Collapsing regional economies (particularly in our inner cities, the Deep South and greater Appalachia), an epidemic of obesity, soaring gun violence and escalating mental health issues- these drivers of socially determined demand have flooded hospital emergency departments and surgical suites with casualties. As society has failed many of its most vulnerable citizens, it has also allowed its public health, mental health and chronic care infrastructure to decay, leaving expensive acute care hospitals and their overtaxed staffs to clean up the wreckage.
If we want health costs to moderate, we must: rebuild weakened urban and rural economies, find housing and care for the homeless, markedly improve treatment for drug addiction, recreate a humane alternative to the hospital emergency department for violent schizophrenics, keep weapons out of the hands of the mentally ill and suicidality inclined, find solutions to the epidemic of obesity (and the diabetes which follows directly), and support family care giving as an alternative to institutionalizing chronically ill and frail older folks. The hospital isn’t the right social tool to fix these problems. It isn’t a shortage of money but rather a shortage of resolve and lack of focus, that holds us back.