For four decades, American corporations have been caught up in a whole series of refinements that are intended to improve efficiency and productivity. Our processes are lean. Our efficiency is six-sigma. Our productivity has mysteriously run far ahead of employee compensation in a way that has made CEOs billionaires while leaving workers on food stamps.
It’s a system that maximizes profit. But it’s also a system that assumes that everything can be stripped to the bare bones; that business can make do with minimal staffing, minimal supplies, minimal alternatives. Nothing is there that makes the system in the least unprofitable. The system stands like a house of glass, waiting for something to challenge its fragility.
And in the United States, health care is just that kind of system.
Like every other system in America, we now have a super-lean, infinite-sigma healthcare system, absolutely dependent on every cog remaining in place. It’s one in which there are fewer than a million hospital beds for the entire nation; one in which many, many rural counties have no hospital at all. Because that’s the most profitable way of running the system, and that’s what happens when health care is subjected to the winnowing of the marketplace—just barely enough health care, at the highest possible prices people will tolerate without demanding a change.
It’s exactly where a nation does not want to be when encountering a health crisis. And it’s why America is, unfortunately, about to get a lesson in why there is much more to a national health system than whether you pay for it in taxes or with checks to an insurance company.
In the 1960s, astronauts used to joke about flying on a giant rocket built by a collection of contractors who submitted the lowest bids. But NASA had a safety culture then, and now, that demanded each of those components be tested and retested until its function was as near certain as possible. A spacecraft is the opposite of “lean,” with a backup, and a backup, and a backup to the backup’s backup at every possible point—and a massive staff of very smart people standing by to get creative if Murphy scores a perfect strike.
None of this is true for our healthcare system. Failure very much is an option at every clinic and hospital in America. A certain level of failure is even assumed. Building a system with redundancies and experts who were not always pushed to their absolute limits would cost more. Every intern, doctor, and nurse (especially nurse) who you ever met was overworked, because running the system on the ragged edge of failure is exactly the sweet spot. Or at least it is as far as corporations whose goal is to milk every penny from the process are concerned. In the average hospital visit, there are more people involved in billing you than in treating you.
This thinking isn’t just pervasive and accepted—it’s also actively considered a very good thing. During his press event on Wednesday afternoon, before fumbling the hot coronavirus potato into the waiting hands of Mike “Smoking is good for you” Pence, Donald Trump defended the cuts he had made to the CDC and the experts on pandemics he had dropped from the National Security Council and the epidemiologists he had flushed from his planning team. He didn’t want those people sitting around when they weren’t needed, said Trump. Besides, he claimed, you could always go and get them when they were needed. Because somewhere, somehow, there is a system that keeps vital specialists waiting in hermetically sealed containers, fresh, ready, and informed to meet the nation’s needs.
That is, it goes without saying, bullshit. But let me say it again. Bullshit. The value of an expert brought in to repair a system after disaster strikes is so much less than the value of having that person on hand to plan that the old ounce of prevention being greater than pound of cure formula doesn’t begin to cover it. You cannot decide to hire some pilots after the plane has crashed.
The thing about extraordinary events is that they’re extraordinary. Planning for them will never improve profits. It will only save lives.
By treating health care like a business, Americans have already seen one of the first people who dared ask to be tested for COVID-19 get handed a bill for thousands of dollars, the primary result of which will be to dissuade other Americans from asking to be tested. Which is, right there, exactly the result that is best for insurance companies—and worst for the nation.
It’s an absolute certainty that Americans will hide their sniffles, drown their symptoms in over-the-counter drugs, and try to “tough it out” because they can’t afford health care. Besides, they have no paid sick leave, no paid child care, and no guarantee that missing a day’s work won’t mean being cast to the curb. All that “socialist” crap.
And because our whole system runs so excellently lean, American hospitals are already seeing shortages of everything from gowns to masks to painkillers, because the single-source, lowest-price vendor of those items happens to be in an area that’s already been overrun with the coronavirus. Not only have those factories on the far side of the planet been sitting idle for weeks, but what production has been available has been needed close to home.
Right now in Hubei province, Chinese healthcare workers are staggering around in exhaustion. Or, as American hospital workers call it, Thursday. Our understaffed, under-supplied, overworked facilities spend every day running at their limits. That’s what is considered normal.
The concern about dollars over people is so accepted that on Thursday the White House announced two new members of the Coronavirus Task Force—Treasury Secretary Steven Mnuchin and National Economic Council chief Larry Kudlow. Though to be fair, it’s not as if they completely lack expertise. Kudlow does have long familiarity with taking nasally administered drugs from rolled $100 bills. So there’s that. And if in this version of The Stand the role of the Rat Man is to be played by Mnuchin … no one can say that this is not good casting.
Disaster is far from certain. Local and state officials can still take measures that will slow the impact of COVID. And antiviral medicines may prove effective, or maybe a vaccine will come along more quickly than expected— though, should either happen, you can assume there will be a line of Pharma Bros on hand to buy the companies involved and raise the prices to eye-watering levels. After all, holding people’s lives hostage is exactly what our healthcare system is all about.
COVID-19 is going to swing a big hammer at the glass house of American health care. All anyone can do is hope they don’t get cut in the process.
And then vote to change the damn system.