A Health System Disconnected and Conflicted in an Un-united United States.

Posted on | March 31, 2020 | 2 Comments

President Trump applauds Mike Kaufman, CEO of Cardinal Health

Mike Magee

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 yesterday, “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 have’s and have-not’s. 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:

There is no national system – not for health, not for disaster.
The buck stops nowhere. Since there is no plan, and no point of central control, there is no one in charge.
“1000 points of light” doesn’t cover the absence of “good government.”
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.
“Just in time inventory management” boosts profit margins, but leaves all vulnerable to shortages during a crisis.
Extreme care delivery segmentation – confronting a disaster scenario – fails for all, not just the poor and disadvantaged.
There is no tradition nor apparatus for sharing of human or material health resources in America.
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, only 32 states, 80 counties, 17 cities, the District of Columbia and Puerto Rico are currently being urged to stay home. For the others, their citizens (and the virus) continue to wander around.

Our President is unrepentant. Yesterday, for the second day in a row, he paraded corporate leaders of “the greatest health system in the world” in front of the cameras on the White House lawn. At the March 29^th conference, Trump proudly introduced middleman pharmaceutical distribution CEO Michael Kaufman of Cardinal Health, for mutual admiration. Without a hint of irony, or acknowledgement 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.

Comments

2 Responses to “A Health System Disconnected and Conflicted in an Un-united United States.”

Sandi Sherman
March 31st, 2020 @ 11:27 pm

Great points but we cannot get the health system you advocate under capitalism. It will require a revolutionary transformation of our society and I’m not talking about Bernie’s “political revolution.” The only country in the world that organized its health care system for human need and not private profit is Cuba. And they got rid of capitalism.
Mike Magee
April 1st, 2020 @ 8:49 am

Sandi, thanks for your thoughtful comments. I agree completely that the steps we need require a significant adjustment of the American culture away from greed and towards solidarity and planning. But I don’t feel we are in an “all or none” position. I would suggest we begin by removing Trump in November, providing an add-on public option as an extension of the ACA, and reconstituting a national Disaster Preparedness Office with heavy representation from governor’s offices around the country. Best, Mike