The US’s Wave Of Hospital Closures Left Us Ill-Equipped For COVID-19

| Educate!

Above photo: First responders from IU Health Bloomington Hospital pick up a person describing COVID-19 symptoms in Bloomington, Indiana, March 23, 2020. Jeremy Hogan/Echoes Wire/Barcroft Media via Getty Images.

A couple of weeks ago, as countries scrambled to protect their citizens from the COVID-19 pandemic by closing borders and quarantining travelers, the Norwegian University of Science and Technology, upon the “recommendation of the Ministry of Foreign Affairs,” took the unprecedented step of urging all students who are studying abroad to return home. In the announcement, they emphasized the need to return home if students are living in a country with “poorly developed health services and infrastructure … for example the USA.” The word spread quickly on social media that the United States had been singled out as an example of a country with poor health care infrastructure, with many people in the U.S. agreeing that we lack the capacity to handle the pandemic.

There are many reasons why the United States, which spends the most per capita on health care each year of any wealthy nation, is lagging behind other countries in health care access. Compared to other wealthy nations, the United States stands out for lacking a universal health care system and for prioritizing corporate profits over health. This has led to a fragmented health care system that is ill-equipped for a coordinated response in a time of crisis, such as the current pandemic.

If there is any question that profits matter more than health in the United States, here are three recent examples.

Health insurance companies pushed back when President Trump announced treatment for COVID-19 would be covered without requiring co-pays. America’s Health Insurance Plans, an industry lobbying group, immediately clarified this would only apply to testing, not to treatment. Rising Pharmaceuticals, which manufactures the antimalarial drug Chloroquine that is being tested for use against COVID-19, raised the price of the drug by nearly 100 percent in late January. Incidentally, this drug is still experimental and should not be used without medical supervision, as this Arizona couple did to their demise. And rather than purchase COVID-19 tests from the World Health Organization, as South Korea did, the United States chose to develop its own tests. This has led to a severe delay in access to tests, which means the U.S. missed an important window of opportunity to identify and isolate people infected with COVID-19.

Now, the United States finds itself in the dangerous position of facing a potentially massive number of cases of COVID-19, as Italy is currently experiencing, that could overwhelm our health care system. The Centers for Disease Control and Prevention (CDC) estimated earlier this month that between 160 million to 214 million people in the U.S. could be infected over the next year or so if nothing were done to stop the spread of the virus. Although steps are increasingly being taken, such as closing schools, banning large gatherings and shutting down nonessential businesses, the current rise of cases in the U.S. is steeper than in countries that are experiencing significant difficulties, such as France, Germany, Spain and Italy.

You will find more infographics at Statista

Not Enough Hospital Beds

According to the Global Health Security Index, the United States ranks 175th out of 195 countries for access to health care. Italy ranks 74th and it is having problems with overcrowded hospitals and being forced to prioritize patients for intensive care based on their likelihood of surviving.

Since 1975, while the U.S. population has risen from 216 million people to 331 million, the total number of hospital beds has declined from 1.5 million to 925,000. This decline followed President Nixon’s 1973 Health Maintenance Organization Act, which allowed the privatization of health care. The United States currently has only 2.8 hospital beds per 1,000 residents, just a little over half the average of 5.4 beds per 1,000 residents in other wealthy countries.

According to the American Hospital Association, there are nearly 70,000 intensive care unit beds for adults. This won’t be nearly enough to care for the estimated 2 million people who could be hospitalized for COVID-19. Most intensive care units are near full capacity on any given day. On March 27, New York Gov. Andrew Cuomo stated that New York City will need an additional 87,000 hospital beds including 37,000 more intensive care unit beds on top of the 3,000 that currently exist.

New York City has been inundated with cases of COVID-19. As of this writing, there are nearly 50,000 cases in New York, most of them in and around the city, making it the 6th highest place in the world. Doctors and nurses report confusion over policies regarding the pandemic and shortages of critical supplies such as personal protective equipment, tests and medical devices, including ventilators. The governor reached out to President Trump to ask the U.S. Army Corps of Engineers to build temporary health care facilities, and so far, they have repurposed four buildings to create 4,000 beds and are looking at four more facilities plus using college dormitories and hotels as temporary hospitals. A 750-bed naval hospital ship just docked in Manhattan, in preparation for mid-April when they expect the number of cases to peak.

Where Did the Hospital Beds Go?

Hospitals are closing in the United States at an alarming rate. In 2018, an audit of hospitals by Morgan Stanley found that 8 percent of them are at risk of closing and an additional 10 percent are on a weak financial footing. In 2018, the American Hospital Association estimated that 30 hospitals will close each year and the number is expected to rise over time.

Rural hospitals are closing the fastest. Over 120 have closed down since 2010. A report by the Chartis Center for Rural Health found another 453 of the 1,844 that remain are at risk of closing. The highest number of rural hospital closures, 19, occurred in 2019. Six rural hospitals have already been shut down this year.

Roughly 20 percent of the U.S. population lives in a rural area. Residents of rural areas tend to be older, sicker and poorer than in other areas. They require more care and often can’t pay for it, placing a greater financial burden on local hospitals than populations that are healthier and wealthier. Hospitals are also facing competition from outpatient surgical centers, which draw insured patients away who can pay for care, thus lowering hospital revenue further.

When hospitals are located in communities with high numbers of uninsured residents, they are particularly vulnerable to closures. According to the University of North Carolina’s Rural Health Research Program, the 17 states that did not expand Medicaid under the Affordable Care Act had the highest number of hospital closures. Texas lost the most hospitals, followed by Tennessee, Georgia, Alabama, Mississippi and North Carolina. Over half of the remaining rural hospitals in Texas and Tennessee and more than a third of hospitals in Oklahoma and Georgia are at risk of closing due to their weak financial position.

Failing rural hospitals are preyed upon by large corporations that take them over, extract their revenues and then allow them to lapse into bankruptcy. Kaiser Health News describes one case of a Miami, Florida-based corporation, EmpowerHMS, that bought 18 hospitals in the South and Midwest. EmpowerHMS ran a lucrative but fraudulent laboratory operation out of the hospitals, bringing in tens of millions of dollars, while the hospitals themselves lacked basic supplies and equipment. In the end, 12 of the hospitals went bankrupt and eight closed. Towns were not only devastated by the loss of their local hospital and the jobs that went with it, but they were also cheated out of hundreds of thousands of dollars in unpaid property taxes.

When hospitals close down in rural areas, more people die of preventable causes. In general, the Pew Research Center found people living in rural areas travel twice as far as people living in urban and suburban areas to get to the hospital. According to a study by the National Bureau of Economic Research, mortality rates rise by 5.9 percent when hospitals disappear, especially for people with emergencies such as strokes and heart attacks that require immediate attention.

Hospital closures in cities also tend to occur in areas that serve poor communities and often populations of color. Like rural hospitals, they may be bought by a large corporate hospital system when they are failing and then allowed to go bankrupt. It is often more profitable to redevelop them in a gentrifying area than to keep them open.

This is what happened last September to Hahnemann Hospital in Philadelphia, which served a predominantly Black and Brown community for 178 years and is now slated for redevelopment. Providence Hospital in Washington, D.C., St. Vincent’s Hospital in the Greenwich Village area of New York City and St. Vincent Medical Center in the Westlake neighborhood of Los Angeles, which also provided care for over a hundred years to low-income communities of color, have also been shuttered.

In other cities, hospitals may stay open but close down essential services to make way for more lucrative fields such as orthopedics and cardiovascular disease. MedStar, a Washington, D.C.-based corporation that owns 10 hospitals in Maryland as well as physician practices, laboratories, long-term care centers and other health facilities, abruptly closed whole departments that provided obstetric, pediatric and psychiatric care in recent years.

Health care activists, doctors and patients protest outside Union Memorial Hospital, owned by Med Star, in Baltimore, Maryland, on May 10, 2018. Med Star has been closing essential departments where they are not profitable.

Profits Before Patients Is a Failed Model

As COVID-19 spreads around the world, now impacting over 700,000 people in 194 countries and territories, there is a clear difference in how well various countries are containing the pandemic. Those countries that have universal, publicly financed health care systems are better able to coordinate their responses and care for those who are ill. They have been the fastest to slow the spread of the virus.

For example, a World Health Organization mission reported that, “China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history.” China was commended for the speed with which it identified the virus, acted and modified its strategy as new information was gained about the virus. Now, China is sending medical teams and supplies to other countries that are struggling.

Other countries with single-payer health care systems have also shown their superiority to the United States in handling the pandemic. Patients are able to receive care without concern about the cost and health facilities already have direct communication with the government in order to coordinate care.

The Washington Post quotes epidemiologist David Fisman of Toronto, Canada, who says, “having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.”

That is the reason the Veterans Health Administration (VHA) is playing a fundamental role in the COVID-19 response in the United States. As the nation’s largest publicly owned health care system, the VHA has a “fourth mission” to assist in national emergencies. Candice Bernd of Truthout describes how the VHA is currently coordinating the emergency response to the COVID-19 pandemic in cooperation with the CDC and the Department of Health and Human Services.

If the United States had a universal single-payer health care system like a national improved Medicare for All or a national health system modeled on the VHA, hospitals would not be closing down. A key feature of the House bill for Medicare for All is that it provides global budgets for all health facilities. They would receive a monthly check to cover the costs of providing care no matter what segment of the population they serve. (This provision is lacking in the Senate Medicare for All bill, and should be added.) The VHA owns its health facilities and similarly does not have to worry about turning a profit to keep the doors open.

Support for a universal single-payer health care system in the United States is growing. We can only hope that, in the face of this deadly pandemic, we will see a louder demand and the political will to finally join the rest of the world in treating health care as a public good.

  • 0040

    Hospitals have been chronically understaffed and poorly equipped in “deplorable” America since Reaganomics took hold. Natural disasters , or cold winters , or hot summers cause massive overcrowding , shortages , and deaths seasonally as hospitals are overwhelmed every year by these events.. This year the for profit healthcare systems designed to fleece the poors precarious nature is being spun into a panic to cover a global economic collapse it appears

  • didactic1

    There are too many beds both in US and overseas. Capitalism overhospitaluzes and discourages home care and non technological costly treatment that doctors and device makers can’t control. People on ventilators are generally fatal afflicted breathers who won’t be brought back to life. Keeping people as veggies on respirators is like nursing homes capitalist care. Medicine’s affliction is overmedication and too much technology. Big hospitals are relics.

  • didactic1

    Most hospitals kill not save. Shut em down and jail doctors, especially the specialists with their tech toys that kill.

  • 0040

    1/3 of the 2.5 million Americans who die each year do so in hospitals.

  • voza0db
  • voza0db

    Capitalism PROMOTES:

    Ignorance and Personal Responsibility.

    No wonder so many millions are in panic!

  • didactic1

    Shut down VA. Health care should be a right for all, not just imperialist mercenaries.

  • didactic1

    Absurd. And many die from infections incurred in these oversized impossible to sanitize oversized hospital slums. Doctors keep people who are dying hooked to costly and worthless machines that inflate costs and deprive patients of right to go home and die on piece with access to pain killers.

  • pajarito

    I will spread these words, thanks to Popular Resistance. The drive for profits promotes misdiagnosis and mistreatment. The next several months with COVID19 are alarming. Somehow we must care for the sick AND build direct action in the face of distancing. Nurses and other workers are striking.

  • CALynnie

    Many who recognize the enormous profits in our health “care” system understand that a universal, equitable, affordable system has been a long time coming (either a socialized “nationalized” system or a single-payer like Medicare.)

    But too many don’t take the time to think. Of the tax returns I’ve prepared this season, about 95% are for seniors on retirement and SS. On average, their out of pocket costs for medical are above $10K….which for most is almost one-half of their taxable income. The layers of “coverage” are absurd. $350 a month for supplemental policies. $1,600 for Medicare premiums. $5,000 for dental work. $135/month for cancer coverage. $200 a month for long term care policies. $125 a month for Rx policies. Another $2,000 for medicine. Yet not ONE senior this tax season so far has questioned the amount they pay for medical. Not one. Americans, sad to say, accept whatever is put in front of them. Without thought. They just pay.

    When Medicare began in 1965, it was supposed to be THE answer to medical costs for seniors. Five decades later, thanks to the vultures of capitalism (and Wall Street,) we have ludicrous layer upon layer upon layer upon layer of costs to cover this procedure but not that one.

    I am waiting for the day the capitalists carve up health care to the point where Americans will have to buy separate policies for each body part. That day is not too far off.
    Sad to say.

  • 0040

    Medical Care is a for profit business in America or when done by religionists for power . Easing suffering is a a distant 3d justification . As someone who has survived into my 70s in excellent health thanks to timely and proper medical care I have mixed feelings about that business.

  • 0040

    Until the Vietnam debacle VA healthcare was a great example of socialised healthcare , both timely and efficient. “Sam takes care of his troops” , was widely believed by even those in power. I can testify to that being a beneficiary of that healthcare care system until the 1980s when the Reagan regime destroyed it.

  • voza0db

    Ó passarinho!

    The best solution to end this moronic hysteria and panic behaviour… Everyone gets the natural vaccine. Look at Sweden!

    They seem to still be capable of Critical Thought and Scientific Balance.

  • dopfa

    Capitalism promotes profit before health, voza. It has created entire industries of illness for mass profit. Cheap, GMO-laden pseudo-food does not create a healthy population, it creates epidemics of diabetes, heart disease, cancer, and autoimmune diseases. Where is the “personal responsibility” in creating so much disease for profit?
    It wouldn’t be that expensive to keep people healthy if big ag and big pharma didn’t make SO much money off of sickness. If big ag spent their billions of OUR tax dollars promoting millions of organic farms instead of GMO mono crops, the US wouldn’t be as sick as it is. Modified corn starch is not food. High Fructose Corn Syrup is NOT FOOD. Billions of OUR tax dollars a year go to corporations that make us sick so they can profit obscenely.
    We also allow predatory psychological advertisers to promote crap to kids from the beginning of their tender lives, even though they’re being sold crap that ravages their young bodies with garbage I wouldn’t feed to my dog, much less my children.
    I’m with you, voza. People need to take responsibility for their own health and stop listening to the ads that tell them crap like Beefaroni, Burger King, Gogurt, and Frosted Flakes are okay substances to put in a healthy body. Shun the garbage and make your own immune systems healthy. Goodness knows the corporately owned and operated government doesn’t give a rat’s ass about you, your health, or your family. All it wants is your dollars.

  • didactic1

    Screw the troops. They volunteered and were shocked Arabs were smarter warriors despite lack of tech and no nurses to hold them in a German hospital. Invaders!

  • dopfa

    A real “healthcare system” start at the beginning, with the food people eat. Mothers would be encouraged to nurse their babies as longs as possible, creating healthier babies from the get-go. Then, the children would start on whole, REAL, ORGANIC food when they started eating, not crap like Goldfish, Cheerios, and millions of little plastic tubs of crap. A HUGE part of a real healthcare system would be to NEVER allow garbage food to be marketed to children. Kid’s shows would only be allowed to market healthy food. The billions of tax dollars a year that go to big ag, would only be granted for promotion of healthy food all over the nation. We would have food forests in every public park, community gardens in every vacant lot, and food gardens in every yard instead of the worthless 40 MILLION ACRES of lawns in place now. Every school should have a garden to teach children how to grow and what to eat to keep healthy. School lunches are the dregs of food now, so that would have to change as well.
    Health doesn’t come from a doctor, nor from a hospital. It comes from keeping our bodies healthy despite the overwhelming ads for addictive garbage. “They” don’t want us healthy because there’s just no profit in it.

  • didactic1

    My experience from Vietnam era was that VA gave shi— care. Congress threw billions at VA which were wasted by indifferent staff and docs who used it to build resume cheap.

  • rgaura

    Yes! I would add that children, the majority, should be birthed at home, away from centers of disease. Nurse practitioners should be assigned to every woman when she becomes pregnant, and do home visits. We should be teaching all children in public schools basic health information, concerning health maintenance and healthy reproduction. Educating mothers changes society. It would give every child a better start in life. It is also cheaper than the medicalized, pharmaceutical model. Parents should be give 3 weeks to a month to stay at home and bond with the new family member. The bonds created in the first 3 years are crucial. No business can offer the love and caring that parents and grandparents naturally express. One parent should have financial support to stay home for the first 3 years of a child’s life. These kinds of programs have been run in european countries for generations, and make for better mental and physical health, and more stable and pleasant communities. No vaccinations should be given until the child has a developed immune system, which would stop the high levels of sudden infant death (SIDS). Mothers should be encouraged to nurse. Its not rocket science, folks! We are losing the collective wisdom of healthy practices of eating and living that are our precious inheritance!

  • Not only does the “for profit” hospital industry turn away patients who cannot afford to pay, communities that are relatively poor are abandoned altogether. Monetary wealth is a cultural contagion that has infected humanity. The depth and breadth of the wealth motivated actions driving the collapse of global human community are staggering, with America, as usual, leading the charge. The American constitution institutionalizes the pursuit and domination of private property and of the ownership class. Quality of life has become subservient to material wealth, especially quality of community life. Born and evolved from human slavery, monetary economics is a competition at every level, from the market thru economic sanctions to the endless global wars of today.

    What does this culture say about our deeper human values? What is really important to each of us as individuals, as members of a family, as a human community? Gaming one another for personal advantage may seem like a beneficial strategy in the short term, but Nature is indomitable in imposing her Reality upon human cultural fantasies like money and material wealth. Money is a false metric of human value. We are ruled by Fear when there is only briefly time enough for Love.

    Life will go on with or without us. It is long past time for our dysfunctional human family to get its act together. Now is always a great time to start. Each challenge that Nature throws our way is another opportunity to build a better, more sustainable and more loving human community or an opportunity to be squandered so we can turn another profit.

  • sabelmouse

    will need permits and prove of vaccine status most likely.

  • voza0db

    dopfa… “Where is the “personal responsibility” in creating so much disease for profit?“, I’m not referring to the OWNERS & FRIENDS! Everyone – except the regular modern dumb slave – knows that those in power are terrorists and sociopaths willing to kill millions just for a funny afternoon!

    The way the Owners of the MAIN SYSTEM found to dominate and control huge herds of slaves was to get away from the spotlight (hence democracy!) and to create sub-systems that generate irresponsibility (the act of voting is one of the most pure manifestation of that) and ignorance (that’s why umans heat so many s h i t and then are scared of a weak virus!).

  • Guy

    I can’t see the existing health care system continuing once this crisis is over .The US health care system is method to make money and not to provide health care .Reading this from my Canadian province I shake my head in disbelief .

  • chetdude

    From your lips to Gaia’s (and enough USAmerican’s) ears…

    HR1384 Style Expanded and Improved Single-payer Medicare for ALL NOW…

  • chetdude

    “Attempting to use this panic to push for single payer healthcare is
    unconscionable but predictable and along with Climate Change , it is a
    bandwagon or hobbyhorse with steeply reduced ridership these days.”

    A) HR1384 Style Expanded and Enhanced Medicare for All was wildly popular BEFORE Covid-19.

    B) The bandwagon is filling up – NOT emptying…and rightly so.

  • 0040

    The Coronavirus bandwagon perhaps , comparable to a few of the lifeboats from the Titanic , filling with drowning passengers until they capsized.

  • chetdude

    You seem to be a very gloomy person… 😉

  • CALynnie

    totally agree! thanks for posting.
    I think someone years ago did research on how much the health care system would save if we just eliminated meat (the tortured, drugged, genetically-altered, maimed and slaughtered meat that is CAFOs and is 98% of the food system,) and it was like another 70%.
    Wow!