Amid the COVID-19 pandemic, countless people have been exposed to the unforgiving system that is US healthcare. One man who survived the deadly virus was struck with another plague: his 1.1 million dollar medical bill. The choice of receiving necessary medication or procedures may mean sacrificing economic health for physical health. This scenario is played out again and again at the expense of struggling patients. In fact, as of 2019, a record high 1 in 4 Americans reported that they or a family member put off receiving healthcare for a serious medical condition due to expenses (Saad 2019). Whether US healthcare inaccessibility is due to high prices, low availability of healthcare professionals, or other underlying issues, there are areas within the US healthcare system that drastically need improvement. The United States allocates the most resources towards healthcare but fails to outperform its peers. There is no umbrella solution to the issues that drag on our healthcare system. However, knowing where we have gone wrong can allow us to fix our past to plan for the future.

It is not that healthcare is poor in the United States. The real issue lies in the fact that we commit 16.9 % of our GDP to healthcare, yet still underperform. That figure is double the amount of the average developed country according to the Organisation for Economic Co-operation and Development (OECD). The Commonwealth Fund reported the next highest GDP committed is by Switzerland, at only 12.2% (Tikkanen 2019). Our large investment into the healthcare system allows the United States to have the most up to date technology and treatment options. Aggressive innovation requires large development costs, resulting in more expensive technology. Although newly developed medical treatments are more advanced and effective, there comes a point when it is unobtainable to the majority of the public to actually use these treatments. This trade off of having more advanced treatments but higher medical expenses is quickly approaching a point where the intended patients cannot reap the benefits of the treatments made for them due to exuberant costs.

The cost of healthcare is not need based but profit based. A key distinction to be made between the healthcare system of the United States and most other countries’ healthcare is that the United States employs a fee-for-service model. A fee-for-service model makes it so every service is paid for separately, incentivizing quantity instead of quality. The prevailing and unfortunate mindset within the United States is that healthcare is not a right but a privilege. Since healthcare in the United States is for profit, healthcare professionals can overuse expensive tools for diagnosis. As noted by a survey from the Commonwealth Fund that compared the healthcare systems of 11 developed countries, “Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers.” These technologies are needed for specific scenarios but are over utilized to maximize profit. The fee-for-service model takes away some priority from patient wellbeing.

The US government lacks price regulations over drug and medical technology developers (Meyers 2016). Complete control over the market of medical technologies is not the goal, but when producers engage in price gouging at the expense of patients, action should be taken. Due to private and public healthcare delivery methods in the United States, developers can drive the price up when dealing with multiple buyers. However, some government programs like Medicare, the US government healthcare program for the elderly and people with disabilities, are ostensibly cheaper.

In a study carried out by the Rand Corporation, it was found that in 2018, non-Medicare healthcare costs were 247% more expensive than the same services through Medicare. The monopsony of government Medicare acts in the patients’ favor (Whaley 2020). The government is the only buyer in their respective healthcare market. Therefore drug and technology developers are not able to set their own price because there are not multiple US governments vying for their services. There is only one US government, and therefore one buyer, thus giving healthcare vendors less leverage to negotiate prices.

Health insurance is an oligopoly, and in some regions, a monopoly. This is quite the opposite in the health insurance industry where there is a high consolidation between potential providers. This consolidation limits competition. Insurance providers are allowed to drive the price of health coverage up with little worry of being undercut. The health insurance market of Alabama was dominated with an astounding 94% market share by Viva Health (KFF 2018). In a more mild market like Illinois, where the largest health insurance market share belonged to UnitedHealth Group at a “meager” 71%, the next largest market share of 22% belonging to Carle Holding Company (KFF 2018). Why would these insurance companies cut prices? They have no incentive or pressure to make prices more affordable to the public. At the end of the day, healthcare insurance is a business.

The U.S. population is growing older, and so are physicians. As of September 30th, 2020, only 10 of the 57 states and territories of the United States met 60% of healthcare physician demand while no states or territories covered over 76% of healthcare needs (KFF 2020). This discrepancy in need will only exacerbate as time progresses. The Association of American Medical Colleges (AAMC) published a recent estimate that by 2033, the shortage within the United States will reach between 54,100 and 139,000 physicians (AAMC 2020).

Not only is the amount of primary care physicians decelerating, but the amount of healthcare needed will be amplified over the coming years. In the same estimate by the AAMC, it is noted that the population of aged 65 and over will grow by 45.2% in the next decade (AAMC 2020). This hefty increase in the elderly population will heavily contribute to increasing demand for primary care physicians (PCP). Physicians are not exempt from this aging effect. As stated by the AAMC, over 40% of current physicians will be 65 or older in the next decade. Retirement or decreased work hours are imminent for these older physicians, especially in the aftermath of the global pandemic where many physicians have been pushed to their limits both physically and mentally.

Physician allocation is poor What about the current physicians we have you may ask. How are they being used? Is there reason to believe that we have enough doctors? Christopher Kerns and Dave Willis of the Harvard Business Review make a case for the ineffective allocation of physicians may result in the feeling that we do not have enough. It is noted that physicians spend 20%-30% of their time spent dealing with clinical documentation, electronic medical record (EMR) inputs, and other compliance related work (Kerns 2020). Although this is a necessary part of healthcare for physicians, ways to minimize time spent not treating patients would undoubtedly help in the struggle patients go through to be seen.

To make matters worse for patients, primary care is not offered on nights or weekends. It is understood that being a healthcare professional is one of the most draining occupations a person can choose to be. It is also one of the most invaluable occupations. When care is offered, it is imperative to maximize the efficiency of appointments. On average, examinations run 1.2 minutes longer than expected, taking away needed transitional time for physicians to prepare for their next patient. More than two-thirds of examinations deviated from schedule by 5 minutes or more (Healthday 2021). This places great amounts of stress on physicians when they are taken off schedule. Even more concerning is the fact that clinical capacity is then misused due to lateness and extended durations of visits.

It is easy to scrutinize an industry with as many problems and critics as the US healthcare system, but, it is also important to keep in mind that healthcare is so complex that one could dedicate their life to studying it and be still left with questions. How can we ensure more equitable insurance coverage? How can therapies be so highly priced that many patients are excluded from benefiting from said treatment? How can we maximize physician allocation and efficiency? These questions and more highlight the many shortcomings of the US healthcare system. However, it is also known that America has some of the best preventive care in the world. Our preventive health services allow proactive measures to ensure better health outcomes. Some examples include more opportunities for breast cancer screening and measles vaccine when compared to Canada, the UK, and other countries (Vandebrouck 2020). Another very important strength that American healthcare holds over our peers is the impressive technology and clinical research that is developed within the US healthcare system. Thus, the American people are afforded early access to groundbreaking therapies. This notion cannot be discounted. As we look to the future, step by step improving healthcare, it is vital we remember what we have going for us and where we need to improve.

Sources

AAMC. 2020. “New AAMC Report Confirms Growing Physician Shortage.” AAMC, June 26, 2020. https://www.aamc.org/news-insights/ press-releases/new-aamc-report-confirms-growing-physician-shortage.

Physician’s Briefing Staff. 2021. “PCPs Spend Average of 18 Minutes With Each Patient.” HealthDay, January 7, 2021. https://consumer. healthday.com/primary-care-physicians-spend-18-minutes-with-each-patient-2649619334.html.

Hohman, Maura. 2020. “Why is Health Care so Expensive? 5 Reasons Bills Are Higher in the US.” Today.com, September 22, 2020. https:// www.today.com/tmrw/why-healthcare-so-expensive-united-states-t192119.

Kaiser Family Foundation. 2020. “Market Share and Enrollment of Largest Three Insurers- Large Group Market.” Kaiser Family Foundation, May 21, 2020. https://www.kff.org/other/state-indicator/market-share-and-enrollment-of-largest-three-insurers-large-group-market/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D.

Kerns, Christopher, and Dave Willis. 2021. “The Problem with U.S. Health Care Isn’t a Shortage of Doctors.” Harvard Business Review, February 1, 2021. https://hbr.org/2020/03/the-problem-with-u-s-health-care-isnt-a-shortage-of-doctor.

Meyers, Scottie. 2016. “Lack Of Regulation Allows Pharmaceutical Companies to Raise Prices of Lifesaving Drugs, Expert Says.” Wisconsin Public Radio, September 6, 2016. https://www.wpr.org/lack-regulation-allows-pharmaceutical-companies-raise-prices-lifesaving-drugs-expert-says.

Osborn, Robin, David Squires, Michelle M Doty, Dana O Sarnak, and Eric C Schneider. 2016. “In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care.” The Commonwealth Fund, November 16, 2016. http://www.commonwealthfund.org/publications/journal-article/2016/nov/new-survey-11-countries-us-adults-still-struggle-access-and.

Saad, Lydia. 2021. “More Americans Delaying Medical Treatment Due to Cost.” Gallup, March 23, 2021. https://news.gallup.com/ poll/269138/americans-delaying-medical-treatment-due-cost.aspx.

Stump, Scott. 2020. “Man Gets $1.1 Million Bill after 62 Days in Hospital with Coronavirus.” Today.com, June 16, 2020. https://www.today. com/health/man-survives-62-days-hospital-coronavirus-gets-1-1-million-t184348.

Tikkanen, Roosa, and Melinda K Abrams. 2020. “U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?” Commonwealth Fund, January 30, 2020. http://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.