By Charles Silver & David A. Hyman
Tuesday, April 14, 2020
Some have said the failure of America’s medical system to
handle the surge in demand caused by COVID-19 is proof that the country needs
Medicare for All. They couldn’t be more wrong.
Many countries with nationalized, single-payer schemes,
including England, France, Italy, and Spain, have seen their health-care
systems stretched past the breaking point by the pandemic. More importantly,
the responsibility for America’s lack of preparedness lies squarely with our dysfunctional
government. The real lesson to be learned from our botched response to COVID-19
is that giving the government control of the entire health-care system would be
an enormous mistake.
No system that is sensibly designed to meet our normal
needs for goods and services can respond instantly to a massive surge in
demand. That’s why stores ran out of toilet paper, bottled water, face masks,
antibacterial wipes, and other items when panicked shoppers went on buying
sprees after the pandemic first hit. To increase production, manufacturers must
acquire additional supplies, hire more workers, add shifts, expand facilities,
make shipping arrangements, and so forth. Because doing these things takes
time, in the short run supply is fixed.
The health-care system also faces short-term supply
constraints. It takes years to produce the thousands of new doctors, nurses,
pharmacists, and EMTs that are needed when a crisis hits. It takes time to make
more hospital beds, ventilators, ambulances, and personal protective equipment
too. That we ran short of these resources when the coronavirus reached our
shores is not a sign of a poorly run system, but of one governed by basic
economic imperatives: Health-care businesses sensibly kept only enough
resources on hand to deal with expected demand, because maintaining excess
capacity was not worth the expense.
The pandemic caused demand to skyrocket past expected
levels, so, as typically happens with mass disasters, we’ve faced shortages.
Some can be eased by importing goods and workers from outside the affected
region — think of New York, which is now asking for help from doctors in other
states. But others can only be addressed by ramping up production, which can
take weeks, months, or even years.
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Since markets discourage businesses from maintaining too
much excess capacity, how should we prepare for catastrophes like COVID-19? The
usual answer is that government must do the heavy lifting. Unfortunately, the
government’s record of preparing for disasters is poor.
The response to the COVID-19 crisis is a case study in
governmental ineptness. In 2006, the federal government estimated that 70,000
ventilator machines would be needed in a moderate influenza epidemic. Instead
of going with a large, established device maker, in 2010 HHS hired Newport
Medical Instruments, a small one, to build a fleet of inexpensive portable
devices. Before production started, however, NMI was purchased by Covidien, a
larger device maker. Eventually, Covidien backed out of the contract, no
ventilators were delivered, and the government enlisted a new vendor in 2019.
The government also allowed a contract dispute to interfere with the
maintenance of the ventilators it already had. Consequently, when COVID-19 hit,
the federal supply of ventilators was far too small and thousands of the machines
the government did have didn’t work. Fourteen years after the call for
ventilators went out, the federal government is just starting to fill the need.
What about drugs? Scientists are now studying whether
Remdesivir may be effective in fighting SARS-CoV-2, the virus that causes
COVID-19. Remdesivir was developed six years ago to combat various viruses,
including dengue fever, the West Nile virus, Zika, MERS, SARS, and Ebola. But
it was never approved for use — apparently because Gilead Sciences (the patent
holder) saw too little financial gain to warrant the cost of the FDA’s approval
process. The result is that we are effectively starting from scratch in the
search for a COVID-19 treatment.
The federal government also botched the process for
creating and administering coronavirus tests. Because SARS-CoV-2 is a new
variant, a new test was needed to track its spread. German researchers
developed one in mid-January, but the CDC decided not to use it, instead
pressing ahead with the development of a separate test. When that test was
released in late January, it proved faulty, and the FDA prevented private
laboratories from developing tests of their own. The CDC also distributed its
few test kits equally to labs across the country, without regard to the size of
local populations. The result was a dramatic shortage of valid tests in
populous areas, which created the false impression that the number of cases in
the U.S. was low. In early March, facilities in the U.S. had administered 3,099
tests. By comparison, South Korea, a much smaller country whose epidemic
started the same day as ours, had administered more than 188,000.
Even after the government-created bottleneck was broken,
testing in the U.S. was still stymied by shortages of swabs, transport media, and
reagents that are used to wash genetic material out of swabs for examination.
Evidently, none of these items were stockpiled in sufficient quantities. Items
needed to protect testers and health-care providers, such as N95 face masks,
were also in short supply.
The federal government’s Strategic National Stockpile is
supposed to include such personal protective equipment, as well as antibiotics,
vaccines, ventilators, and other supplies needed to deal with a pandemic. Since
its creation in 1999, the SNS has proven its value in responding to Hurricane
Katrina and the 2009 H1N1 swine-flu pandemic, among other disasters. But SNS
stockpiles were depleted during the Obama presidency, and hadn’t been
replenished by the time the current crisis began. Originally, the SNS got
caught up in the fight between congressional Republicans and President Obama
over spending, with neither side willing to bend enough to ensure that it was
fully replenished. After that, Obama wasn’t willing to expend the political
capital necessary to fix the problem, and President Trump hasn’t been willing
to do so either.
The U.S. spends almost $1 trillion a year on national
defense, but it handles our security so poorly that a virus born in a
provincial city in China has killed thousands of us, sickened hundreds of
thousands more, and sent us into economic freefall in barely a month. With a
record like that, no one should want the government to have more responsibility
for the health-care system than it already does. Medicare For All won’t help
the country in ordinary times or in emergencies — it will only make things
worse.
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