The hospital crisis of our making

We had to destroy the hospitals to save them.

You could be forgiven for thinking that's the upshot of the coronavirus lockdowns that have suspended elective surgeries and generally discouraged people from going to hospitals.

Many hospitals are getting pushed near, or over, the financial edge. At a time when we feared that hospitals would get overwhelmed by a surge of patients, they have instead been emptied out. At a time when we thought medical personnel would be at a premium, they are instead being idled all over the country.

We are experiencing an epidemic that bizarrely -- and in part because of the choices of policymakers -- has created a surfeit of hospital beds and an excess of doctors and nurses.

Not everywhere, of course. Hospitals in New York City and parts of New Jersey have been tested to their limits. But throughout much of the country, hospitals are drastically underutilized, both because states have banned elective procedures and people have been too afraid to show up.

One reason that we didn't want hospitals to get overrun by COVID-19 patients is that we'd crowd out everyone else needing care, but we've ended up crowding out many people needing care as a deliberate choice -- even where COVID-19 surges haven't happened and probably never will.

Drastic measures were called for when the coronavirus hit our shores and began to spread out of control, especially in urban areas particularly susceptible to the pandemic. It is understandable that we wanted hospitals to prepare for the worst, and preserve and muster equipment necessary to caring for infected people safely. Hospitals themselves can become a vector for spread of COVID-19, so keeping away people who didn't absolutely need to show up was a reasonable impulse.

But this is a case where the cure may be really worse than the disease, or at least has created its own crisis.

Elective surgeries are a major source of revenue for hospitals, which have taken an enormous hit as they have disappeared, often in response to state orders.

West Tennessee Healthcare, based in Jackson, lost $18 million in March after the state prohibited elective surgeries, and furloughed 1,100 out of a 7,000-person staff, according to Becker's Hospital Review. Summit Healthcare in Arizona expects as much as a 50% drop in revenue after the state's ban on elective surgeries. Philadelphia-based Tower Health, also dealing with a 50% drop in revenue, furloughed 1,000 employees out of 14,000.

The examples go on and on and on. Even hospitals in New York state, an epicenter for the virus, are feeling the pinch. Catholic Health and Kaleida Health in Buffalo are furloughing workers. So is Mohawk Valley Health System in Utica, Cayuga Medical Center in Ithaca, and Columbia Memorial Hospital in Hudson.

Elective surgeries aren't necessarily what you think. As a piece in The Atlantic pointed out, they aren't just knee replacements. They include procedures for serious illnesses like cancer. A recent New York Times story was headlined, "The Pandemic's Hidden Victims: Sick or Dying, but Not From the Virus." It lead with the story of a Rutgers University professor who couldn't get treatment for the recurrence of his blood cancer.

As with the lockdowns in general, it's not clear how much of the reduced traffic in the hospitals has been the result of people changing their behavior on their own based on fear of the virus, and how much has been the result of state edicts. But it's certainly true that the prohibitions on elective surgeries -- more than 30 governors had issued some version of them as of late April -- were too clumsy and sweeping, and not geographically selective enough.

Governors in some states are now loosening them up, and it's time for other governors around the country to follow suit, except in true hot spots. In retrospect, the bans fail the cardinal rule of health care: First, do no harm.