Why America Definitely Doesn't Have the Best Healthcare in the World
“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”
-Dr. Martin Luther King, Jr.
In a recent conversation — er, better call it a recent existential-crisis-induced bout of emotionally charged word vomit — with my husband, he got a bit irritated with me.
Irritated that the common culprit contributing to the bulk of my new-mama fears and anxieties seemed to revolve around the systemic flaws in America right now.
Well, also the world. But mainly America, since that is where we live and are raising our son. And because it’s too overwhelming to objectively (let alone, subjectively) try to analyze, make sense of, and try to “fix” what is going on in the world at large.
But also because happiness and anxiety are all relative to what an individual is most familiar with and accustomed to. And what one has learned to expect based on said familiarities.
So, for today, I’m going to focus on America. And, for the sake of time, I’m going to focus on healthcare.
Because I disagree with my husband’s blanket statement of us “having the best healthcare in the world.” In fact, I think throwing this kind of rhetoric around without hard data, information, and stories to back it up is inherently toxic and can keep us from progressing beyond the status quo in healthcare as it actually exists today (not its more esteemed status 30 years ago).
Which is why I was pleased to catch today’s mid-morning “On Point” (NPR) interview with Tim Snyder — a Yale history professor and scholar of authoritarianism and tyranny.
After almost dying in an American hospital in 2019, just before the pandemic hit, he wrote a book about the important relationship between freedom and healthcare. It is called OUR MALADY: Lessons in Liberty from a Hospital Diary, and its message echoes the above quote from Dr. MLK, Jr.
"Millions of American Families are One Medical Emergency
Away from Bankruptcy"
Back in 2013, I was working for a financial publishing company and I wrote an article about the staggering number of Americans filing for bankruptcy — more than half-a-million families per year.
And just a couple months ago, I compiled a Brainwash resource page RE: exorbitant medial bills causing two out of every three bankruptcies. And that was before 40+ million Americans lost their jobs due to Covid-19…
Even before the pandemic, 10% of the population was uninsured with an additional 30% under-insured.
So when people — like my dear husband, who works in finance and makes a very comfortable salary with a very comfortable insurance plan — claim that America has the best healthcare in the world, I tend to fly off the handle a little.
Mainly because I come from more humble beginnings, from a family that actually filed bankruptcy due to medical expenses.
Why We Filed for Bankruptcy
When I was 13 years old my mother filed for bankruptcy. My parents had divorced a few years earlier, and we moved from a single-family home in Upstate New York into a three-bedroom apartment in a charming town in southwestern Virginia, where my siblings and I were able to attend a good public school and still cut our overall cost of living.
My mother was working for the Department of Social Services and raising three kids. She took on an extra job on the weeknights, working security for Home Shopping Network — and even attempted a third one at a grocery store during in-between and weekend hours at one point.
We weren't completely struggling to make ends meet. After all, we were exceptionally frugal, living without cable and Internet services until the Web became a necessity for school projects... We would watch the news on an old TV set and plug in the VCR for family movie nights.
Plus, my father was still very present in our lives and paying child support (when he could afford it at least, he was a Roofing Foreman with a bit of a gambling “habit”).
We weren't wealthy by any stretch of the imagination, but had what we needed and my mother would have been able to start setting a little aside for college.
But, life happened.
My younger sister was diagnosed with junior myoclonic epilepsy (JME) about a year before my mother was diagnosed with cervical cancer and suffered a severe staph infection that almost killed her after surgery. She remained in the hospital for the better part of a month, and was back a few months later with new complications.
Hospital bills piled up and my sister required numerous specialists and incredibly expensive medication. Many specialists were at hospitals hours away from us, adding travel and lodging costs to the pile of medical bills. My parents' work schedules were greatly disrupted, further contributing to their financial woes.
My mom's family insurance plan was sufficient in keeping the cost of many of my sister's prescriptions down to the bare minimum, but it just wasn't enough. At one point, my sister was on 15 different pharmaceutical drugs, including several experimental drugs with bad side effects requiring additional medication to counter the negative effects of the primary drugs.
Paying medical bills was complicated as well. Even when a specific hospital was in our network, some of the doctors or phlebotomy-labs that played a role in the process weren't.
Whenever my mother would pay off one bill, another would inevitably arise.
Doctors decided my sister's epilepsy might be something other than a traditional case of JME after she responded poorly to traditional treatment. Her seizures were difficult to manage, so the experiments continued. She was in and out of research facilities, neuroscience offices, and hospitals instead of in school most of the time...
Facing Bankruptcy
At the height of our family's crisis, my mother felt there was only one option left: bankruptcy.
As ashamed as she was, she felt trapped and without an alternative. And her situation is not unique...
For the 92% of the medically bankrupt, high medical bills directly contributed to the motion to file for bankruptcy. Since 2001 the proportion of all bankruptcies attributable to medical problems has increased by 50%.
Why Is This Kinda Thing Always Swept Under the Rug?
Tim Synder argues that it’s easy for middle to upper-middle class Americans to overlook these stories and statistics because of a contagious and enthusiastic belief in “American Exceptionalism.” An enduring trope that America's values, institutions, and “empire of liberty” are innately superior to any system anywhere else in the world.
Think: growing up high on a sugarcoated fairytale version of our history vs. what really went down in a more Grimms’ version of reality. From those early seeds that plant our understanding of America’s heritage grows a mighty tree of disillusion — an idealistic idea of America’s core and character, in spite of the overwhelming stories (and stats) highlighting a world vastly different than our Mayberry dreams.
But it’s not all doom-and-gloom. America, in many regards, is amazing. But what’s most amazing about it, perhaps, is its potential to actually be all of the things we already believe it is. A real land of liberty and justice, for all. Regardless of our race, zip code, or tax bracket. And, as Snyder argues, that all starts with looking at health care as a human right.
“In the United States, providers charge whatever they think they can get away with, and they can get away with a lot, because it’s really difficult to put a price on, like, not dying.”
— Author, educator, and YouTuber John Green
I mean, sure, people like my husband have a point. We do have the “best healthcare in the world” available in SOME places to a select few. Meanwhile, huge pockets of the country have to travel great distances to receive quality care. And huge chunks of communities struggle to see a doctor at all.
Another alarming statistic Snyder brought up this morning was this:
A black pregnant woman in the U.S. could, theoretically, travel to 70 other countries in the world that have better maternal survival rates.
A white pregnant woman in the U.S. could find 40 countries where this is also true for her.
Another worrisome note: Americans longevity peaked in 2014 and has been stagnant ever since.
Not to mention all the doctors overlooking serious issues.
Personal Anecdotes
Similarly to what happened to Snyder, in 2009-ish, my sister had appendicitis and her doctor said it was just food poisoning. My mother and myself flat out said that was all-but impossible based on the type and limited amount of food she had eaten. Sure enough, her appendix ended up rupturing in the elevator of the hospital after she went to the E.R. days later.
And sure enough that led to a painful, expensive, traumatic hospital experience of emergency surgery whilst trying to rid the body of the poison emitted from her appendix.
In 2016, I tore my ACL playing in a recreational football league. Despite not being able to walk without crutches, it took over two weeks to see an orthopedic doctor. Instead of ordering an MRI, he asked if I’d heard a loud “pop”, if the knee was buckling, etc. I answered “yes” to all the questions, but he had me walk across the room putting light pressure on the leg and decided it was probably just a sprain.
Doc said I could continue my volunteer work at the animal shelter after two weeks, some ice, and elevation. Welp, I ended up fainting in front of an entire class I was training on new methods to walk the bigger dogs. My knee buckled after an abrupt movement and I was in extreme pain under the hot mid-day July sun. I fell at least 2-3 times in addition to that one before the doctor could finally squeeze me in for an MRI another two weeks later.
Results took several days, but the extent of injury was crystal clear. A completely torn ACL. Not a fiber still connected. Long story short, I tore the ACL in the very beginning of June. I didn’t get the surgery September 16. Muscles had already atrophied badly, I should have been in physical therapy pre-surgery, my actual surgery was badly botched (including ACL slightly askew and surgeon harvesting my hamstring vs. using the cadaver he told me he was using 20 minutes before I went under ), and had debilitating issues that took over two years and another separate surgery to pseudo-resolve. The first surgeon also accidentally cut my sciatic nerve, so about 1/4 of my lower leg is permanently numb.
In fact, while going through IVF, my husband was administering a shot of progesterone oil into my lower back (after a doctor told me I would definitely not be taking any more shots for that portion of IVF… but that is ANOTHER terrible, no good healthcare + crazy money story for another day) as part of a daily 10-week routine… he hit my sciatic nerve and I legitimately couldn’t walk the next day.
That was an awkward phone call with my boss…
And I’m not going to even get into my labor and delivery experience, because that was an actual nightmare and I will spare the details for pregnant readers.
Point is, I have a VERY hard time believing this is the best we are capable of. And I know I’m still one of the lucky and privileged ones.
Black Americans, for example, are disproportionately seen in the Emergency Room for issues that could have been addressed or prevented by primary care doctors that either aren’t available or affordable to them. In fact, nearly half of all U.S. medical care comes from emergency rooms (the numbers are higher for minorities and women).
NOTE: I had routine blood work two weeks ago to check thyroid levels, It was a 20 minute visit plus a quick trip to the blood lab. I had a $25 co-pay, a $158 bill for seeing the doctor, and have yet to open my bill from the lab that processed my blood.
So yeah, for people without insurance or under-insured, they’re not getting the preventative care they need. They’re not going to the doctor until it’s an emergency. And at that point, hospitals are charging an actual arm and a leg just to get in the door.
And, regardless of your socioeconomic status, “Disease, sickness, and old age touch every family. Tragedy doesn't ask who you voted for. Health care is a basic human right,” Senator Elizabeth Warren reminds us.
America is an amazing place. And capitalism clearly has its merits. But healthcare should be an entirely separate ideology. Here’s why:
A Picture Is Worth a Thousand Words
Astronomical medical costs are met with major shortfalls in care. It is rare to get the quality of care you pay for nowadays, despite the fact that the U.S. outspends all other OECD nations on health care both per capita and as a portion of GDP:
We need to revamp the entire system.
Doctors should be rewarded for quality of service, not volume of service.
Big Pharma is a huge hindrance. Physicians and specialists are less inclined to spend time interacting with patients to understand what's really wrong, and are instead rewarded for selling brand-name drugs to as many patients as possible.
People don't always need drugs: they need to improve their health. And that starts with quality primary and preventative care. For everyone.
Compared to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, the United States comes in dead last in five areas of health system performance: quality, efficiency, access to care, equity, and the ability to lead long, healthy productive lives, according to the Commonwealth Fund.
It is shameful that costs are rising while care is declining.
If health care costs were under control and growing no more quickly than the economy, we'd stand a chance at getting a handle on our national debt and liberating Americans from the tyranny of poor health and Big Pharma. Unfortunately, health care spending is currently growing at about 1.5x the rate of the GDP — and is already ~18% of the entire economy ($3.6 trillion).
As mentioned above, on a per capita basis, our healthcare system is the most expensive among advanced nations. But it ranks 29th in terms of actual care, access, etc. A dramatic drop from 1990, when we ranked 6th in terms of healthcare and education.
Forbes reports: "Health care spending will eat up the federal government’s budget even sooner, and that is the root cause of the U.S. sovereign debt problem."
Congressional leaders, the health care industry, and Big Pharma need a new concrete strategy — before this looming health care/bankruptcy crisis snowballs into a national debt and humanitarian crisis we'll never get out from under.
If we want to reclaim our dominance on the world stage, one of the most powerful assets we can bring to the table is a healthier, happier populace — empowered to live a life free of the injustices associated with the inhumanity of rampant healthcare inequality.
