Where the US Healthcare System Went Wrong

Copyright free image from Karolina Grabowska

“A man who was hospitalized with COVID-19 for 62 days received a $1.1 million medical bill” at the end of his hospital stay [3]. The COVID pandemic has exposed devastating flaws in the US healthcare system. Not only is going to hospitals a risk to one’s health due to the risk of contracting COVID, but healthcare costs are also much more expensive than those of other countries. In 2019, the Congressional Budget Office estimated that of those under the age of 65 years old alone, 30 million Americans were uninsured, whereas 99.6% of the population in Taiwan has coverage [7,5].

So why are medical bills so expensive in the United States? Many of these people attribute their lack of insurance coverage to reasons like affordability, that they “live in a state that didn’t expand Medicaid, or [that they] are undocumented” immigrants [4]. Unfortunately, even for the people who have health insurance, they still have to pay a hefty amount of fees for important medical procedures and treatment, like psychotherapy sessions or “elective” surgeries [4]. The bills are so expensive that medical expenses are one of the leading causes of declaring bankruptcy in the US [1].

The US has adopted a fee-for-service attitude towards medicine, causing physicians to order large amounts of unnecessary tests. According to Dr. Harlan Krumholz, a cardiologist who works at the Yale School of Medicine, “it’s in the economic interest of the hospital, the physician, the health care system…. and the justification is that more is better” [3]. However, that is not true in every case, especially if it leaves patients with medical debts that they spend the rest of their lives trying to pay back. Oftentimes, there is no adequate reason to run these tests [3]. Having too many tests also has other side effects, such as causing even more medical problems: in South Korea, thyroid cancers became very common due to excessive ultrasound screenings [2]. This problem has happened in the US as well, even though it is manifested in other ways. 97% of the doctors in the US have run tests that were unnecessary, “even if they know the results won’t really help them decide how to treat their patients” [6]. Because of this, the US wastes $210 billion in additional health care costs and that means less affordable care for patients as well [6]. 

To counter these problems, systemic change is needed. For example, the US is one of the only countries in the world that relies on a “for-profit insurance system” [3]. This means that 

when private companies control insurance administration, most people have to “pay for it themselves, even if their employer subsidizes some of it” [3]. On the contrary, other countries consider healthcare a basic human right and utilizes the government’s resources to insure most of their population [3].  For example, in Taiwan, everybody receives healthcare insurance coverage and has created a “Medicare-for-all” system while keeping the quality high [8]. It has adopted a single-payer system, which the government’s National Health Insurance Administration runs. A single-payer system motivates companies that make drugs and run hospitals to keep costs low, because they have nobody else to sell these services to other than the government. Although patients still have to pay extra money when seeing a doctor or receiving their medication the fees are “generally low…about $12…or less” [8]. Unfortunately, this system is not without its flaws, and the US should also be careful if it wishes to transition to this system. Because of cheap doctor visits, “the average number of physician visits per year [in Taiwan] is nearly twice that of other developed economies”[8]. These excessive visits mean that healthcare providers do not have a lot of free time and can be overextended. However, it is not worth it for the US to keep its current system, as a lot of people who need care are afraid to receive it because of the price. Perhaps, what the US needs is something in between. 

One thing that the US can start off with is revising its education for both physicians and consumers. In medical school, which consists of mostly STEM courses, physicians should also learn how to ethically use their medical resources and help keep medical expenses for their patients a priority along with their health. As for consumers, learning how to not overuse medical resources would be helpful as well. Maybe, the government can provide a certain amount of cashback from the amount they paid through their insurance if they use medical resources only when they need to. 

Edited by: Haleigh Pine

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