Slow Medicine: COVID-19 Exposes What’s Wrong With U.S. Healthcare


Since the COVID-19 pandemic began, U.S. policymakers, healthcare leaders, and the public alike have looked far and wide for a technological fix to the crisis. News coverage has focused on the search for “magic bullet” cures; hospitals have ramped up ventilator supplies; and there have been widespread calls for increased testing capacity.

Other nations have also sought technological solutions, but the emphasis has been different. For example, many Asian nations rushed to implement simple, inexpensive public health measures — including improved hygiene practices, social distancing, and face masks. These simple measures were implemented broadly to all sectors of society, regardless of socioeconomic or other factors. In the U.S., simple public health measures received less attention — and at times even scornful disdain.

What has been the result of these differing approaches?

Despite all the technological investment in the U.S., COVID-19 rates have been among the highest in the world. In contrast, nations that have effectively implemented the simple public health measures — such as Japan, Taiwan, Hong Kong, and Iceland — have fared much better. While there are many potential explanations for these discrepancies, at least part of the reason may be the contrasting responses to the pandemic. Growing evidence now supports the value of simple measures, including masks, distancing, and hygiene.

The divergent responses between the U.S. and other nations is far from unique to COVID-19. Rather, it is emblematic of how the U.S. approach to healthcare differs from that in many other nations. Compared to other countries, the U.S. offers substantially more high-tech, aggressive care — more advanced imaging studies; more invasive procedures, such as coronary artery bypass surgery; and more novel pharmacotherapies and medical devices.

Yet at the same time, the U.S. healthcare system fails to provide many basic services. U.S. patients frequently fail to receive evidence-based preventive care, counseling, and chronic disease management. Palliative care is markedly underutilized. And U.S. patients, particularly those of low socioeconomic status, face substantial barriers accessing primary care and mental health services.

The net result is that despite the aggressive approach to care, health outcomes in the U.S. — such as life expectancy and maternal and infant mortality rates — are mediocre, while U.S. patients commonly experience frustration and dissatisfaction with the care they receive, suffer high rates of misdiagnosis, and experience alarming health disparities.

This is not to say that technology is unimportant in healthcare. To the contrary, thoughtful, targeted technologies can deliver important health benefits. For the COVID-19 pandemic, we depend on innovation to deliver a solution to the pandemic — hopefully in the form of a vaccine. Similarly, there are numerous examples of technological breakthroughs that have greatly improved care for patients, such as cancer drugs, life-saving medical devices, and important diagnostic technologies. Nevertheless, on the whole, the U.S. healthcare system may overemphasize high-tech, aggressive solutions, while undervaluing simpler measures that drive population health.

How do we solve this mismatch?

Unfortunately, there is not an easy solution. Policymakers, clinical leaders, and economists have proposed a multitude of fixes, such as utilization review programs to discourage high-tech, invasive services of limited value; pay-for-performance to promote simple but effective care; and “value-based payment models” to simultaneously incentivize underutilized services while discouraging wasteful care. Yet the impact of these “carrot or stick” reforms has been modest. Simple policy changes do not appear to be sufficient.

Still, there is reason to hope. COVID-19 — coupled with recent attention to health disparities — has brought the imbalance in U.S. healthcare into focus more acutely than ever before. With respect to COVID-19, the U.S. has finally begun implementing simple measures like hygiene, social distancing, and face masks more aggressively. While implementation may lag relative to other nations, public attitudes have begun to shift in a meaningful way. There may be an opportunity to build on this momentum, leading to greater emphasis on simple public health measures such as lifestyle changes and evidence-based preventive care — as well as interventions to promote health equity — in the post-pandemic era. If so, this could represent a significant silver-lining of the pandemic.

Michael Hochman, MD, MPH, directs the Gehr Center for Health Systems Science at the University of Southern California’s Keck School of Medicine.

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