Everyone’s worst pandemic nightmare is happening in Los Angeles. Intensive-care units are overflowing with patients gasping for breath, and there might not be enough ventilators to go around. If a patient has virtually no chance of survival, ambulances have been told not to bother transporting them to a hospital at all. People experiencing a heart attack or kidney stones can’t count on a bed being available for them.
But perhaps it should be no surprise that California’s hospitals are full to bursting: the state has one of the highest COVID-19 hospitalization rates in the country, and it has relatively fewer hospital beds than most other states—just 1.8 per 1,000 people, compared with 4.8 in South Dakota, which has the most beds in proportion to its population. California’s relatively few hospital beds are attended by relatively few nurses, compared with other states’ staffing levels. Now the state’s hospitals have become overwhelmed, flooded with COVID-19 patients and unable to help them all.
The health-care system in California is fraying because the state has tried to run its health system efficiently. The principles are simple: Keep patients out of hospitals, funnel people to primary-care doctors, and don’t build hospitals you don’t need. In normal times, that strategy would make perfect sense. Typically, doctors’ trying to treat patients outside of hospitals is smart. Medical advances mean that procedures such as mole removals and knee replacements can be done in just a few hours instead of a few days. And holding patients in hospital beds is much more expensive than sending them home, while people languishing in hospitals risk acquiring infections.