Healthcare as a Role Model for an Equitable Solution to Our COVID-19 Inequity Problem

Published - Written by Hayward Zwerling, MD

The COVID-19 pandemic threatens the viability of our healthcare system and will exacerbate our economic inequity problem by disproportionately impacting hourly wage workers, increasing rates of homelessness, malnutrition, social discord, depression, disease and/or family instability. These problems will make it even more difficult for them to abide by “social distancing” guidelines, thus lengthening the duration of the pandemic and reduce their ability to partake in a future economic recovery.

To minimize the impact of COVID-19 on the most vulnerable we must immediately institute policies to reduce this inequity. As the Trump Administration will not address this problem, we need to look elsewhere for a solution.

As a physician who lives at the higher end of the economic spectrum, I am uniquely qualified to advocate for self-sacrifice as a means to reduce health and economic inequity and particularly if my sacrifice may mitigate the consequences of COVID-19 pandemic.

Toward this end, I would suggest that all healthcare institutions ask their employed physicians, as well as other employees who earn more than $115k/year (top 10%), to accept a pay-cut of 20–30%. The healthcare institutions would then channel these extra monies into a fund that would pay laid-off hourly wage employees at a rate of about 80-85% of their weekly take-home pay.

Providing a revenue stream to these highly-trained, laid-off employees would enable them to continue to meet their basic needs and ensure that they are ready to return to the healthcare workforce on a moment’s notice thus ensuring the short-term viability of our healthcare institutions. It would generate tremendous institutional loyalty, promote a collective understanding that “we are all in this together,” and reduce America’s inequity problem.

This model could also be applied to any business which continues to receive a revenue stream during the COVID-19 pandemic and to any business that continues to pay their salaried employees.

Some will argue my proposal is anti-capitalistic. While my suggestion may appear to be more socialistic than capitalistic, I believe my proposal would foster the more expeditious resurgence of capitalism after the COVID-19 pandemic and protect the longterm viability of our healthcare system.

Some economists might argue that the pool of money raised by my proposal will be insufficient to meet the anticipated need. To them, I say: “tweak” the proposal so that the math works.

Some people will argue that physicians are entitled to high salaries because they routinely put their health at risk while taking care of COVID-119 patients. Physicians who take care of patients with communicable diseases are aware of the risks and mitigate the risks through a variety of means. However, there are also many other careers in which the employee receives a fraction of a physician’s salary and yet is exposed to the same health risks as physicians including nurses, janitors, medical assistants, NPs, PAs, clerks, EMTs, firefighters, police, military, sanitation workers, coal workers, and other first responders. So clearly our capitalist society has decided that a high salary is not justified simply because an occupation confers a higher health risk. And speaking from personal experience, I do not believe that any physician I know and respect would argue that their salary should be high because of inherent occupational risks. Nor would they argue that a high salary is the “incentive” which drives them to care for COVID-19 patients. They do what the do because they are physicians in the best sense of the word who are fully committed to their profession.

The COVID-19 pandemic will exacerbate the US economic and health inequities while threatening the viability of our healthcare system. Physicians and healthcare institutions have a professional obligation to protect the viability of our healthcare system. 

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