healthcare system

Inflamer of Inequities and Ineffective System

“There is a crack in everything, that’s how the light gets in.” – Leonard Cohen

Society was destabilizing and disintegrating in front of our eyes. The severely cracked foundation that America was built on had crumbled to dust and was laid bare for us to see. Our unemployment, student loan, welfare, health insurance, and housing systems were built on antiquated platforms that had barely sustained us. The pandemic flooded and overwhelmed these systems that our society relied so heavily upon. This was an incredible opportunity to absorb that which didn’t serve us, learn what worked well for us, and build a new system that could allow us to thrive.

Inflammation is a vital component of any injury. Whether it’s a physical injury to the body or an intangible injury to complex societal systems, inflammation is necessary. Before the pandemic hit, the United States was under a state of widespread, low-grade inflammation. We knew certain aspects of our society were not working, but we were willing to overlook them since they were functional, and frankly, no one was screaming yet.

This acute, low-grade inflammation served as a warning sign, a red indicator, a perfect time to start recruiting resources to protect against the dangers that lurked around the corner. Resources aren’t spontaneously generated from nothing. These resources had to be taken from somewhere. This shifting of resources leaves another organ in the system vulnerable to subsequent attack. America’s acute inflammation was not painless and it is always better to address it early.

As companies grow, as technology advances, as more systems connect to each other, complexities and bottlenecks exponentially increase. The risk for data exposure, the risk for customers falling through the cracks, the risk of insufficient services, all compound together and can culminate in grave danger. The more touch points and transfers that are present in a system, the greater potential for error. Healthcare is not immune to this juxtaposition of sophistication and disarray. The American Health System is comprised of thousands of segmented hospitals, insurance companies, public health offices, testing laboratories, and supply chains. Interoperability is vital in connecting these fragments so that lives can be saved and people do not have to die unnecessarily.

The pandemic highlighted the need for adaptive technology across the healthcare supply chain that has the ability to track patients and supplies. It had never been more critical that our leaders knew hospital capacities, supply levels, and viral transmission rates. This information was crucial in shifting resources to meet the needs of a community that was enduring the latest outbreak.

Hospitals have always functioned under a high cost, maximum capacity model. Whether we care to admit it or not, the fact is that hospitals are businesses. They have to survive in order to serve patients. To survive is to balance the cost of employees, supplies, and medications, against the incoming payments from patients and insurance companies. An essential cornerstone of any business is to squeeze as much efficiency out of costs. It’s inevitable that strained strings sever. These operating conditions are not suitable in times of a pandemic. Investing in hospital beds and extra ventilators is not cheap; however, they can save lives and many costs during times of a pandemic.

One item that consumes the valuable time of healthcare workers is charting. Documenting diagnoses and treatments in a patient’s chart is vital to the continuity of care; however, there are lots of ancillary questionnaires, screenings, and redundancies executed solely for billing purposes. In an effort to exploit reimbursement opportunities, the practices of nickel-and-diming through excessive charting has hindered the care that patients receive. Some governors officially acknowledged this obstacle and implemented policies that diminished the burden of charting by releasing practitioners from liability if they’re acting in good faith and performing necessary tasks to respond to the pandemic.

Capacity issues were also revealed in the drug supply chain. The Food and Drug Administration (FDA) admitted that pharmaceutical companies have no incentive to manufacture less profitable drugs. That is a problem if a drug is in extreme demand and can save hundreds of thousands of lives, but will not generate enough revenue to sustain the company that’s making the drug.

The pandemic not only caused supply issues for drugs that are difficult to manufacture, but also those that are the simplest to make. One such drug was sterile salt water. It’s needed for all drugs that get delivered intravenously. For being one of the most developed countries on the globe, this was unacceptable. Supply chains must gain the capability to foresee potential vulnerabilities so that these issues won’t happen again. No American should be denied access to a life-saving drug, especially one that costs pennies to make.

It is not a matter of if, but when, the next pandemic occurs. We need to be able to have surge capacity in our hospitals and factories during pandemics, just as we have surge capacity in our arsenals during times of war. Some healthcare reformers were proponents of a single payer system; however, the issue was much broader than that. We needed an interoperable system that connects data from across the healthcare continuum encompassing access, treatment, supplies, and continuity of care. If policy makers and healthcare practitioners had accurate, real-time data that provided insights into each step of the healthcare supply chain, the American Health System could protect the public’s health while reducing costs.

In addition to the American Health System being broken in terms of a business model, it’s also broken when treating communities of color. The majority of minorities lack access to basic economic and social needs. These pre-existing issues don’t stay siloed away from one’s health, but rather, they negatively compound it. For example, someone who doesn’t have money for food will eat cheap junk food, they get obese, then develop diabetes and high blood pressure. If they cannot afford food, they certainly cannot afford health insurance, so they don’t get treated for these preventable conditions. This is what the tapestry of inequity looks like.

Disease states such as diabetes and high blood pressure can burden the body over time, making it generally easier to contract other diseases and viruses. An individual with underlying health conditions is more likely to die than their counterparts who do not have pre-existing conditions. The coronavirus made this clear. The data showed that minority populations were succumbing to the virus at a much higher rate than their nonminority peers. Everyone had the potential to get the virus, but due to minorities having a higher prevalence of pre-existing conditions, their viral experience was amplified and essential bodily functions were exacerbated.

Health risks aren’t simply those in a medical chart. Where one lives, works, and plays can also impact one’s risk. Working in a grocery store versus an office building poses different risks to an individual. Transportation, or lack thereof, can also contribute to one’s health risk. Minorities generally work in the service industry with lots of contact with surfaces and other people. During the pandemic, their jobs were deemed “essential”, meaning they had to physically go to work.

If an essential worker had children, but daycares were closed, what were they to do while they were at work? If they got infected, they couldn’t quarantine, because like most Americans, they lived paycheck-to-paycheck and needed the money. If they got severely sick where they couldn’t physically work anymore, they lost their economic security. This would take a toll on anyone’s mental health.

Suicidal thoughts and substance abuse were growing among minorities and essential workers. If one cannot afford a car, they rely on public transportation. There is a grave risk of viral exposure when using public transportation due to prolonged durations being in a tight, physical space. To some, these issues may seem trite, but they all add up over time. They’re all interconnected and have the potential to exacerbate each other. The reality is that the virus schemed with the existing inequities in order to produce the maximum devastation possible.

“Justice will not be served until those who are unaffected are as outraged as those who are.” – Benjamin Franklin

The pandemic inflamed society’s pre-existing condition: systemic racism. Incidents of racism did not increase, rather such incidents were being recorded at a higher rate. The advent of body cameras and cellphones made this possible. With people being quarantined and cities under lockdown orders, people were actually paying attention to incidents of racism.

A black man was accused of using a fake twenty dollar bill, he was choked to death by police. Another black man was accused of trespassing, he was shot in the back seven times by police and was paralyzed for life. Contrast these incidents to a white anarchist crossing state lines, shooting two people, and walking past multiple police cars while brandishing an assault rifle. He was allowed to freely go back to his home state. These were just some of the incidents that broke through the major political and pandemic headlines. There were many, many more events like this happening around the country. Even in the midst of a pandemic, minorities just could not catch a break.

Something felt different about this time in history because white people joined the fight against racial injustice. Communal outrage caused protests to erupt all over the country for many weeks. This was not isolated to one part of the country, or to certain police precincts. This collective awakening to the need for police reform was not a call for immunity from the law, but rather an equal application of the law. No public display of this scale had previously formed around the call to address racial issues since the turn of the century. Some minor reform was adapted in some states, but patchwork reform does little to combat the racism that is heavily entrenched in all layers of our society.

The pandemic made it clear that minority workers make up the majority of service positions that are essential to the backbone of America. They are the people working in the farmlands, meat packing plants, and grocery stores. Without these workers, food literally wouldn’t get on our tables. The economic disparity perpetuated by these low-earning service jobs force many to live in multi-generational homes. This put their loved ones, and the general community, at greater risk for contracting the virus. We all call America our home. Nobody is safe until black and brown people are safe. Coronavirus demonstrated our reliance on communities of color. We need to protect each other.

Systemic racism silently navigates below the streets that we transgress on a daily basis. Our country was built on it. Our neighborhoods have nurtured it. History books and railroad tracks have suppressed society’s need to acknowledge it. People do not live in “poor” neighborhoods because they choose to. They live there because they have to. It’s what they can afford, in part because our society artificially placed a higher monetary value on whiter neighborhoods. They simply don’t have the means to live elsewhere or physically cannot make the move. In America, the neighborhood where someone lives is vital in predicting the quality of education, healthcare, and food that one has access to. These basic needs have the ability to catapult someone towards success, or impale them towards failure.

Societal conditions, just like medical conditions, transmit across generations. Progression inches along when trying to climb the economic ladder. An educated slave getting education, buying land, earning a livable wage, and getting a seat in the boardroom – that kind of progress takes generations. At best, merely having the financial means to achieve those things can span a few lifetimes of savings. At present, while whites have had twenty generations to accumulate wealth, nonwhites have only had three.

Things can suddenly happen in life. If someone dies, their earning potential dies with them. Households that used to rely on two incomes, now must survive on one. A traumatic event such as a targeted, race-fueled massacre can physically and mentally decapacitate anyone. If a single mother can no longer raise her children, they get moved to foster care. All of these scenarios have the ability to threaten a generation’s progress.

In the majority of states across America, the proportion of black people in prisons is at least three times more than black people who are not in prison. The majority of the charges are for nonviolent drug crimes. During the pandemic, these offenders were the first to be released early. The prison system could not handle the spread of infection that thrived under the crowded conditions of prison. Not only were the prisoners’ health at risk, but also the workers who return to the community every day.

The criminal justice system inherently focuses more on prison sentences than rehabilitation programs. That’s what it is designed to do. However, when compared against rehabilitation programs, the prison system is an endless drain for taxpayers’ money. It can cost up to $25,000 per inmate per year. Think about it – shelter, clothing, utilities, medical care, and food. Even if a fraction of that money was diverted from the jail system to rehabilitation programs such as housing, mental health, and substance abuse services, this country could have many more contributing members of society. This would lessen the tax burden on all Americans in addition to allowing numerous economic sectors to flourish.

The American way of living is inequitable in and of itself. We are parasites to the very earth that graciously gives us life. One of the many governmental orders due to the onset of the virus included reducing building capacities by a certain percentage. Because of this, many office buildings became desolate, or even vacant. People that could telework did not physically go to an office. This meant people weren’t driving to work. It did not take long before the air was cleaner, the skies were bluer, and the water was clearer.

There was less street traffic. Wild animals were able to come into areas they previously could not. Animals took to the streets and reclaimed their natural habitat that had been taken over by corporate America. The irony is that as humans were sick and dying, the environment was able to heal itself and thrive again. Our environmental impact was laid before us.

But despite the environment healing, this was an opportune time for construction projects to accelerate to completion since traffic was at an all-time low. Railroad tracks expanded, tunnels burrowed, sidewalks were installed, and bridges were erected. Some projects were able to be completed a couple months early while remaining under budget. When traffic returned to peak levels, congestion was reduced, which allowed more traffic to accumulate and pollute. The fractional rejuvenation of the environment was negated by the completion of construction projects.

We have vandalized these grounds for far too long. We must respect the limits of our natural resources. It became clear that we can live symbiotically if we make some adjustments to our destructive way of living. We must live in harmony with nature instead of dominating it. For taking care of the earth is taking care of ourselves. The virus was a gift to Mother Nature.

What got exposed during the pandemic was previously dysfunctional. The existing structures had allowed resources to flow upwards instead of towards the people they were intended for. The virus did not respect borders, but it did flow along the structures we had created – the structures that had disproportionately burdened particular people. What it had taken for us to wake up to these issues ultimately brought more suffering on the people who could not take anymore because it was already too much.

Inflammation is the precursor to the development of an immune response. If there’s no inflammation, then there’s no development of an immune response. America’s ineffective and unequal systems endured additional inflammation during the pandemic and highlighted the urgency of the need to reform. America needed to develop an immune response to reform the programs that were bleeding out.

It’s been said that the squeaky wheel gets all of the attention. During the pandemic, everything was squeaking and calling us to awaken to the existing inequalities and ineffective systems present in American society. My hope is that when the squeaking subsides, when the overburdened reduces to just burdened, we go back and fix what was broken and not become dismissive just because it’s silent. All of these inefficiencies and inequities had surpassed their boiling point, now everything was uncontrollably bubbling over. If we were simmering before, we were burning now.