Despite its proven effectiveness and Eugene Litvak’s promotion, smoothing is used in only 6% of U.S. hospitals and was dismantled at BMC, where it succeeded. The issue lies in misaligned hospital financial incentives, which prioritize revenue over vulnerable populations and emergency care.

While the expansion of MGB may have driven up costs, so has post COVID inflation. Existing regulation has already been curtailing expansion for more than 20 years. One result has been disaster-level ED crowding from inadequate inpatient beds for emergency conditions. Healthcare reform is needed.

The collapse of Steward, months-long waits for primary care, catastrophic ED crowding, mediocre population health KPI‘s and exorbitant per capita US healthcare costs—double that of the next priciest country—prove it: treating healthcare as a for profit business is a failed strategy.

Totally agree. The term “ED crowding” minimizes the systemic issue. It’s really a resource gap for emergency care or hospital overcrowding. The demand is predictable, driven by social factors, but if funding and accountability were in place, this symptom wouldn’t exist.

ED crowding isn’t due to performance inefficiencies but lack of regulatory oversight. Joint Commission fails to enforce standards, allowing institutions to prioritize profits over safety, ration care for vulnerable populations, and allowing severe crowding to steadily worsen.