Evaluation: America's health system continues to exhibit significant flaws and necessitates a comprehensive revamp
The United States healthcare system, known for its high costs and underperformance, has become a subject of intense scrutiny. With annual per-person spending of about $13,432, nearly double that of countries like the UK, France, or Australia, the system ranks last among high-income nations for access, efficiency, and health outcomes.
One of the primary reasons for this discrepancy lies in the complex insurance market, high administrative costs, exorbitant prices for medical services and procedures, and a fragmented care delivery system. Despite these high costs, many Americans face significant out-of-pocket expenses, creating gaps in access and affordability.
Potential causes for this state of affairs include the absence of universal coverage and regulatory price controls, a complex insurance market with numerous private insurers, market pricing for medical procedures and pharmaceuticals far exceeding those in other countries or medical tourism destinations, and a limited focus on preventive care and coordinated care.
Countries with better-performing and more affordable systems, such as Australia, Netherlands, and Germany, tend to have universal or nearly universal coverage, tighter regulation of private insurance, capped out-of-pocket costs, and more equitable resource allocation.
To fix the US system, potential solutions include moving towards universal or near-universal coverage schemes to improve access and equity, implementing stronger regulatory controls on health insurance to reduce premiums and out-of-pocket costs, price regulation for medical procedures, pharmaceuticals, and administrative services to control overall spending, incentivizing care coordination and preventive care to improve health outcomes and reduce costly complications, and simplifying insurance markets to reduce administrative overhead.
These reforms aim to reduce costs while improving access and health results, as evidenced by other wealthy countries spending less and achieving better outcomes. The absence of transparency in billing is another concern, with every charge, from aspirin to doctor visits, potentially resulting in a bill for the patient.
The debate over Certificate of Need (CON) laws continues, with some arguing they help control costs, prevent duplication, improve access, and maintain quality standards, while others claim they impair competition, encourage monopolies, and increase costs.
In 2024, the United States spent $4.87 trillion on healthcare, or $14,570 per person. Approximately 9% of the population remained uninsured, leaving approximately 39% with insurance through their employer or private pay. The average health insurance premium for a family was $25,572 in the same year.
Some physicians, including subspecialists like gastroenterologists, dermatologists, and dental care providers, have sold out to private equity companies, prioritizing profit over patient care. The move to a single-payer system, while controversial, has worked well in some Western European countries.
The US healthcare system's complexity is further evident in the payment system, with patients receiving multiple Explanation of Benefits (EOB) and bills after hospitalization. Hospital providers and physician groups have contractual arrangements with Medicare and insurance companies, resulting in insurance companies paying a fraction of the charge.
The system's high costs and underperformance have led to a significant number of Americans accumulating medical debt. In 2024, 20 million Americans had medical debt, and 3 million citizens owed more than $10,000. The healthcare system's failure to provide affordable and accessible care is a pressing issue that requires systemic reform.
One success story in this regard is Dr. Donald Saelinger, a retired gastroenterologist who founded Patient First Physicians Group in 1976 and sold it to St. Elizabeth Healthcare in 2009. After serving as Sr. VP of St. Elizabeth Medical Center, he retired in 2010. His story highlights the potential for change, demonstrating that a focus on patient care and coordinated care can lead to improved outcomes and reduced costs.
As the US healthcare system continues to evolve, it is crucial to learn from successful models abroad and implement reforms that prioritize patient care, access, and affordability. The future of the US healthcare system depends on our ability to address these challenges and work towards a more equitable and effective system.
- In the complex health care system of Cincinnati and Northern Kentucky, the government plays a significant role in navigating the high costs and underperformance.
- The government could focus on improving health and fitness-and-exercise in the workplace-wellness sector to reduce medical-conditions and overall health-and-wellness costs.
- To address mental-health concerns, the government could invest in various therapies-and-treatments and ensure accessibility to experts such as psychologists and psychiatrists.
- The government might consider implementing regulations for nutrition labeling and affordable organic food options within food markets to promote better eating habits.
- In terms of personal-finance, financial education programs could be established to help Americans better manage their money and reduce their debts resulting from medical expenses.
- The government could encourage investing in affordable housing and public transportation, as access to these resources positively affects overall health outcomes and reduces transportation-related medical expenses.
- To ensure equitable resource allocation, the government could establish universal coverage, similar to other countries like the Netherlands and Germany, ensuring that no individual struggles with CBD (cost burden of diseases).
- To minimize prices for medical services and pharmaceuticals, the government could implement financial regulations and invest in researching cost-effective treatments and innovations in the field of science.
- As the Cincinnati and northern Kentucky region moves forward, learning from successful foreign healthcare systems and adopting reforms focused on patient care, access, and affordability is essential for the future of the local healthcare system.
