WASHINGTON -- As hospitals, doctors and state and local governments race for masks, ventilators and other medical supplies with little coordination by the Trump administration, the well-connected are often getting to the front of the line.
An outpouring of corporate and philanthropic support has funneled badly needed supplies to combat the coronavirus to well-known institutions such as Cedars-Sinai and UCLA medical centers in Los Angeles and the University of California, San Francisco Medical Center.
But in the absence of an overall nationwide distribution plan, many smaller hospitals, nursing homes and physicians are being left behind, especially those who lack relationships with suppliers, ties to wealthy donors or the money to buy scarce equipment at a time when prices on the open market are skyrocketing.
"It's frequently all about who knows someone who knows someone who can get hold of this or that supply," said Dr. Alex Billioux, public health director in Louisiana, which is battling one of the nation's most aggressive coronavirus outbreaks.
"That unfortunately means supplies aren't always equitably distributed," Billioux added. The state often finds itself competing not just with other states but with its own medical centers, he said.
The competition for scarce supplies threatens to deepen inequalities in the nation's health care system, putting Americans who live in more isolated regions of the country at highest risk.
The federal government has authority to manage the acquisition and distribution of medical supplies in a national emergency. President Donald Trump hasn't used that power.
Rather than direct federal agencies to establish a nationwide system, the White House has largely deferred to medical distribution companies, commercial suppliers and the generosity of manufacturers and charities to fill the gaps.
Many companies have stepped forward, including tech giants, automakers and others. But private companies don't have to report where they send supplies or how they determine who gets assistance.
A spokesperson for Apple, for example, refused to provide any details about the company's plans to distribute 10 million masks that Chief Executive Tim Cook said Apple secured.