By MIKE MAGEE, MD
Governors like Andrew Cuomo of New York have discovered the price for inefficiency and conflicts of interest in the face of the COVID-19 epidemic. As he said last week, “No one hospital has the resources to handle this. There has to be a totally different operating paradigm where all those different hospitals operate as one system.”
Our system is marked by extreme variability: a nation of health care haves and have-nots. Yet even when we Americans acknowledge the absurdity of our convoluted system of third-party payers and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it, many still find solace in telling themselves, “Well, we still have the best health care in the world.”
This crisis in a matter of weeks has revealed the limitations of a conflicted network built on short-term profiteering and entrepreneurial adventurism. Here are a few early learnings:
1. There is no national system – not for health, not for disaster.
2. The buck stops nowhere. Since there is no plan and no point of central control, there is no one in charge.
3. “1000 points of light” doesn’t cover the absence of “good government.”
4. There is no national inventory stockpile because there is no national health plan. When Obama (post-Ebola) constructed centralized disaster planning to try to umbrella this weakness, Trump rapidly disbanded it to erase the Obama name and play to conservative partisans.
5. “Just in time inventory management” boosts profit margins, but leaves all vulnerable to shortages during a crisis.
6. Extreme care delivery segmentation – confronting a disaster scenario – fails for all, not just the poor and disadvantaged.
7. There is no tradition nor apparatus for sharing of human or material health resources in America.
8. What is shared and heavily coordinated are the federal government relations lobbying plans and strategies of the national associations that constitute the Medical Industrial Complex in America including insurers, pharmaceuticals, hospitals, and medical organizations.
The United States is un-united when it comes to public health policy and responses to this crisis. For example, our President is unable to bring himself to insisting on a national stay at home policy. In states like Florida, citizens (and the virus) continue to wander around.
Our President is unrepentant. He continues to parade corporate leaders of “the greatest health system in the world” in front of the cameras on the White House lawn. At the March 29th conference, Trump proudly introduced middleman pharmaceutical distribution CEO Michael Kaufman of Cardinal Health, for mutual admiration. Without a hint of irony, or acknowledgment of the cloud currently overhanging his company for their central role in creating the opioid epidemic, Kaufman proudly proclaimed, “We have really seen government agencies working with industry like no time before.”
Though many will die, as even the President now admits, we will survive as a nation. But hopefully, with a new leader, the first order of business will be to create a rational and universal health care system capable of protecting and securing the health of all Americans. Because, as we are tragically realizing, there is no “united states” without a safe, secure and reliable health care system.
Mike Magee is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“