In the past 20 years the United States has witnessed and participated in efforts to counter several severe epidemics and a few pandemics: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), coronavirus disease 2019 (COVID-19), Ebola, Zika, and more than average flu pandemics in 2003, 2008, 2017, 2018, and 2019. After all that, you’d think we would have learned enough to be well prepared. This pandemic has shown that we have not.
We did learn that we lack a robust national public health system; that we lack an effective supply chain for personal protective equipment, medical equipment, and testing supplies; that we are unable to communicate coherent messages about appropriate behavior that could minimize disease transmission.
More importantly, the fundamental mission of the nation’s health care delivery system has been called into question. We must create a new vision for that system. Success would be measured by a reduced need for people to feel forced to go to a hospital or emergency department for care, by measurably higher levels of wellness and physical and mental function, by fewer time-consuming in-person visits to doctors’ offices, and by keeping people with multiple chronic illnesses functioning at the highest level possible. A relentless focus on better outcomes, safety, and service, while reducing avoidable costs, will result in yearly savings in health care expenditures in the $700 billion to over $1 trillion range.
Those savings can be wisely reinvested in a medical delivery system that not only cares for people who have the usual assortment of medical conditions, but also can respond to catastrophic medical events. To accomplish this, the nation should have a high degree of readiness, almost a military level of readiness. A readiness that we hope we never need to use, but we know we will. That is what resilience is all about. When a pandemic hits, we’re ready to go—we have masks in storage places, we have updated drugs in ample supply, we are working on vaccines all the time, we have needed equipment available, and we have a ready and trained workforce.
The United States spends several hundreds of billions of dollars a year on the military to assure readiness in case of threats from adversaries. We can now see that the consequences and costs of a pandemic are on par with warfare. A similar level of investment, paid for by the savings created by a more effective health care system, would allow the nation to establish a civilian national emergency medical system and workforce. The return on investment would be readiness in workforce, facilities, and supply chain and logistics.