Sadly, it has evolved into a highly corporatized system controlled by a decreasing number of increasingly powerful conglomerates where profit is often the main metric of performance and success. The stark realities of this dark devolution create daily difficulties for patients trapped in this harsh and inequitable system.
A frequent, disturbing type of patient encounter during my practice highlights the essence of this decay. Often when suggesting the need for a particular surgery to a patient they would rarely ask the most obvious and important questions such as: “Will I have significant pain? Is it dangerous? Can I die?”
Instead, they more commonly asked: “How can I pay for this? Will I lose my house or my job? How fast can I get back to work?,” followed, all too frequently, by comments like: “There is no way I can afford this. I don’t have access to that level of deductible. This will bankrupt me.” And, periodically, they would come to this decision: “I just can’t proceed, doctor. This will put my family in the street. I’ll just tough it out and take my chances.”
There is something deeply and fundamentally wrong with this increasingly common situation where the accessibility of healthcare, which I believe should be a basic human right, is determined by one’s financial station in life. For this to be occurring in the most affluent country in the world is not just wrong, but in my opinion, abjectly amoral.
It is as true today as it was 50 years ago when Martin Luther King Jr., so rightly said: “…of all forms of inequality, injustice in health is the most shocking and inhumane.”1 Unfortunately, these inequities in access to care are a demonstrable result of our current broken and failed healthcare system.
Unsustainable and irresponsible political promises, unrealistic patient expectations, as well as corporate and individual greed have created this flawed system—one that is too expensive and costs twice that per capita compared to the rest of Western world.2
This system leaves too many people out resulting in 26 million uninsured and 43 million underinsured.3 In fact, recent World Health Organization metrics suggest that the US does an incredibly poor job with healthcare delivery, with the US ranked 37th overall to comparable Western country metrics and last among the 11 highest-income countries.4 These rankings are not surprising when you consider the fact that the US healthcare delivery system consumes 17% of our current gross domestic product and is the leading cause of personal bankruptcy accounting for 66.5% of total US individual monetary defaults.5,6
Placing Profits over Patient Care
The US healthcare system handicaps business competitiveness with a crippling 160% increase in employer healthcare costs in the last 20 years, which averages about $14,000 per employee.7 This system also causes downward pressure on employee wages resulting in a 8.9% inflation adjusted decrease in employee household income.8 In addition, it requires many Americans and their families to line up in fields for humanitarian healthcare events mirroring the activities of many third-world countries as well as requiring increasing numbers of citizens to use the ER as their default medical care.
This default is fragmented, costly, inefficient, and a generally poor method of providing care with a total lack of continuity. This healthcare model also drives significant racial disparities in the availability and quality of care, and in the outcomes for these patient populations.
Currently the US, compared to similar Western countries, has the lowest life expectancy at birth, highest reported maternal and infant mortality, highest hospitalization rate from preventable causes, highest death rate for avoidable and treatable conditions, highest suicide rate, and highest chronic disease burden rate in the world.9
In essence, we are spending more than any other civilized country in the world and getting markedly worse results. No other known industry in a competitive or many noncompetitive societies could survive by being twice as expensive while producing markedly inferior products, services, and results.
Over the past several decades, many inadequate policies, negative influencers, and societal and demographic changes have come together to create our current failing healthcare system.
Our system lacks an emphasis on primary and preventive care. We strain under a dysfunctional payment system. It is plagued by a costly and onerous liability industry, and it has fallen prey to the detrimental policies of the medical industrial complex and corporatized care.
Our system struggles to care for an exploding aging demographic. It is threatened by a significant impending shortage and maldistribution of providers. Our politicians and citizens refuse to maturely engage on a solution to the looming financially threatening entitlement crisis. We have irresponsibly significantly underfunded our public and mental health systems.
Finally, we have tolerated a general lack of accountability for much of our population as it pertains to medical compliance and irresponsible behaviors such as overeating and sedentary lifestyles, as well as cigarette, alcohol, and drug abuse.
These and many other events, policies, and forces have created the broken dysfunctional system of American healthcare. A system that is so badly flawed that most experts believe it will likely implode, creating devastating effects on our country's health and economy. As a nation, we cannot and should not continue to support or tolerate a system that threatens the quality, safety, accessibility, and affordability of its citizens’ healthcare.
To successfully meet the many requirements and challenges to achieve inclusive and affordable national wellness, we are going to have to radically reform the current failing system.
