There isn’t a textbook definition of “collapsed health care system.” But it can be framed through a related concept in global health, defined by the World Health Organization: health systems resilience. Thought of as bulwark against collapse, resilience describes the ability of a health system to absorb shocks and adapt while delivering core services. That is, during a big disaster, a functioning health care system can take care of the wounded, as well as patients with the assorted health emergencies that pop up in regular life, alongside those who need routine preventative care. In terms of resilience, our system over the past year has not passed muster. Last year, it quickly became clear that we didn’t have a contingency plan for a prolonged disaster like a pandemic. During the first year of the pandemic, utilization of routine preventive care—like childhood immunizations and colon cancer screening—plummeted while our health system was overwhelmed with COVID. Nearly half of all patients, according to data from a large survey, forewent medical care, following the implications of public health messaging at the beginning of the pandemic to stay home unless there was an emergency (even though hospitals proved an unlikely place to catch COVID). The number of excess deaths during the pandemic in the United States is estimated to be more than 900,000. If America’s health care system might in normal times be too expensive for many to access and, for some, difficult to trust, the pandemic made things terrifically worse. Health care workers, lacking the support needed to function at such a grueling pace for so long, are voting with their feet. Nurses, fed up with working in a dysfunctional system, are quitting their jobs in droves, while an uptick of doctors are retiring early or following other health care workers to the exits.

I don’t blame voices in media and in public health from hedging their descriptions of where our health systems have stood throughout the pandemic. COVID has been unpredictable. No one wants to cry wolf or be wrong. Yet brink and hedge words like it—cusp, verge, threshold—offer us a state of suspended animation between normalcy and a true crisis. Focusing on language so intently may seem pedantic. But there is power in simply stating the truth. It validates the experiences of health care workers on the ground, and those of people who are unable to get adequate health care. In the future, acknowledging that our health system did collapse under the weight of the COVID-19 ultimately sets the stage for comprehensive health reform. It pushes back against any revisionist history that may emerge in the coming years; it’s easy to imagine accounts that conveniently emphasize health care heroes while waving away how flawed our health care system is. Recognizing our failure brazenly could push us to build a system that is more resilient.