The Wall Street Journal has detailed how a lean hospital business model, the standard structure for hospitals in the US system, was overwhelmed by the coronavirus pandemic: https://www.wsj.com/articles/hospitals-for-years-banked-on-lean-staffing-the-pandemic-overwhelmed-them-11600351907 . In the US, hospitals have a just-in-time staffing and supply model. The nature of capitalism is that this feature will not change. Solutions include:
1. Create back-up staff and back-up PPE supplies and production capabilities.
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- There are National Guard and Army Reserve units throughout the United States. Medical training – for example, nursing and medics – could be provided within the active military and to these reserve units. Medical training would be useful outside pandemic situations, for example in schools and workplaces. Personnel who complete training and obtain qualification could receive a pay premium. This would also raise employability for veterans or Guardsmen who complete training and qualification.
- PPE is supposed to be maintained in national stockpiles; the pandemic revealed that some of those supplies were past their expiration date. This problem could be avoided by rotating supplies out of the stockpile (for example, to VA hospitals) well before their expiration date. Back-up production capacity could be created in a few US locations and then shipped around the country during emergency need.
- As private hospitals are evolving into regional and national chains, create back-up plans internally in these systems, including movement of personnel and supplies on a temporary basis during an emergency, or movement of patients.
2. Use the military (active or reserves) for the construction of field hospitals during an emergency. This can include repurposing of existing buildings or construction of temporary facilities, both of which have been done during the pandemic.
3. Have and execute a national plan. As is well-known, the Obama administration built a pandemic response unit in the White House, which Trump disbanded, and the administration has refused to create or execute a national plan in response to pleas from the governors, public health experts and the public. Utterly ridiculous and despicable, and the central reason why we are where we are. Central, avoidable failures:
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- Development and provision of adequate testing capabilities. The key need for re-opening is accurate testing with rapid (preferably on-site) turn-around.
- Development and implementation of adequate contact tracing, testing and isolation staffs and protocols.
- Coordination of resources nationally with “SWAT” team capabilities to be used when hotspots emerge.
- Because the virus is now embedded in the global population, the previous three items are an ongoing need. Every new day is an opportunity to start addressing this need.
4. Move toward a public health system. Whether it’s revitalized Obamacare (short-term) or a more full-blown national health system (long-term), this has been the obvious shortcoming of the US system in relation to other developed countries. The employer-based healthcare system has many problems of coverage and complexity. The US has a partial national system now (Medicare and Medicaid, plus Obamacare), and the federal government already buys about half of all medical care in the US (the systems just mentioned plus healthcare for the military, veterans and federal employees). This system’s enormous expense and below-average results is a major drag on American employers and the economy, not to mention the negative health and mortality effects on uninsured and underinsured Americans. This does not necessarily mean an end to private health insurance – the public system could provide universal basic care, with more advanced care (elective and cosmetic procedures, for example) still provided privately. However, universal basic care would improve overall population health and lead to financial efficiencies (resource distribution, federal price negotiation for prescription drugs and medical supplies and appliances), as well as removing a significant administrative burden from employers.