Not long ago, journalist Elisabeth Rosenthal wrote a book named An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (2017). She argued that healthcare in the United States is broken. In a newer book named Under the Skin: The Hidden Toll of Racism on American Lives and on the Health of Our Nation (2022), journalist Linda Villarosa makes a similar though more pointed argument.
Both authors convinced me, although anybody living or traveling in the United States should already know that our healthcare is broken. They should know, not because they read about it, but because they suffered the profound misfortune of experiencing it.
Healthcare in the United States is not just frayed around the edges or a little spotty in the interstices; it is fundamentally, structurally back-asswards. As in, SNAFU!
I noticed this for years before I started reading about it. As a crisis it’s not new news, but every time I think about the depraved system that we (as taxpayers and patients) pay for, my blood boils. I become incensed! Despite the quaint positivist “optimism” of authors like Rosenthal and Villarosa, I still haven’t found an (overpriced) prescription that yanks me back to 98.6.
My understanding of healthcare in the United States comes from direct observation of institutions and practitioners. It comes from vetted reporting like Elizabeth’s in Kaiser Health News and Linda’s in the New York Times. It comes from struggling to navigate labyrinthine policies concocted by the Red Queen in Washington DC and the Queen of Hearts in various State capitals.
Lately my understanding of healthcare has been burnished by Dandy, Fats, Deacon, Dopey, and Specks — the birdbrains on the US Supreme Court. I have also dabbled around the edges of the mind-numbing black hole of scholarly research on health disparities, health inequities, and health illiteracies. The research shows that natives in America are restless about their shitty healthcare but still “love” their wallet-vacuuming health insurance.
So you and I, we’ve already read or at least suspected that healthcare is broken, but what does that mean? In what ways is it “broken”? Let me name the few that stand out in my mind: each of them, coincidentally, evidence-based and incontrovertible.
- Ethically — healthcare in the United States routinely violates the Hippocratic Oath
- Practically — it yields grossly inferior outcomes compared to peer systems and other industries
- Economically — it fleeces and bankrupts millions of patients who have the greatest medical needs
- Morally — it barbarously discriminates against people of color, the poor, and the marginalized
- Pedagogically — it takes much too long and charges way too much to train far too few healthcare workers
- Qualitatively — it routinely makes innumerable medical and administrative mistakes and rarely admits them or accepts blame for them
- Socially — it reinforces unjust health disparities and health inequities in favor of obscene profit margins on services untethered to outcomes
- Technically — it exaggerates the value of biomedical and digital innovations that deliver indecent ROI to their funders
- Structurally — it bewilders providers and patients alike with impenetrable complexity and lack of transparency
- Administratively — it is run as a medical industrial complex rather than human services in the public interest
- Financially— it bills for services like a vampire squid wrapped around the face of a hapless population
- Organizationally — it is balkanized, greedily competitive, and grotesquely inefficient
- Emotionally — it generates feelings of hope followed by fear, loathing, and helplessness in patients and their families
You may wish to quibble with one or more of these shortcomings of healthcare in the United States, especially if you’re a provider whose self-worth and net worth are derived from the broken healthcare system. Quibble away then, but not with me. Every point in my list is demonstrably true for enough people in the United States to make it true for all people in a civil society (if that’s what we are).
More important than quibbles, if you accept that healthcare is broken, then how can it be fixed? The answers so far are lame. They sum up to providing more healthcare. As in, keep doing what we’re doing no matter how miserable the results, but do more of it.
My view is different. I believe healthcare in the United States can’t be fixed. It must be replaced. I won’t go into the details here, because that will provoke a discussion of politics as stupid as it is fruitless.
My view is that healthcare in the United States must be replaced, not repaired, and in the meantime what we can do, as a society and more importantly as individuals, is promote self-care. By empowering each person, regardless of background, to recognize, understand, control, and improve the determinants of their own health.
Mind you, this is not a call to cure incurable diseases (a hobbyhorse of the NIH and nonprofit health associations). It is not a call to concoct drugs that lengthen life while decreasing life’s quality (a hobbyhorse of the health tech sector in Silicon Valley). It is not a call to attach bodies to digital nurses that monitor noncompliance with clinical regimens (a hobbyhorse of clinical entrepreneurs). It is not a call to tell people what they must do about their health (a hobbyhorse of health educators).
Instead, it’s a call to empower people to make their own choices and decisions about their health, and accept the consequences.
I believe the reason we put up with a healthcare system that is broken is because we like having somebody or something, other than ourselves as individuals, to blame for the consequences of our behavior. That’s bullshit and it needs to stop.
Are you unhealthy? Then you should take more responsibility by addressing the causes. If you’re delegating all the responsibility for your health to strangers wearing white coats, you’re putting yourself at the mercy of officials in black coats with matters other than your health on their minds. Good luck with that.