The coronavirus pandemic has prompted many Americans to reevaluate the country's health care system. The debate about improving health care is not new, but over several months there have been changing attitudes.

Americans previously showed more trust in federal public health institutions in the face of a crisis. In October 2014, global concerns grew about exposure to Ebola, though Americans had faith in the federal government's ability to prevent it from spreading to the country. According to a Pew Research Center survey at the time, only 32% of Americans were worried that the government would not be able to prevent an outbreak.

The COVID-19 pandemic appeared to weaken public trust in the U.S. health care system.

A poll released in July 2020 from PBS NewsHour/Marist showed that 35% of Americans feel the U.S. health care system is “below average” compared to 25% before the pandemic hit, while 42% said their nation’s health care system is "above average" compared to the rest of the world.

Such opinions are likely due to the pandemic response. “It made people feel our health care system is not nearly as good as we thought it was,” Dr. Ashish Jha, Dean of the Brown University School of Public Health, told PBS NewsHour in a September report.

Meanwhile, there has been growing discontent with the extent of resources, the ability to deal with a pandemic, the costs for insurance payers and trust in government health agencies.

In the early days of the pandemic, there were serious concerns about the shortage of masks, ventilators, and hospital beds, while doctors and nurses were overextended.

Experts even sounded alarms about contract tracing. Darren Dworkin, the senior vice president of enterprise information services and CIO for Cedars-Sinai Medical Center, told CNBC in November that there was a lack of coordination by some states when it came to contract tracing.

“The reality is that health care before the pandemic was very fragmented in the United States,” Dworkin said. “We are discovering the downsides... and this is falling between the cracks.”

In a May 2020 op-ed in the New York Times, former emergency room physician Elisabeth Rosenthal noted that the health care industry is still highly motivated by profits.

"The Covid-19 stress test has laid bare a market that is broken, lacking the ability to attend to the public health at a time of desperate need and with a government unwilling — in some ways unable — to force it to do so. This time around, thousands of stalwart medical professionals have answered the call to treat the ill, doing their best to plug the longstanding holes that the pandemic has revealed.

"Whether it’s regulated or run by the government, or motivated by new incentives, the system we need is one that responds more to illness and less to profits," Rosenthal wrote.

COVID-19 patients who went to hospitals saw high costs. According to analysis from independent nonprofit FAIR Health, "the total average charge per COVID-19 patient requiring an inpatient stay is estimated at $73,300 and the total average estimated in-network amount per commercially insured patient at $38,221."

Months into the pandemic, Americans appeared to shift their opinions about single-payer health care. In September, a survey from Pew Research asked how the government should provide health insurance coverage -- 36% said it should be provided through a single national government program, a sharp jump from 30% when the question was asked in 2019.

Prior to the pandemic, out-of-pocket spending climbed 4.6% in 2019 to $406.5 billion, which was higher than the 3.1% rise in 2018. A Gallup and West Health poll published in March showed 18% of Americans said they would be unable to pay for quality care.

There is also growing distrust for federal agencies like the Centers for Disease Control and Prevention.

A survey conducted in February by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health showed that just 54% of respondents have a great deal of trust in the CDC. Even fewer had that same level of trust in the Food and Drug Administration and the National Institutes of Health.

“How the public sees public health is incredibly important,” said Dr. Robert Blendon, co-director of the survey.

“When it comes to trust with health information, which is the heart of what public health is about, they’re much more likely to trust clinical physicians and nurses than public health institutions and agencies.”

Coronavirus Healthcare