Crisis highlights fissures in health-care system
To the editor,
COVID-19 illustrates the vast deficits in our current ill-equipped health-care system. Why wasn’t our health-care system prepared for something like this? An argument could be made that it’s because too much of the system is profit-driven.
Hospitals are businesses, and their financial success hinges on generating revenue that meets or exceeds costs and expenses. High-margin procedures that contribute greatly to the bottom line include elective surgeries like knee and hip replacements and plastic surgery.
Because of the demands of the COVID-19, hospitals have cancelled elective, nonessential procedures, and the result is a significant drop in revenues. A Michigan hospital system recently reported that it expects to take a $1 - $2 billion hit to its normal annual revenue of $8 billion.
America’s disinvestment and privatization of hospitals since the Reagan era in the 1980s has left us horribly unprepared for this public health disaster. Looking at hospitals 40 years ago, before health care was dominated by the “business” of health care was enlightening.
In 1960, The U.S had over nine hospital beds per 1,000 people. Between 1981-99, the number of in-patient hospital beds declined by an extraordinary 39 percent. The purpose was to raise profits by increasing the number of occupied beds. Management’s goal of 90 percent occupancy meant that hospitals no longer had the capacity to absorb patient influx during epidemics and medical emergencies. The number of hospital beds continued to be decimated, and by 2017, we had less than three hospital beds per 1,000 people.
For comparison, other countries with universal health care show an improved preparedness. For example, Japan has over 13 beds/1,000 people and Germany has eight beds per 1,000 people. Interestingly, the number of deaths in Germany are relatively low. Epidemiologists suggest the chief reasons are early and widespread testing and treatment, plenty of intensive care beds, and a trusted government whose organized social distancing protocols are widely observed.
Because our hospitals have cut their reserves so drastically, they now have to depend on the federal government’s stockpile. It contains extra things we might need in an emergency like medications, PPEs and ventilators. Except, someone forgot to stock it with ventilators.
In 2012, the federal government contracted with a small medical-device company to build a low-cost ventilator to build up the stockpile. The company was later bought out by a large corporation who decided that manufacturing these devices was not profitable, so scrapped the project. The name of the bigger company is, ironically, “Covidien.” They cancelled the project, and no one in government picked up the ball. This is another fatal flaw of an excessively profit-driven system.
Our lack of preparedness has resulted in a slower and uncoordinated ability to take care of Americans during a pandemic. Health-care workers are overwhelmed and worsened by the lack of resources.
Capitalism may do a better job of managing certain areas of our lives, but we are watching how loosely regulated capitalism has decimated our ability to manage the stresses of a pandemic. COVID-19 puts more pressure on these fault points, especially insurers.
Patients couldn’t get out of the hospital because they were awaiting authorizations from health insurers. People went to the hospital to get tested but had to wait for authorizations from their insurance companies. The hundreds of different insurance policies with different rules compound inefficiencies. Nothing is uniform because these are all separate, private companies making their own decisions.
During this pandemic, insurance companies are still asking whether the treatment you’re receiving is medically necessary. They are still questioning the exhausted medical providers. The focus isn’t on getting better but on “what’s covered and will be paid for.”
To stem this pandemic and minimize harm from the next one, we need a dramatic overhaul of our health-care system. Crises like this are a time for compassionate action, as well as change. We need national standards for hospital and provider procedures/charges, and the ability for government to negotiate drug prices. Capitalism that is “highly regulated” has allowed other countries with universal health care the sustenance to traverse this pandemic.
As the financial rescue packages have made starkly clear, we have more than enough financial resources to create these vital changes. Once this crisis is over, it would be a mistake to go back to the way things were; we need to demand better. Let’s lay the groundwork for a competent government that is capable of planning for an uncertain future.
– Jan Phillips, Durango