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

That era has largely arrived end of last week because the public health emergency for Covid-19 has expired. For Covid, the government bought vaccines and drugs in bulk and distributed them to everyone who needed them a set of emergency provisions approved by Congress as long as the White House declared they were needed. It required insurance companies to pay for all Covid tests and to pay for testing equipment when uninsured people used it. It guaranteed hospital bills for anyone who needed hospitalization for Covid.

Now that the government’s state of emergency has ended, these programs are being phased out. Some people will still be able to get free Covid tests if their insurance is willing to cover them that way. Other people will have to pay a co-payment or co-payment for these tests.

If you have insurance, you can still get free Covid vaccines. But if you’re not insured, you may have to pay out of pocket starting next year.

And how much you pay for an antiviral drug like Paxlovid will depend on what kind of insurance you have.

As for hospitalizations with Covid, they will now be just like any other hospitalization, possibly subject to huge co-pays or co-insurance – just like the hospitalizations of people in recent years who had pneumonia without Covid, even though their illnesses were often just as serious and necessary. 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 transition from free to not-free for some types of treatment will be unpredictable, linked to when government supplies of the stuff run out.

Of course, America’s health care system for every other disease it tends to be confusing and bumpy. Patients with other conditions – such as cancer, arthritis, hepatitis C or diabetes – have dealt with these vagaries all along. These diseases are also major public health problems.

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

Proponents of the current system say it uses market forces to keep costs down, encourage innovation and limit unnecessary treatments. Letting people get unlimited free tests, for example, may have prompted some testing facilities to do so charge outrageous prices, as reported by my colleague Sarah Kliff. The government’s bulk purchase of the two mRNA vaccines may have hampered the study and outreach other types vaccines that may be better in some cases.

But opponents have long said the patchy nature of the U.S. system and unpredictable consumer costs are harmful because they force the sick to avoid needed care or endure financial distress when there is a crisis. For enthusiasts and A “Medicare for All” which the government insures everyone and guarantees most care for free—usually supported by taxes—Covid was something of a test case.

What you think about this change can help reveal what you think about our wider system.

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