For end-of-the-year columns, it’s customary to recap the events of the past 12 months, usually highlighting a mix of the good and the bad. Because this (past) year has been dominated by health, in particular COVID-19, and my beat is health, it seems fitting to reflect on where we are. Where we are is not good.
A headline in the Los Angeles Times seemed to sum up the current state of the U.S. health care system: “Bodies pile up, patient care falters as COVID-19 devastates L.A. County hospitals.” In the Times’ story a hospital critical care nurse says, “No one would believe this is the United States.” Indeed, they would not.
A story from Wisconsin tells us that a hospital pharmacist deliberately destroyed some 500 doses of vaccine. No reason given, at least none the media have reported. This behavior, I dare say, would have been unheard of in 1947 when New York City managed to vaccinate five million people against smallpox in two weeks.
At the end of 2020, the government’s goal of vaccinating 20 million people against COVID by the last day of December fell way short with only 2.7 million doses administered. In some ways that is hardly surprising, given how chaotic the whole COVID affair has been since the beginning. First, we failed to recognize how lethal the virus was; then we were slow to get testing up and running; next came problems with contact tracing because Americans were reluctant to cooperate. Lab results were delayed. Americans flouted the rules and advice to stay home, and on it went until we find our nation in a very unenviable position at the beginning of 2021.
Yet the mythology surrounding our health care system – that it is the best in the world – continues. This year has shown that America, contrary to its self-image, does not have the most effective and efficient health care system in the world. That’s a bitter pill for many Americans to swallow.
At the end of December, a new study emerged in the journal JAMA Internal Medicine that further deflates America’s standing. It found that wealthy, white Americans generally have better health outcomes than the average U.S. citizen but generally worse outcomes than average citizens in other higher income countries. In other words, the U.S. continues to spend gobs of money on health care but doesn’t necessarily get a healthier population for its expenditures. Not a lot of bang for the buck!
Two pieces I wrote this year drove home that point for me. They showed the inadequacy of health care for too many rural Americans even in “normal” times when there’s no virus lurking among us. One woman from a sparsely populated county in central Nebraska recently wrote to tell me about the lack of in-network doctors available to people who join Medicare Advantage plans. Those plans require seniors to use network physicians to get benefits. If they don’t, the result is high out-of-pocket bills.
If people in those sparsely populated regions don’t have doctors who pass muster with their insurance company, how many go without care?
Another piece I wrote discussed federally qualified health centers, which serve many low-income communities across the country. Doctors at one such health center in western Nebraska serve 17 low-population counties, and patients drive many miles to see a doctor. Those doctors also report that they examine more patients for dental problems than for other medical issues. That speaks to lack of access to oral health care for way too many Americans; another health problem policymakers brush off.
Although the pandemic has exposed serious flaws in America’s health care arrangements, maybe, just maybe, it will spark a serious national discussion about the kind of health system we want for everyone when the postmortem on COVID-19 is done.
In the meantime, all of us will have to figure out how to get tested, get vaccinated, and stay safe without a lot of reliable information to guide us along the way. Because so much of the information from the federal government has been politicized, I turned to the website of Britain’s National Health Service www.nhs.uk, which I’ve visited and written about several times.
It is a model of clarity and good information about COVID. For example, the advice for pregnant women and those thinking about becoming pregnant was the clearest I’ve seen. The website also tells visitors when it was last updated and when the next update will be.
That website shows how much better America could be.