COVID-19: A Chance for Health Care Revolution
By Timothy Hlavinka, MD

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This story was previously published on MedPage Today and is the opinion of the author, and not the Texas Medical Association.

I previously wrote about the Centers for Disease Control and Prevention’s (CDC's) abject failure in testing for COVID-19. At that time, I was certain a full court press would emerge from this debacle, and we would right the ship of health care, cruising toward the uncharted waters of COVID-19 undaunted and united.

The weeks since then seem like an eternity, yet we are still facing the same bottlenecks stemming from a lack of testing, protective supplies, and medication. It is unfathomable that with this much lead time, we seemingly have to repeat the mistakes of every other country that has experienced this pandemic.

Physicians are arguing about the evidence on television, in conversations that would best be had in the doctor's lounge, leading to public confusion and a lack of consensus about which steps we take moving forward.

The politicization of the narrative has worsened and permeated the dialogue even now on local levels. We take days to come up with basic instructions to the public, because every player in the game has to sign off on the verbiage. I think the American people have seen enough of sausage being made for a lifetime, and they are weary to the bone of its public display.

I am a member of the area strategic advisory council in charge of planning the COVID-19 regional response – without funding. We scramble to find sources of revenue and supplies. One of our big coups was having a local flag-making company manufacture our surgical masks. This is what we are left with, as providers, in this bottom-line, bare-bones health care system where we are more prepared than others to fight the surge, but still face daily, seemingly insurmountable, challenges. All of us are devoting our entire lives to preparing for this pandemic, and we have not even seen the surge.

I have spoken to colleagues, and they share the same heartfelt pain. We are worried for our patients, families, employees, and businesses. We are fearful in handling something few of us have faced before. We agonize over doing all of this with limited resources, testing, and treatments. We agonize over the decisions that will have to be made by physician teams and ethicists in the coming days and weeks. But not one has shrunk from the task ahead.

As a nation, this is different from any other crisis we have faced. In the past, our national zeitgeist was supportive of our armed forces and first-responders in dealing with the challenge at hand. Aid was rushed to them as the rest of the nation and international forces mobilized, pitching in and doing what needed to be done to help.

But now, we cannot look to the neighboring community or the neighboring state. What support could be garnered is locked down in their homes, paralyzed from coming to our aid. We are alone. And with limited resources. How would history judge a political system that let our soldiers go into battle with no weapons and no armor at the height of the battle? What about first-responders without protective equipment and the materials to respond to a disaster? That is exactly what we are being asked to do. Moreover, there are no replacements – no reserve troops or second wave to be had.

With every grave condition, opportunity emerges. I see opportunity. But we must not let this historical moment pass without a sea change in the narrative of health care reform.

A health care system run by bureaucrats is exactly what got us into this catastrophe, and it cannot be entrusted to emerge on the other side with any reasonable chance of avoiding institutional collapse. We must use the bully pulpit of the public trust that will come with leading America through and beyond this crisis. Enough is enough.

We have let the stakeholders in our grand profession become pharma, the American Hospital Association (AHA), and the insurance conglomerates. Quasi-governmental agencies like CDC are the intergovernmental intermediaries. We have seen the best that they can do. We are living it right now.

Those on the front lines of this crisis need to be the ones who lead us into a new vision of our health care system. Those who make decisions about life and death should be the ones who make decisions about how our health care system is run. We have been left out, at the bottom of the decisionmaking chain, until times like these occur, and it is our burden to make do with whatever resources we have.

From this moment forward, carry the narrative of a health care reform run by providers, and let those whose decisions make the difference in life and death make the decisions that propel us forward into a new health care paradigm, where the "stakeholders" are the patients first, providers next, and the remainder left to serve those constituencies.

Timothy Hlavinka, MD, is a urologist practicing primarily in San Antonio.

Last Updated On

April 03, 2020

Originally Published On

April 03, 2020

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