North End resident Dr. Glen Mays admits to not owning a crystal ball. Still, as a specialist in health policy and health economics, and chair of the Department of Health Systems Management and Policy at the Colorado School of Public Health, he possesses a unique vantage point from which to reflect on the lessons of recent epidemics and the current one and contemplate the future. He is optimistic that medicine will shift in new ways a result of Covid.
“For 30 years we’ve been talking about tele-medicine and thinking around the edges, but there’ve been policy barriers to really doing it on a broad scale, and Medicare and Medicaid pay only for very limited things; this pandemic really opened the floodgates to tele-health and tele-medicine, and we’ve learned very quickly how to scale this work up.” Mays believes these changes will continue to enhance how people interact with doctors and receive medical care well after the current pandemic is under control.
A key lesson learned from Covid, he says, is, “We’ve learned a lot about the constraints of our current healthcare system and its limited surge capacity.” Everyone has paid the “very steep price” of “literally shutting down the economy to avoid overwhelming our health care system because our capacity was so constrained, particularly on the inpatient side.” Mays faults cost-control measures over the last three decades that resulted in fewer hospital beds per capita, for example, than in other industrialized nations. Hospitals and healthcare systems, he says, will have to address how to meet excess capacity so they won’t be caught off-guard in the next pandemic. And yes, that’s right. There will be other pandemics, fostered by climate change and other factors, which Mays predicts will bear down with “more frequency, more intensity.”
A third area where he sees room for growth in the post-Covid-world is in the very nature and design of the US healthcare system. The pandemic underscores “the limits of our fragmented, federated kind of healthcare delivery systems in the US.” While Mays says it is too soon to know whether this experience represents a tipping point that will signal a shift to universal coverage or a single payer system, he thinks those states that hadn’t opted to expand their Medicaid coverage under the Affordable Care Act (aka “Obamacare”) may now take steps to do so. “We’re still going to see the problems of not having any universal coverage system in place with health insurance losses and job losses and the economic effects that that has on hospitals and health care providers,” he observes. But perhaps new models will emerge.
In light of the way the coronavirus has especially devastated communities and individuals with comorbidities like hypertension, heart disease and diabetes, Mays hopes that “prioritizing prevention” will be one of the other takeaways of this experience. Short-term, however, he worries that the pandemic has kept people from receiving vital medical, mental health, and substance abuse screenings, routine vaccinations and preventive treatments. As unemployment pushes more people off their employer-provided insurance policies and co-pays and deductibles loom, some people may well choose to forgo preventive screenings, exacerbating inequities and making them even more susceptible to Covid and other illnesses.