It is well known that the United States spends more money per person on health care than any other country in the world. That does not mean that we have the best care and that we are the healthiest nation in the world. On the contrary: we have to pay huge insurance premiums, various extra charges generated by a visit to a medical facility, the highest cost of drugs and other medical accessories, but still have lower life expectancy than other developed countries. The excuse we get from our health industry and the politicians who support it is that a lot of the money we pay goes toward research and that we do not have to wait for surgery, medical procedures and hospitalization as long as our neighbors in Canada and other countries with national health care. My own experience and those shared by DC area acquaintances picture a bleaker reality.
"Ask your doctor" is an irritable phrase on the labels for traditional and alternative remedies, as well as advertisements for health accessories, exercises, and diet recommendations. The phrase often comes with a stock photo of a sympathetic doctor leaning toward a worried patient. Similar doctor-patient images appear on the home page of every health insurance portal, except that the patients in those look happy. Do advertisers really think that we have such close relationships with our health care providers? I don't even know mine, because every time I come in, there is someone new. Perhaps the advertisers' thinking is clouded by visions from their grandparents’ past.
The 2020-2022 Covid pandemic serves as a general excuse for the current state of the US health care, but no one is fooled. A few decades ago I noticed a slow but gradual decline in the quality of health care and a simultaneous rise in the costs. Before that I was healthy and rarely need to see a doctor. But now that I do I have to make an appointment to see any physician at least three months ahead of time, which means that I have to look for alternative help if I suddenly feel sick. If I call the office to "ask the doctor", I get a recorded message saying an administrator will respond within 24 hours. Most often the promised call-back never comes. But the cost of a basic visit has risen at least three times in the past decade.
After a recent consultation with a doctor from the George Washington Medical Faculty Associates, she wanted me to make an appointment for a test at the same facility. But when she brought me to the reception, there was no one to make the appointment. All the staff had left for the day at 5:00 PM although the doctors were still seeing patients. The calls to the telephone number the doctor gave me to make the appointment were answered by a robot urging me to stay online because someone “will be with you shortly.” After three days of listening to godawful music and the robotic voice repeating the phrase, I literally begged my primary care facility to make the call for me through a line reserved for the physicians. They managed to obtain an appointment for me the next day, but no one informed me so I almost missed it.
The test results for several issues have long been sent to me by mail, but I still don't know what they mean because my follow-up appointments with specialists are one and two months away respectively. I hope I don't have a fast-spreading cancer that could metastasize before I see a doctor.
Following a remote decade (cca 1980s) of seeing the same primary care physician, doctors in my life started rotating with increasing speed. I recently waited three months to meet my new PCP only to be called on the day of the appointment and told that she is leaving. Most of the time instead of a doctor, I see registered nurses. Before any visit, I am asked to complete a myriad of forms online, sign multiple waivers and authorizations, most importantly, of course, commitments to pay the bills if my insurance refuses to.
Currently I have three insurances: primary, secondary and a separate one for dental work. I am being urged to take out a fourth one for drugs. The amounts providers claim from health insurances are staggering these days: a visit to a primary physician that used to be about $150 or less can now easily top $600. And this is for about 10-20 minutes that you spend with the doctor discussing symptoms you have already described in detail online. Most of the visit is spent with nurses and administrators.
The cost of dental care is astronomic but dental insurance companies rarely cover more than 10% of the claim no matter what they promise. They employ their own so-called experts to determine if the procedure is "necessary." Guess what? ..... Yeah. The best dentists and medical doctors do not accept insurance because it requires an extra employee just to deal with the amount of paperwork required for the approval of even a minor procedure. If you cannot afford their exorbitant prices, you have a choice of traveling overseas where the dental care prices are normal and the total cost with air fare will be lower than in the US, or you can go to a so-called network dentist (the one that has a contract with a particular insurance company and charges the prices agreed with the company). During Covid I went to one such dentist who persuaded me to cap 10 front teeth for a better looking "smile." After only a few months, the crowns began falling out one after another and I inadvertently swallowed one with food. I have had dental work done in Croatia all my life before that and had never heard that a crown can fall out. Under the circumstances maybe I should consider myself lucky because of the $20,000 plus claimed by the dentist, the insurance only paid him $800. I paid about a third, but he could not claim more from me after the shoddy work he had performed.
I could write a hefty book describing my poor experience with the US health care. Suffice it to say that the system has made me (and a lot of other Americans) resort to emailing doctors or dentists in Europe for advice, researching symptoms online and self-medicating. During the rare occasions I see a doctor, I tell them what I think I have, they order blood tests, urine tests, biopsies, X-rays, CT-scan, MRI or whatever and then confirm or reject my supposition. So far the former has been more common than the latter.
Of course, it is possible that the situation is better in other states. But a recent international study has found that "people in the US see doctors less often than those in most other countries." The report by The Commonwealth Fund’s International Program in Health Policy and Practice Innovation, says this is probably because the US has a below-average number of practicing physicians, and the US is the only country among those studied that doesn’t have universal health coverage. In 2021 alone, the report says, 8.6% of the US population was uninsured.
“Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services,” researchers at the Commonwealth Fund, headquartered in New York, wrote in the report. “Affordability remains the top reason why some Americans do not sign up for health coverage, while high out-of-pocket costs lead nearly half of working-age adults to skip or delay getting needed care.”
The report’s lead author, Munira Gunja, said in a release that “To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population.”
But it is nothing new. Study after study in recent years have found that the United States spends more on health care than any other industrialized nation (3-4 times more than South Korea, New Zealand and Japan, about twice as much as Germany and Switzerland), but still has the lowest life expectancy at birth and the highest rate of people with multiple chronic diseases. A study by the Organization for Economic Cooperation and Development has found that the U.S. has fewer hospital beds and physicians per person than France, Australia, Italy and Austria, the countries that spend a lot less on health than the US. Many countries also outrank the U.S. in access to advanced medical technology the nation is so proud of.
Healthcare system in the United States is not only the most expensive but also the most complicated in the world. There is no universal care and the majority of individuals rely on private healthcare provided by their employers. Retired employees who have contributed to the federal health insurance Medicare are entitled to enroll into its plans once they reach the required age. Some low-income individuals have access to public plans subsidized by the government. Rich Americans can afford to pay for the best private insurance and get the best care. For an additional $1,000-$2000 per year "concierge" fee, their doctor will also talk to them on the phone and answer their e-mail. US Congress members also get the best health care, but at the expense of taxpayers, and don't care how many of those taxpayers have no insurance themselves.
Privatizing health insurance was supposed to spur market competition and decrease the prices, but analyses show the opposite has happened. And yet, the idea of nationalizing health care sparks horror in the minds of many Americans, even those who have no health insurance. We all know how hard it was to pass the so-called Obamacare and how targeted it has been since then by the politicians who want to dismantle it.
Economist Jonathan Skinner said that the powerful health-care lobbies and Americans' suspicion of what many see as socialized medicine make a radical overhaul of the system difficult. He was one of the experts I interviewed for the Voice of America 2006 report, titled Is America's Health Care System the best or just the most expensive in the world? Skinner also said the increasing financial strain of health care spending on American businesses, government and families would make some change inevitable. The report was relative news at the time and was cited in subsequent literature on the state of the US health care until it was pushed out from the internet by newer and more dire studies. Here we are almost 20 years later with experts still urging the administration and Congress to expand access to health care and control the costs, with no solution in sight.
So where does the money go? I have yet to meet a doctor in D.C. struggling to survive on their income. So when the George Washington University Hospital network last year sent me a colorful envelope asking me to reward my doctor's hard work with a several-hundred-dollar gift, I was puzzled. The envelope had a place for a doctor's name. I had no idea which doctor could be considered as mine since I had not seen one doctor more than once in years and no names came to mind. But how typical of America to push its ordinary citizens to share their hard-earned middling income with the highest paid professionals, rather than its most needy citizens.
