America has become accustomed to talking about what divides us. We debate taxes and tariffs, immigration and education, healthcare and climate change. Cable television reminds us what separates us. Social media rewards us for disagreeing more loudly than yesterday. Yet, beneath those disagreements lies something quietly remarkable.
Some experiences strip away nearly every political label we wear. One begins with a phone call in the middle of the night: A husband develops crushing chest pain, a daughter is rushed to an emergency department after a car crash, or a mother hears the word every family fears: cancer. In those moments, yesterday’s arguments suddenly become distant.
Fear has no political party. Neither do hope and love. When someone we love becomes ill, nearly every person wants the same things: timely, safe care, clinicians with the time and support to provide it, and the confidence that if something goes wrong, someone will notice. Imagine two members of Congress recovering in neighboring hospital beds, one Republican and one Democrat. Only hours earlier, they may have been debating healthcare legislation from opposite sides of the aisle. Now neither asks how the nurse voted, whether the surgeon supported the last presidential candidate, or whether the respiratory therapist watches Fox News or MSNBC. They ask the questions every patient asks: “When will the doctor be back?” “Why am I still waiting?” “Am I going to be all right?”
A hospital bed has no political party, and neither do the patients that need it. Disease does not ask how someone voted. Cancer does not distinguish between conservatives and liberals. A heart attack ignores ideology. Safe healthcare should, too. That does not make politics unimportant. Decisions made in Washington profoundly influence healthcare. But before healthcare becomes a political issue, it is a human experience. Instead of asking which party has the better plan, we can ask: What would we want if the patient were someone we loved? Surely people of every persuasion can agree on the destination: Every patient deserves timely, safe, compassionate care; every clinician deserves a working environment that makes excellent care easier rather than harder; and every taxpayer deserves a system that achieves those goals responsibly. These are not Republican or Democratic aspirations. They are American aspirations.
If we agree on the destination, evidence can help us choose the route. During more than a quarter-century studying hospital operations, I came to appreciate something most patients never see. Almost every person enters a hospital through one of two doors. One is scheduled: surgery planned for weeks or months. The other comes without warning: a frightening symptom, a fall, a child struggling to breathe, or an elderly parent whose condition suddenly deteriorates. One door is predictable. The other is not. Yet patients entering through both depend on the same beds, nurses, operating rooms, and intensive care units. Patients compare hospital rankings, search for the best surgeons, and ask friends for recommendations. Rarely do they ask what operational condition the hospital will be in that day. Outstanding clinicians do not work in isolation. They work within systems. Those systems can amplify clinical excellence or quietly undermine it.
Much of the strain hospitals call unpredictable is actually created by how they schedule predictable work. Elective surgeries and admissions are often concentrated on particular weekdays, typically at the beginning of the week, producing peaks in demand for beds, nurses, and intensive care. At those peaks, emergency patients board in hallways, nurses carry unsafe workloads, urgent operations wait, and scheduled procedures are canceled. Days later, some of the same resources are underused. Hospitals can reduce this artificial variability by smoothing elective admissions: distributing planned cases more evenly according to the hospital’s actual capacity. Smoothing does not mean performing fewer surgeries, rationing care, or giving emergency patients priority at the expense of everyone else. It means organizing scheduled work so that both scheduled and unscheduled patients can receive timely care.
The results are not theoretical. By using its existing beds, operating rooms, and staff more effectively, Cincinnati Children’s generated more than $137 million in additional annual revenue from increased patient throughput while avoiding more than $100 million in capital expansion.
The Ottawa Hospital reported that after redesigning surgical flow, mortality among patients requiring urgent surgery fell from 3.9% to 3%, representing about 40 lives in one year, while the hospital achieved $9 million in efficiency gains. At Boston Medical Center, redesigning the surgical schedule was associated with a 99% reduction in postponed or canceled operations, lower nursing demands, shorter waits for admitted emergency patients, and multimillion-dollar margin improvement.
WASHINGTON’S $200 BILLION HEALTHCARE BLIND SPOT
The problem is not a lack of evidence, but the absence of a national mechanism for turning individual hospitals’ achievements into standard practice. Nationally, this would mean reducing the U.S. healthcare costs by over $200 billion annually. CMS could help create that mechanism: by sponsoring demonstration projects, publishing results, and rewarding hospitals that reduce unnecessary congestion while simultaneously improving quality or access. Hospitals that have already succeeded could help mentor participating institutions. This could all be done without waiting for major legislation.
This is not a Republican solution or a Democratic one. It does not require Congress to appropriate billions of dollars, or patients to accept less care. It requires hospital leaders to examine how predictable work is organized and to act on evidence. The view from Capitol Hill is intrinsically broad: budgets, elections, legislation, and the responsibility of governing a nation. The view from a hospital room is different: frightened patients, anxious spouses, exhausted nurses, dedicated physicians, and families hoping someone they love will come home. Every healthcare debate should begin by looking through both.
Eugene Litvak is the president and CEO of the nonprofit Institute for Healthcare Optimization and an adjunct professor at the Harvard T.H. Chan School of Public Health.