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What the coronavirus reveals about the US healthcare system: New Yorker. Our medical system is controlled by profit-hungry investors and costs twice as much as it should.

2020-07-06

em coronavirus from NIAID– CC license

This article in the New Yorker is actually “old”– it’s from April 27– but it’s still highly relevant.  It was pushed to the back burner by the crush of news about the novel coronavirus, but it seems it’s on the front again with the crisis in Texas, Florida, and elsewhere in the South and West.

I won’t go into all the details of the article, just a quick summary– you should read it yourself if you care about fixing the problems we have in this country.  But you should be very pessimistic about the chances for changing anything.

The article explains that there are certain problems that can be fixed.  One is the way the system is organized.  There is a supply line that has too many choke-points: if one factory’s output is lost, there are no other factories that can make up for the lack of the components that it produces.

Chinese factories made most of the masks that we needed.  When they started hoarding them in January because they had to shut down, there was no-one else who could make up for the shortage.  Price competition had caused all the competitors to quit making masks and dismantle their production lines.

The National Strategic Stockpile was supposed to have a lot of masks.  It was depleted during the last crisis, and when the Obama administration requested the money to replenish it, they were turned down by Congress.  When the new administration came in, the Stockpile had only some old masks that had deteriorated over the years to the point where the elastic bands broke when they were put on.

These old masks were not replaced.  The new administration wasn’t interested in replenishing the stockpile because they didn’t realize that another pandemic was coming and didn’t think they needed to spend the money.

The information systems that support clinical medicine are broken.  Electronic health records were supposed to revolutionize medicine, but instead, they have become separate islands with no method for intercommunication between hospitals or between doctors.

The records are used for billing insurance companies, not for communication of medical findings between providers or coordination of treatment approaches.  Instead of helping doctors to advance medicine, they have become another time-consuming headache: filling out charts.

Shortages of specific medicines have been occurring more frequently over the past few years.  This is because pharmaceutical companies have shut down production lines for products that are not profitable.  Some products were left with only one supplier, and if that one’s production was shut down (for example, by quality control problems) then the product became unavailable.

Business practices that make sense for individual firms– to save money– cause major problems when they are followed by every firm.  Tightening up supply chains, with “just in time” manufacturing, leads to sudden shortages when a link in the chain is broken.  Squeezing the inefficiencies out of production leads to breakdowns when emergencies occur because all the resiliency is removed from the system.

The same applies to research capabilities.  Squeezing all the inefficiencies out of our research programs leads to not having any excess capabilities when emergencies hit.  Having enough slack in the system makes it resilient to sudden changes in demand and to having capabilities that are currently unused but might be needed in an emergency.  That costs more money, which eats into profits.

My conclusion, even after reading this article, is that there are too many basic deficiencies in the US healthcare system.  The most important deficiency, the one at the root of the worst problems, is that the system is entirely dedicated to producing a profit for certain participants– those who invest in producing all the components of health care.

Instead, the system should be geared to producing the most health improvements to the largest number of people (“the greatest good to the greatest number”– Mr. Spock.)

Right now, the investors are the ones who make all the decisions.  In order to change all the bad things about the system, it would be necessary to remove the investor.  Instead, the US federal government should be the primary payor.  All the other components will have to be changed to make this work.  That means that the people who are making money off the system the way it is would have to be removed by buying them out.

Only when the profit motive is secondary will there be room to build in excess capabilities that are not currently needed and which cost a little more money.

This is impossible.  Too many investors are making money off the backs of the American people.  We are paying twice as much as our peers in Europe for health care, and the money is going into the pockets of the people who own insurance companies, hospitals, clinical laboratories, and other expensive parts of the system.

The government would have to buy out all these people– pay them off for their investments.  Why should they sell out?  They see their way clear to continued profits at the expense of the average American.

The system is crashing.  Too much demand for medical care is leading to critical shortages of medicine, providers, and bed space.  When the system is unable to provide for the needs of people who have the capability to pay, there will be irresistible demands for change.  Even then, the basic profit motive will continue to rule.

The only fair way to remove the profit motive is to have the federal government buy out the system.  That will take a revolution, which will only happen when too many people are suffering to hold back the changes that are needed.  Revolution will cause even more suffering because there won’t be fair changes– someone will get hurt.

 

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