From a population health point of view, it's not clear that hospitals help, everything considered.
What would things look like if we simply closed all the hospitals and then let that situation stabilize?
Hospital roles in epidemics and pandemics
For one thing, hospitals are currently the largest single breeding ground for the new generations of massively drug-resistant germs. No where else are so many sick and vulnerable people brought into such proximity with each other.
It's not just that patients become "infected" at hospitals. Patients ALSO become the petri-dish in which hospital-based infections can expermient, mix and match their DNA segments, searching out for a yet more powerful way to kill people and spread.
In the Congo, during the Ebola epidemic, the primary mechanism for spread of Ebola was the "health care system". Ebola otherwise would incapacitate and kill a person near where they lived, and therefore be somewhat self-limiting. But, the patients were brought to hospitals, where it was much easier for them to infect the health care workers and other very sick patients.
But, some might say, in a serious epidemic, woudn't hospitals be a big help? Actually, no. in a serious wide-spread epidemic, hospitals might effectively shut down themselves. There is essentially ZERO "stretch" or "surge capacity" or slack built into the US Hospital system. There are no EXTRA BEDS for people who have some serious contagious disease -- although maybe inflatable tents and gymnasiums or stadiums might be commandeered to hold dying patients, if the 1918 "Spanish Flu" epidemic is a guide to what to expect the next time this happens, which it will.
If you experience a 4-hour waiting time in the Emergency room NOW, imagine (a) what it would be like if everyone with a wide-spread contagious disease went there TOO all at the same time, and (b) how much you, if you had anything else wrong with you besides that, would be willing to go sit amid all those sick and contagious people waiting for YOUR examination and treatment.
It's only a question of when, not whether.
Hospital roles in Intensive Care / End of Life care
So there is at least one reason to consider closing hospitals. Also, they are quite expensive to operate, so there's a second reason.
Hospitals, being "systems", as John Gall pointed out, will of course be very good at coming up with all sorts of narratives and justifications for why they should continue to exist. By itself, that proves nothing.
Let's suppose that, if we didn't have hospitals, most very sick patients would simply die and we'd remove the last 3 weeks of the patients lives, and associated transfer of wealth from the patient's estate to the hospital, device manufacturers, drug-manufacturers, etc. Something like 40%, almost half of all health care expenses are incurred in the last few weeks of patient's lives -- and often, the patient is not really even conscious during this time period.
In terms of cost-reduction of total health care bill for the country, frankly, that looks like one candidate. It turns out many patients themselves are not really interested in living their last 3 weeks attached to machines and drugged up with tubes down every orifice in their body -- they'd rather simply die and get it over with when it's that time in their lives.
Hospitals, in other words, are being paid a huge amount of money, total, and from families life-time earnings, in order to sustain the myth for a few more weeks that the patient is not actually going to die. We are paying for delusion. And we are paying a LOT for it.
In most senses, terminal patients have already died as interacting human beings and members of society, and it's all over except the admitting it and the falling down part.
I realize there is a vast stereotyping regarding "death panels" and other wild imaginings. I'm not suggesting some panel of "experts" decide they will not treat a sick patient, in the interests of saving money. I'm suggesting the patients themselves, in many cases, would actually prefer not to be treated like some kind of side-of-beef for their last experience on Earth. They would rather be remembered in a different way by their children and friends.
Chronic Disease care over the lifetime
Hospitals are set up for very short burst events of "acute care", not for long-term, daily care processes that go on your entire life. If our need is to counsel people who are diabetics, or overweight, or under stress, we don't need "hospitals" in order to meet that need. Hospitals would be, pardon the phrasing, "overkill". They'd be like using a bulldozer to plant a rose bush.
Mid-range problems and the Lawn-Mower Repair model
OK, overstating the case somewhat but with more than zero truth in it, hospitals don't do much for intense end-of-life care, because you're going to die anyway; they don't do much for chronic care, because they have way too much overhead to be cost-effective means of interacting with people regarding their lives at home and work.
There is a much deeper and more profound problem, however, with the entire hospital model, which I will call the "lawn-mower repair model" of care.
The whole idea of hospital care is based, effectively, on the model of Western Science that was rampant and dominant during the last century.
Science was, and mostly still is, the activity of studying things that are easy to study because you can isolate them from their home environment and bring them into the lab and they still behave the same way they did at home.
Anything that was effectively inert, such as a lawn-mower, could be repaired as easily in a lawn-mower repair shop as it could be at home, in its natural lawn environment.
The hospital model is based on the assumption that people are, in that sense, lawn-mowers -- that a person, pulled out of their home and work life, stripped (literally) of their clothes, put in a sterile room that emphasizes their vulnerability and dependency, removed from friends and family, is, in fact, the "entity" that is broken and needs to be fixed.
In this environment, a doctor can look at such a context-stripped patient-mower, and with a straight face, give what is called a medication order, saying "You need to take this drug 3 times a day for 8 weeks, and you need to cut down the carbs, and get more rest - at least 8 hours a day."
The doctor does not need to think about whether the patient can afford that drug, or whether the patient has a refrigerator or a home for that matter, or whether the patient's family or room-mates will steal the drugs, or whether the patient has a job that lets them carry their noon dose with them at work, or whether the patient has it "together" and is sufficiently organized to do ANYTHING 3 times a day at given times, let alone take a drug that has some annoying side-effects.
The doctor does not need to think about the fact that the patient has only 3 friends left in the world, and the only time he sees them is when they go out drinking and eating pizza, and if the patient were to turn down the beer or pizza, they would, due to our sub-culture training, be seen as rejecting their friends and therefore be rejected and lose their only remaining friends in the world.
The doctor does not need to deal with the fact that the patient is under huge stress at the workplace, which has been "cutting staff like crazy lately" and has been told effectively or literally "If you don't come in Sunday, don't bother coming in Monday." This is not the doctor's concern.
All of these considerations are stripped away, in moving the patient-mower object into the hospital-laboratory setting to be examined, tuned, and "fixed."
The patient, given their marching orders, will probably nod and mumble "Uh, .... OK" or something and walk out. When they get to the drug store and find out what the drug costs, they may realize they cannot afford $200 for some pill that might or might not help. They also quickly realize they coudn't take it, realistically, 3 times a day if they tried. Nor could they cut out carbs. Nor could they get good sleep. Heck -- if they could get sleep and good food, they wouldn't have gotten sick in the first place, they don't need some doctor to tell them that.
The point is this: the THINGY that's broken is the patient's LIFE -- the part that the hospital system insists they check at the door when they arrive, and the part that the doctor is too busy and too important to go see. The patient's BODY is only a downstream symptom of their LIFE.
So, what needs to be FIXED is their LIFE, not their BODY. If you could fix their life, the body would take care of itself and heal. There's little or no value in doing a one-time "fix" of the body, if the underlying causes of the problems aren't also fixed. The patient will just "be back" in 6 weeks. The doctor will be angry at this "bad patient" because they are "non-compliant" and REFUSE TO FOLLOW MEDICAL ADVICE. The doctor throws up his hands in disgust. What can he do? It's yet another "bad patient".
So, in the lawn-mower analogy, maybe the mower could be "fixed" but shouldn't someone look at why it was used to mix gravel in the first place?
The hospital is part of a much larger Myth-Maintenance system that tells us what is broken is the person, not the society. In reality, the 'repairs" done by the hospital to the lawn-mower-body are going to be short-lived, if successful at all. Probably, in fact, even if the patient were to follow the advice, it would only ROTATE the problem, like "whack-a-mole", so that yes, now they no longer had THAT set of problems ... but, um, ... now they have a whole NEW set of problems somewhere else, because the true CAUSE of their problems, their broken life, has not been addressed.
In fact, we have a name for recommending a strategy that clearly fails to fix a root problem, and at the same time masks or prevents addressing the root problem -- it is called "Quack medicine".
The basic fact is that hospitals are designed for the lawn-mower repair model. They are designed to detect and repair relatively simple problems that exist INSIDE the patient's body, and that come in the door with the patient, and that can be fixed INSIDE the body in a visit or two. For these things, all the "tests" and "vital signs monitors" and "charts" can be very helpful, as well as the high-technology drugs and equipment to "see inside" a body-lawn-mower.
Hospitals, however, are just terrible at the person-with-broken-life situation. The things that are broken are OUTSIDE the patient's body, and in fact, are OUTSIDE the hospital walls. You can let the vital signs monitor run all day and you will not see them go by. You stripped them out with the patient's clothes, because they don't FIT the lawn-mower-repair model of care.
It is not surprising, given the mismatch between what is wrong and what it is hospitals do that people in general are getting sicker and, at the same time, now spending more money on "alternative medicine" than on hospital care, because, frankly they are voting with their feet and this hospital lawn-mower-repair model isn't doing much to help their actual needs.
On detecting failure
We as human beings hate "failure". We avoid it and deny it. It's very uncomfortable.
Systems hate failure as well, and also do what they can to emphasize the bright side of things while covering up or deleting entirely any mention of the darker side of things.
Humans also have a fascinating tendency, when something doesn't work that "should", to just keep on trying it with increasing intensity.
We can detect something that looks awfully much like a totally broken health care system, but more to the point it's not just the "working-out-the-details" or "paying for it" part of the health care system that's broken -- it's the whole underlying premise that humans are lawn mowers so a chain of mower-repair shops ("hospitals") SHOULD do the job.
I just love John Gall's insightful work "Systemantics .. how things fail". Here's what John has to say about system failure.( page 69-70, in the text.)
IN COMPLEX SYSTEMS, MALFUNCTION AND EVEN TOTAL NON-FUNCTION MAY NOT BE DETECTABLE FOR LONG PERIODS, IF EVER.
When first propounded this Theorem elicits surprise. However, illustrative examples abound, especially from the field of History. for example, it would seem reasonable to suppose that absolute monarchies, oriental despotisms, and other governments in which all power is concentrated in the will of one person would require- as a minimum for the adequate functioning of those governments -- that the will of the despot be intact. Nevertheless, the list of absolute monarchs who were hopelessly incompetent, even insane, is surprisingly long. They ruled with utter caprice, not to say whimsically, for decades on end and the net result to their countries was -- undetectably different from the rule of the wisest kings.
LARGE COMPLEX SYSTEMS ARE BEYOND HUMAN CAPACITY TO EVALUATE.
The problem of evaluating "success" or "failure" as applied to large systems is compounded by the difficulty of finding the proper criteria for such evaluation. What is the system really supposed to be "doing"?
Another example from history might the the huge activity called the Vietnamese War, which "succeeded" (to hear the government's opinion) for years until it finally "ended" and we came home. To many people, the "success" was indistinguishable from "failure".
In any case, let's return to the questions of what exactly it is that we thought Hospitals would be accomplishing for us, that we bought so many of them (as a society), and ponder whether they are, in fact, delivering what we paid for, or if we have, as a people, been sold a bill of goods.
Sadly, this gets into the success or failure of an even larger system, Capitalism, the work ethic, a college degree as the ticket to success, the entire nation, Western Science, and the economy. Are we better off due to Western Science? Did it "work" to alleviate suffering and pain and give us all a "better life?"
We seem to be surrounded by things that some people are championing as wildly successful, while many other people, to put it mildly, aren't experiencing that success quite so vividly in their own lives.
OK. Let's review some thoughts. First, if we eliminated all hospitals, the same number of people would die as die now -- we get exactly one death per person per lifetime. That's a given.
Second, if we eliminated the illusion that people could lead terrible lifestyles and then go to the doctor to pop a pill or get surgery so they could go on with their terrible lifestyles, MAYBE people might take responsibility for their own lives and clean up their acts. MAYBE having hospitals perpetuates the myth that we don't need to take care of ourselves, because someone else will clean up our mess for us.
We would probably be no worse off in any major disaster scenario, because hospitals have zero "stretch capacity" for huge numbers of injured patients, and essentially zero room as well for dealing with highly-contagious patients in an epidemic.
The point of this thought exercise is not to conclude and assert that we should shut down the hospitals. It's to make a case that hospitals are not doing for us what we may think they are doing. We need to have an intelligent debate about how to deal with the health, over the lifetime, of people who do not fit the "lawn-mower" category, who have problems that are more structural, in the sense that their lives are broken, which is messing up their bodies, so we should be focusing more attention on fixing their lives, not on fixing the bodies
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