a national pandemic. Many were laid off from medical staffing firms at the beginning of the pandemic so as to protect the profit margins of the private equity firms that own them. Others were laid off as clinics that were deemed non-essential were closed. A report from the American Academy of Family Physicians estimates the closure of upwards of 60,000 family clinics by June, impacting over 800,000 workers. We can get these trained experts back to work at the same time we expand necessary healthcare across the country.
This whole system can be run out of the county health offices that already exist to handle this crisis. There have been significant advancements in logistical technology over the last several years. That same technology can be used to implement effective, quick, and thorough testing and contact tracing. There are foundations and donors looking to give money to programs that can make a difference, so let’s use them. We have too many different groups focused on reinventing the wheel rather than looking to existing models around the world for guides on how to build a functioning system. Rather than relying on profit-driven corporations to build proprietary walled gardens, we could be building a universal system, one that works with and for every person in America, regardless of income.
Once up and running, these mobile healthcare facilities can be utilized for community contact tracing and testing, a response to the pandemic that we desperately need. Later, as this crisis is brought under control, we can continue to fund this program in order to offer real primary care facilities that go to the people in need, those otherwise unable to travel to perhaps distant medical centers. If we can create a regular schedule, making appointments, offering school physicals, vaccinations, maternal and prenatal care, and providing chronic care monitoring, we can create relationships and extend care in areas that are chronically underserved. Not only will we keep those without primary care physicians out of the emergency room, but by extending healthcare into these communities we can improve overall health by addressing chronic conditions and providing preventative care to those who need it most.
To meet the long-term demand for doctors and nurses a program like this will create, we need more than just money. We will need Congress to open up the caps on residency openings in this country in order to train the numbers of primary care physicians this country will need long after we get through this pandemic. In addition, pressure must be brought to bear in order to stop the repeated attempts to slash the funding of Medicare and Medicaid, the programs we rely on to pay for these residency positions. Building on the success of the Teach for America program we can introduce a similar initiative that will allow medical students to work in underserved communities to pay off their medical school expenses. This would give our young doctors and nurses valuable practical and personal experience in treating patients in need.
Our nation’s healthcare system faces challenges on so many fronts, with so many things in need of attention that we can feel paralyzed by how much there is to do. Unfortunately, the cost of the status quo has grown too high to be allowed to continue. By focusing on a community based solution that can be built into a nationwide network, we can get started on the mountain of challenges in front of us, while laying the groundwork for a continued and necessary way to treat the most vulnerable among us. This is something we can do now to make real change and have a positive impact on the lives of millions. The health of millions, and of the nation, rests on our resolve to act now.