The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.

A universal, single payer model for the American health system aligns with and should emanate from commonly held values contained within the country’s foundational religious teachings, morals, ethics and democratic heritage. The Affordable Care Act in its attempt to create expanded health access has met with significant challenges. The conservative Supreme Court decreases the likelihood of a federal mandated single payer model. As uncertainty of the structure of the healthcare system increases, this paper supports its transformation to a single payer model. Healthcare should be considered a duty within the framework of a Kantian approach to ethics and a social good. Evidently ignoring this duty, the American health system perpetuates a healthcare underclass, with underserved portions of the population, with unequal access to quality care and persistent health status and outcome disparities. The COVID-19 pandemic demonstrated the effect of social determinants on optimal health outcome. A health insurance system based on the nation’s commonly held values has the potential to eliminate these disparities.

(1) Background: the patient experience may be a performance indicator in value-based reimbursement. Accordingly, providers have an incentive to understand factors that affect their patients’ experiences. This study evaluated the relationship between health insurance type and patient experience ratings. (2) Methods: individual-level demographic, health/healthcare, and patient experience data were extracted from the Full-Year Consolidated Data File of the 2019 Medical Expenditure Panel Surveys. A logistic regression was used to evaluate whether how persons—included in this study’s analytic sample (aged 18 and over with complete covariate information)—rated the healthcare they received from all their providers was associated with their health insurance types controlling for covariates. (3) Results: relative to people 18–64 years of age with private health insurance, people 18–64 years of age without health insurance were less likely to rank their healthcare as a 9 or 10—where a 10 indicates the best possible care—(OR: 0.69; p = 0.015) while people aged 65 years or over with Medicare (OR: 1.34; p = 0.002) or with Medicare/private health insurance (OR: 1.48; p < 0.001) were more likely to rank their healthcare as a 9 or 10. (4) Conclusions: Select health insurance types were associated with how patients rate their healthcare. Stakeholders could use this information to create programs aimed to improve patient experience.

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