Face It, US Healthcare Sucks. But There’s Still Hope

America is a pretty great country. You may even think it’s the best.

But it’s not.

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I know you’re thinking, “This girl is so unpatriotic,” but I’m not at fault. There’s no denying the statistics. If you look to where the well-being of our people lie, the healthcare system, you’ll see we are nowhere near the top (well, except for health care costs).

Where We Stand

A 2013 survey published by The Commonwealth Fund showed that in comparison to 10 other industrialized nations, the United States fared the worst in terms of health care cost, access, and affordability. For example, 37% of US adults did not get the care they needed because of cost while 4% and 6% of United Kingdom and Sweden citizens faced the same issue. Also, 41% of those in the US spent $1,000 or more out-of-pocket regardless of insurance status while only 2% and 3% respectively of Sweden and United Kingdom citizens had to pay similar costs. You can see these data for these countries and others displayed in the graphs below.

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While our healthcare system is making it difficult for us to get adequate care and costing us a bundle, we’re also overall less healthy.

  • We’re the second most obese of well-populated countries with 31.8% obesity only falling short to Mexico with nearly a third of its citizens packing the extra pounds according to a 2013 U.N. study.
  • Our lives are shorter with an overall life expectancy of 79, placing us at 33rd of the World Health Organization’s 2011 rankings while countries such as Japan and Switzerland have a life expectancy of 83.
  • According to a 2013 study, we’re ranked 27th for overall death rate and 28th for years of life lost to disease.
  • Overall, the World Health Organization ranked our healthcare system as the 38th best out 191 in 2000 as we fall behind many countries like France and Italy.

I could bore you with statistics all day long, but all you really need to know is we have a lot of room for improvement.

Making Changes at Home

This past fall, the United States passed the Affordable Care Act, which addresses some of the cost, access, and affordability issues facing our healthcare system – definitely a step in the right direction. This came with strong opposition – enough to shut down the government for 16 days before it finally passed. While those opposed to the ACA generally agreed that everyone should have access to health care, they disagreed on how that care should be funded.

Opposition to this idea is natural as the “American way” is everyone for themselves and universal health care in practice requires more of a collective perspective in which everyone contributes financially to make health care a right not a privilege. Understanding this major barrier in our culture may help us find a way to overcome it though changing a culture in itself is a long and difficult task.

Until this barrier is overcome, government-run universal health care as we know it will face strong resistance in the United States. Our options are to change our culture to favor a more collective perspective or develop an alternative strategy that can still improve health care cost, accessibility, and affordability.

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Looking Around the Globe

Perhaps to improve upon our healthcare system, we need to look at how other, more highly ranked countries run their healthcare systems and incorporate their ideas into our own. Here are some examples of what other countries have that we do not:

  • The French government supervises non-profit insurance as their form of universal health care, but people have the freedom for supplementary insurance as well.
  • The French government is also allowed to bargain with hospitals, doctors, and pharmaceutical companies to bring down drug and other medical costs.
  • France has a separate malpractice system of special review boards that avoid judicial costs, and malpractice payments come from a national fund. This reduces the costly occurrence of “jackpot” payouts for malpractice that are more likely in the judicial system.
  • French doctors are paid much less, meaning patients (or their insurance) gets to pay them less, but they also don’t have to pay for their medical education or malpractice insurance.
  • Italy funds its universal system through a broad tax system that isn’t focused on the upper-middle and upper classes, and so there is a shared burden for health care.
  • Canada covers health insurance for every legal resident through a publicly financed provincial or territorial plan. This plan covers hospital and physician services, but lets each province decide whether to cover additional benefits like dental care and drug coverage (which can otherwise be covered by supplementary insurance). This also makes it easier for doctors to deal with insurance thus bringing down their cost and time to do so while also giving states freedom to choose their best insurance coverage.

Of course there are downsides to these healthcare systems as well.

  • Italy pays very high taxes, keeping people from building wealth
  • In many countries with universal health care such as Canada, the waiting time to see a doctor is absurd. Particularly for specialists.

What Can We Do

As future and current medical professionals, we may not be able to directly change healthcare policy, but we can still do our part to help. This starts with educating ourselves so we can educate others. Learn where health care spending goes (you can find a good explanation here), learn how other countries run their healthcare systems (such as that described above), and tell people about it! Engage yourself in discussions about healthcare and one-by-one educate your patients and your peers. Perhaps from these discussions, we can get new ideas to improve the system.

We can also directly combat the issues our system and others face by using our experience on the frontline of health care to develop novel tools for improving our practice and directly influencing patients. Perhaps it can be something as simple as creating a more efficient way to alert clinical staff that a patient is in the waiting room to shorten wait time. Perhaps it can be a new way to reach out to patients and engage them about exercising more regularly and eating more nutritious meals. Whatever it is, our experience will help us dream up the idea and put it into effect.

You’re going into this profession because you want to help others live their lives, right? Well understand that you can do this through the doctor-patient interaction but also beyond. How our healthcare system is set up can determine whether every US citizen is able to and can afford to see a doctor – that’s a lot more people you can affect than you’ll ever personally see in your practice. As someone who is involved in the medical field, engage yourself and help make our health care better.

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Hanna Erickson, "Almost" MD/PhD

Hanna is a MD/PhD student at the University of Illinois and an aspiring physician scientist who aims to specialize in hepatobiliary cancers. She is also passionate about teaching, leadership, and advocacy. The energy she once used to pep up crowds as a college marching band member is now directed toward exciting and educating others about science and medicine, especially through her tweets at @MDPhDToBe and her blog at www.mdphdtobe.com.