Column: The Health of Healthcare

The Covid-19 pandemic is probably over. We lost over one million of our fellow Americans as it grew from a menacing public health incident to a full blown national disaster. It is apparent in retrospect what went wrong. It is also apparent that despite the awful losses we suffered that not much has changed. 

When this deadly virus reached the United States, its arrival was dismissed by our highest ranking elected officials as unworthy of concern.  Routine public health measures adopted for much more treatable and less lethal biological agents were deemed unnecessary. There was no allocation of additional resources or personnel to manage a possible epidemic or even to coordinate a national response. The government position was wait and see and hope we do not face the same devastation experienced by every other country that took no preparations against a Covid epidemic. We were not spared.

Currently our healthcare system is understaffed. underfunded, and under-equipped. Staff burnout is epidemic.  Emergency rooms and critical care units are still being stretched to the breaking point with this year’s RSV and flu infections. The newly elected Congress has sworn to investigate Hunter Biden (I forget what office or government position he holds) until they find terrible things that he has done during his inauspicious life, but there is no talk of healthcare reform. On the contrary, the new leadership has assured us that they will dismantle to the extent possible whatever measures their opposition legislated while the Democrats held the majority of votes in the House and the Senate. Our newly minted Congress is not discussing solutions to problems we still face, even though we need more than the perennially offered thoughts and prayers to protect us from the next medical catastrophe.

What needs to be done is self-evident. First of all, we need personnel trained and equipped to manage the inevitable next disease wave. This means doctors, nurses, respiratory therapists, and other “essential” healthcare workers.  We need a veritable army of these professionals, ready for deployment and, if necessary, relocation. One of the many problems with recruiting this army is that, unlike our well-funded and highly incentivized military, healthcare professionals need to pay for admission to this force. They do not get paid during their training. On the contrary, they must pay dearly, both financially and socially.

The cost of a medical education is obscene. Annual tuition, fees, and supplies (independent of living costs) range from $40,000 at publicly supported state school to over $60,000 at private institutions. Most medical students are either wealthy before they enroll or are saddled with over $100,000 in debt by the time they finish four years of medical school. That assumes they did not already incur any debt during the four years of undergraduate training required for their application to medical school. This debt burden drives physicians away from relatively low paying specialties, like pediatrics, family medicine, and emergency medicine, precisely the areas most likely to serve as the first defenses against a pandemic.

The cost of training for nurses and allied health workers is similarly challenging for most individuals interested in careers in this area. These costs and the commitment of time required to get licensed in the healthcare arena serve as barriers to many who might otherwise expand the ranks of healthcare workers. 

Just as we need a formidable military to protect our country against enemies foreign and domestic, we need a formidable healthcare force to protect our population from epidemic and pandemic diseases.  We spend tens of thousands of dollars annually to train and equip each soldier, sailor, marine, and aviator recruited into the military. They are paid while they are being trained, and we recognize this as an investment in the safety and security of our nation. Why we do not value and subsidize our healthcare professionals to an equal extent we value and subsidize our military forces is a mystery.  The cost of medical, nursing, and allied healthcare professional training should be paid by the government, at least for state-funded schools.

Before my fellow citizens scream that this is another step toward socialism, allow me to remind you that many of us are relieved to be covered by a relatively inexpensive and highly efficient health insurance program, heavily subsidized and administered by the federal government, called Medicare. We are also beneficiaries of that unapologetically socialist program called Social Security. Note that both of these programs pay out considerably more than any equivalent insurance or annuity programs pay to participants or investors.  If you are concerned about the additional expense of subsidizing the cost of training doctors and nurses, you need only adjust reimbursement to these subsidized healthcare providers through Medicare or other publicly funded programs. If you believe doctors, in particular, will attack legislators who freeze or reduce their Medicare reimbursement, you can address their concerns by capping malpractice awards and thereby reducing the annual cost of malpractice insurance, which for many physicians is nearly or more than $200,000 annually.

We need advanced planning for the unforeseen.  Access to and stable costs for medical equipment and supplies should be negotiated annually for the entire nation. With the Covid-19 epidemic, we had states bidding against other states for essential medical supplies and ventilators. This drove up costs, fostered hoarding, and delayed access to life-saving equipment. In wars, the government does not hesitate to control prices to avoid price gouging. It directs the distribution of vital equipment and supplies. It can and has repurposed entire industries to address war needs. A pandemic is just another kind of war. It demands the same type of coordinated action routinely adopted in military emergencies.

We probably have a little time to plan our response to the next pandemic or epidemic. We must plan now or we shall merely repeat the errors of 2019 and 2020, regardless of who controls the Congress or the White House. 

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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