There’s a major disconnect within the United States’ healthcare system. Healthcare is modeled after and functions as a business. This industry does not economically benefit when people are healthy, yet the common goal of healthcare is “promote, maintain, and restore health and well-being”. Do you see the paradox here? One set of behaviors and practices benefits the healthcare industry, while the opposite set of behaviors and practices is hoped for.
For example, doctors sometimes overprescribe both medications and tests for a variety of different reasons, which contributes to rising healthcare costs. However, the laundry list of tests and medications isn’t always necessary or beneficial to that patient, yet they still have to foot the bill. There’s an economic benefit to the business, yet not much “restoration of health”. And I get that no healthcare model can be perfect, as that simply does not exist. But it sure as hell can be more ideal, ethical, and cost-efficient.
Shortcomings of the U.S. Healthcare System
The United States healthcare system has many, many shortcomings. Let’s talk about them:
Health Disparities
In the United States, along with many other countries, health is a privilege. It is not treated as a human right. This is why we see systemic and avoidable differences in both health outcomes and access across different populations. For example, some races, ethnicities, and other groups of people have poorer health outcomes, such as higher rates of chronic disease, infant mortality, and premature death, compared to their white/wealthy counterparts. These disparities affect the health and well-being of individuals and communities, but also contribute to higher healthcare costs and increased social inequality.
Quality and Outcomes
Despite its high spending, the U.S. Healthcare System usually underperforms and produces poorer results compared to other developed nations such as Canada, Germany, and Switzerland. For example, the U.S. sees worse outcomes with infant mortality, life expectancy, and access to care when looking at the statistics for developed nations. The U.S. also sees higher rates of avoidable deaths and hospitalizations from preventable causes. Lastly, this country struggles to provide equitable and affordable access to care, which is a big contributor to these poor health outcomes.
Rising Costs
U.S. healthcare costs have been steadily rising. The total cost reached $4.9 trillion ($14,570 per capita) in 2023. That’s so much fucking money it’s incomprehensible. Like it’s just numbers at this point. But anyhow, healthcare represents over 17% of the nation’s GDP. This is a significantly large portion of the economy. Lots of things contribute to these rising costs, such as new technologies, an aging population, administrative inefficiencies, increased drug costs, insurance market dynamics, and increased utilization of healthcare services. Regardless, these rising costs have a profound financial burden on individuals, families, communities, and the economy as a whole. And unfortunately, it will become more difficult to afford medical care in critical circumstances as costs continue to rise.
Lack of Coverage
In 2024, over 8% of the U.S. population was uninsured. That’s about 27 million people. 3.7 million of which are children. With the new administration in office, I can only imagine what those numbers are now. Because they certainly won’t be getting any better.
This lack of coverage is due to the high costs, inadequate public programs, lack of employer-sponsored coverage, and the “Medicaid Gap,” in which some low-income individuals don’t qualify for Medicaid, yet still can’t afford to purchase insurance. This issue is important to address because it contributes to financial burden, delays in care, and increased mortality, among other consequences. Coverage must be easier to obtain to reduce disparities and increase access and affordability to healthcare for all.
Lack of Access
Millions of Americans are impacted by the lack of access to both physical and mental health services. This lack of access is caused by numerous factors such as geographical limitations, high healthcare costs, and lack of insurance.
As with all these shortcomings, it’s vital to address the issue to relieve the financial burden this puts on individuals and communities. This also causes people to delay care and leads to poor health outcomes. Things that can be done to address the lack of access to healthcare include expanding insurance coverage; improving access in rural areas by incentivizing healthcare providers to work in underserved areas; lowering premiums, deductibles, and co-pays; increasing access to Medicaid, CHIP, and other programs; expanding mental health services; and addressing the social determinants of health such as poverty, food insecurity, and transportation issues.
Increased Spending, Poorer Outcomes
A Blue Zones article I read the other day said, “The economics of healthcare in America reward sickness.” That much is true. Pharmaceutical companies benefit when a prescription is filled, surgeons benefit from doing procedures, and hospitals make money when they occupy a bed. These healthcare companies and facilities do not profit from our health. Yet, with healthcare costs higher than anywhere in the world, you’d expect both exceptional service and outcomes. However, this is not the case.
Our healthcare system delivers outcomes no better than countries spending half as much as us. That’s kind of pathetic. And while healthcare costs continue to rise, there isn’t much improvement in quality outcomes. For example, the number of people suffering from chronic illnesses like heart disease and diabetes has doubled from 30% to 60% since 1980. Since 2019, life expectancy in America has fallen by over two years. And while COVID-19 played a huge role in this drop in life expectancy, it’s not the only cause.
It is also known that the United States ranks dead last for premature deaths amongst wealthy nations. Premature deaths include deaths caused by diabetes, heart disease, dementia, and cancer. These preventable deaths also account for 90% of our healthcare expenditures.
So what’s the solution?
Putting Prevention Above Profit
The aim of public health is to improve and protect the health and well-being of populations. Prevention is a big part of that. If we can use education, public health campaigns, and policy to promote healthy lifestyles and prevent certain diseases from occurring, we could not only spare suffering for people all over the country but also save money doing it.
When it comes to health and well-being, individual choice and personal habits do play a role, but the environment and policies hold a much stronger influence on health outcomes. So why not start there?
A better approach to long-lasting health would be investing in ways to change our environment so that it supports our well-being. And of course, healthy habits like movement and mindfulness make a huge difference, but we can’t reach optimal health in an environment that doesn’t set us up to succeed. We don’t need to go on diets, go to the gym more often, or buy a grocery list of supplements to be healthy. We just need to do the little things, live our lives according to us, but in an environment that fuels our well-being. Environments designed for movement and connection, with clean water and air, good food, intellectual stimulation, and all the other things that make a person happy and healthy.
Blue Zones: Environments Built for Wellbeing
I keep mentioning the importance of the environment for our health and disease prevention. The Blue Zones, which are specific geographic areas in which people live longer and healthier lives, set a good example of the kind of environments that support wellbeing.
The Italian island of Sardinia is built in small clusters of mountain villages that require walking up steep cobblestone streets to get everywhere you need to go. This environment, which was built to ensure daily movement, may be why men there tend to live to one hundred at ten times the rate of their U.S. counterparts.
Similarly, women in Okinawa, Japan, have an average lifespan 8 years longer than that of women in the U.S. This is likely due to the emphasis their culture places on superfoods such as sweet potatoes, turmeric, and soybeans. That’s not exactly what an ordinary American’s diet consists of. The traditional norm in each Blue Zone is a plant-based, whole foods diet. Okinawa also places much importance on purpose and lifelong friendships to combat loneliness in old age. These are two other lifestyle factors that contribute to that longer life expectancy.
Another great example we have is Costa Rica. Costa Rica spends about one-seventh as much money on healthcare as we do here in the U.S., yet it still somehow has better outcomes when it comes to preventing chronic diseases. This is attributable to their strong public health system. They have a program that sends people to the countryside to visit every household at least once a year as a way to catch illness early on and prevent visits to the emergency room. Since the 1990s, this program has helped reduce the number of deaths from communicable diseases by 94%. This program has also played a significant role in reducing infant mortality and increasing life expectancy.
Lastly, Singapore focuses on policies like subsidies on healthy foods, smoking bans, and increased accessibility to public transportation and parks to keep its citizens healthy. They also have more strict regulations on guns and drugs, but they seem to make a large difference in the nation’s health and well-being. For example, Singapore saw only 19 deaths from drug overdoses in 2019 compared to over 100,000 in the United States. They saw only 3 deaths from gun violence that same year, compared to over 49,000 in the United States.
Making America Healthy
In order to place more emphasis on prevention rather than relying strictly on the healthcare industry, America must build environments with movement and connection in mind. Bike lanes and sidewalks should be accessible and safe in every community as a way to promote movement. Schools, grocery stores, and restaurants should encourage healthy eating habits. Communities should have greater opportunities for connection through things like volunteering, clubs, and other social activities. When environments are built in a way that reflects the values of health and well-being, people don’t even necessarily have to try to make lifestyle changes. Dieting, exercise programs, overpriced insurance plans, and other individual means of gaining “health” aren’t the answer here. Our environment must support us. Health shouldn’t be something super difficult or expensive to attain, nor should it be a luxury. Health is a human right, and where this country fails is in seeing it as such.
And in a country where profit is of utmost importance, these goals can seem distant. For instance, Naples, Florida, recently underwent a six-year-long city makeover program as a way to improve the health of its residents. NCH Hospital in Naples decided to invest in the makeover program. This makes sense, given that a hospital would want to support the health of its community. However, they had to go against the advice of the hospital’s CFO to do this. That’s huge. It’s admirable that the hospital decided the health of their community was more important than their own profit. As a result of this makeover, the health of the community did improve, and NCH Healthcare reported a 54 percent decrease in healthcare expenditures over six years. But if the shared goal is community health, then who gives a fuck about your decreased expenditures? Because I don’t.
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As a closing, I just want to say by no means do I have or hold any grudge with healthcare and hospital facilities or staff. I work at a hospital myself. I’m just saying that this country’s current system and business model isn’t doing our health and well-being any favors. Or our wallets. Yet healthcare is a necessity in each and every country. Emergencies happen, people get sick, and a perfectly healthy life just doesn’t exist. I utilize the healthcare system when I need to and encourage everyone to. I’m grateful for the healthcare providers who work hard and diligently to help others. The problem I have is systemic. It’s the model. The emphasis on profit. The idea that we are a bill to be paid and not a patient to be seen and cured. That’s where I see and call bullshit. And that’s my piece.
Alright. Thanks for reading. If you’re interested in public health-related issues, check out all my public health posts here. Also, be sure to check out my “Ultimate Guide to Public Health” if you want to learn more about the topic. My post “Blue Zones Vs American Culture” also ties into what I discussed today, so if that sounds interesting, give it a read!
Lastly, most of what I’ve learned today I read from this post— “A Healthier America? We’re Aiming at the Wrong Target”. Check it out!!
Be back next week! Stay cool:)