The Crisis in Care

The Crisis in Care

Minnesota needs to refocus on the basics of delivering health care.

I had the good fortune of getting to know Chuck Mooty a bit for our Hall of Fame feature this issue, and he surely lives up to the hype. I urge you to read about his fascinating, multi-faceted career and his approach to leadership.

His tour of duty at Fairview (now M Health) was typical of his career, parachuting into a quagmire of sorts and building a team to define a direction and move out of a crisis. Not everything we discussed made it into the article, but I did try to include his comment about the state of the health care industry, because I think it’s terribly salient right now.

Mooty’s concern is that all the dynamism and profit in American health care is on the payer (insurance) and pharmaceutical side of the business. That care systems are struggling to generate sufficient return and also struggling under enormous burdens brought on by the pandemic is a critical situation.

We in business journalism are quick to anoint the latest insurance innovator or med device startup, but the care side of the system generates little buzz.

“That care systems are struggling to generate sufficient return and also struggling under enormous burdens brought on by the pandemic is a critical situation.”

Over the pandemic years, my family has managed to avoid Covid entirely, but we have not managed to avoid intensive contact with the broader system. My parents moved into a senior living/care community last year, and we’ve also had various interactions with hospitals and mental health providers.

A few observations stand out:

  • Watching the public health sector inveigh on behalf of the nation’s seniors, you’d think we were a nation that actually prioritized and cared for its elderly. Which struck me as ironic, because I can think of few nations that treat elders with less regard than America. That was validated in the pandemic when the specter of their demise was endlessly used by the public health sector as a means of justifying various mitigations, but our most dire outcomes were in elder care communities. Walk into one of these communities today and they are hollowed out, depleted of services and basic amenities because they can’t find staff.
  • Efforts to sort through the efficacy of various Covid treatments and vaccine effects revealed the dodgy state of the so-called empirical studies that guide approval of medical devices and pharmaceuticals. The politicization of the pandemic had one good impact—it exposed how many of these efforts to vet safety and efficacy are hopelessly biased or riddled with nonmedical agendas.
  • The pandemic’s worst impacts have been on the young. The elderly are the most vulnerable to Covid; the young are hardest hit by its collateral damage, mostly in learning loss and psychological strain imposed by adults trying to protect themselves. In so doing, they’ve exposed the very group they sought to protect to levels of risk and harm far worse than Covid portended by disrupting their lives for extended periods.

Talk to a teacher or a school counselor or a mental health provider—if you can find one who isn’t on a months-long wait list because of enormous need—and the crisis among children becomes obvious. Should your child need inpatient care, good luck. Minnesota (and the nation) is experiencing a tsunami of kids who are a danger to themselves and others, with nowhere to accommodate or treat them.

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In April, M Health’s Masonic Children’s Hospital converted an ambulance garage to accommodate the skyrocketing number of children arriving in mental health crisis. Many are there for several weeks. Yet the state continues to lose beds and residential facilities for these patients.

The thinking has long been that inpatient mental health units are a suboptimal way to manage people with chronic problems, but our failure to invest in alternatives, while hacking away at what remained, has left huge numbers of mentally ill adults living on the streets and a cohort of young people in repetitive crisis after being deprived of access to the stabilizing influences of a regular life for two years.

Everywhere I’ve looked in and around the health care system, I see closed floors and facilities dark due to lack of qualified employees. Those who remain are stressed out and often less than empathic, to be honest.

As much as I am a fan of innovation and entrepreneurism, it’s manifestly clear that we are flunking the basics today. Chuck Mooty’s warning is worth heeding.