Coronavirus Will Collapse — and Transform — our Health Care System.

Dear Tom,

I’m a doctor. My father is a doctor. So is my brother. And my sister. And my wife. And my sisters-in-law. (Indians and medicine…)

I’ve been reading you since the beginning of The Palm Beach Letter. You and Mark Ford changed my life. By giving me a perspective not only on finances, but on a life well lived.

I had a chance to meet you at the Palm Beach Infinity Conference, I think the one in 2016. I felt something was off (as physicians, we’re trained to notice weight loss), but I didn’t want to pry. As the two of you became less involved, I missed the philosophy you and Mark had brought to The Palm Beach Letter, and I hoped you were okay.

Now, with “Postcards From the Fringe,” I understand what was going on. Thank you for being so transparent about it. I am so happy for you, Kate, and your kids. Your weight is clearly back. And I’m once again following your financial advice!

I’ve been reading you for so long now…I was touched to see that you wanted to hear from health care workers like me, in the midst of the coronavirus pandemic. So, you’ve moved me to write to you.

I’ve been writing about health care for a while now – if interested, you can read my thoughts here or just look me up on Medium. Given much of my family being in the field, and given what we as a family went through when sudden health events in our parents threw us headlong into the other side of health care – the fate of our health care system is deeply personal to me. And with the coronavirus pandemic, I feel like I’m watching a train wreck happen in front of me. Unfortunately, one I saw coming.

Justin Ford, with whom I’ve had the privilege of investing on a couple of deals in the Dealbook, got together briefly with me while he was in town in Houston, where I live.  It was stimulating for me to pull the curtain back on health care a little bit with him. But that was before this coronavirus disaster really got going around the world.

In essence, just like you’ve been writing about the world financial system, the world health care system is collapsing. As the financial system is built on quicksand, so too is the health care system. Coronavirus will lay bare its fragility.

My critique is phase-specific:

1) As urged early on by Nassim Taleb and others, we didn’t cut off the left-sided fat tail quickly enough, when the virus was early in its exponential growth. If individuals – not by centralized nation-state fiat but by self-organized interest in the well-being of the collective – shut things down for two weeks, it would have been at minimal cost to the economy and society. It would have protected the vulnerable among us. And there would have been no pandemic. As someone else has said, coronavirus doesn’t have wings.

China did not help in this strategy, with its secretiveness early on. I’m curious how you feel about this, having traveled throughout the country.

2) Now, lockdowns are being enforced around the world through command and control. As a physician who has seen how the inside game of health care is played, this makes me angry.  Because this devolution to a totalitarian state would be completely unnecessary, were it not for the fact that modern health care systems around the world are run by administrators disconnected from the reality experienced by everyday health care workers.

You want to know why we’re forced to take drastic steps to “flatten the curve,” so as not to overwhelm our health care system’s capacity to care for people? Because executives took control of the system, optimized it for “efficiency,” consolidated institutions into “too big to fail” behemoths, and converted physicians into cogs in the machine. There are no redundancies in the system. Like the financial system, when it fails – it fails big.

One example, of many: The CDC is forced to tell us on the front line to wear bandanas and scarves, in order to ration masks which are in short supply. Why? Because group purchasing organizations (GPOs) were given safe harbor by Congress to get kickbacks from big manufacturers, in return for exclusive access to hospitals. Because of these sole-source contracts, no other manufacturers can enter the market to sell masks. Having controlled the entire health care supply chain merely by pushing paper contracts, the GPOs distribute the kickbacks as sharebacks to health care CEOs, to the tune of millions of dollars per year. All it would take to end this nonsense is a repeal by Congress of the safe harbor – a move that would conservatively save the system $250 BILLION per year. No need for a bailout put, paid for as always by everyday working people…

But it’s never happened, because Congress is in the pocket of the GPO and hospital lobbies. Democrat or Republican, it doesn’t matter – they know the problem, they know they can fix it, but they won’t. They will never be straight with you. They would rather pass $2 trillion stimulus packages full of treats for their buddies, while they pat themselves on the back for saving America.

Another example: The level of testing for coronavirus in the US has been a disaster. Like the blog post from Matt Smith you linked recently correctly pointed out, we should be doing MASSIVE testing. We’re not. A physician friend of mine went to a big hospital here in Houston with symptoms but was initially denied testing because he didn’t fit the “criteria.” When we know that there is asymptomatic spread. I was told a major lab company is touting that they are doing 20,000 tests per day. I was also told what they don’t tell you: A million tests all around the country go to one centralized place in California. Which is why it can take more than a week to get a result back. By that time, the person may be dead.

I started getting symptoms myself recently, but I’m having to wait to get tested. Because there just aren’t enough kits. One of the few sources for the viral transport media is in Italy. There goes that supply chain. So when people are being turned away from testing, it’s not because they don’t fit “criteria.” It’s straight-up rationing.

At the very least, all of us health care workers should be screened with a rapid antibody test. If I had it and have already developed antibodies against it, I should be back out there. But right now, some health care workers who are symptomatic and haven’t even been tested are told to come to work anyway if they have no high fever or cough, with their recycled masks in tow. What a joke.

Now, Congress is set to pass a $2 trillion stimulus package that gives over $100 billion to hospitals who helped get us into this mess in the first place…the moral hazard parallels to the financial system bailout of 2008 are stunning.

But it will not last. As I’ve learned from you, truth will always have its reckoning. This health care system has been plundered by an oligarchy, emperors with fancy clothes who, in the name of efficiency, destroyed the redundancies that would make the system antifragile. COVID-19 is showing the emperors to have no clothes. And, just as you portend the end of the 40-year experiment in paper money, the end of the 40-year experiment in “efficiency” medicine is near. It is, indeed, bound to be rocky.

3) Behind it all – behind the rigged games of health care, banking, the stock market, science, education, media, and governance – is what Dr. Marc, a wonderful mentor of mine, calls a global intimacy disorder. We don’t have a shared story. We’ve deconstructed away that shared story so much, we don’t know what it means to be a human anymore. And what it means to be intimate with one another, as human beings.

I won’t get into whether one believes this coronavirus came from the wet market of Wuhan or a biowarfare lab in the US or China. Whichever theory is correct, when you have bats sitting on top of chickens sitting on top of ferrets in cages – or when you have secret agents of the Deep State conducting cold war games, at the expense of the will of everyday people – you have a global intimacy disorder, which births coronavirus.

As beautiful as it is, I’m troubled by Italians resigning themselves to singing across the streets to one another, as they tacitly give away their power to health care and government utilitarians who, because of their inattention to festering systemic wounds, now have to decide who gets to live, and who has to die.

I’m troubled by the namelessness in the numbers we get every day of number of cases and number of deaths around the world, like some public health pinball machine. We can’t hold the pain, so we look away from the unique names of those whom these systems have failed.

I’m troubled by stories like the one of the medical technician in Georgia who apparently had flu-like symptoms, was probably sent home by her workplace, had nobody checking regularly on her as a single mother, and was found dead, probably for many hours, next to her unattended 4-year-old child. Why not put the millions of people sitting at home to work, having them call on the sick and alone, to make sure they’re okay?

I’m troubled by the lip service paid to fact that we’ve learned what the #1 cause of death is around the world. It’s not diabetes, hypertension, heart disease, or even infectious diseases. Those are just what get written on the death certificate. It’s loneliness. Now we’re forced to increase loneliness, to do “social distancing.” A term I hate – because human beings are meant to touch and be touched.  It’s crucial to our health.  Physical distancing is one thing, but true social distancing will be the death knell of humanity.

I’m troubled by a health care system that cares little about promoting the fundamentals of good health including clean food from rich soils, clean water, clean air, and the sunlight that makes all life on earth possible, while it makes billions of dollars papering over chronic conditions like diabetes, hypertension, and heart disease. Largely preventable conditions that are now the doorways open for coronavirus to step in and kill us. And now that system needs an emergency bailout to prop up business as usual, as it collapses every other societal system with it?  [A situation Dr. Shiva Ayyadurai, the founder of Systems Health, has been railing against.]

I’m troubled by my fellow colleagues in medicine who have chosen to allow the Borg to absorb them – and with them the heart and soul of medicine itself, the sacred relationship between patient and doctor – only to now wring their hands with passive-aggressive anger as they find the Borg isn’t really interested in keeping them safe from harm. Where there is no intimacy, there is no care.

All that said, I am ever the optimist. You’ve proven it yet again for me, Tom. As much as I’ve enjoyed it, the most powerful thing you’ve shared with us in your postcards isn’t the Dow-to-Gold ratio. It’s not the inner workings of the repo market. It’s not the ballooning balance sheet of the Fed. It’s not the unraveling of the paper-money experiment. It’s not even your vagabond train-hopping.

The most powerful, and heartwarming, thing you’ve shared with us is the evolution of intimacy. In yourself, on the heels of suicidal depression. In the relationship with your ex-wife-soon-to-be-wife, Kate, the rock of your family. And in the bonds you reforged with your precious kids, Dusty, Miles, and Penny. You discovered that you were always intimately connected to them. You were never alone.

The evolution of love is the story you share, the shared story for us all. It’s the golden thread you weave through all of “Postcards from the Fringe.” That’s the golden thread that attracts us, that wants us to keep reading you, that uplifts you when you hear from us.  That golden thread weaves its way through the entire universe.  I feel it, as a physician, and as a human being when I’m intimate with our shared humanity.  And it’s worth more than all the gold in the world.

Thank you for inspiring me to write to you. It’s somewhat long, but I know you and Kate read every letter you receive. I also know that you’re worried about your mother and father. I will pray that they will get through this mess fine. They certainly deserve more than what the UK National Health Service and American health care system offer them. I, with help from dear friends along the way, will do everything in my power to make it so – to see to it that our system of caring for the health of one another is worthy of them…of you and Kate…and of your kids and mine.

Warm regards,

Venu Julapalli, M.D.