Thursday, September 10th, 2026
The 340B discount programme was built so safety-net hospitals could buy drugs cheaply for their own patients. It ran through a single contract pharmacy in 1995 and through 32,528 of them by 2024. Two bills now in Congress propose opposite explanations for how that happened.
Hospitals across the state have agreed to stop turning ambulances away when the emergency department fills up. Diversion was never extra capacity. It was a way of moving a full department's problem onto the ambulance and the patient inside it.
A hospital can substitute a drug, a surgeon and a shift. It usually cannot substitute the single-source device a procedure was built around, and nobody notices which items those are until one of them stops arriving.
Assaults on hospital workers are frequent enough that security has become a standing cost, and the spending competes directly with the staffing whose absence contributes to the problem.
Imaging systems and infusion pumps are capital assets depreciated over a decade or more, running software the manufacturer stops supporting long before the hardware wears out.
![14-1011-039 print 8x10 b&w "D" Ward, US Naval Hospital, Quantico, VA. [Ward][Nurses][Corpsmen][Patients] Navy Medicine Historical Files Collection - Facilities](/assets/photos/travel-nursing-permanent-1600w.jpg)
Hospitals brought in contract nurses to cover a crisis and have not been able to stop. The rates came down, the dependency did not, and the permanent staff who remain now work beside colleagues paid differently for the same shift.
Obstetric units require staffing around the clock for a volume that cannot pay for it. Hospitals keeping the lights on elsewhere are shutting maternity first, and the distances patients travel are becoming the clinical problem.