Our Malady: Lessons in Liberty from a Hospital Diary

by Timothy Snyder

To understand the shortage of beds, it helps to think of just-in-time delivery. Companies like to have just enough space for what they need, work with, and sell, not more and not less. For a hospital, the human body is the object that is to be delivered, altered, and shipped away just in time. There should never be too many bodies, or too few bodies. There should be just the right number of bodies on just the right number of beds. Good doctors, good nurses, and good assistants resist this logic all the time, but they are pushing a boulder up a mountain. Maintaining beds costs money. No hospital, in American commercial medicine, is going to maintain a reserve of beds when other hospitals do not do so. Since financial logic dominates medical logic, the country must always be unprepared for epidemics. There can never be a reserve of beds, nor for that matter a reserve of protective equipment or ventilators. Managers counting on a quarterly profit cannot factor in pandemics, which arrive about once a decade. Each time a plague comes, the situation will be defined as exceptional, and the shortages will make the emergency even worse than it had to be. Then money will fly around: not to where the doctors might want, since they will not be asked, but to the sectors of the economy with the loudest voices. This just happened, and with commercial medicine it will keep happening. In the hospital, sad to say, a body is a widget. Kindly assistants, competent nurses, and decent physician...