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Biden's new at-home Covid-19 testing plan is way too complicated

Jen Psaki's snark about free at-home Covid tests was misplaced.

The problem: Americans aren’t getting tested for Covid-19 enough to help public health officials more easily track the spread of new variants like omicron. The obvious solution: Provide Americans with the rapid, at-home tests that are widely available in other developed countries.

Why not just provide the tests free or for a nominal fee like in other countries?

Well, sort of. White House chief of staff Ron Klain announced on Twitter last week that President Joe Biden would be announcing “FREE and RELIABLE at home tests.” Except the program is more complicated than that, a fact that highlights the uniquely American approach to health care that has plagued this plague response for over a year.

White House press secretary Jen Psaki fielded a question at Monday’s daily briefing about the multistep scheme that the Biden administration has put into place, which requires private insurance companies to reimburse people for the full costs of tests: Why not just provide the tests free or for a nominal fee like in other countries?

MS. PSAKI: Should we just send one to every American?

Q Maybe. I’m just asking you — there are other countries —

MS. PSAKI: Then what — then what happens if you — if every American has one test? How much does that cost, and then what happens after that?

Q I don’t know. All I know is that other countries seem to be making them available for — in greater quantities, for less money.

MS. PSAKI: Well, I think we share the same objective, which is to make them less expensive and more accessible. Right?

Psaki’s mocking tone did the White House few favors when you consider that, yes, ideally the federal government should be sending free antigen tests to every American. As many have pointed out, that’s what the United Kingdom does. In fact, Brits can order a pack of seven tests every day at zero cost. If they’re presenting even mild symptoms, they can also order a free PCR test, which takes longer but is more reliable.

In Germany, a program that provided free weekly tests was phased out in October, aiming to encourage more Germans to get vaccinated. But tests are still readily available and are cheap: roughly $1 versus the nearly $20 you might pay for the Abbott Laboratories BinaxNOW two-pack in the U.S. — if you find it on sale, that is. Or for sale at all for that matter; the supply of at-home tests has so far lagged way behind the demand. (Anecdotally, two weeks ago, I checked three local pharmacies in my neighborhood in Queens and came up empty-handed.)

Even if you do find a full-price test available, under the newly announced U.S. plan, you won’t be able to just walk out of the store with it. First, you’ll have to have some kind of private health insurance. Then, you’ll have to save the receipt and file it with the insurance company that you surely have, a task that Americans love to do and perform without complaint. (I can only hope my pure, unbridled sarcasm came through in that last clause.)

You also have to be aware of the program in the first place, which is no guarantee. That’s only one of the potential issues with the White House plan, experts told NBC News’ Laura Egan:

It is also unclear whether the plan will limit the amount of tests a person can get reimbursed for and whether there will be certain restrictions on who qualifies for a reimbursement. Some experts, for example, worry that insurance providers might only reimburse tests for people who have an underlying condition or who were directly exposed to someone with Covid.

The Biden administration has said that they plan to release more details by Jan. 15. "All those details need to be determined and I am not yet convinced that, at best, we will get more than one test per person," said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. "In order to reduce the number of cases we're seeing, we need to have widespread, easy and free — or near-free — access to these tests. And I'm not at all convinced that what they're proposing is going to achieve that."

And for those without insurance? An unintended consequence of the new program may be higher prices for people who can’t be reimbursed. “If the consumer is thinking, ‘I will get reimbursed,’ they won’t really care about the price,” Ge Bai, a professor of health policy at the Johns Hopkins Bloomberg School of Public Health, told The New York Times. “The rule is meant to help promote testing, but it also instills inefficiency into the system.”

Which brings us back to Psaki trying to explain why just doling out antigen tests is impossible. The tests being used in the United States, she said, have gotten Food and Drug Administration approval. “Whether or not all of those tests would meet that standard is a question for the scientists and medical experts, but I don’t suspect they would,” Psaki said.

The best defense for not copying the U.K. and Germany’s plans, though, is one that Psaki didn’t bring up directly: scale.

Technically, she has a point. One of the tests used in the U.K. failed to meet FDA scrutiny this summer, which caused the FDA to advise Americans who have them to throw those testing kits away rather than trust their results. And in Germany, regulators have cleared dozens of tests for use compared to the 14 that have been approved here, suggesting a less stringent metric for approval. As part of Biden’s new strategy, the FDA will be prioritizing new at-home tests for potential new emergency use authorizations. But that high standard that the FDA prides itself on is a hinderance to actually getting swabs in noses.

And so, the best defense for not copying the U.K. and Germany’s plans, though, is one that Psaki didn’t bring up directly: scale. The United States, it’s easy to forget, is a really big country. As a recent Kaiser Family Foundation study put it, even ramping production up to “300 million rapid tests per month, would be less than one test per month per person in the U.S. For two times per week testing, it would cover less than 40 million individuals.”

That’s a real problem — but not the one that people are taking issue with. Psaki is right that it’ll be a long time before there are enough tests to send to every American. That doesn’t explain, though, the intermediary step that the White House has insisted on adding between the manufacturers and Americans. It doesn’t explain why a public good isn’t being fully financed for the public. And it doesn’t justify the number of hoops that only a subset of people will even have the chance to jump through to maybe get their money back if they’re lucky enough to find an at-home test for sale.