When People Say U.S. Healthcare is a Nightmare, This is What They Mean
The United States has the most expensive healthcare in the world. Compared to other wealthy nations, it also has some of the worst health outcomes. Anyone who looks at the numbers knows that, but most people don’t look at the numbers until something has gone horribly wrong.
For most of my life, I was lucky. No major health scares. Good insurance. Then something went horribly wrong: one of my children had a medical emergency. My child is now fine, for which I am grateful. But my experience was jarring, and it inspired me to step back and take a look at the U.S. healthcare system. What I found was disconcerting. One in five U.S. households has medical debt. And medical debt outweighs all other sources of debt. This simply doesn’t happen in other wealthy nations.
To talk about the big picture, I want to place what I found in context. So I’ll start by telling you about my child’s medical emergency. Here’s what I learned about medical treatment in the event of your child being bitten by a venomous snake.
Snakebit
After arriving at the hospital, a physician recommended that my child be given an antivenom (also called antivenin). I happened to know that the relevant antivenom was expensive, and we had a few minutes to make a decision, so I called my health insurance company.
What I found was that an insurance company does not apparently have to tell you whether, or to what extent, it will cover a given procedure or medication without knowing the “code.” (At least, my insurer couldn’t or wouldn’t tell me.) I was told to get that information from the doctor. The doctors, however, did not know what the code was. That, I was told, must be done in billing.
As a result, there was no way for my spouse or I to know whether, or to what extent, our insurance would cover the antivenom treatment my child needed until, well, whenever billing got around to it. In the meantime, we had to make a decision about treatment while our child was writhing in pain and we worried about how to mitigate potential long-term health effects related to circulation loss and tissue damage.
Needless to say, that is not market-driven consumer decision-making. It is extortion.
We opted for the antivenom and hoped for the best. Then we waited for the bill.
Three months passed before we got the bill. We were charged more than $56,000 for the antivenom and one night in the hospital. Because I am fortunate enough to have very good health insurance, my insurer paid for more than $50,000 of that. Leaving me responsible for paying more than $5,000. That is a sizeable bill, and we spent many months paying it off.
How Expensive is U.S. Healthcare?
This experience made me ask: How do people without insurance survive even minor mishaps in the United States? If I did not have insurance, we would have had to sell our house to pay that bill. And if we didn’t have insurance or a house to sell, we would have been financially ruined.
This experience also made me wonder how doctors in the U.S. handle the knowledge that a decision they make to help someone can, simultaneously, destroy a family’s financial security. They never know if the thing they’re doing to reduce someone’s pain is going to result in that person losing their house. Or not being able to go to college. Or a loved one not being able to afford a prescription drug. (I’ve since talked with doctors about this, and it is definitely something many struggle with.)
To be clear, I don’t blame the doctors and nurses. The system itself is based on the idea of extracting money from people who will suffer or die if they refuse a given treatment; who have no idea which treatments they actually need; and who are making decisions under conditions that are extremely stressful and often physically painful or disorienting.
A recent federal mandate requiring hospitals to make their prices publicly available does little to mitigate this problem, since people facing medical emergencies are not in a position to engage in comparison shopping. For example, it is unlikely that people will have the wherewithal to compare prices when seeking care for a heart attack or a car accident. What’s more, many people do not have access to more than one hospital. However, the mandate requiring that hospitals make their prices public does highlight the costly problems inherent in the U.S. healthcare system. (And hospitals have been erratic in complying with the mandate.)
After talking with various experts and reading myriad reports on our healthcare system, I’ve drawn two conclusions. (Neither is novel, but both bear repeating.)
1). The health care system in the U.S. is designed to generate profit, not necessarily act in the best interest of the patient.
2). This is why we have the most expensive healthcare in the world and among the worst health outcomes.
It’s worth reminding Americans that it is not normal for a healthcare system to focus on making money. In most other countries, the primary goal of the healthcare system is to heal the sick and maintain health in the well. And their way is cheaper.
How much cheaper? Well, according to the federal government, U.S. healthcare expenditures for 2019 came to $11,582 per person. The World Bank says U.S. healthcare expenditures for 2018 were $10,623 per person. What does healthcare spending look like elsewhere? It’s a lot less. Like…a LOT less. In the United Kingdom, it’s just over $4,300 per person. Japan’s is just under $4,300. Canada spends less than $5,000.
Is U.S. Healthcare Better?
So, we’re paying more than anyone else for our healthcare. Are we getting what we pay for?
Reader, we are not.
Health outcomes in the U.S. are, frankly, pretty bad.
What do I mean?
One report compared the U.S. to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. And despite spending almost twice as much per person on healthcare, the U.S. had a lower life expectancy than any of the other countries.
As the report notes: “Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.”
But what about other aspects of health? Is the U.S. healthcare system good at anything?
Good question! And the answer is…not much.
According to a 2020 report, we are slightly better than our peers at having patients survive for at least 30 days after a heart attack or stroke. And we do a better job of preventing post-operative sepsis.
That’s the good news. Now for the bad news.
We have a higher disease burden than countries of comparable wealth.
We rank last in access to healthcare.
We’re worst in maternal mortality.
We have more medical, drug and lab errors than our peers.
We also do a poor job of preventing post-operative blood clots.
Don’t get me wrong — heart attack and stroke treatment are important. And preventing post-operative sepsis is also important. But the fact that the U.S. pays so much more, only to have worse health outcomes in almost every category, is a good indicator that our healthcare system is fundamentally broken.
But I’m Okay, Right?
Maybe you’re like I used to be. You may think you’re in the clear. That you are okay, because you’ve done everything right. You have insurance. You make healthy choices.
But guess what? You’re not in the clear, folks.
You can do everything right — but you have one piece of bad luck and you’re in trouble. Have a bike accident? A deer comes out of nowhere and you get in a car accident? Something unforeseen happens and you’re looking at hospital time? Even after insurance, you could be looking at a bill for five figures. Maybe more.
Can you afford the equivalent of an extra mortgage or rent payment every month? Can you afford to have your savings wiped out?
This isn’t an abstract intellectual exercise. Our health system will either leave you penniless, or leave you to suffer.
The U.S. healthcare system has gotten so bad because people who can make a difference don’t notice how rotten the system is until they find themselves facing a financial nightmare. It’s easy to pretend it’s someone else’s problem — until it’s your problem.
But it doesn’t have to be this way. The U.S. healthcare system isn’t the norm. Every other wealthy nation has figured out a system that allows people to get the care they need without inflicting patients with crippling debt. We could do it too. And we should. I don’t have all the answers, but I know that our current healthcare system is a nightmare. We need to make this a core issue when we go into the voting booth, because health is central to all of our well-being. And we all deserve better.
