Superheroes like Batman, Spiderman, Captain America, and Black Panther wear masks, and their brave acts reduce social costs. When these superheroes take on dangerous villains, their masks protect their identities and those they love. If their identities were revealed, their family and friends would be at risk.
A couple of leading physicians began to wear masks to protect their patients from infection in 1897. During the 1918–19 influenza pandemic, face mask mandates in some U.S. cities contributed to a decline in deaths. Put simply, face masks save lives and, quite likely, reduce health care costs. Failures to mandate and enforce prudent safety measures — like wearing face masks — increase social costs.
Seat belts and helmets
While federal law requires all vehicles (except buses) to be fitted with three-point seat belts, enforcement of seat belt use is left to the states. Nearly all states require the use of seat belts by some (e.g., age 18+) or all ages in some (e.g., front) or all seats, but there’s a lot of variation. Most states allow police officers to stop and ticket a driver if they observe a seat belt violation. All but one of the remaining states allow officers to ticket a driver for a seat belt violation as a secondary offense when the driver is pulled over for another reason. New Hampshire, whose motto is “Live Free or Die,” is the only state that does not require adults to wear seat belts (but requires their use by minors).
Motorcycle helmet laws also vary across states. Fewer than half the states require all motorcycle riders to wear helmets. A slight majority of states require riders under a certain age (often 17 or 20 and younger) to wear helmets. And then there are the few states with no helmet laws, including Illinois, Iowa, and — surprise, surprise — New Hampshire.
Why should people wear seat belts or helmets? Because they save lives. And in the event of non-fatal accidents, their use can improve outcomes. In turn, improved outcomes can lower health care costs, which in turn reduces insurance premiums. In many places, the potential threat of a ticket encourages compliance. But in situations where there is less external motivation for people to be compliant, payers can help to make a difference.
Where’s a masked superhero when you need one?
We currently lack enough superheroes in federal government to require individuals to mask up. There is no national face mask mandate and there is too little leadership by example — perhaps leading Idaho, Missouri, North Dakota, Oklahoma, and South Dakota to shun face mask mandates. But the absence of bold federal leadership often masks brave leadership at the state and local levels. Most states have face mask mandates for the general public, and several states — even New Hampshire — allow local officials to require face masks for the general public. Good grief! Don’t you wish there were something like a Bat-Signal that could call a superhero during our times of need?
Payers will continue to incur the cost of COVID hospitalizations, and many patients will have to share the costs. The list of states that require insurers to waive cost sharing for COVID treatment is short: Idaho, Massachusetts, Michigan, Minnesota, New Mexico, and the District of Columbia. New Mexico and D.C. have gone one step further, waiving cost sharing during the national emergency period for non-COVID respiratory illnesses (e.g., pneumonia). Ironically, Idaho has no face mask mandate for the general public but requires insurers to waive COVID cost sharing. So much for an ounce of prevention is worth a pound of cure!
Mandates to waive cost sharing do not impact everyone with coverage through Medicare or a self-insured employer, although, most Medicare Advantage plans and many commercial insurers have voluntarily waived cost sharing for COVID-related treatment. However, no cost sharing to the member does not mean no cost to the plan.
Covering less-effective vaccines and preventable treatments
Within limits, payers manage care and related costs. They pay some attention to preventive services (e.g., screening or counseling), especially when they are paid or required to do so. But payers typically focus on medical prevention (e.g., vaccines or mammograms). Rest assured, payers will pay for COVID vaccines. But they generally do not tread heavily on lifestyle behaviors — eating, drinking, exercising, buckling, helmeting and, now, masking — that some individuals fiercely defend as their individual right. By missing opportunities to change lifestyle behaviors, payers wind up paying for treatments for bad outcomes that could have been prevented.
Too often, payers pay more for care than the cost of the prevention. Face masks are much less expensive than hospitalizations, and possibly more effective than future vaccines. When testifying before a Congressional hearing on September 16, 2020, Centers for Disease Control and Prevention Director Robert Redfield said, “These face masks are the most important, powerful public health tool we have. And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings. … We have clear scientific evidence they work, and they are our best defense. I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine, because the immunogenicity may be 70 percent.” We have face masks today but do not yet have, but anxiously await, safe and effective vaccines. A COVID vaccine coupled with a face mask would be a dynamic duo.
Rather than educate about face mask use, cover members’ costs for the safest, most efficacious face masks, or even pay a premium for more fashionable or more comfortable masks that could boost compliance, payers will pay for hospitalizations and other care that costs much, much more — including some hospitalizations that could have invariably been prevented by the use of face masks. If Benjamin Franklin were alive today, he might say, “An ounce of face masks is worth a ton of hospitalizations.”
Cover up
Upstream costs — political and economic — to mask up compared with the downstream costs of hospitalizations are pennies on the dollar. As a likely second wave of COVID crashes down upon us, payers need to fasten their seat belts and put on their helmets in preparation for higher treatment costs in states and locales lacking the necessary leadership. It is not too late for superheroes to save the day by requiring face masks and leading by example.
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