Brown University doctor explains why America’s health care system has “already collapsed”


The U.S. healthcare system was completely unprepared for the COVID-19 pandemic and has already collapsed beyond the point of collapsing, according to Vishal Khetpal, resident doctor in internal medicine at Brown University.

Photo: BRYAN R. SMITH / AFP / Getty Images

Khetpal explained in an article published in Slate Tuesday that the staggering number of coronavirus cases has flooded hospitals beyond their capacity to treat patients and that increased rationing of care both proves our private for-profit paradigm has failed.

“For about a year, we have been told several times that the American health system is in the throes of on the verge of collapse. Over the past month, this phrase has been used to describe the plight of hospitals in Oklahoma, Louisiana, Alabama and Alaska; last winter it was used to describe the health systems in California and Idaho. The Mississippi health system, in a recent New Yorker essay, was observed to be statewide approach to failure, while in a Politico headline at the start of the pandemic, New York hospitals were quickly reaching a breaking point. Descriptions of health systems on the verge of functionality rank among other COVID clichés such as new normal and in these difficult timesKhetpal wrote. “But to say that our health system is in edge of collapse is to water it down. The story of a veteran dying near a town known for having some of the best hospitals in the world – and a very treatable disease – illustrates that our healthcare system has already collapsed.”

Khetpal said symptoms of systemic collapse should be obvious to anyone with a medical degree.

“My time as a doctor has been defined by working in a system that has already collapsed. The American healthcare system I work in has featured limited personal protective equipment, oxygen shortages, and the construction of field hospitals in convention centers and parking lots. Last winter, many hospitals across the country instituted crisis care standards, forced to ration health services on the basis of criteria few imagined would be used outside of a mass casualty event. , like a terrorist attack, ”he stressed. “Today, hospitals are full in much of the country, with patients requiring an intensive care unit being flown thousands of miles in search of a staffed bed. These are not the characteristics of a failing health system. These are the hallmarks of a dramatically collapsed healthcare system, forcing doctors and patients to climb the rubble for help. “

Khetpal went on to say that the World Health Organization’s definition of collapse – which measures health systems by their “resilience” – best matches the worsening situation in the United States.

“Resilience describes the capacity of a health system to absorb shocks and adapt while providing basic services. That is, during a major disaster, a functioning health system can take care of the injured, as well as the patients suffering from the various health emergencies that arise in ordinary life, alongside those in need. routine preventive care. In terms of resilience, our system over the past year has failed, ”he said.

“Last year it quickly became clear that we did not have a contingency plan for a protracted disaster like a pandemic. In the first year of the pandemic, the use of routine preventive care, like childhood immunizations and colon cancer screening, plummeted as our healthcare system was overwhelmed by COVID. Nearly half of all patients, according to data from a large survey, have foregone medical care, following the implications of public health messages at the start of the pandemic to stay home except in emergencies ( even though hospitals have proven to be an unlikely place to catch COVID). The excess death toll during the pandemic in the United States is estimated at over 900,000, ”Khetpal added, noting that dozens of doctors and nurses have simply given up on trying to keep pace with the uncontrolled spread. of the coronavirus.

“While America’s healthcare system might under normal circumstances be too expensive for many to access and, for some, difficult to trust, the pandemic has made matters much worse. Healthcare workers, lacking the support to function at such a grueling pace for so long, are voting with their feet. Nurses, tired of working in a dysfunctional system, are quitting their jobs in droves, while a slight increase in doctors are retiring early or following other healthcare workers on their way out, ”he said, adding that for change to happen, Americans must first recognize the failings of our current system.

“To say that we are on the edge of the disaster offers hope that those responsible can take action to prevent us from plunging into an abyss. This suggests that the situation is at least temporarily sustainable, that you may be able to continue squatting and doing what you have been doing, and you will be fine. But it is not sustainable, and it is not good, ”concluded Khetpal. “The health care system is not approaching some kind of cliff, but still functioning – what is happening right now is killing people like Daniel Wilkinson. People who don’t have to die are dying.

The story continues to Slate.

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