Analysis: A U.S. experiment on single-payer care just ended

For the last three years, the United States has been operating an experiment in single-payer health care — for one disease.

That era largely came to an end last week as the public health emergency for COVID-19 expired. For COVID, the government bought vaccines and drugs in bulk and handed them out to everyone who needed them, as part of a set of emergency provisions authorized by Congress for as long as the White House said they were needed. It required insurers to pay for all COVID tests and paid testing facilities when uninsured people used them. It guaranteed the hospital bills of anyone who needed hospitalization for COVID.

Now that the government’s official emergency is over, those programs are phasing out. Some people will still be able to get free COVID tests, if their insurance wants to cover them that way. Other people will need to pay copayments or deductibles for those tests.

If you have insurance, you can still get free COVID vaccines. But if you’re uninsured, you may have to pay out of pocket starting next year.

And what you’ll pay for antiviral drugs such as Paxlovid will depend on what kind of insurance you have.

As for COVID hospitalizations, they will now be just like any other hospitalization, possibly subject to huge deductibles or coinsurance — just like the hospitalizations for people in recent years who had non-COVID pneumonias, even though their illnesses were often just as serious and required many of the same treatments.

The transition is likely to be confusing and bumpy. The details of how your COVID treatment will be covered will depend a lot on what insurance plan you have. And the exact switch from free to not-free for some treatments will be unpredictable, tied to when government supplies of things run out.

But of course, the U.S. health care system for every other disease tends to be confusing and bumpy. Patients with other ailments — such as cancer, arthritis, hepatitis C or diabetes — have been contending with these vagaries all along. Those diseases are also major public health problems.

Democrats in Congress are pushing for a policy that would limit how much people have to pay for insulin, which many diabetes patients ration for cost reasons. But that approach, too, would be limited to one class of drugs, for one disease.

Proponents of the current system say it deploys market forces to keep costs low, encourage innovation and limit unnecessary treatments. Letting people get unlimited free COVID tests, for example, might have induced some testing facilities to charge outrageous prices. Bulk government purchasing of two mRNA vaccines may have hampered the study and reach of other types of vaccines that might be better in some cases.

Detractors have long said the U.S. system’s patchwork nature and unpredictable consumer costs are harmful, by causing the sick to avoid necessary care or endure financial distress when there is a crisis. For enthusiasts of a “Medicare for All” system, in which the government insures everyone and guarantees most care for free — typically backed by taxes — COVID has been a kind of test case.

What you think about this change may help reveal how you feel about our broader system.