My Vanderbilt-educated brother-in-law, who works on the front lines as a rural nurse practitioner, says we should have seen coming the American health care system’s complete lack of preparedness for what has hit us.

For those readers inclined to see events through a partisan – or even conspiratorial – lens, know this about my brother-in-law: He’s no bleeding-heart liberal. He voted for Trump in 2016, and probably will again because he doesn’t trust Democrats to protect his Second Amendment rights. But neither does he have the blind faith in a politician that is prevalent these days on the right. He holds the two major parties equally accountable.

He sent me this email earlier in the week:

America is in crisis with the coronavirus. But don’t worry, it could get a lot worse.

As government officials stand in front of the cameras and microphone banks, you can tell they have no idea what to do, or what to say. They have no real solutions to deal with pandemics and they know it.

The United States health care system has increasingly evolved into a business of greed and customer service. Rather than focusing on treating disease and preparing for pandemics, the government has mandated that health care institutions – with the threat of decreasing payments – provide a customer service experience similar to Disney World. Because we all know that a colonoscopy has the same excitement and thrill as riding Space Mountain.

While we should have been focusing on ramping up efforts to fight disease and outbreak threats, health care providers were told to focus on increasing menu options so patients would have a happy customer service experience while hospitalized. While I could keep going about the silliness of comparing a hospital stay to four-star resort, I’ll refrain.

The purpose of this discussion is to point out some massive problems within our system that are not, or barely, being mentioned. The United States is not equipped to deal with a pandemic. Some hard decisions could have to be made, and that’s the part no one wants to talk about.

One of the most important items is the lack of medical supplies. Forget testing. The U.S. government has already proven it is incapable of managing that. Gowns, masks and gloves are in short supply. And guess what? A lot of those supplies are not made in the U.S. As companies try to ramp of production of these items, the U.S. sits and waits for the much-needed medical items to come on board. Let’s hope that the countries where these supplies are made do not begin to hoard them if this pandemic worsens.

Would you ask a health care worker to take care of patient with a highly contagious disease without the proper protective equipment? If you said “yes” then I have to ask you another question? Would you ask a construction worker to work without protective hard hat?

There’s also the question on whether health care workers would even agree to put their own health at risk due to the lack of protective equipment. It definitely would be a question that health care workers would have to ask themselves. Are they willing to put their well-being at risk, or their family members’ health at risk, for total strangers because they do not have the tools necessary to protect themselves?

But for the sake of argument, let’s say all frontline health care workers agree to work with limited protective gear. That brings us to the next problem: lack of medical treatments, medical space and medications.

We are lucky in a sense that the coronavirus seems to produce mild symptoms for most people and they do not require hospitalization. But even then, the virus still could easily overwhelm the system due to the harder effects of the disease on the elderly and the immune-compromised. And everybody in the U.S. knows we have a high elderly population.

Health care rationing could become a reality on a large scale. We are already seeing it. Hospitals are already beginning to cancel or postpone elective surgeries due to the fear of running out of capacity. That’s just the tip of the iceberg. Even if we build makeshift or tent hospitals, there are still two inadequacies that people are forgetting about: the lack of medical treatments and the lack of doctors and nurses to care for the sick.

There has been a shortage or doctors and nurses in the U.S. for decades. Hospitals are constantly dealing with staff shortages when there aren’t pandemics. Are extra health care staff going to magically appear in times of crisis? The answer is no. There aren’t enough of us to go around. Not to mention, all doctors and nurses are not trained to take care of the critically ill, if we had a high number of patients requiring intensive care.

There has been mentioned the possibility of running out of ventilators if we have an influx of patients requiring this treatment. The lack of ventilators will only be part of the problem. Not to pick on any certain specialty, but do you think a dermatologist will all of a sudden become an expert in hypoxic respiratory failure? Do you think a surgical nurse will all of a sudden be an expert in ventilator management?

Too often, doctors and nurses are put in a generic category of “jack of all trades.” That’s not how the system works. Health care is so specialized nowadays. But even if we all were experts, there is still not enough of us to go around. Go ahead and build your tent hospitals; there will not be enough staff to man the stations.

This brings up the next concern no one has really talked about: true care rationing and legal liabilities. Has anyone thought what a massive run on the hospitals would look like? Sure, we have disaster drills every so often, but those drills don’t take into account the lack of supplies, lack of medical treatments and lack of space. This pandemic could get really bad, really fast.

But while Americans are stockpiling toilet paper, they are unaware of some life-and-death problems that could arise. Let’s present the following example. You are a doctor at a hospital. You have one ventilator left. Two patients need it. The first patient is an elderly person with dementia. The other patient is a middle-age woman with two children. The elderly patient is one of your parents. Who gets the ventilator?

When I ask this question, the response is always the same: “I wouldn’t want to make that decision.” As a health care provider, I am going to be asked to make this decision. I will also have to try and sleep at night after that decision has been made and life has been lost. Many health care providers could have to live with decisions like this.

Not only will they have to live with choosing who lives or dies; they also get to live with all of the upcoming lawsuits by the families who are in shock that their family members could not get the care they needed. Their lawyers will be ready to pounce, and health care providers will get the brunt of the blame.

I truly hope this virus subsides and the above-mentioned scenarios are just that – scenarios. But this should be a wakeup call for all Americans. We need better protections in place such as mandatory medical supplies and medication manufacturing in the U.S., increased training for existing and new health care workers for pandemics, actual plans to deal with the manpower shortage in health care, and tort reform to protect health care professionals in times of crisis.

Congress and the presidential administration have definitely missed the mark on this crisis. While they squabble over funding for Medicaid and school lunches, they are missing the real problems. We are not prepared now, nor will we be in the future if nothing changes.

Steve Stewart is publisher of The State Journal. His email address is

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