With the banning (and subsequent unbanning) of a certain app in the wake of the President’s inauguration, there was much conversation.
One of the most trending ones was this exchange between a Chinese and an American user, in which the former said the latter didn’t believe them when they said an ambulance ride in the U.S. would bankrupt them.
How do you even begin to respond to that? It’s no secret that the U.S. healthcare system hasn’t been at its best for decades now, both with how expensive and inaccessible it can be for patients. But the other side is how bad it has been for the people working in said system.
In light of recent events, perhaps it is a good time to finally discuss where U.S. healthcare is headed, both for patients and the doctors who look after them.
- Where Healthcare Is Dwindling
- How Physicians Feel About Working Within The System
- Why America Has An Employer-Based Healthcare System
Physicians Don’t Like The System Anymore
We’ve discussed physician burnout before and how it impacts the services that a primary care physician provides. But the real root of that burnout is a system that is simply too convoluted and overtaxed to work long-term, going so far as to be deemed a ‘public health crisis.’
Doctors in the U.S. are some of the only healthcare providers in the world that don’t work in a universal healthcare system. This means that a lot of their caregiving is dictated by insurance companies, who require so much paperwork just for basic procedures. This impedes on a physician’s time that they could, instead, be used on helping the patient directly.
On average, 20% of American doctors stated that most of their time goes into filing insurance paperwork or fighting disputes, which doesn’t leave them with much time to dispense the healthcare and attention their patients need. This is probably why said patients have some of the fewest health consultations amongst any other developed nation.
And this leads us to a bigger problem: The spending.
Not Enough Money
Doctors in the U.S. might have some of the highest salaries, but that money goes into paying back the loans they incurred during medical school.
The average medical student in the U.S. incurs about $267,000 in student loan debt. It is only after they have spent even more time and money completing a residency and going into a specialization that they are able to earn a better salary.
Even when they reach that point, physicians are too overworked to continue. Residency training often forces doctors into shifts that exceed 24 hours, with little to no breaks in the middle. After COVID-19, there was a sharp decline in nurses in hospital settings, leading to doctors treating patients in understaffed wards while dealing with their own physician shortage issues.
The way these issues are left untouched is a big reason doctors are fed up with the healthcare system themselves. It is forcing more and more physicians to rethink working in the medical field, with 7% of physicians retiring because incurring burn out is a high price to pay for little reward.
And in some cases, it gets even worse. Physicians in the U.S. are more likely to be depressed than the rest of the population, leading to accelerated aging. The fatigue from that depression manifests itself in rampant medical errors, desensitization, and lack of safety for patients.
Now, we could continue blaming doctors or insurance companies over all this, but that distracts us from the real problem: The system itself is set up to elicit the most profits rather than equity in caregiving. This is problematic, considering just how much we’ve invested into said system.
And we’ve invested a lot.
Big Expenditures, Less Implementation
The U.S. spends an exorbitant amount on healthcare, yet its system is the lowest-performing of all developed countries. And by exorbitant, I mean truly unfathomable numbers.
The amount that the U.S. spent on health care grew 7.5% in 2023, going from $4.5 trillion in 2022 to nearly $5 trillion. For comparison, that alone could be a country’s entire GDP, and it would be considered the fifth richest country in the world.
The issue here is that it just doesn’t make sense. For a country that depends so heavily on private healthcare, we’ve spent more on our public health infrastructure than countries operating only on universal healthcare. And then we go on to spend even more than that on the whole private healthcare sector.
Yet somehow, our healthcare system is almost primitive when compared to countries such as Japan, Switzerland, or even our neighbor, Canada. For example, the U.K. ranks first when it comes to affordability; the Netherlands happens to be the most accessible, and then Germany shares the top spot with the countries above when it comes to availability.
Meanwhile, 41% of Americans spent $1,000 or more on health care in 2023. That was out-of-pocket spending, not insured spending.
But instead of receiving the quality of healthcare that should come with so much money spent on it, U.S. Healthcare ranks last amongst other high-income countries. Our healthcare system is at the bottom when it comes to the following services:
- Care Access
- Efficiency
- Equity
- Outcomes
According to the CDC, our life expectancy is the lowest at just 77.5 years, brought even lower after the Pandemic. People in the U.S. die the youngest, with one in 25 Americans not living to see their 40th birthday. And it’s all mostly avoidable deaths, to boot. This is a concern when you see how little we invest in primary care and preventative measures versus specialty care that deals more with disease and technological advancement.
Speaking of accessibility, America has a huge rural population with almost no way of getting quality healthcare. The 20% of Americans who live in these rural areas often die premature deaths, have a higher risk of diabetes and obesity, and are more susceptible to accidental deaths such as overdoses and even suicide.
Telemedicine would be a simple solution for this, and you’d think we would have expanded on it a decade ago. And yet, we only saw telehealth become a thing during the pandemic, and it has only grown bigger since. Despite that, it’s evident that mother necessity is the only thing that forces invention – the doctors are too tired to innovate beyond dire circumstances.
Instead, we’re making things expensive to the point that patients would rather forego treatment. 72% of physicians noted that most patients ignore their recommended health plan because they can’t afford them. And even if they do agree to do the treatment, insurance causes so much delay that it doesn’t even matter at that point.
This not only leaves the patient hopeless but doctors too. Patients have no faith in the healthcare system benefiting them, and physicians are left frustrated because they can’t give the patients the care they need without mountains of administrative red tape to go through.
So, it wouldn’t be a stretch to call the U.S. healthcare system ‘broken.’ And with the recent news that the U.S. has opted to step away from the World Health Organization, things feel bleaker than ever.
I genuinely wish I could say something more positive, but the only thing I can offer is solidarity. As physicians, we are just as tired of the system as the patients are. And we have to be a voice of reform rather than let the bleakness dictate how we dispense healthcare.