COVID Is Exposing the Underlying Weakness of Our Healthcare System

Two issues came to our attention this week which demonstrate the need for big, structural changes in our healthcare system. COVID-19 didn’t cause these problems; it merely exposed them.

Nursing Shortage

First, in our COVID Action Call on Tuesday, we heard from the Chief Medical Officer at Tuba City Regional Heath Center that the most important problem they currently have is the shortage of RN-level nurses. These are nurses that are needed to provide critical and intensive care to patients. When we hear that hospitals are “at capacity,” they are not usually out of beds; what they are usually out of is staff qualified to meet the needs of patients. And, it’s not just Tuba City — remember that Mayor Cuomo called for healthcare providers — mostly nurses — from all over the country to come to New York to help with the surge of COVID-19 patients.

COVID-19 has heightened the need for well-educated nurses, but that need has been there for decades. Unlike teachers, nurses are paid well. Perhaps not well-enough for the grueling, bedside work they do. The incentive for nurses is to move up the ladder to higher-paid jobs away from bedsides. As with so many industries, the front-line workers are underappreciated and underpaid. Fundamentally, however, we don’t have enough nurses because we don’t educate enough nurses. Nursing education is expensive and we don’t have enough nurse educators — that’s because the colleges and universities cannot pay nurses enough to attract the talent that’s needed to teach the next generation of nurses.

COVID-19 didn’t create the nursing shortage. But it’s shown a big, bright light on the fact that this country has a major structural problem in how we pay and educate nurses. That problem will not go away when we have a vaccine for COVID-19, and we shouldn’t just shove the problem back out of the light when this crisis has passed.

Hospital Bankruptcies?

The Arizona Hospital Association said today:

An association analysis shows Arizona hospitals are reporting revenue losses of 30% to 40% because of cancellation of elective procedures and a reduction in emergency department visits. Statewide, that equates to a revenue reduction of $430 million to $575 million per month, and hospital officials don’t know how long the COVID-19 crisis will continue here.

As a result, the Association is asking Governor Ducey to lift restrictions of elective procedures and to allow hospitals to relax on reserving bed capacity for COVID-19 just as we’re approaching the projected peak of COVID-19 cases. The restrictions on elective procedures were put in place in part to preserve personal protective equipment and today hospitals are still accepting community donations because of shortages.

The financial crunch faced by hospitals as a result of the pandemic is not a surprise. Two weeks ago we read reports of a hospital in Green Valley that was facing closure and asking for emergency funding from the state to stay open. The state conditioned emergency funding on the hospital’s executives taking a 20% pay cut and holding back any payments to any private owners, investors, management consultants, shareholders, or board members.

The data cited in the Arizona Hospital Association’s request as reason to relax the restrictions on hospitals now has a large caveat:After June 8, 2020, relaxing social distancing may be possible with containment strategies that include testing, contact tracing, isolation, and limiting gathering size.” But Republicans in the state are calling to open up Arizona much sooner than that — which would create a new surge of cases.

We should not be in a position where the choice is to drive hospitals into bankruptcy or to take risks that threaten lives. It’s time for big, structural change in how we run hospitals, finance hospitals, and pay healthcare workers.

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