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Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

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Adapted from OECD; Chart: Naema Ahmed/Axios

The shortage of hospital beds in the U.S. didn't happen by accident. It's a result of both market pressures and public policy.

Why it matters: The bed shortage is one of many factors complicating America's response to the new coronavirus. But if we want to have more beds and critical equipment on hand for the next pandemic, the government will need to make it happen — and pay for it.

By the numbers: The U.S. has 2.8 hospital beds per 1,000 people, far fewer than other developed countries.

How it happened: Health care resources, including hospital beds, are allocated mainly by market dynamics, not public-health blueprints. 

  • Over the last 50 years, a great deal of care has shifted away from inpatient hospital settings and into outpatient services. 
  • The motivation was to help control costs and improve the quality of care, while making it more convenient for patients.

Government also worked to directly cut the number of U.S. hospital beds, believing in a rule called Roemer's Law, which said that "a hospital bed built would be a hospital bed filled," driving up costs.

  • The push to reduce beds was embodied in a 1974 law that set up a health planning system in every state. A central objective was to get the U.S. below three hospital beds per 1,000 people, the level many think is now too low today.
  • And though it was repealed under President Ronald Reagan, the broader push to reduce capacity continued in many states.

The bottom line: If we want to have surge capacity of hospital beds and equipment in place for the next crisis, and if we don’t want to push health care costs higher, hospitals will need to acquire extra beds and then leave that surge capacity largely unused until the next crisis.

  • That means Congress would have to dictate that capacity by law, decide which hospitals to put it in, and fund it, while increasing the strategic stockpile of equipment like ventilators, masks and other protective equipment at the same time.

Go deeper

Why migrants are fleeing their homes for the U.S.

Illustration: Eniola Odetunde/Axios Photo: Herika Martinez /Getty Images 

Natural disasters in Central America, economic devastation, gang wars, political oppression, and a new administration are all driving the sharp rise in U.S.-Mexico border crossings — a budding crisis for President Biden.

Why it matters: Migration flows are complex and quickly politicized. Biden's policies are likely sending signals that are encouraging the surge — but that's only a small reason it's happening.

Cities' pandemic struggle to balance homelessness and public safety

Illustration: Sarah Grillo/Axios

Addressing homelessness has taken on new urgency in cities across the country over the past year, as officials grapple with a growing unhoused population and the need to preserve public safety during the coronavirus pandemic.

Why it matters: It’s led to tension when cities move in to clear encampments — often for health and safety reasons — causing some to rethink the role of law enforcement when interacting with people experiencing homelessness.

Biden to sign voting rights order to mark "Bloody Sunday" anniversary

President Biden will sign an executive order today, on the 56th anniversary of "Bloody Sunday," meant to promote voting rights, according to an administration official.

Why it matters: The executive order comes as Democrats face an uphill battle to pass a sweeping election bill meant, in part, to combat a growing number of proposals introduced by Republicans at the state level that would restrict voter access.

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