Can We Fix Our ‘Broken’ Health Care System?

Regarding healthcare in the United States, it is truly “the best of times, and the worst of times.”

This awkward paraphrase of one of Dickens’ most famous lines most colorfully conveys this paradox:

While the US has the best doctors and hospitals in the world, many Americans cannot afford to access the advances of modern medicine because of a lack of basic health insurance. The United States is the only nation in the world that does not provide health coverage for all its citizens… and our health is suffering because of this.

The US spends nearly $12,000 per person per year on health care… the most of any nation in the world…more than $4,000 more than the “runner-up” (Switzerland).  Yet, we perform quite poorly when it comes to basic health metrics.  Life expectancy is several years below that of other G20 nations, and infant mortality is significantly higher.  Pharmaceutical companies tout their latest products with pervasive direct-to-consumer advertising (allowed, by the way, only in the United States and New Zealand). Still, these new wonder drugs are unaffordable to most. Many individuals have to decide whether to purchase their blood pressure or diabetes medication or use that money to put food on the table.  How did we get here?

Third-party health coverage became popular after World War II when post-war prosperity led to a period of high inflation.  Because wages and prices were frozen for a period of time, workers were offered the “perq” of health coverage by their employers in place of an increase in take-home pay…hence the genesis of employer-sponsored health insurance coverage.  Most Americans under age 65 have historically procured health insurance in this fashion, financed through third parties such as Blue Cross or other major commercial carriers.

However, we no longer live in the United States of the 1950s and remain in the same job or company, for “life” is much less common today than in mid-twentieth century America.  Increasingly, people are working via contracts or other adjunct arrangements such that they are not provided health insurance through an employer.

When one loses or changes jobs, one loses health insurance (employer-provided).  The COVID pandemic brought this issue into high relief!  Today, some 30 million Americans are uninsured, and millions more are “under-insured” – meaning that though they might nominally have health coverage, their plans require such high co-pays or deductibles that they must pay a large share of their health care costs out of pocket. This state of affairs is unique to the United States.

Health care “under-insurance” exists nowhere else in the world.  In fact, healthcare debt is the principal cause of personal bankruptcy.  We must face the unfortunate truth that each of us could be one illness or serious injury away from… not only a personal health crisis, but financial ruin in the process.  Isn’t the primary purpose of insurance to protect finances in the event of a catastrophic occurrence?  Not when it comes to health…

Commercial health insurance carriers are now large for-profit financial behemoths traded on US stock exchanges.  Their primary allegiance is to their shareholders, not the beneficiaries they serve. This creates an inherent conflict of interest.   For largely this reason, the slogan “patients over profits” has become a rallying cry for many health professionals.

It must also be emphasized that health care in the U.S. is extremely expensive.  For example, an MRI costs 3 to 5 times as much in the U.S. as in comparable G7 countries.  We also condone a large amount of administrative “bloat.”  Too many middlemen come between health professionals and the patients they care for.

What is to be done?  I don’t profess to have all of the answers, but I do have several suggestions:

– Uncouple health insurance from one’s employment.  Each American should be able to purchase, or otherwise acquire, affordable health insurance independently of how they earn their living.  Though no one can be forced to carry health insurance, it should be made so affordable and easy to procure that few would even think of doing without it.  Individual freedom would increase since no individual would need to stay at an unsatisfying job because  “I need health insurance.”  Our corporations would no longer have to factor in the cost of employee health care when pricing goods and services, improving our competitiveness in global markets.  Insurance functions best when the “risk pool is large.”  WE NEED EVERYBODY IN, NOBODY OUT!

– Health care must be carved out of the profit-driven marketplace.  It is an essential service…. every bit as important as reliable mail delivery, electric power, and potable drinking water.  It is not a commodity that people can shop for, like a new car or smartphone.  If private health insurers continue to operate, they must compete on customer service, not price.  They must operate transparently under the authority of the Federal Government.  Perhaps they should function as the airlines did before the age of de-regulation.

– The delivery of health services must be streamlined.  Remove administrative burdens that so annoy physicians (a significant cause of “burnout”).  Redesign our electronic health records to make them more useful for patient care, not billing.  There is no reason why we cannot develop a single standard health record that is secure, portable, and accessible as needed to every physician and hospital in the nation.

Much of the above can be accomplished by moving toward some form of single-payer health insurance. All countries (save for the U.S.) make the provision of health care for their citizenry a priority.  Why don’t we?

I know there are many questions:  How will we pay for it?  Who will run it?  Will physician income and the incomes of other health professionals suffer?  How much will taxes have to go up?  How do we get there from here?

Yes, there are problems, but providing health care to all Americans is morally right and makes economic sense.  It will not happen without hurdles, potholes, and even the occasional storm, but we must move toward that goal.  Our collective health and well-being depend on making drastic changes to transform our nation’s healthcare delivery.

Originally posted Written by Dr. Lloyd Alterman.

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