America’s COVID Response is Old News

Our current media environment is simply overwhelming. Talking heads dissect and opinionate on every minute occurrence and off-handed comment ad nauseam. Enough true news simply does not exist to support the advertising driven media ecosystem which now saddles us.

The pandemic has only made this worse.

I suppose whenever you live within an environment or industry, it is always rather amusing when the news and social media discover what has been known for years within your circles. This is how I feel about much of the news surrounding the boots on the ground handling of the pandemic.

None of this is New

“America’s health care system is neither healthy, caring, nor a system.”

-Walter Cronkite

Hospitals overwork nurses, doctors, EMTs, clinical staff everywhere leading burn out and unsafe conditions? Who knew? COVID just shines a light.

Hospitals have making money hand over fist on procedures which, when postponed have apparently had little effect on the over health of the population(which begs the question of why we are doing them in the first place), This has destroyed hospital hospitals bottom lines. COVID shines a light.

America incentivizes hospitals not to care for the sick and ill, but to provide procedures aimed at making the lives of people with good insurance more comfortable. Is it so shocking this has led to hospital systems prioritizing such care over general health? COVID shines a light.

Health systems were caught flat footed protecting front line workers because prioritizing staff safety didn’t generate RVUs and billable procedures? COVID shines a light.

Health inequalities are rampant and appalling – both at point of care but as part of the baseline health of large portions of the population? People of color are suffering more disability and dying at higher rates than the general population? COVID shines a light.

The American Healthcare System Prioritizes Private Wealth over Public Health

Walter Cronkite knew what the problem was decades ago, and we haven’t done a damn thing to fundamentally alter the situation. COVID isn’t anything new, it is just happening all at once when we are all paying attention.

We do not have a meaningful public health system. We have a private disease treatment facilities. Our healthcare system works great for young, healthy, and wealthy individuals. Guess what? They rarely need healthcare.

Why can’t we effectively respond to a widespread, nationwide public health crisis? Because we do not have a comprehensive, nationwide public health infrastructure.

As long as we treat health as an individual problem, we will be unable to respond to any true public health problem.

Just Look at our track record:

Obesity Epidemic – only getting worse

Opiate Epidemic – people dying by the thousands

COVID 19 – check the counters on your favorite news platform.

Well…you get the idea.

Hospitals are not substitutes for Public Health Infrastructure

Hospitals treat individuals, they do not coordinate responses to widespread public health disasters, even if those disasters produce individual illness.

Yet, we keep trying to force a square peg through a round whole. We call it population health now, as if it is somehow different from public health. Hospitals and clinics will always fail to address these problems because they are the wrong tool for the job.

Healthcare services determine only about 20% of a person’s health status. That means, 80% of the outcome of any individual’s health is already decided when they show up at the hospital.

We need to actually protect the public’s health

It is unfair to our fellow citizens (particularly to the poor, people of color, and the mentally ill) to expect doctors and nurses to make up for a lifetime of abuse and neglect society has visited upon many people in our society.

Yes, bias (based on race, class, disability, mental illness, etc) in the provision of healthcare negatively affects the health of many people. However, it is time that society accepts responsibility for our fellow citizens and recognizes the patterns of our lives drive our health far more than anything that happens within the doors of a hospital.

My work reminds me of this reality daily. I have the power to do many things, yet more often than not, I am effectively powerless in the shadow of a life lived without access to healthy food, a good education, a safe environment, the list goes on.

Poor people will always have poorer health outcomes than rich people, because resources matter. Yet, we as a country can and should do better. And we need to stop looking at the end of the pipe for solutions.

The disaster COVID is wreaking on the health of Americans is no surprise, if you were paying attention.

A system is designed to get the outcome it gets. We have designed our system to produce these unequal, inconsistent, and often deadly results.

The outcomes the pandemic has brought to light have been happening every day, in every corner of this country, for decades.

The light was apparently just not bright enough.

6 thoughts on “America’s COVID Response is Old News”

  1. If I stay within the system as a physician I’ll only add to the problem. If I exit it then whomever depends on the measly services they get will be stranded.
    The Obesity epidemic, along with the Opioid one, both were blamed on physicians – not educating patients enough and overprescribing. Will we be held responsible for a sicker patient population who succumbed to disease far more than other societies?

    Do you feel that you’re still doing some good out there or is it just about a paycheck at this point? At least you’re out there in the middle of nowhere, you’re helping those who may otherwise not have much.

    1. We can only function within constraints of our reality, as shitty as that might be. The obesity epidemic clearly has very little to do with the provision of healthcare services, I feel like physicians are just picking up the pieces of a problem they had little to do with creating. The opiate epidemic, on the other hand, I think physicians do shoulder some of the blame for, but only in so far as they were acting within an exploitative and corrupt system. Clearly a small minority of physicians have been functioning as drug dealers, but the rest of those who have prescribing huge amounts of narcotics got there through good intentions, being lied to by pharma, and a society who now thinks discomfort is a treatable medical illness. And now we have to deal with it.

      I am sure there will be some who blame physicians and hospitals for all of our necessary death, but I do actually believe that most people will see it as a collective failure of leadership and not a point of care problem, but who knows?

      As far as doing some good, I think I do enough good to keep doing it – for now. Eventually, I think palliative care will be where I end up. For now, the volumes are small enough and I am technically only part time so I think I can largely keep from getting too burnt out. A smaller organization has its faults, but I can actually have some influence on the organization overall, which helps me feel like I am not just toiling in obscurity. How about you? How you holding up? Jonesing for Spain?

      1. Thank you for your reply and for writing this great blog. I am, burning and itching and jonesing for Spain. The US passport thing has me here in Portland for a while longer. I decided to take the FM Board exam for recertification. With the NBPAS board, or any alternative board like that, it’s impossible to get a word in for any kind of decent job application. And as long as I’m here in medicine I feel that I need to do something.

        1. Good luck with the recertification. If you get that done and are interested in getting a new state license and trying out rural medicine let me know, it looks like we may be in need of some locums coverage for a bit to help with paternity leave sometime in the next year for a couple of months.

  2. Hi HP, nice to see you writing again. I appreciate your shedding light on the current medical situation we are experiencing. I also appreciate your commitment to continuing your efforts to educate people. I just wish more people saw this as an issue in the same arena as poverty, racism, etc. It is truly all connected.

    1. Thanks for reading, Donna. I am glad you find some value in what put out here. I am not sure how many people I am educating, but I am glad someone finds value in it! Thanks again!

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