This question preoccupies me and maybe yours as well: Is the US healthcare system expensive, complicated, dysfunctional or broken? The simple answer is yes to all. Below are 10 of the most compelling arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry developed in the United States just to help people tackle the insanely complex task of choosing health insurance.
The cost is enormous
- High cost, not the highest quality. Although the US spends far more on healthcare than other high-income countries, performs poorly on many important health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all of this cost Satisfaction with the current health system is relatively low in the USA.
- Financial burden. High costs combined with a high number of under or uninsured people mean that many people are at risk of bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your health options – or even know what a bill to expect. And even if you ask a lot of questions in advance and stick to the doctors recommended by your health insurance network, it can happen that you get a surprising bill. My neighbor did it after knee surgery: even though the hospital and its surgeon were in their insurance network, the anesthetist wasn’t there.
Access is uneven
- Employment-linked health insurance. During the Second World War, Health care was offered to attract workers since employers hardly had any other options. Few people were privately insured back then, but today being laid off can jeopardize your access to health care.
- Differences in healthcare. The current US healthcare system has a cruel tendency to delay or deny quality care to those who need it most but who can least afford the high costs. This contributes to avoidable Health inequalities for colored people and other disadvantaged groups.
- Health insurers can discourage care to keep costs down. Many health insurers restrict expensive drugs, tests, and other services by refusing coverage until forms are filled out to justify the service to the insurer. While this can avoid unnecessary spending on the health system – and on the insurance company. But it also advises against the care deemed appropriate from your doctor.
This can lead to short-sighted decisions. For example, if drugs are prescribed for rheumatoid arthritis, coverage may be denied unless a cheaper drug is prescribed, even if it has little chance of effect. A survey (Note: automatic download) found that 78% of doctors reported that this caused people to give up recommended treatments; 92% felt it contributed to delays in supply. And since expensive drugs can prevent future knee or hip replacements, delaying them can ultimately be more costly to insurance plans and patients, while also adding to suffering.
Investments in health care seem misguided
- Emphasis on technology and special care. Our system focuses on disease, specialty care and technology rather than prevention. During my medical training, I received relatively little instruction in nutrition, exercise, mental health, and basic care, but I devoted a lot of time to inpatient care, intensive care units, and sub-areas such as cardiology and gastroenterology. Doctors who practice in specialties where technology abounds (think anesthesiology, cardiology, or surgery) usually have a much higher income than those in primary care.
- Overemphasis on procedures and drugs. Here is an example: A cortisone injection for tendinitis in the ankle is usually covered by health insurance. It doesn’t have to be a shoe insert that could work just as well.
- Stifling innovation. Payment structures for private or state health insurances can stifle innovative health services. At-home treatments such as Elderly care and Cancer treatment, be cost effective and preferred by patients. However, because current payment systems do not routinely cover this maintenance, these innovative approaches may never catch on. Telemedicine, which could bring millions of people with poor access to medical care, was relatively rare before the pandemic, in part due to the lack of insurance coverage. And yet, Telemedicine is flourishing necessary to demonstrate how effective it can be.
- Fragmented care. A hallmark of the U.S. health care system is that people tend to be treated in a variety of settings that may have little or no connection to one another. This can lead to duplicate treatment, poor coordination of services, and higher costs. A doctor may prescribe a medicine that may have dangerous interactions with other medicines that the person is taking. Medications that were prescribed years earlier by a doctor who no longer cares for a person can be continued indefinitely because other doctors do not know why they were started. Doctors often repeat blood tests that have already been done elsewhere because the results of previous tests are not readily available.
- Defense medicine. Medical care, offered primarily to minimize the likelihood of legal action, increases costs, provides little or no benefit, and can even affect the quality of care. Malpractice lawsuits are so widespread in the United States that for doctors in certain specialties, the issue is not if, but when to be sued. Although it is at least difficult to measure how great the effect of defense medicine is a study suggests that it is not small.
Not an easy solution
Even insured Americans spend more out of pocket on their health care than people in most other wealthy nations. Some buy drugs from other countries where the prices are much lower. The status quo may be acceptable to health insurers, drug companies, and some health care providers who are amply rewarded with it, but our current health system is not sustainable (Note: automatic download).
Other countries have approached health care very differently, including payers, state systems, or a mix of private and public offerings. Perhaps some of the most successful can serve as role models. But with so much at stake and well-funded lobby groups of competing interests ready to fight, it is far from clear whether our healthcare system can be reformed anytime soon.
I haven’t met many patients who think our current health system is great. In fact, I don’t know anyone who would design the system we currently have – well, except for those who benefit from it.
The question for the future is whether there is the confidence, will, and vision that it takes to create something better. It won’t be easy, but the alternative – keep complaining while waiting for the system to implode – is unacceptable.
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