If you are like me, you are aggravated that many people refuse to take simple steps to stop the spread of COVID-19 – measures like masking, social distancing, and avoiding crowds. We see these people in our stores and in other public places that post clear instructions of preventive requirements upon entering their establishments. The offenders know but simply do not care about prevention.
Since these people refuse to adhere to health standards even though the virus has killed over 213,000 in the United States and nearly 4,700 in Ohio, let's offer them a different view of the effects of the coronavirus: the monetary costs to people who contract the virus. Those who are infected can face astronomical fees for treatment.
It is my hope that this entry will shed light on the tremendous costs incurred by COVID-19 patients. Perhaps some of those who believe their individual rights and freedoms supersede public heath concerns will wilt after looking at the personal costs of contracting the virus. Consider that the total COVID-19 treatment cost for payers could be as high as $546.6 billion, according to an America's Health Insurance Plans study.
Michael Cohen, PhD Senior Consultant and Julie Peper, FSA, MAAA. “COVID-19 Cost Scenario Modeling: Treatment.” Wakely. June 03, 2020.)
As of October 10, 2020, the number of hospitalizations in the state is 16,301 with 3,413 ICU admissions. Being hospitalized for coronavirus can leave patients with a bill totaling tens of thousands of dollars, depending on their health insurance, level of treatment, and which state they live in.
The average cost of a hospitalized COVID-19 patient can range from $14,000 to nearly $75,000, according to several studies. Cynthia Cox, vice president of the Kaiser Family Foundation, a California-based nonprofit, says …
“If someone is very ill and needs to go to the emergency room and be hospitalized with coronavirus, that’s where they can come into some very hard financial situations.”
(Megan Henry. “Being hospitalized for COVID-19 can cost you tens of thousands of dollars, studies show.” The Columbus Dispatch. July 26, 2020.)
The length of a hospital stay for a COVID-19 patient depends on how sick the patient is. The median length of hospitalization for COVID-19 survivors is 10 to 13 days, according to the Centers for Disease Control and Prevention, and the average cost to treat a hospitalized patient with COVID-19 is $30,000, according to a study by America’s Health Insurance Plan, a trade group for insurers based in Washington, D.C.
For patients who require ventilator support, the combination of longer stays and higher-intensity treatments results in higher average spending. The bills of COVID-19 patients who go on a hospital ventilator can easily reach $80,000 or $100,000.
Other studies give estimates that are lower and higher. A study in the health policy journal Health Affairs found the median cost of a coronavirus hospitalization is $14,365, not including follow-up care. And yet another study reported a hospitalized coronavirus patient should be prepared to pay anywhere from $42,486 to $74,310 if they are uninsured or if they receive care that’s deemed out of network by their insurance company, according to the New York-based nonprofit FAIR Health.
Cynthia Cox said …
“Even if the hospital is in your health insurance’s network, sometimes the doctors who work at the hospital are not.”
Consider that this “sticker shock” for healthcare can prevent some people from seeking treatment. Experts caution that when the bill comes for coronavirus treatments, a patient should check with the hospital’s billing department and the state’s insurance department, if it’s a private insurance plan, to see if the patient is allowed to be billed.
Cheryl Fish-Parcham, the director of access initiatives at Families USA, a Washington, D.C.-based consumer advocacy group, reported insurers in Ohio can still charge copayments or coinsurance. Fish-Parcham said …
“In a number of states there have been requirements that are state-specific that says that for COVID treatment there can be no copayments or coinsurance, so you want to find out if your state is one that has a rule about this during the emergency.”
(M. Hackett. “Hospitalized care for COVID-19 averages $34,662 to $45,683, varying by age.” Healthcare Finance. July 15, 2020.)
Earlier this year, FAIR Health released cost projections of COVID-19 inpatient stays for someone without insurance or who received out-of-network care – the costs were estimated to be over $73,000.
If patients had insurance or were covered under Medicare or Medicaid, the price estimates reduced significantly.
For commercially insured patients, it was estimated that their inpatient services would cost about $38,000. For Medicare and Medicaid patients, the cost was reduced to about $10,000 and $7,000, respectively.
How about bills for something as simple as getting tested? For some Americans, the bills could start mounting with frequent tests. Insurers are generally required to pay for those tests when physicians order them, but not when employers do.
The Trump administration made that clear in June, when it issued guidance stating that insurers do not have to pay for “testing conducted to screen for general workplace health and safety.” Instead, patients need to pay for that type of testing themselves. Some might be able to get free tests at public sites, and some employers may voluntarily cover the costs. Others could face significant medical debt from tests delivered at hospitals or urgent care centers.
Covid tests typically cost $100, but one emergency room in Texas has charged as much as $6,408 for a drive-through test. About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight. With 108 million tests performed in the United States, that could amount to millions of tests that leave patients responsible for some share of the cost.
(Sarah Kliff. “How Much Would Trump’s Coronavirus Treatment Cost Most Americans?” The New York Times. October 07, 2020.)
And what about those “special” treatments taken by President Trump? Remdesivir is said to shorten a patient's hospital stay by about four days. It's unclear whether the drug also improves survival. Dr. Anthony Fauci, the nation's top infectious disease specialist, has called it the new "standard of care" for Covid-19.
Remdesivir is in high demand but in limited supply. Remdesivir shortages force doctors to make "heart-wrenching" choices about who will get the drug.
The U.S. government, which is deciding where remdesivir goes, has offered few answers and little guidance since the drug was authorized for use on hospitalized patients. No comprehensive plan for distribution has been publicly released in the days since. Hospitals decide which patients are the best candidates, though they will follow FDA rules. Candidates for the treatment are those with severe cases of COVID-19 pneumonia, but who don’t have kidney or liver failure.
In the United States, Gilead Sciences will charge $520 per vial for patients with private insurance, with some government programs getting a lower price. With a double-dose the first day, that comes out to $3,120 for the five-day treatment course. For governments in developed countries outside the U.S., it will cost $390 per vial, or $2,340 for the five-day course. How much uninsured patients would pay is still unclear.
Rep. Lloyd Doggett, D-Texas, called the price "outrageous." He says …
"Without a taxpayer investment of $99 million, this drug would have been abandoned. It would be on the scrap heap of failures. So it's the taxpayer who's really taking the risk here and ought to get the reward of the angel investors that taxpayers are."
Public Citizen, a nonprofit consumer advocacy group, echoed Doggett's remarks with a similar sentiment. Peter Maybarduk, director of Public Citizen's Access to Medicines Program said in a written statement …
"In an offensive display of hubris and disregard for the public, Gilead has priced at several thousand dollars a drug that should be in the public domain.”
(Sydney Lupkin. “Remdesivir Priced At More Than $3,100 For A Course Of Treatment.” National Public Radio. June 29, 2020.)
Trump also received an experimental antibody treatment from Regeneron. It’s currently available to clinical trial participants or to those granted a “compassionate use” exemption. In either situation, the drug would typically be provided to the patient at no charge. This will most likely change, however, when the treatment finishes trials and hits the commercial market. These types of drugs are hard to manufacture, and other monoclonal antibodies cost thousands of dollars.
The Bottom Dollar
Uninsured patients could be stuck with the entire hospital charges and not receive any discounts. While the Trump administration did set up a fund to cover coronavirus testing and treatment costs for the uninsured, The New York Times has reported that some Americans without health insurance have received large bills for their hospital stays.
If a new Supreme Court challenge to the Affordable Care Act is successful. That case argues that all of Obamacare is unconstitutional, including the health law’s protections for pre-existing conditions. The administration filed a brief in June supporting the challenge.
The Supreme Court hears that case on November 10. If the challenge succeeds, Covid-19 could join a long list of pre-existing conditions that would leave patients facing higher premiums or denials of coverage. In that case, coronavirus survivors could face a future in which their hospital stays increase their health costs for years to come.
And, as we, the premium-paying insured, all know, most Americans have a story about a fight with their insurance. Also, we understand our insurance companies (not to mention our benefit-granting employers) – to whom we pay large premiums – will pass all increasing fees associated with the coronavirus along to us, the holders of the policies.
As of 2019, the average, non-elderly family in America paid $8,200 per year or 11% of their annual income to insurance fees, according to the research group Kaiser Family Foundation. Their employer also made payments toward insurance, on average around $5,500.
(“The Real Cost of Health Care: Interactive Calculator Estimates Both Direct and Hidden Household Spending” Kaiser Family Foundation. February 21, 2019.)
The truth is that COVID-19 could put untold multitudes in the poor house. There is a phrase in American medicine for extraneous costs and the stress of not knowing who will pay them: “financial toxicity.” That ugly phrase has often been used in discussions of cancer treatment, which are so expensive a remarkable 42.4% of American cancer patients deplete their entire life savings two years after a diagnosis. (This was a nationally-representative investigation of an initially-estimated 9.5 million newly-diagnosed persons.)
(Adrienne M. Gilligan, PhD et al.“Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer.” Clinical Research Study. The American Journal of Medicine. May 2018.)
To add insult to injury (Pardon the pun.), Americans pay more for healthcare than any other nation, including during a pandemic. At the same time, Americans rarely know how much a given treatment will cost even as they receive it.
Here's an example we all saw – experts put the cost of Trump's coronavirus treatments, including helicopter rides to and from the hospital at least at hundreds of thousands. Dr Bruce Y Lee, a professor at the City University of New York School of Public Health, said …
“I would not be surprised if it were to exceed $1million.”
Trump has excellent government insurance and his treatment by the White House Medical Unit is free. Lee explained …
“The majority of Americans don’t have the best treatments, whatever Trump said, because it’s about access. The care that he received is available only to a very small minority of Americans.”
(Jessica Glenza. “Trump enjoys top Covid care that could cost ordinary Americans millions.” The Guardian. October 08, 2020.)
So my point today is this: Consider how your brazen refusal to wear a mask in public, social distance, and avoid large crowds – simple, inexpensive measures – may cost a person(s) not only their health but also their savings … and a huge hunk of their present and future incomes. And that is if the person(s) can afford the bill. Many cannot.
Many of those who support Trump speak of their love for his economy. They see this as his saving grace. Regardless, I ask you to see his failing health policies. He repeatedly downplays COVID-19 and shirks responsible behaviors to prevent the spread of the disease. In fact, he has promoted opening America even as the pandemic kills an average of 919 a day since the first case in the U.S. was reported in mid-January. Consider that the number of coronavirus deaths on October 8 was 957. We are still in deep trouble.
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