Why the U.S. Health Care System Failed the Coronavirus Test

Why the U.S. Health Care System Failed the Coronavirus Test

Remote Area Medical (RAM), a provider of pop-up medical clinics for underserved communities, was founded in 1985 to operate medical missions in the Amazon. Over the next 30 years, 90 percent of its operations shifted to the United States, where 740,000 people have lined up for its services—some driving hundreds of miles. In 2014, the group rented out the Javits Center in New York City to provide free care to the uninsured or anyone who needed care they couldn’t otherwise afford. A few weeks before the event, the New York State Health Department blocked RAM from holding it, declaring that “no hospital can be operated without a valid operating certificate.”

Six years later, amid a pandemic, there are makeshift tents in Central Park operated by medical missionaries, and the Javits Center has become a field hospital—valid operating certificate be damned. Although they have been heralded as bold acts of ingenuity, these stopgap solutions are better understood as emblems of a health care system that is uniquely vulnerable to failing the people who need it most.

The coronavirus pandemic has revealed that the U.S. health care system is in bad shape; it is both overdeveloped and underdeveloped, creating a confusing pattern of excellence and profound failure.

The coronavirus pandemic has revealed that the U.S. health care system is in bad shape; it is both overdeveloped and underdeveloped, creating a confusing pattern of excellence and profound failure.

Any pandemic can cause devastation, but COVID-19 has a higher mortality in people with diabetes, obesity, and heart disease and among older adults. Its secondary impacts on the economy also intensify the risk of deaths of despair (by suicide and addiction) or other causes. For most people, chronic conditions come in twos and threes. They take decades to set in and reverberate across generations. The prevalence of chronic conditions in the U.S. population was already projected to grow substantially over the next decade, a burden disproportionately borne by the poor and working class, particularly devastating for people of color, and intensifying for all with age.

At first glance, the U.S. health care system appears to just fail on the margins; however, COVID-19 illuminates that these failures are vast and growing. The current design of the health care system is failing Americans, and the $4 trillion per year question is why.