Despite Trump’s initial confidence, it is becoming increasingly clear that the coronavirus has exposed that the American health system is flawed and insufficiently equipped, with funds and personnel not meeting demand in this public health emergency.
“The public health system we needed to be prepared for this crisis was simply not in place,” said José Szapocznik, a public health scientist at the University of Miami.
Far from being the number one in the world in preparation, the United States has long ignored the massive deficiencies in its public health system that have led it to be number one in the world only in terms of cost, while remaining lagging behind the rest of the world in terms of quality of results.
“I think this is a time when all the different pieces of the system that were papered in the good times are coming back to haunt us.” said the doctor Vikas Saini, President of the Lown Institute, a nonpartisan group of experts in Massachusetts that advocates for health reform.
“It’s like the collapse of 2008. People talked about it, but most thought it was fine,” he said.
Some political commentators and activists have been quick to point to the United States’ private health insurance system as the culprit, arguing that the coronavirus epidemic would have been better managed by a universal health system, or the ‘Medicare for All’ program. raised by Democratic Party presidential candidate Bernie Sanders.
Is Europe better?
But, then, how do you explain why countries like Italy, Spain, France, and the United Kingdom, which have large government-run health systems, now encounter some of the highest numbers of covid-19 cases and deaths.
“This is not a matter of (insurance) coverage. No one is being refused treatment. It’s about service delivery, like test kits to identify infection cases, “said Szapocznik.
Public health experts, including Bill Gates, Microsoft’s billionaire founder, have been warning for years that the U.S. health system was ill-equipped for a major pandemic, citing a number of problems such as a lack of hospital beds and medical professionals. They also highlighted that the system is fragmented and lacks centralized control, and is instead state-by-state isolated.
Responsibility for the United States’ healthcare system is divided between the states and the federal government, creating conflict and confusion at best.
” This is not something that a state can handle. States do not handle public health emergencies“Andrew Cuomo, the governor of New York, said during an interview on CNN on Thursday.
Furthermore, observers indicate that a widely criticized lack of quick and decisive leadership from the White House only made matters worse.
As a result, the response to the spread of the virus has varied widely, with some states taking drastic and proactive measures to quarantine residents, while others have resisted limiting movement to avoid shutting down the economy.
“The central government has been slow because our leadership minimized the problem,” said David Blumenthal, president of the Commonwealth Fund, a 100-year-old New York-based private foundation that seeks to promote improvements in the quality of the health system.
” The President was unwilling to influence production and supply allocation“he added.
Instead, procurement of supplies was left to state governors, leading to a bidding war for vital items like respirators, face masks, and other protective gear that have raised prices due to a global shortage.
According to some reports, the lack of coordination resulted in sale of a large number of mouth masks made in the United States to foreign buyers.
To make matters worse, despite the existence of a ‘National Strategic Reserve’ of medical supplies, the White House was slow to move those products and, worst of all, the reserve did not have enough necessary items, while some had spent their due date.
Military to the rescue
Finally, under pressure from some governors, Trump called the Army to the rescue to build field hospitals. He was also forced to mobilize two Navy hospital ships sent to the ports of New York and Los Angeles.
Using the military to respond to the coronavirus leaves some experts wondering why health care is not a national security problem, on par with the war on drugs or terrorism.
The White House removed the National Security Council’s Global Health Security and Biodefense office last year and added it to another section, although some officials say the relevant experience was not lost due to the restructuring.
“We maintain an army of two million people. He is prepared for war, “said Szapocznik.” However, we don’t think of it that way for public health. In this war, we also need an army, an army of health workers“, said.
Much of the essential supplies, such as ventilators and hospital protective equipment, are manufactured abroad. “Would we outsource aircraft to the Air Force?” Szapocznik wondered. “We should see the Armed Forces more as our model,” he added.
Field clinics and a hospital ship: NY strengthens its capacity to deal with the flood of patients with covid-19 (photos)
“One for all and all for one”
Experts argue that the president’s decision not to use all his authority to impose a national ‘stay home’ quarantine has fueled the mosaic approach and allowed the virus to spread.
The problem is that the virus doesn’t respect borders, experts say. ” If a state doesn’t, you’re going to fight a losing battle, like walking on a treadmillBlumenthal said.
The only way to beat the virus is “all for one and one for all,” he added.
The test kits
Perhaps the biggest institutional flaw is the slow distribution of test kits to identify people with the virus. The Centers for Disease Control (CDC), long regarded as an exemplary government agency and a world leader in the fight against infectious diseases, has been widely reported to have made a number of catastrophic mistakes.
Instead of adopting one of the test kits already used in other countries, he decided to make his own. But it does not work. Instead, the government was forced, at the end of the day, to turn to the private sector to produce the kits.
In addition to that, the government did not have trained teams ready to go out into the field and find infected cases and trace contact history with other potential victims.
” This is epidemic 101, drawer public health“Blumenthal said, noting that it is a widely used practice for other diseases, such as sexually transmitted diseases and tuberculosis.
Blumenthal and others say the issue of test kits illustrates a key vulnerability in the nation’s public health system. ” We have a tremendous deficit compared to other advanced countries of first-line providers They can offer that initial contact with the health care system, where symptom identification can take place and where detection could be done outside the crowded and most dangerous environment of a hospital emergency room, “he said.
In that regard, the private insurance system makes the United States more vulnerable to the spread of the coronavirus, even if it is not entirely at fault.
“The health of one of us affects all of us,” said Saini of the Lown Institute, which was founded by Nobel Peace Prize winner Dr. Bernard Lown, who invented the defibrillator and co-founded International Physicians for Prevention. of the Nuclear War.
” If people cannot afford insurance, they will continue to spread the virus. You can’t nip it in the bud if you can’t get people into the system (for treatment), “he said.
The fact that health insurance is tied to a person’s employer also creates more problems when, as reported Thursday, a surge of 6.6 million people applied for unemployment benefits, bringing the two-week total to nearly 10 million.
Cost of care
The coronavirus has also exposed other structural problems such as cost, capacity, and quality of health system care.
States like New York have called on retired doctors and nurses to rejoin the workforce, as well as to graduate medical students early to strengthen hospitals.
Fewer beds, less medical
Cox noted that The United States has fewer beds per capita than any other developed country, due to a combination of government efforts to reduce costs and industry efforts to maximize profits.
At the same time, The United States has fewer doctors per capita than other countries, in part due to lobbying by the American Medical Association to limit the numbers. While this group says this is necessary to ensure quality control, critics say there is also a financial reason to keep wages high.
As a result, The United States spends about 18% of GDP on health expenditures, more than double the average among developed countries.
Experts say that is also because other countries devote more resources to preventive care, working at the community level to provide cheap medicines, as well as food and shelter, to screen for diseases before they require costly hospital treatment.
Despite all the inherent weaknesses of the public health system in the United States, at the end of the day, many experts agree that in the case of covid-19, the problems being addressed now could have been avoided if the government federal would have responded faster. The slow response created a domino effect.
” The reason we need artificial respirators is because we couldn’t contain the epidemic. South Korea contained the epidemic and does not need artificial respirators, “said Szapocznik.
“That is really serious failure here. The government did not pay attention to the first signs of the epidemic,” he added.
Photographs of the pandemic in the US: this is how the country faces an unprecedented health crisis (photos)