The Occasional Considerations - 3/23/20

Periodic Meanderings and Ideas Deemed Important by The Fickenscher Files…

Keckley Considerations – one of my colleagues, Paul Keckley – one of the nation’s leading thought leaders in health care – sent out some considerations we need to seriously contemplate as we move forward.  His thoughts follow with special attention (from my perspective) to the last one…

“Who would have thought the Chinese were better prepared for coronavirus than the U.S.?

Who would have predicted the Pandemic Preparedness Task Force in the National Security Council would be dismantled in 2018?

Who would have predicted the ACA’s funding for Public Health Prevention ($15 billion) would be used otherwise?

Who would have thought that out of necessity telehealth, state health departments, community health centers and FQHCs would become mainstream healthcare?

Who would have believed the healthcare supply chain was inadequate to meet surge demand?

Who would have Republicans and Democrats would authorize a trillion dollar emergency funding package?

And who could have imagined the perfect storm: coronavirus, the oil dispute between Russia and the Saudi’s and softness in the overall economy? 

It’s a great time to reflect on what we’re learning and hardwire systemic changes to the health system! Hang in there all!!!!”

Paul captured it well.  We really do need to be thinking about the lessons learned and consider the “systemic changes” which need to be implemented for the future.  Some of the ones I’ve been thinking relate to the following considerations…

Right On Governor Kaisch! – Former Governor John Kaisch was on the CNN Anderson Cooper program the other night and he took both Republicans and Democrats to task for not collaborating more effectively to solve the Covid-19 crisis.  He pleaded with both sides to put aside their political machinations and “solve the problem”.  We should not be succumbing to ideology as the barrier to reality. Kudos to Governor Kaisch.  It is time to make the rhetoric a reality by resolving our differences and implementing policy that we believe can solve our nation’s – no, the world’s – problem related to Covid-19. Hear, hear – Governor Kaisch. 

We Are Naked In The Winter Of Drug Production – I was going to write a long piece on this topic but it has become front and center news in the mainstream media over the last two days.  We have a major problem.  Our supply chain of basic medications (e.g. penicillin, vancomycin, acetaminophen, heparin, etc.) has become entirely dependent upon China or India. The difficulty – aside from the trade disputes – is the fact that the governments (especially China) have not effectively regulated the production of these medications.  At the present time, 40% of the medications sold in the US are manufactured by only one overseas company. Disruption of the supply chain causes inexorable problems. No less an authority than the Council on Foreign Relations has issued a white paper outlining the problem – which is stark.  Furthermore, the report notes that about 80% of the active pharmaceutical ingredients (APIs) used in making all medications are derived from India and China. For all intents and purposes, despite the presence of large multi-national pharmaceutical companies in the US, we’ve outsourced nearly the entire function for production to those two countries.  For a critical supply – that’s a problem.  In the short-term, not much can be done but, for the longer term the US needs to resolve this problem. The issue needs to be front and center as a major policy debate once we get through the current crisis. 

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