How did American healthcare go so wrong?

We all have bad weeks. Mine recently amazed me at the amazing dysfunction of our healthcare system. In calling the System, I intend no disrespect to the talented and heroic high achievers in nursing, pharmacy, medicine and other providers who fight against the System every day on behalf of our patients.

Despite these efforts, the sad but undeniable fact is that our health care system – the way the US distributes and pays for health care – makes it the costliest failed enterprise in the history of human civilization.

Part of what excited me this week was a series of examples of my patients’ chronic struggles to access mental health services. After years of poor financing and a flood of inquiries since the pandemic began, providers are in short supply. Scarcity is coupled with barriers imposed by insurance networks. Without adequate access to services, GPs like me become psychiatrists of first and last resort, pushing the limits of our competence. But what else can we do?

A second part of the week was the latest obstacles to drug therapy. The cost of so many drugs is so high that even insured patients are struggling. Take Ozempic. There’s no generic, and it’s a financial drain at almost $900 a month, but it’s helping my diabetics — until last week when they couldn’t find it. Why? Because of its newly recognized use for weight loss. It’s suddenly so popular that pharmacies are running out. How can a system allow wealthy individuals looking to shed a few pounds to use their money to sideline diabetics who actually need the drug?

A third glaring failure of our healthcare system that looms in the background every week for doctors like me is hospital funding. Hospitals have survived for years by charging commercial insurers high fees to subsidize losses from treating Medicaid and Medicare patients. With the cost of care rising and a shift towards patients with government plans and away from private insurance, even the most respected and well-run hospitals, both locally and nationally, are facing an emerging tide of red ink. Many cut costs drastically to maintain solvency. In a rational system, the revenues that support critical facilities like hospitals would not face constant financial crises.

These are just a few examples of how the failure of the US healthcare system is now weighing on doctors. Here’s something else that should haunt every American: The cost of this failing system challenges understanding. For comparison, World War II appropriately set the benchmark for unbridled public spending, when the US government invested almost $6 trillion (in current US dollars) in the military from 1940 to 1945. We now spend more than $4 trillion on healthcare every year. What do we get for this incredible sum? Statistics from the Organization for Economic Co-operation and Development tell an embarrassing story. On critical rankings such as life expectancy at birth and deaths from preventable diseases, the US ranked bottom.

Why has the US, the world leader in drug and health technology, fallen so far behind? The answer is that the system stopped serving the public a long time ago. It serves the needs of those who benefit from healthcare. Powerful lobbies representing insurance companies, pharmaceutical companies, medical associations and others are blocking meaningful reforms.

The biggest hurdle is the insurance industry. Administrative overheads are about 17% of revenue, compared to Medicare, which spends only 2% of operating expenses on administration. If a federal payer system — like Medicare for All — saved even 10% of what insurers waste on administration, the additional billions could revolutionize care. This sum could expand psychiatric care, subsidize access to medicines and stabilize hospital financing.

As we pay more and more for substandard care, increased attention is inevitably drawn to the system’s glaring weaknesses, particularly administrative waste. Overcoming the special interests and solving the problems will not prove to be an easy task. The inertia of our political system required the Depression to legislate Social Security. Improving access to insurance through the Affordable Care Act required an influx of law reformers inspired by the 2008 financial crisis.

I’m not sure what national disaster it will take to break the status quo this time, but American healthcare failures are certainly increasing. When inevitable major reform finally comes, those like me who make our living in healthcare deserve a contribution. But the patients who pay the bills and live and die in our system deserve changes that would prioritize compassion over profit.

How did American healthcare go so wrong?

Leave a Reply

Your email address will not be published. Required fields are marked *

Scroll to top