Unhealthy Country

By Saad Hassan / Spring 2020

We are truly living in unprecedented times. What started off in an innocent seafood market in Wuhan, China has evolved into a global catastrophe that nobody could have foreseen. The United States’ unpreparedness for the coronavirus pandemic has been quite evident, but it has also opened up the public eye to just how disastrous the medical system truly is in this country. Even prior to COVID-19, the healthcare system had no shortage of issues, but with the death toll continuing to rise, I feel that now more than ever it is crucial to expose the flaws in one of this country’s most significant social systems.

Try and picture this scenario. One day you get out bed, not feeling particularly well. You decide to go and visit the doctor, in hopes of diagnosing your illness. Upon arrival, you are told that there is a co-payment that needs to be fulfilled before seeing the doctor. You exit the office and head to the bank in order to withdraw a sufficient amount of money. During this process, you begin to contemplate if this visit is truly worth the price of admission. Maybe you could shrug off the illness and feel healthier in a couple of days? This is an experience I witnessed far too often during the summer of 2017, when I had the pleasure of shadowing a physician and directly interacting with patients. There were numerous times when uninsured individuals did not have enough cash in their wallets, and therefore required a bank visit before receiving the appropriate care. The appointments were relatively simple in nature as well, requiring approval for conventional items such as birth control and sleeping medications. These instances primarily evoked anger and annoyance, as I found the notion of charging an absurd amount for a minor check-up to be quite ridiculous. It is hard to fathom how such a simple concept of visiting the doctor when one is ill has become an unnecessarily complex financial hurdle. My physician would echo this sentiment and convey to me how difficult it is to restrict treatment for certain patients until the proper funds are paid. While I do understand that this is a business, it appears to be one that prioritizes profits over patients.

The rising cost of healthcare is a direct result of the United States vastly overspending on it’s complex, cluster of programs. Administrative costs constitute a significant 8% of national healthcare spending, while most industrialized countries only spend a meager 1-3% (Investopedia 2020). Because the medical system is comprised of numerous private insurers, each with their own unique regulations and coverage plans, there is an enormous amount of paperwork regarding coding, billing, and deductible payments. My uncle is a physician in Brooklyn, and I’ve seen him firsthand spending his Saturday nights completing paperwork for the previous weeks’ patients. Each individual has their own health insurance with their own coverage plan, and therefore meticulous attention to detail is necessary when monitoring the services that each patient receives. The process is both time-consuming and expensive, and this scene truly conveyed to me that treating the patient in the clinic was only the first step in navigating this nightmare of a system.

The high cost of drugs also contributes to this country’s overspending on healthcare. Many pharmaceutical companies exploit the limited regulation of drug prices in the United States, and consistently find loopholes to maximize profits. There are few competitors in the pharmaceutical industry, allowing drug manufacturers to aggressively raise prices to arbitrary amounts that they deem appropriate. In the last 10 years, drug company Mylan has raised the price of their commonly used EpiPen by over 500%, an absurd increase for the regular consumer (Entis 2019). This is in contrast to Europe, where the government heavily regulates the cost of prescription drugs based on their clinical application (Investopedia 2020). It is certainly no surprise that some individuals will refuse medication altogether to avoid emptying their wallets. This limited regulation extends to hospitals and clinics as well, where these facilities have the luxury of charging inordinate amounts of dollars for their services. For instance, “a heart bypass operation in the US” costs over 50% more than the same service offered in Switzerland (Investopedia 2020). The common denominator with these factors is that a disorganized healthcare system has created a neoliberal environment that allows private, wealthy companies to gleefully profit off the vulnerable population.

The most notable problem with the medical system is undoubtedly the economic inequality in healthcare. Historically, there has long been a correlation between social class and health outcomes. The United States has had among the highest income-linked health disparities in the world, and continues to increase at an alarming rate (Khullar 2018). Many studies have conveyed that upper class white men are among the healthiest individuals in the country and enjoy a longer life expectancy, while working class families continue to suffer the consequences of an inadequate system (Khullar 2018). The cost of healthcare is rising and becoming increasingly difficult for many families to afford. In fact, one in five families from working class neighborhoods have refused care from doctors merely because they are unable to afford the costly medical bills that this country demands (Khullar 2018). This becomes particularly problematic when illnesses escalate to a point where emergency intervention becomes necessary. In addition to their low-paying salaries, blue collars jobs are physically-demanding and stressful, causing further complications such as back pain and high blood pressure. These individuals desperately require treatment, yet elect to circumvent the pricey costs in order to support their loved ones. Unsurprisingly, medical debt has also become a major contributor to bankruptcy in these areas (Khullar 2018). As a result, families are left with the impossible decision of either emptying their savings or worsening their illness. There are social reproduction consequences to this as well because chronically ill individuals will have difficulties securing a high-paying job, ultimately leading to poverty. This will make it difficult to afford any medical expenses for their children, and the pernicious cycle will continue.

One of the economic hurdles that working class people will encounter is difficulties in acquiring health insurance. According to a study, approximately 60% of higher-income individuals obtain health insurance through their employer (Khullar 2018). In contrast, less than 30% of working class individuals receive that same luxury (Khullar 2018). This has led to an uninsured population of over 27 million in the United States, many of whom have virtually no access to novel drugs and clinical care . The cost of deductibles and co-payments can be astronomical, and it becomes much easier to forego treatment rather than stomaching that enormous price-tag. It is also important to not discount the socioeconomic factors, as lower income neighborhoods will often suffer the greatest health challenges including obesity, stress, and diabetes. Furthermore, these communities will have trouble accessing fresh foods, clean water, and even medical facilities that are more likely to be found in the higher income neighborhoods. The irony in this system is that while lower class families require healthcare the most, they are the least likely to actually receive it.

Another major issue stems from the racial prejudice that minorities experience in healthcare. While socioeconomic conditions certainly contribute to an increased mortality and morbidity rate among minorities, the inadequate and biased treatment that they receive in a medical setting cannot be understated. In particular, black people greatly suffer from inferior healthcare, as their medical experience vastly differs from that of their white counterparts. According to the National Academy of Medicine (NAM), black individuals are less likely to receive appropriate treatment for procedures such as kidney transplants, cardiac care, and cancer screenings (Bridges, ABA). In addition, they are more likely to be treated with older and cheaper devices, as well as being discharged from the hospital during stages when it is deemed inappropriate (Bridges, ABA). There is an inherent bias that people of color are more likely to die at a younger age, and therefore physicians feel less inclined to provide the best possible treatment for these individuals. A visit to the doctor should be one of trust and comfort, yet the NAM’s studies convey the frightening reality we live in. This disastrous experience ultimately culminates into a statistic, as minorities continue to die from a lack of proper medical care. The fascinating aspect of this absurdity is that even despite possessing comparable insurance statuses and incomes to white people, minorities still reported receiving lower-quality healthcare (Bridges, ABA). This goes beyond the aforementioned economic disparity, as the issue is no longer achieving access to healthcare, but rather overcoming the racial perspectives that have become ingrained in the medical system. It is quite astonishing to imagine that something as mundane as the color of our skin has become a determining factor in saving peoples lives.

The LGBTQ community has been ridiculed for numerous years by many groups and organizations, and the medical system is no exception. The process of coming out and accepting oneself is already such a daunting experience, that it deeply saddens me that the doctor’s office cannot be a place of solidarity for these individuals. The numbers are significant as well, as over 50% of gay or lesbian people, and over 70% of transgender people have reported a discriminatory experience while seeking healthcare (American Heart Association News). This can include encounters consisting of verbal abuse, refusing to look the patient in the eye, or simply being denied any form of treatment. More disturbing experiences can escalate into receiving unexpected genital exams without a patient’s consent (American Heart Association News). Similar to the outcomes of many minority groups, the consequences of this close-minded perspective can be life-threatening. Restricting visits and denying cancer screenings can quite literally be the difference between life and death. Unfortunately the path to equality is not becoming easier, as the Trump administration recently finalized a rule that would redefine gender identity in regards to receiving healthcare and health insurance. For instance, a transgender person could be denied proper treatment by hospitals and insurance companies solely because of their sex identity (Simmons-Duffins 2020). This ruling is particularly harmful during the coronavirus pandemic, as the arduous task of acquiring testing becomes even more challenging for LGBTQ individuals. It appears the medical system requires a revision of the ethical principles it swore to practice because the present-day environment is simply inexcusable.

The flaws within the medical system have especially been magnified during the current coronavirus pandemic. The shortage of testing kits and medical equipment has harmed both patients and hospital workers alike, as COVID-19 cases continue to escalate. Nurses are being encouraged to reuse single-use masks because there simply isn’t enough available for the hospital staff. Ventilators have become prizes in bidding wars, as hospitals fight to obtain even a fraction of the necessary quantity (Gaffney 2020). The decline in patient beds due to “profit- driven cutbacks” has also overwhelmed many hospitals that are desperately attempting to absorb this patient influx (Davis 2020). Relative to its population, South Korea has over 3 times more available hospital beds for its citizens than America does (Davis 2020). It is particularly frustrating that despite also enduring flu seasons in 2009 and 2018, where it was virtually impossible to find a vacant hospital bed, America did not learn from its mistakes (Davis 2020). Rather than intelligently addressing this shortage, the vacuous decision to reduce it’s bed supply left this country ill-prepared to handle any sort of pandemic, and the consequences are not surprising.

Even outside the hospital environment, the coronavirus is triumphing over victims of the medical system. The uninsured population continues to rise, and a tanking economy will surely add to that number. Medical bills will become unaffordable and unattainable, as this financial ruin will discourage working class people from even pondering about hospitals (Gaffney 2020). With no access to a primary care doctor and a delay in seeking treatment, sick individuals will gradually begin to present more catastrophic symptoms as their illness worsens. It is not hard to blame them: why spend ridiculous amounts of money for inadequate treatment? But while that desire to simply “fight it off” is admirable, this will undoubtedly increase the spread of infectious people in these communities. Furthermore, undocumented immigrants are unable to receive Medicaid, as it could affect their chances of acquiring a green card (Kapczynski 2020). In fact, the Trump administration even came out and stated that “immigrants need to become self-sufficient”, which is perhaps the greatest example of neoliberalism (Kapczynski 2020). High- profile celebrities and athletes are effortlessly able to acquire tests without presenting symptoms, yet regular people showing symptoms are not as fortunate. This whole system is a “capitalist marketplace”, and truly requires a complete overhaul (Mallett 2020). While our hearts mourn for the loss of so many individuals, perhaps this virus was a blessing in disguise, as it appears that this country’s leaders are finally recognizing how the flaws of this system are to blame for the deaths of many.

Universal healthcare that relies on a single-payer system appears to be one of the more promising ideas to solve the healthcare crisis in this country. More commonly known as Medicare For All, this medical system continues to garner support with over 70% of people in the United States in favor of this movement, particularly the Democratic Party (Mastroianni 2020). While there are different iterations to this policy, the primary objective of this program is to provide universal coverage for the entire population by eliminating the need for private companies and employers in providing health insurance. Public health agencies would become our front-line of defense for future epidemics that may arise (Gaffney 2020). Doctors and hospitals would only have to deal with a singular insurance agency, and therefore provide a common low-cost service across the country. Taxes alone would cover health expenses and enable everyone to be insured, mimicking the programs installed in Canada and England.

There are national implications as well, as it was reported that the United States would greatly reduce total national health spending and “could potentially save $600 billion in administrative savings” by adopting this program (Mastroianni 2020). The expensive deductible and co-payment costs would disappear as well, particularly benefitting patients that require frequent visits. That last point especially puts a smile on my face, as the thought of a patient effortlessly walking into a clinic without having to worry about any financial burden is refreshing. The single-payer system especially helps uninsured and impoverished individuals by providing them the option of visiting the doctor during times of illness. The economically vulnerable populations desperately require access to care, and this program would make an enormous impact in not only reducing the mortality rate, but also allowing them to carry out healthy, productive lives.

Despite the auspicious nature of Medicare for All, there are several opposers to this universal ideology. The primary concern revolves around the governments ability to efficiently administer such a wide-spread program. Universal access to healthcare will likely result in long waiting times for several procedures, and it will be the governments responsibility to keep these services limited in order to minimize national spending. Unfortunately, driving the cost down will not be appealing to doctors and specialists, and could directly impact the quality of service that they provide if they are not satisfied with their salary. As an aspiring future doctor, I hate to admit that I too would share this dissatisfaction. Less national spending will also result in less funding for hospitals, and prevent them from potentially acquiring new healthcare technologies. Undocumented immigrants are also a forgotten group who will not experience any benefits, as there is no guaranteed care for them under this program (Mastroianni 2020). Evidently, there is much work needed to be accomplished before Medicare for All becomes a reality, but I firmly believe that this program would be a massive first step in improving the overall health of this country.

The United States medical system has adopted a neoliberal model that continuously preys on a large majority of its citizens. While the wealthy few enjoy exceptional care devoid of racial prejudice and financial burdens, the less fortunate are sacrificing college funds for a modicum of that same treatment. This has evolved into such a grave predicament that needs to be immediately addressed, as people are incessantly dying from inadequate healthcare. A single- payer system would help alleviate many of these issues, yet there are also nonclinical actions we can embrace. It is paramount that we treat one another with kindness and acceptance, and offer equal forms of treatment regardless of race, sex, and socioeconomic status. Once we resolve this deeply-rooted systemic bias, only then can we begin to address the economic disparities that have bled from this system. The handling of the coronavirus was a colossal disaster, but through every failure is a valuable lesson. Time will tell if America utilizes this historic tragedy to successfully remedy one of its many broken social systems.

Works Cited

“6 Reasons Healthcare Is So Expensive in the U.S.” Investopedia, Investopedia, 1 June 2020.

American Heart Association News. “For LGBTQ Patients, Discrimination Can Become a Barrier to Medical Care." Www.heart.org, 4 June 2019.

Bridges, Khiara M. “Implicit Bias and Racial Disparities in Health Care.” American Bar Association.

Davis, Mike. “Mike Davis on Coronavirus: In a Plague Year.” Jacobin, 14 Mar. 2020.

Entis, Laura. “Why Does Medicine Cost So Much? Here's How Drug Prices Are Set.” Time, Time, 9 Apr. 2019.

Gaffney, Adam. “America's Extreme Neoliberal Healthcare System Is Putting the Country at Risk | Adam Gaffney.” The Guardian, Guardian News and Media, 21 Mar. 2020..

Kapczynski, Amy, and Gregg Gonsalves. “Alone Against the Virus.” Boston Review, 31 Mar. 2020.

Khullar, Dhruv. “Health, Income, & Poverty: Where We Are & What Could Help.” Health, Income, & Poverty: Where We Are & What Could Help | Health Affairs, 4 Oct. 2018.

Mallett, Kandist. “We Shouldn't Go Back to the Way Things Were.” Teen Vogue, 24 Mar. 2020.

Mastroianni, Brian. How a Single-Payer Healthcare System Could Save Money in a Year. Healthline, 24 Jan. 2020.

Simmons-Duffin, Selena. “New Government Rule Removes Non-Discrimination Protections For LGBTQ In Health Care.” NPR, NPR, 12 June 2020.