Some Things Should Just Be off the Table: A Deep Dive into American Healthcare
American healthcare has been flawed and dysfunctional for decades, but the COVID-19 pandemic finally brought it to its knees.
Between 1950 and 1955, only 11 nations possessed a life expectancy higher than that of the United States. Contrast this with the UN’s 2020 report on global life expectancy where the US ranked a disappointing 37th, behind countries like Barbados and Costa Rica. More troublingly, since 2017, the life expectancy of the average American has been in outright decline. This has been attributed to an increase in the death rate among middle-aged Americans. But how is such a thing possible in the world’s richest nation? Is it because of growing obesity, alcoholism, an increase in rate of suicide and drug use, or in other words personal dietary, mental and physical health issues which have contributed to the decline? This is the commonly accepted medical consensus, but there is another, more opaque reason for the United States’ poor health performance. If you’ve already faced medical bankruptcy, paid off a mountain of medical debt or have rationed medication, you know what it is.
A Brief History of American Healthcare
The roots of America’s modern healthcare system are visible in the Taft-Hartley Act of 1947. The act was passed during an unprecedented wave of civil disobedience by unions in the aftermath of World War 2 and severely restricted the agency of union workers, who were prohibited from participating in a range of strikes and protests. One of its greatest impacts was tying health insurance to employment, although unions retained their collective bargaining power. Though most working people in the 1950’s and 60’s were able to afford hospital care, the Taft Hartley Act’s provision tying insurance to employment left the elderly population in dire straits. Before the passing of Medicare in 1965, 29% of 65+ Americans lived under the poverty line. But health expenditures overall were far lower, and even before Medicare, 70% of Americans had hospital insurance and 67% had surgical insurance. This was achieved in a much poorer society, where the yearly per-capita healthcare expense was only $147 in 1960 or $1,285 in 2020 dollars. Meanwhile, the OECD put America’s modern per-capita costs at a staggering $11,072 dollars in 2019. Considering we spend nearly 9 times more than Americans did 60 years ago even accounting for inflation and a higher cost of living, you would expect our healthcare to be high-quality and universal.
High quality care? Questionable. Universal and efficient? The opposite. In early March 2020, before the COVID-19 pandemic had exerted its full wrath upon Americans, the Norwegian University of Science and Technology urged Norwegian citizens living in countries with “poorly developed health services” to return home immediately, heeding warnings from the Ministry of Foreign Affairs.
The United States was cited as an example, and this would prove prophetic considering how much COVID has exposed our healthcare system.
5 Horrible Things about American Healthcare
- Tied to Work
Remember how health insurance is tied to employment in the United States? Well, this system immediately falls apart in economic downturns where millions of people are laid off. The United States boasts its ultimate dedication to free-market capitalism, but this system strangles a “free market” in its crib. How is there any job flexibility when your ability to go to the doctor is dependent on where you work and your ability to work?
Not to mention that the clause in the Taft-Hartley Act which sanctions collective bargaining for unions is no longer useful, as only 11% of Americans are members of public or private sector unions as of 2017. With lack of bargaining power, your employer can strip health insurance at a whim, and there’s no guarantee that every job will provide coverage. The Affordable Care Act improved this system by fining large employers who refused to provide health insurance, but there is no legislation which requires it. Even if you wanted to change jobs and found another one with an insurance plan, you would be liable to amass mountains of medical debt in the period of unemployment between jobs. American healthcare essentially chains millions of people to their jobs like serfs to their land. And there is nothing more cruel and inhumane for millions of unemployed workers to risk medical bankruptcy during a raging pandemic and economic calamity.
2. Inefficient and Cumbersome
There’s this myth that privatization immediately makes things more efficient and cost-effective. Looking at the history of American healthcare since the 1970’s, this does not stand up to scrutiny. After Richard Nixon signed the Health Maintenance Organization Act of 1973, relatively modest non-profits like Blue Cross were allowed to become for-profit entities and received federal subsidies. The act was actually intended to curb rising costs of healthcare incurred by national programs like Medicare and Medicaid by easing the burden on the state and subsidizing HMO’s (Health Maintenance Organizations) to act as independent insurance providers. This opened the path for the corporatization and commodification of the medical industry, as state-funded HMO’s dominated the market and wiped out competition from smaller healthcare providers. The efficiency that this system was supposed to create is misleading, as it is extremely diligent in producing profit but woefully inefficient in actually providing care. When profit incentive is created in a system such as healthcare, the goal would be to extract as much money from the patient as possible. And so, billions of dollars every year simply disappear from Americans’ pockets into the void like a huge oil leak. The medical industry is so lucrative for health providers that they are content in maintaining a massive bureaucracy of coders and billers which pinches every last penny for corporations and makes the lives of patients and doctors a living nightmare. This bureaucracy leads to waste on a tremendous scale. A 2019 study by the American Medical Association revealed that 760+ billion dollars was squandered on non-medical occupations like coding and billing. Keep in mind, this system isn’t even universal. Healthcare in the United Kingdom is totally nationalized, universal and incurs a per-capita expense just 42% of what Americans pay. With a public healthcare system, the government also would have been able to conduct a coordinated national response to the pandemic without having to rely on an uneven and messy hodgepodge of insurance providers to get people tested and treated. Private healthcare is overall great for the shareholders but a misery for the ordinary consumer.
3. Kills People
Former Republican Governor of Alaska, Sarah Palin claimed Obamacare exacerbated healthcare rationing and created government death panels to determine which patients should live or die. The sick irony of this statement is that it already happens in our current system. Insurers can decide not to cover procedures for life-threatening ailments if they perceive it to be unprofitable or a bad investment. And there is not an iota of accountability. If a state-run healthcare program was badly run or mismanaged, the public would at least have some leverage on it. That is not the case here. The corporate boardroom would sooner have your loved-one die rather than lose a penny in profits. And they aren’t elected, so you have no control. For all the reactionary critiques of socialized medicine, such as “too much bureaucratic power” or “rationing care,” that already happens in America. Meanwhile, not a single Canadian, Irishman, Frenchman, Spaniard, German, Australian, Englishman, or Italian has to choose between paying for an emergency surgery or making next week’s rent. And not a single person of any of these nationalities must die because they don’t have insurance. It just isn’t a thing in their countries, but it is here. 45,000 Americans a year must pay for a lack of health insurance with their lives.
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If there is any statistic which so solidly corroborates America’s declining life expectancy, it is this one. How many of those deaths could have been prevented if doctors were deciding their treatments rather than corporate death panels?
4. Too Big to Fail
If you disturb even a single block in a huge Jenga tower, the broad repercussions will spread far beyond that single block and could potentially topple the tower. The prime weakness of for-profit healthcare is that it assumes a position akin to a bank during a financial crisis. Like a bank whose failure may lead to economic ruin, health insurance providers and hospitals cannot go under lest they leave millions of Americans uninsured, vulnerable to medical bankruptcy and without medical care. Hospitals and healthcare providers received $175 billion of bailouts in April 2020, as they faced collapse due to lack of income, which is usually generated by elective procedures. The number of hospitals encountering “financial risk” has increased from 1 in 5 to nearly 2 in 3 due to millions of people losing their employment-based insurance plans. You see, this system is literally weaker than a Jenga tower. With a Jenga tower, you can pull out a few blocks and be ok, but when push comes to shove our healthcare system crumbles like a row of dominos. I’m starting to think it was literally set up to most effectively hurt the consumer during a time of crisis.
5. Hugely Unequal
We’re supposed to have the best healthcare in the world, right? Well we do, considering all the rich Europeans and Gulf-state playboys who come here for treatment. All jokes aside, the pandemic has revealed some serious disparities based on the size and location of hospitals. Large hospitals in populated areas have been able to stay afloat as their bigger facilities enable easier isolation of COVID patients, leaving room for more revenue-generating elective surgeries. However, some of the hardest hit hospitals are in rural areas when facilities are smaller and lightly funded. Rural hospitals, already facing financial difficulties have been totally overwhelmed. It’s easy to see how this system is like a tinderbox. If a local hospital shuts down, you go to another hospital which primarily services another area. That hospital is promptly overwhelmed and the death rates go through the roof. This conjecture is sadly backed by data. The rural county of Burleson, TX is currently experiencing one of the country’s highest per-capita death rates, a staggering 230/100,000, nearly 6 times greater than the state average. In fact, the top 32 counties with the highest death rates from COVID-19 are all rural or sparsely populated. There is no incentive for a large hospital chain to set up shop in Burleson county or other rural areas, because they simply don’t pay. The facilities which do get built are lower quality and face much greater difficulty in generating profits. The plight of inner-city hospitals is even worse.
Community safety-net facilities like Chicago’s Mercy Hospital and Medical Center have been forced to shutter not only due to their dire financial situation but because better-funded hospitals in other areas of Chicago have been spiriting away patients who are able to afford better treatment. So when the country is hit with a pandemic and economic disaster, frontline hospitals are some of the first to face collapse. And wherever the medical system breaks down, it brings countless people down with it. This creates what amounts to a permanent underclass of people who lose the ability to stay healthy based on their location and financial situation.
A key reason why we are where we are is because our political spectrum has shifted in such a reactionary direction, although public and universal healthcare is really nothing radical. Every American president from 1933 to 1969 supported some form of a national health system. But a wave of neoliberalism and neoconservatism starting from the 1980’s has sadly left us with one party hesitant to reform this system, and the other flatly opposed to it. President Ronald Reagan once insisted that the 9 scariest words in the English language were “I’m from the government and I’m here to help.” Pure rubbish. Look what universal programs have achieved. The American education system in the 1950’s and 60’s essentially built the most prosperous and wealthy middle class on the planet. Social Security and Medicare have dropped the elderly poverty rate from over 29% in 1966, to less than 9% in 2019, while Medicare has cut the percentage of uninsured elderly from 48% to just 1% in 2016. The United States Postal Service allows isolated communities to get their mail across the country speedily and efficiently with cheap rates. Imagine what we could achieve with Medicare for All. It would lift huge financial burdens off of millions of people, that’s for sure.
The overall message here is for every American to know that they are entitled to healthcare. Yes, entitled. Don’t you want the consolation that you’ll never again have to worry about those medical bills? That you’ll never again hesitate to go to the doctor when those headaches won’t let up? That the kid across the street won’t have to ration insulin anymore? A national health system isn’t just a national health system. It’s dignity, respect, compassion, solidarity, and countless other features of a society which chooses to put the well-being of people over profit. A society which affirms the fact that yes, some things should be off the table.
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