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My focus has always been on how are market-based system of
healthcare response to the health needs to the contrary, and
I'm partly obsessed with this because much of that market-based system
has developed since I trained as a doctor in the late 80s and early 90s.
So to me, the experience of COVID and
watching this pandemic plague in the US has been like a stress test for
our system and reveal things that even I kind of knew, but
it's brought them out into the light in such stark and dysfunctional ways.
And I'm hoping, as we move forward in the future, to kind of
reimagine our health system that will address some of the things it's taught us.
And I think, just to give a little example,
when suddenly we saw pictures of all the people in Italy needing ventilators,
and we realized, My gosh, the hospitals in New York may not have enough.
There was a lot of finger pointing.
They said, well, there should be a national stockpile,
and the President said, why don't you have them?
Well, think about a market-based system.
A market and all of our hospitals, including the not-for-profits,
operate, I would say, more like hotels and hospitals.
They want to run at near full occupancy.
They keep the supply chain stock that they need to do these elective procedures,
mostly that are their bread and butter in terms of where their income comes from.
So what incentive do they have to stockpile ventilators,
if they're not required to do so?
Someone said to me, well, why don't they fundraise?
And I'm like, yeah, development offices are focused on like a new cancer wing or
genomics institute, like big donors don't want to pay for a storeroom
of stock of vents that probably will never be used in the basement.
So what we're seeing is that our system is terribly prepared for
public health events, and particularly unforeseen public health events.
And the difference is this was not unforeseen.
I mean people like Dr. Fauci foresaw it, but
there was no incentive within the system to prepare for it.
And that goes not just for ventilators.
It goes for PPE masks.
So that's one kind of area.
Another is, the way we watch test development,
right, and vaccine development.
It pains me to knowing that the US is not
part of the International Consortium developing a test.
And why is that?
I think partly because we trust in the private market.
We want to give priority to our private market, to develop,
to get patents, but it's so wrong from the aspect of global health.
Likewise for testing.
CDC doesn't have the capacity.
The commercial labs are like, why are we going to develop a test?
We don't even know the pandemic's coming here.
There's no CPT code.
How do we build for it?
How much are you going to pay?
So I think all of the quote unquote incentives we use
are really business incentives.
And I'm not saying we have to get all the business out of healthcare, but
I am saying we have to really find a way to focus healthcare on health first and
let the business models follow.
So as we look forward, I think there's so many important lessons, including and
I'll end here that, one of the great insights for
me was that actually if we had a Medicare for all system, it would
have solved many of these problems, because Medicare is a basically a payment
system that relies on hospitals and doctors to be prepared to do what we need.
And we saw they were not.
So that in and of itself will not be the entire answer, if that's what we choose.
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