Lessons to learn from virus crisis
C OVID-19 has exposed the “Man behind the Curtain,” but even the Wizard of Oz is nowhere to be found. Not only has President Donald Trump once again been demonstrated a liar, aggrandizer, and bearer of overblown and false prophecies, our health care system has been unmasked for what it is — a complex, inefficient, low quality, uncoordinated patchwork of players who not only can’t get their act together during routine times, but become totally unhinged during a crisis.
Yes, what is occurring now is unprecedented. And, maybe, the degree of confusion and lack of direction is unpreventable. But there has been an overall dearth of consistent, experienced political and medical leadership at the top, superimposed on a chronically problematic U.S. health care delivery system overpopulated by medical subspecialists, corporate bureaucracy and profits.
Paramount in the conversation is Trump’s dissolution of the National Security Council’s pandemic unit. It rendered the nation rudderless and leaderless at this time of need. As for Trump selecting Vice President Mike Pence to head up the Coronavirus Task Force — really?
We’re left with Alex Azar, Secretary of Health and Human Services, a businessman, lawyer, and Trump nominee, who serves without appropriate medical credentials. In life before Trump, Azar served as president of the U.S. Division of Eli Lily and Company, a pharmaceutical firm. Under his leadership, the price of Lily insulin was jacked up to the unheard-of cost of $300 per vial. Insulin is required by Type I diabetics for day-to-day life. Without it, they die.
Citizens have become pinballs in an arcade game, bumping along day to day with contradictory and, at times, false information, and insufficient advice or guidance. The nation continues in reactive mode. Proper preparation would have allowed the nation to be proactive from the start, with a well-defined game plan.
With the virus spreading and deaths growing, it’s politics as usual with Trump blaming China and Europe for the cause and the media acting as fear mongers. The multitude of mixed messages regarding the availability of testing and medical care continues. The executive branch must drop the bullying, blame game, lies, and confabulations. Put citizenry first. Appoint a COVID-19 Czar, heading a committee with experts in virology who will make key decisions, give updates, and not be undermined, rejected, or negated by the president and his colleagues. It’s only in this way the nation can finally get ahead of this thing, if that is still at all possible.
Inhibiting our response is the nation’s health care delivery system. The United States is the only industrialized nation with a medical workforce two-thirds subspecialist, one-third primary care provider. Other peer countries function with opposite numbers — two-thirds PCP and one-third subspecialist — and these nations consistently demonstrate higher quality at lower cost.
When those nations face disaster, PCPs jump to the forefront together with experts in the field to take control of the medical-care crisis. Our cadre of U.S. subspecialists are frequently so narrowly educated, they can’t help much.
And delivery system design? Try to get 1,300 U.S. health insurance plans together to fight an enemy like coronavirus. It can’t be done. It is a system targeted at generating profit margins — often by excluding the sick and avoiding payment for testing and/or treatment — and rarely focused on quality and coordination of care.
COVID-19 shows the need to reform how health care is provided for Americans, whether it be via one-payer system, as in Canada and Taiwan, or via a pluralistic system, as seen in the European countries where for-profits are allowed, but where federal governments mandate universal coverage, comprehensive health benefits, robust support of the economically disadvantaged, better scrutiny and control of the for-profits, preventing discrimination aimed at citizens with pre-existing illness. In crisis, a good, federally administered health-care system can transition from routine to emergency national care quickly.
Once the COVID-19 crisis passes, and it will, some form of a federal medical disaster oversight committee, which speaks with one voice distilled from a panel of medical experts, must be reinstituted to replace the now defunct National Security Council’s pandemic unit. This committee should be charged with planning for a nimble, quick response to manage future U.S. medical disasters, whether infectious, like COVID-19, or nature-induced, such as hurricanes, tornadoes, and earthquakes.
The nation cannot continue with either no expert voice or a single solitary one, currently Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, whose comments have been contradicted or squashed almost daily by the Wizard and other politicians.
The nation must improve readiness for the next health emergency. And yes, there’s one probably quietly incubating as we speak.
Dr. Robert A. Linden is a Niantic internist/geriatrician serving on the teaching faculties of both Yale and the University of Connecticut medical schools. He is the author of “The Rise & Fall of the American Medical Empire.”