By Gabriel Winant and Theresa Brown, Illustration: Jimmy Simpson, The New York Times, May 9, 2022
America was in a health care crisis before Covid, and the stresses of the pandemic have made it worse. Since the pandemic began, the health care work force — the country’s largest industry by employment — has shrunk by nearly 2 percent. That may seem like a small amount, but historically, the health care work force doesn’t shrink; it only grows. Now, with astronomical turnover and rising demand as patients seek care that they may have put off during the height of the pandemic, hospitals, clinics, nursing homes and home care agencies across the country lack sufficient staff members to adequately care for patients.
The health care system, before it is anything else, is a work force — that’s the “care” part. Without enough nurses and aides, patients in skilled nursing facilities cannot be bathed when they need it, or have their pain relieved or wounds dressed in a timely manner. Patients who can’t feed themselves may not eat enough because no one has the time to help them. Hospital nurses coordinate care by dispensing medications, prepping patients for tests and scans and, most important, quickly intervening when serious problems develop. Respiratory therapists in hospitals manage the ventilators that keep many Covid patients alive, and without enough pharmacists, medications cannot be efficiently and safely prepared for patients.
Most hospitals might be private companies in their formal legal identity, but the reality is that government has shaped the health care system every step of the way of its modern existence. That shaping dates back to the 1940s, when tax policy and labor market regulation led to the establishment of private employment-based health insurance. Medicare and Medicaid account for more than one in three health dollars, and Medicare has absorbed hospital capital costs since it was established in 1965, meaning that the federal government paid to create much of the existing facilities and equipment used by hospital systems today.
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