It hit me like a sledgehammer a few weeks ago: Americans are dreadful at making healthcare decisions and constructing sound health policy.
A couple of vignettes:
#1 – An adult walks into an urban hospital emergency room; undergoes a quick triage to ensure he is not having a heart attack; is told to wear a hospital mask and sit over there (a large entry area with chairs six feet apart from other waiting patients). For over three hours he sits near a man and women in their 50s and a senior citizen, perhaps 80. During this time he finds out the two adults are brother and sister, and the senior is their mom.
He learns they came to the emergency room about an hour before he arrived and have been trying to keep their mom from throwing a fit. It is clear she is agitated, and frustrated like she does not want to be there. Eventually a nurse comes to take her to see a doctor, and the daughter leaves with her. After they leave, the son shares: “Mom has Alzheimer’s and came down with a cough.” He goes on, “With all the COVID out there, we thought she better be seen to make sure she doesn’t have it.”
#2 – While the adult is sitting uncomfortably, in deep pain and trying to remain calm by taking deep breaths, a nurse starts chatting with a woman who looks pretty rough. Dirty, disheveled and generally unkempt. It is not that cold outside, but the woman is wearing layers of clothes. Everyone can hear the conversation between the nurse and woman. They clearly know each other. The nurse asks “What’s up tonight?” The woman says she is really tired and cold, and her head hurts. The nurse explains that it will be hours before she is seen because they are so busy. The woman says ok and asks for some pain medicine. She’s told no, and raises her voice, clearly frustrated with the answer.
#3 – After three hours plus, the adult waiting in the emergency room is seen by the attending doctor and eventually admitted to the hospital two hours after seeing a doctor. The hospital room is located on a floor which has been transformed from a short stay unit (less than 36 hours) to a COVID plus unit. Some of the rooms have been retrofitted to serve COVID patients, while others serve traditional hospital patients. The next morning the patient notices that some of the rooms have been retrofitted with small enclosures (i.e. somewhat like a screened in porch, but with thick plastic and storm doors) where staff can change into and out of personal protection equipment (PPE) before entering the rooms. The inside of the rooms are super modern, and have a pulley system over the bed to help staff move people in and out of bed. In bold letters, the pulley system has a little sign on it: “Rated to 400 lbs.”
After a few days, the patient learns that the short stay unit increased its staffing levels to address the super sick patients. Expensive, visiting nurses were hired from around the country to support existing staff who had to undergo extra training to effectively assist the COVID patients.
If you know my story, you may have guessed by now that these experiences involved me during my most recent 11 day hospitalization. And yes – that is correct. I experienced all of this and more.
While I was hospitalized I saw the absolute best of American healthcare. The incredible acute care system where creativity, research, deep science along with technology, skill, art, and ingenuity come together to keep people with healthcare challenges like me alive. Yet, I also saw the absolute worst of American health policy and culture. The unnecessary use of the ER system. The refusal to treat one’s social determinants of health (i.e. homelessness, substance use, food insecurity, et cetera) to assist a patient’s physical and mental health needs. The obesity epidemic which requires hospitals to install pulley equipment in each room to move patients. The inability to stop spreading a virus by masking up, washing hands, and physically separating.
All of the choices described previously – individual healthcare choices and policy makers choices – increase the cost of our healthcare system by billions of dollars per year.
Instead of going to the ER in the absolute middle of the night for an elderly, mentally and physically challenged woman with a cough to see a doctor due to the fear of having COVID, we need to ensure that each person has a medical home. A place where a primary care doctor, physician assistant, or nurse practitioner knows their patients well, and can see them within a day. This may require us to: Train and hire more doctors, PAs or NP; Eliminate medical school debt; or Increase primary care reimbursements. But this shift in funding would be less expensive than having people visit the ER when there is not a need.
Instead of having frequent fliers visit ERs due to homelessness and all of the complications life on the street creates, let’s create more supportive housing. Our housing policies and funding models need to change. We have a wrong pocket problem where hospitals, law enforcement and others end up serving many of the least among us at gigantic costs with terrible outcomes. Instead if we shifted a portion of the money to supportive housing programs, local, state and the federal government could save taxpayers millions of dollars annually. For it to be a net savings though, entrenched bureaucracies in healthcare, law enforcement, and certain non-profit industries need to get to ‘Yes in their Heart’ so positive change can occur that may reduce their funding, but help improve people’s lives (which is a goal of public service).
Instead of subsidizing corn production (as in we need more and more corn syrup to serve as a sweetener in everything), we need to modify our food production model. How can we incentivize less processed food production, and start supporting the production of more fresh fruit, vegetables, and natural production. Obesity and its byproducts of diabetes, heart disease, and hypertension cost our healthcare system billions of dollars annually. (Not to mention the cost of building extra wide doors as well as buying extra large furniture and pulley systems in hospitals.) I am sure this type of change will gore someone’s ox, but courage is necessary since we are seeing life expectancy drops due to the impacts of obesity.
And last, we now have a pretty incredible solution to COVID: proven vaccines. At my last count, there are four vaccines which have been developed and approved by regulatory agencies in the western, first world (Pfizer, Moderna, J&J, Astra Zeneca) and two vaccines developed and approved in second world countries (Russia and China). Science works. And simple lifestyle changes like wearing masks and washing hands can prevent the spread of COVID as well.
My idea to consider this week is this: Let’s move our healthcare system toward a prevention model. Our nation’s hospitals are absolutely incredible. A true national treasure. Moreover, our acute care healthcare system will do all it can by providing incredible resources (physical, people, and financial) in an effort to save one’s life. I have personally benefited from this reality. But so many of our public healthcare challenges can be solved by employing different strategies.
I would like to see us start this journey with a bit of humility, and begin by taking a problem solving approach to healthcare instead of maintaining our current winner/loser approach. I know we can do it. Remember there was a small celebration a few weeks ago where adults and teens from different cultures, traditions and sectors come together to create beauty. Let’s do it together now on something larger and more complex to improve the lives of so many.