Logistics

February 21, 2021

On January 8, 2011 Jared Lee Loughner brandished a 9mm pistol with a 33-round magazine and opened fire at a Safeway Supermarket near Tucson Arizona. He had purchased ammunition for the firearm that very morning at a nearby Walmart. His first target was US representative Gabby Gifford who was hosting a community political gathering. Gifford was shot through the head and Loughner continued shooting wounding 13 people and killing 6 including a 9 year old girl. Gifford survived but was severely damaged. The next morning a smiling arrest photo of Loughner was published in many American newspapers. The haunting photo and story of Loughner attracted world-wide attention.

The assassin had a long history of substance abuse, bizarre behavior, and skirmishes with law enforcement including running a red light on the way to buy bullets that morning. A personal acquaintance who was attending a World Health Organization meeting at the time of the shooting related a conversation he had heard there. While discussing the horrendous event, a physician from Denmark casually inquired, “who was his family doctor?” The implications of that question have rolled around in my mind for over a decade.

It is not that I think a family doctor could have intervened and somehow stopped the awful attack. My ponderings are more centered on the concept of an organized healthcare system. Denmark’s system is built around primary care. Every citizen has an assigned general doctor and they have a nationalized health services data base. This gives them ability to analyze their nation’s needs. They can plan budgets, respond to person-power shortages and develop health improvement strategies. They can also act efficiently when crises such as pandemics and other natural disasters strike. On January 15, 2021 a Medical Press release reported that Denmark “tops the EU in vaccinations, far ahead of Italy and Slovenia and at a pace almost three times higher than the EU average”.

This is not to say that Denmark does not also have healthcare problems. Their vaccination rate has slowed now because of shortages of available vaccines. The United States is experiencing a “logistical nightmare” delivering vaccines even when there are vaccines awaiting customers in some locations. Some providers have been sanctioned for giving vaccines to anyone handy rather than adhering to the “plan” that might have meant that the precious warming commodity would “go to waste”. A national healthcare information system could give more precise data regarding what vaccine is needed and where. If family doctors could serve as the point of distribution, they might also convince reluctant people to take the vaccine, wear masks and practice social distancing. They could also use the access advantage to address other medical problems and behaviors that impact population health. Personal and community relationships build trust that can surmount some of the barriers better than edicts from an anonymous authority. But that would require a differently organized national healthcare system.      

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