The Health Care System Has Collapsed

---

The Health Care System Has

Collapsed

BY VISHAL KHETPAL

SEPT 07, 20215:45 AM

Recently, a local news station in Houston ranastory about a manwho passed

away while waiting for a hospital bed. The story wentviral.

Daniel Wilkinson, a 46-year-old veteran who served two deployments in

Afghanistan, presented to a community hospital a few doors down from his

home in Bellville, Texas,a small town on the outskirts of Houston. He was

feeling sick and was ultimately diagnosed withgallstone pancreatitis.

In countries with modern health systems, gallstone pancreatitis is a dangerous

but highly treatable diagnosis—often requiring an emergency interventional

procedure that can be done at most large referral hospitals (including many in

the Houston area), followed by a short ICU stay. But with the COVID-19

pandemic raging throughout Texas and much of the larger region, finding an

ICU bed these days is no small task. Wilkinson was forced to wait more than

seven hours before a bed finally opened at a VA hospital in Houston. But by

then, gas pockets had started to form inside Wilkinson’s pancreas, suggesting

that the failing organ was spreading an infection throughout his body. After

waiting too long to have that procedure done, Daniel Wilkinson died.

For a year or so, we’ve been told repeatedly that the American health system

has been on thebrink of collapse. In the past month, this phrase has been used

to describe the plight of hospitals inOklahoma,Louisiana,Alabama,

andAlaska; last winter, it was used to describe health systems

inCaliforniaandIdaho.Mississippi’s health care system, in a recent New

Yorker essay, wasobserved to beapproaching statewide failure, while in a

Politico headline at the start of the pandemic, hospitals inNew Yorkwere

quickly reaching abreaking point. Descriptions of health systems at the very

limit of functionality rank among other COVID clichés likenew normalandin

these trying times.

But to say that our health care system is on thebrinkof 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 systemhas alreadycollapsed.

Daniel Wikinson’s story feels at once shocking and almost typical at this point

in the pandemic. As a resident physician who has only trained in an era of

COVID—I was asked to considergraduating from school earlyin April 2020 to

help with medical staff shortages—my time as a doctor has been defined by

working in a system thathas already collapsed. The American health system I

work in has featuredlimited personal protective equipment,oxygen shortages,

and the construction of field hospitals inconvention centersandparking

garages. Last winter, many hospitals across the country institutedcrisis

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. Today, hospitals are full in much of the country, with patients

requiring an ICU being airliftedthousands of milesin 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.

There isn’t a textbook definition of “collapsed health care system.” But it can

be framed through a related concept in global health, defined by the World

Health Organization:health systems resilience. Thought of as bulwark against

collapse, 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. 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,utilizationof 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

provedan unlikely place to catch COVID). The number ofexcess deathsduring

the pandemic in the United States is estimated to be more than 900,000. 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, arequittingtheir jobs in droves, while an

uptick of doctors are retiring early or following other health care workers to

theexits.

I don’t blame voices in media and in public health from hedging their

descriptions of where our health systems have stood throughout the

pandemic. COVID has been unpredictable.No one wants to cry wolf or be

wrong. Yetbrinkand hedge words like it—cusp, verge, threshold—offer us a

state of suspended animation between normalcy and a true crisis. Focusing on

language so intently may seem pedantic. But there is power in simply stating

the truth. It validates the experiences of health care workers on the ground,

and those of people who are unable to get adequate health care. In the future,

acknowledging that our health system did collapse under the weight of the

COVID-19 ultimately sets the stage for comprehensive health reform. It pushes

back against any revisionist history that may emerge in the coming years; it’s

easy to imagine accounts that conveniently emphasize health care heroes

while waving away how flawed our health care system is. Recognizing our

failure brazenly could push us to build a system that is more resilient.

Some health care leaders are starting to take a blunter approach in their

messaging, in hopes of accurately communicating the help that is needed right

now. In Baton Rouge, Louisiana, Catherine O’Neal, a physician and chief

medical officer of Our Lady of the Lake Hospital, warned her community

recently in a press conference about what it means to haveno beds leftin her

hospital. “We can’t tolerate it,” she said, going on to explain that there are

people sitting in ERs waiting for a bed as they risk health complications and

even death. “We are out of things in our pockets to open beds. We need you

to open our beds for us,” said O’Neal, urging people to get vaccinated. To the

public, acknowledging that the health system has collapsed communicates the

gravity of the situation. It adds further urgency to calls for people to get their

shots, and to mask in areas with significant community spread. Already,

vaccination rates haveincreasedin states significantly impacted by the delta

variant.

To say that we’re on thebrinkof 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. 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.