Is American Healthcare Really the Best?

Is American Healthcare Really the Best?

Have you recently been surprised at how quickly you or a loved one was discharged home from a hospital after an orthopedic procedure? Disappointed by the brevity of an office visit? By your inability to share all your concerns with a doctor during the visit? By your inability to see a doctor in a timely manner? By your inability to see a doctor at all? By the brevity of your rehab stay? By the rising cost of that care?

If you have been, you’re not alone. Welcome to the American Healthcare System, version 2.0, crafted for the twenty-first century. Where costs and cost controls have taken precedence over the quality of care delivered. Your quality of care. What this series of articles is designed to do is to take you behind the scenes, to uncover the inner workings of the health care system, to explain why what you experience is so far removed from the medical care that your parents and grandparents experienced.

But why should you accept what I have to say? Well, perhaps it is because I’ve spent over thirty years providing that care to thousands of adults as their primary care physician. Or maybe it’s because I have served also as an administrator of a hospital sponsored multi specialty group practice. Or because I have been a regional administrator for a large nursing home chain which provides physicians for rehabilitation facilities around the country. Or maybe it’s because I have served on the senior medical advisory boards for three of the top ten medical insurance companies in this country, as judged by the US News and World Reports rankings. Or maybe it’s just because I am one of you: a frustrated, disappointed consumer of health care.

Whatever the reason, I will attempt, in the next several articles, to pull aside the veil and explore the reasons why health care has evolved as it has, and what we have to look forward to. There are many who think that the solution to the current crisis in health care is to transition to a single payer system. That we should simply overhaul the present system and redesign it to better meet our needs. But there are economic forces at work which make this nearly impossible. From the regulation and restrictions of Wall Street and its banking institutions to the current, outmoded models of education in health care training to the current legal tort system, there are several rather insurmountable obstacles.

But to begin to understand the problem, we need first to look at some basic facts. According to a PBS News Hour report from 2016, the average cost of health care per person in the US was over $10,000. The next closest countries spent at least $3000 less per person. But, you say, the American Health Care system is clearly superior to any other system in the world. Well, not so fast. While we may lead the world in health care research and in cancer care, other metrics aren’t nearly as reassuring. Average life expectancy in this country is 78.7 years. Among other industrialized nations, the average is 79.8 years.

But, clearly, isn’t it true that we have more doctors here, that are more available to their patients than the other countries? Not so fast. Actually we have an average of 2.4 doctors per 1000 patients in this country while the average in the 34 industrialized nations surveyed is closer to 3.1 doctors per 1000 patients. What’s more, we have fewer hospitals and hospital beds than other comparable nations as well.

So why is our care so expensive? Are we getting our money’s worth? Because clearly the individualized care that we have come to expect has, as time has gone by, eroded. Oh, that’s not to say that we can’t find a “concierge practice” to provide us with a more customizable experience. A more Marcus Welby MD experience. But it costs much more money. And it doesn’t deliver what you might expect.

So here is the problem. The costs of medical care continue to escalate, while what we get for that money continues to dwindle. And while many of our health care policy wonks wring their hands over this trend, struggling with how to get the costs under control, the patterns continue. And we will, with the following articles, review how those wonks have tried to grab this tiger by the tail, and what it means for your health care experience.

Unlike many, I won’t try to redesign the system. I believe that if we can identify the problems, there are many, much brighter than I, that can look for solutions. But as you go forward, it may be helpful to place your health care experience into perspective, with the benefit of some insider knowledge.