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Brown University Physician Breaks Down Why the American Health Care System Has ‘Already Collapsed’

The American health care system was completely unprepared for the COVID-19 pandemic and has already crumbled past the point of collapse, according to Vishal Khetpal, a resident doctor of internal medicine at Brown University.

Photo: BRYAN R. SMITH/AFP/Getty Images

Khetpal explained in an article published in Slate on Tuesday that the staggering number of coronavirus cases has inundated hospitals beyond their abilities to treat patients and that the increased rationing of care both prove that our privately-run, for-profit paradigm has failed.

“For a year or so, we’ve been told repeatedly that the American health system has been on the brink of collapse. In the past month, this phrase has been used to describe the plight of hospitals in OklahomaLouisianaAlabama, and Alaska; last winter, it was used to describe health systems in California and IdahoMississippi’s health care system, in a recent New Yorker essay, was observed to be approaching statewide failure, while in a Politico headline at the start of the pandemic, hospitals in New York were quickly reaching a breaking point. Descriptions of health systems at the very limit of functionality rank among other COVID clichés like new normal and in these trying times,” Khetpal wrote. “But to say that our health care system is on the brink of collapse is to sugarcoat it. The story of a veteran dying near a city known for having some of the best hospitals in the world—and from a very treatable ailment—illustrates that our health system has already collapsed.”

Khetpal said that the 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 health system I work in has featured limited personal protective equipmentoxygen shortages, and the construction of field hospitals in convention centers and parking garages. Last winter, many hospitals across the country instituted crisis standards of care, forced to ration health services based on criteria that few people envisioned would be used outside of a mass casualty event, like a terrorist attack,” he pointed out. “Today, hospitals are full in much of the country, with patients requiring an ICU being airlifted thousands of miles in search of a staffed bed. These are not features of a health system that is approaching failure. These are features of a health care system that has broken down spectacularly, forcing doctors and patients to climb through the rubble looking for help.”

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

“Resilience describes the ability of a health system to absorb shocks and adapt while delivering core services. That is, during a big disaster, a functioning health care system can take care of the wounded, as well as patients with the assorted health emergencies that pop up in regular life, alongside those who need routine preventive care. In terms of resilience, our system over the past year has not passed muster,” he said.

“Last year, it quickly became clear that we didn’t have a contingency plan for a prolonged disaster like a pandemic. During the first year of the pandemic, utilization of routine preventive care—like childhood immunizations and colon cancer screening—plummeted while our health system was overwhelmed with COVID. Nearly half of all patients, according to data from a large survey, forwent medical care, following the implications of public health messaging at the beginning of the pandemic to stay home unless there was an emergency (even though hospitals proved an unlikely place to catch COVID). The number of excess deaths during the pandemic in the United States is estimated to be more than 900,000,” Khetpal added, noting that scores of doctors and nurses have simply given up trying to keep pace with the uncontrolled spread of the coronavirus.

“If America’s health care system might in normal times be too expensive for many to access and, for some, difficult to trust, the pandemic made things terrifically worse. Health care workers, lacking the support needed to function at such a grueling pace for so long, are voting with their feet. Nurses, fed up with working in a dysfunctional system, are quitting their jobs in droves, while an uptick of doctors are retiring early or following other health care workers to the exits,” he said, adding that in order for change to occur, Americans have to first recognize our current system’s failures.

“To say that we’re on the brink of disaster offers hope that the people in charge can take steps to keep us from plunging toward an abyss. It suggests that the situation is at least temporarily sustainable, that maybe you can keep hunkering down and doing what you’ve been doing, and everything will be fine. But it is not sustainable, and it is not fine,” Khetpal concluded. “The health care system is not approaching some kind of cliff, while still functioning—what is happening right now is killing people like Daniel Wilkinson. People who do not have to die are dying.”

The story continues at Slate.



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