Misha Friedman/Getty Images
Nurses and doctors.
- The coronavirus pandemic has placed the American healthcare system under a historic amount of strain.
- Some experts say the profit-driven nature of the system hampered the US's readiness for fighting the pandemic.
- "Getting the for-profit element out would allow us to better prepare for pandemics like this. Like having adequate back-up facilities and inventory," Dr. Gerald Friedman of the University of Massachusetts Amherst told Business Insider.
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The coronavirus pandemic has placed the nation's healthcare system under strain, exposing its vulnerability to an extraordinary public-health emergency.
Medical providers are scrambling to obtain masks, gloves, ventilators, and other protective equipment that's short supply across the country. That's driven some workers to use bandanas as masks while others are making gowns out of garbage bags.
A federal watchdog faulted these types of "severe shortages" of personal protective equipment - along with testing kits - for impeding hospitals' ability to fight the outbreak.
Much public attention has been focused on how the nation's expensive healthcare system discourages people from seeking coronavirus treatment. Some experts, though, are finding fault in the profit-driven design of the system - and they say its undercut the nation's readiness for combating a public health emergency like the coronavirus.
"Getting the for-profit element out would allow us to better prepare for pandemics like this. Like having adequate back-up facilities and inventory," Dr. Gerald Friedman, author of "The Case for Medicare for All," said. "It may cost money, but there's a public interest in being prepared for a disaster."
Friedman, an economics professor at the University of Massachussetts Amherst, acknowledges that the US is not the only country with private-sector involvement in its healthcare, citing the Canadian and the UK healthcare systems as examples. He argues that compared to those nations, the US doesn't do as much to regulate its sizable private health sector.
"The US is the only country where we've really handed over a big part of our healthcare system to for-profit entities," he said.
Some of that drive to ramp up profits also filtered into the production of critical medical equipment over the past several decades.
"We're making this stuff far away"
Mask shortages can be explained by US companies' decision to move their production abroad to countries like China to cut costs and pay lower wages, according to Dr. Susan Helper, a manufacturing expert at Case Western University and formerly chief economist for the Department of Commerse.
After China joined the World Trade Organization in 2000, it became a manufacturing powerhouse and tied its prospects to the global economy. The world's second largest economy also became essential in the production of protective medical gear.
Figures from the HHS show 95% of surgical masks and 70% of respiratory gear like the tighter-fitting N95 masks are made overseas - and much of their materials are produced in China.
An invisible microbe exposed the perils of concentrating production in one country to save money.
As the coronavirus spread across China beyond its point of origin in Wuhan, factories shut down and workers were thrown into a state of lockdown, slamming the brakes on a huge amount of production of many goods. That includes medical supplies frontline workers depend on to treat patients infected by the virus.
"We're making this stuff far away and in multiple countries," Helper said, noting the ripple effects of the outbreak that sidelines one nation can drastically impede product assembly.
Helper continued: "We have long-term corporate decisions... they didn't think through the private costs of a pandemic. And some of it is corporate decision-making induced by public policy like trade agreements."
The Associated Press reported that the painful shortage of critical medical supplies could be traced to a halt in shipping from China as it doubles down on efforts to fight its own outbreak.
The Trump administration has urged governors to buy medical equipment on their own, placing more of the onus on state governments to take charge instead of the federal government. "We're not a shipping clerk," Trump said at a press conference last month.
REUTERS/Jonathan Ernst
Donald Trump at the daily coronavirus response briefing at the White House on March 23, 2020.
That's prompted a frenzied race between desperate states to buy gear and equipment - which has led to them paying jacked-up prices for some goods as they compete with each other, according to The Washington Post.
"You've got 50 states and the federal government all chasing the same companies. It's crazy," Ohio Gov. Mike DeWine told the Post.
Meanwhile, the Strategic National Stockpile is already depleted of personal protective equipment, The Hill reported, triggering concerns among lawmakers of a "free-for-all bidding war."
And while some companies like 3M still produce masks in the US, they're struggling to keep pace with unprecedented demand.
Much of healthcare remains a business in America
Another element hobbling the country's readiness to respond to the pandemic include the government's failure to build a reserve of ventilators, a potentially life-saving machine for patients with severe cases of COVID-19.
The New York Times reported a federal initiative to design and build a fleet of affordable ventilators collapsed after a multibillion dollar medical device maker bought out the small company tasked with constructing them. None were built.
It underscored the risks of outsourcing a federal project with significant public health ramifications to a private company.
Dr. David Blumenthal, president of the Commonwealth Fund, a healthcare research group, said that extremely high US healthcare spending didn't align with its ability to stockpile reserve equipment to battle a pandemic.
Reuters/Caitlin Ochs
New York City Mayor Bill de Blasio stands next to ventilator during a news conference at the New York City Emergency Management Warehouse.
"It's just startling given we spend almost one out of every five dollars in this country on healthcare that we're not luxuriating in excess capacity," he said.
Tara O'Toole, a former homeland security official who chaired an advisory committee on the federal emergency stockpile, said decisions to build reserves of critical equipment had lost out to the bottom line.
"We've made healthcare into a business where cost and profit matters more than the capacity to surge," she told the Atlantic.
The US has fewer hospital beds per capita compared to most other developed nations, according to the Commonwealth Fund. Blumenthal says that's not a cause for concern in a normal year, but the lack of additional capacity can strain hospitals facing a surge of patients during a pandemic.
Hospitals across the country are also contending with a steep drop in revenue from the loss of non-urgent surgeries, Business Insider's Kimberly Leonard reported. Thousands of workers are being furloughed to save on costs.
Though many furloughed employees aren't involved treating coronavirus patients, the reduced staffing is placing additional strain on front-line workers who have to deal with longer hours.
Blumenthal said hospitals remain, at their core, businesses.
"In times like this, we kind of hope that hospitals will leave their economic motivations aside and start acting like charities. But that's a lot to ask," he said. "They are private, they have to bring in revenue to employ people."
He concluded: "They live off what they sell. And when they stop selling stuff, they can't pay people. If we want organizations not to behave like businesses, we have to stop asking them to behave like businesses. I would say we're not ready to do that."
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