The U.S. healthcare system, as it turns out, is far more complex than even war-torn scenarios, as four-star general Gustave Perna has recently discovered with chaos, uncertainty, delays, and confusion reining supreme in the first weeks of the vaccination programs. Operation Warp Speed, the initiative set up by the White House to accelerate vaccine and therapy development, production, and distribution scored a solid grade of an “A” on rapid acceleration of R&D and clinical development, perhaps a “B” for the middle activity (production) and what appears to be an “F” for the latter grade (distribution). Although General Perna took responsibility, it’s not his fault that the heavily privatized, for-profit and highly-fragmented and regulated U.S. healthcare system isn’t conducive to orderly militaristic-like planning. That’s not how it works. The politicians in Washington made a number of critical assumptions, gravely underestimating the complex, dynamic, and diffuse system for purposes of crisis management, let alone even harmonized vaccine shipments. With no federal mandates, states were left to their own devices and in many cases took on significantly different approaches to combating COVID-19.
Making matters more complicated, within each state different health systems, hospital, and physician networks as well as community clinics which vary in their overall wherewithal and general capacity to respond to such an all-encompassing, ubiquitous global healthcare crisis. From the highly-uneven availability of COVID-19 testing, to challenges associated with the distribution of novel therapies and vaccine product itself, regional disparities and even problems associated with basic housekeeping matters such as billing mechanisms, the U.S. healthcare system, like many others, was caught unready to systematically, comprehensively and collectively respond. There was no central health-directed authority, or for that matter, strategy, but instead an ecosystem emerged involving literally many hundreds to even thousands of private companies and non-profit organizations vying for resources, capital and access, while the drug producers themselves competed to secure billions of government funds in a race to develop products. Welcome to the Wild West of American healthcare.
Know Thyself; Know Thy System
This unfortunate systems-diagnosis also represents an ongoing prognosis as a new Sheriff steps in, with a new team. First and foremost on the President-elect’s agenda most certainly is the COVID-19 pandemic. As authored recently by Kaiser Health News’ Elizabeth Rosenthal, Dr. Vivek Murthy was recently named by Joe Biden as the incoming surgeon general, and he shared that the present White House administration’s prediction that the COVID-19 vaccines could be widely distributed by April, 2021 was in all actuality way off. More marketing than reality—fluff than stuff. Why? Because, the “planners” assumed in a system rich with dynamic chaos that there would be no real problems; no real risks; no process friction. Yet America’s system of government, let alone healthcare system is by no means efficient nor a friction-free process. Actually, the situation is quite the opposite. Now the incoming team suggests a target for wide-scale vaccination by the summer, if not the fall, of 2021. Soon the attention for accountability and oversight will pass from one figure head to the next.
Don’t Blame the General
General Perna offered to fall on his sword, but this debacle wasn’t his fault. Rather, although big in stature as an accomplished military officer, he was merely a pawn in a bigger game, if one could call it that. A free-for-all would be a better term under the existing POTUS, who sort of just let things unfold, when it came to the fulfillment of products in the marketplace.
Now one could argue that from his point of view there was constant attack from day number one. Hence an air of paranoia set in on Pennsylvania Avenue. It’s not TrialSite’s place to take on the world of politics. But suffice to say, the laissez faire approach to the pandemic response in all reality felt normal to many if not most in society. It’s pretty much how the U.S. health system works; that’s how it evolved in the past decades.
Although POTUS is a convenient and easy target for all blame, the real underlying culprit represents perhaps a far deeper set of endemic forces—too complex and intertwined a reality for most to fully comprehend. This includes issues from out-of-control government and private sector payer spending on healthcare (approaching 20% of GDP, yet based on many measures continuously worse outcomes) to an incredibly dense regulatory and compliance jungle both at the federal and state by state level to thousands of health systems, hospitals and health care organizations in some cases collaborating and in others competing. In all reality, our system can be a cut-throat capitalist adventure posing as an altruistic healthcare charter. Combine all of the dynamics, laws and rules, territories and fiefdoms, competitive energies, desirous pecuniary incentives, emphasis on treating the sick, then keeping them healthy in our large federal republic deeply infused with a unique Anglo-American individualistic tendency, and odds are the incoming bunch will struggle as did the bunch on their way out.