Why are we failing
It’s simple, we believe everything, including public goods like healthcare, must be run like a business. I worked for a non-profit for 12 years and I came to realize we were hamstrung in our ability to really impact our community in any profound way because we were sacrificing too much on the altar of efficiency. I mean, we did some good, no doubt, but we could never achieve significant impacts because of these efficiency constraints placed on us by our “business leader” board.
Our response to this Coronavirus public health crisis is rooted in precisely this same problem. Financial engineers running everything make decisions that are now putting healthcare workers and hospital staff at risk needlessly. Here in Ohio 18% of our positive test results are healthcare or hospital workers.
Here is an interesting article from Global Biodefense from last November. I found it after I typed this post and was looking for an image for the header. There’s No Such Thing as Just-in-Time Healthcare and Public Health Preparedness
PPE Supply shortages are the hallmark of this crisis
There are lots of reasons for those shortages. Here is the top two in my mind:
- Offshoring manufacturing capacity. The first thing China did when they acknowledged they belatedly acknowledged the crisis was to order all PPE manufacturers to stop the international distribution of their products. Then, since most of the world's PPE happened to be produced in Hubei Province, as they shut things down there the international supply chain froze up. I have a friend who is a doctor and she started pointing to this supply problem immediately back in January.
- Profit centered hospitals, or non-profits run like a business, run by financial engineers, rather than public health officials or doctors squeeze every penny out of the system they can. So they adopt just in time inventory practices because storage space costs money. So what stockpiles of PPE they had were designed to cover a few weeks of a crisis, but not much more than that. Their staff are now at extreme risk, sacrificed on the altar of business efficiency.
Sure Trump and his “private-public” partnership nonsense (and it is nonsense even when Democrats say it, which they have been saying it for decades now, its the party ideology now in fact) leading to his refusal to fully implement the Defense Production Act has hamstrung or ability to respond. But those two big problems listed above are the systemic problems we are facing right now.
PUBLIC GOODS should be run to meet the public need
This goes for all public goods. The profit motive should not be a part of administering public programs and goods. Besides, privatizing the provision of public goods costs taxpayers more while the frontline workers delivering the goods or services end up getting paid less with worse benefits. This is true in private prisons, private motor vehicle administrative centers, and on and on and on. We spend more, those actually doing the work on our behalf get paid less.
We need to drop this obsession with the public-private partnership when designing public systems. If a private partnership might work for a particular thing, let's go for it I guess, but, as our governmental departments have shrunk or remained frozen staff wise, and more public goods have been shoveled to private administration our costs have skyrocketed, enriching shareholders and reducing pay for those actually providing the service.
It does not work, and seeing what is happening to our public health system at the VERY FRONT END of this crisis should provide all the proof of that fact any of us should need.