Our healthcare system is crashing. Congress must stabilize it.

When a patient is unstable and hemorrhaging, before we do anything else, we have to find a way to stop the bleeding and stabilize the patient. That is always the first step.

I spent more than two decades doing this as a pulmonary and critical care physician. Now, as a member of Congress, I am watching our healthcare system in freefall. Washington keeps responding as though there is time to spare. There is not.

Two forces are combining to push of our already-precarious healthcare system off a cliff. First, the Republican-controlled Congress and White House. Their multibillion-dollar cuts to Medicaid and their refusal to extend the enhanced Affordable Care Act tax credits have pushed more than 8 million people off their healthcare insurance. In Oregon’s 3rd District alone, an estimated 29,466 people could lose coverage. Second, the rapid consolidation of healthcare is placing more hospitals, physician practices, nursing homes, and community clinics under the control of large, profit-driven corporations.

These trends directly aggravate one another.

When Congress cuts Medicaid and chronically underinvests in affordable health coverage, clinicians lose essential revenue sources and are forced to care for more people with fewer resources. Some healthcare providers will close practices permanently, leaving communities without care. Others will be forced to sell to keep their doors open. Increasingly, those buyers are large, profit-driven healthcare corporations that view healthcare delivery as another stream of revenue. As independent providers disappear, local communities lose control over their healthcare, and patients are left navigating systems designed to maximize profit margins instead of meeting medical needs.

Consider Hahnemann University Hospital in Philadelphia, a 171-year-old institution that primarily served low-income patients and communities of color. In 2018, a private equity investor bought the hospital, failed to deliver on its promise to improve conditions, and closed less than two years later , selling the real estate for redevelopment. A registered nurse who had worked at Hahnemann for 17 years said the new owner seemed to have intended all along to buy the place, let it fail, and shut it down.

As a critical care physician, I know that a crisis rarely begins at the moment a patient arrives in the unit. By then, the warning signs have been building for hours, days, or years. The same is true of our healthcare system. If we wait too long to act, the damage will be impossible to reverse.

To stabilize the healthcare industry, we must treat healthcare delivery itself as essential national infrastructure. The interstate highway system was not built to maximize quarterly returns. It was built because the country understood reliable roads and bridges connect communities and expand opportunity. Their value cannot be measured solely by the revenue they generate or the returns they deliver to investors. We have never applied that same thinking to the places where our communities are born, healed, and cared for at the end of their lives. That is a profound failure.

The healthcare debate in Washington has rightly focused on expanding health insurance coverage to those who need it. That work must continue. But insurance is only meaningful if there is a clinician there to deliver care, a neighborhood clinic accepting new patients, a pharmacy that hasn’t closed its doors, and a healthcare workforce large and varied enough to meet the needs of the community. Preserving and expanding coverage must go hand-in-hand with stabilizing the places where people receive care and investing in the professionals who make that care possible.

For months, I have convened a healthcare working group of experts, physicians and advocates to develop a path forward. Our solutions are grounded in an idea that should not be radical: the delivery of healthcare is infrastructure, as critical as roads, bridges and clean water.

There is precedent for leveraging federal dollars to support critical healthcare infrastructure. In 1946, Congress passed legislation to fund hospital improvements because the country recognized access to care was a national priority, not merely a business opportunity. We should meet this moment with the same ambition. As financially strained hospitals and clinics seek lifelines, our goal cannot simply be to stabilize balance sheets so they can be absorbed by ever-larger healthcare conglomerates.

Public investment should preserve these institutions as community assets, with accountability to the people they serve rather than to investors. Today, public hospitals make up only 15 percent of the nation’s hospitals but a disproportionate share of our nation’s Level I trauma centers, often operating on tighter budgets than their private counterparts.

We are at a too-big-to-fail moment. Congress can continue to stand by, allowing private equity and corporations to buy up the healthcare system, with all the baggage that comes with their top priority being profits instead of patients. Or we can recognize healthcare is infrastructure and publicly invest in a system designed to serve people for generations. That is the choice before us.

In the intensive care unit, every second matters once a patient is crashing. As a country, we are past the point of pretending we have time to spare. Stop the bleeding and stabilize the system — then build it to last.

Maxine Dexter represents Oregon’s 3rd District in the U.S. House of Representatives.