In short, we're doomed

In short, we’re doomed. The United States spends far more on healthcare than its counterpart first-world countries, all of which have universal healthcare. Of course there are many factors, but to me, a lot of this boils down to the United States’ insurance system. There are countless insurance companies offering coverage for individuals and they’re not working in our favor.

Insurance companies are exactly that: companies. At the end of the day, their bottom line is to make a profit and increase shareholder value. Some medical practices like evidence-based medicine support cost-saving by using therapies that are effective, safe, and cost-effective. However, insurance goes beyond this in many cases through denials of therapy and prior authorizations, and step therapy. Insurance companies are further trying to lower costs using AI in the prior authorization process that often reject requests outright. Their cost-saving comes from denying patients necessary procedures, therapies, and medications. Yet, increasing shareholder value shouldn’t be the goal when people’s health and lives are at stake.

I took a health policy and economics class in Ross last fall looking at drivers of healthcare spending. The United States keeps up with or exceeds other countries for quality through our practitioners, health systems, and technology. One thing rarely mentioned is that the United States has far more medical technology (i.e. MRI, CT, ultrasound, surgery robots) than similar countries. Technologies cost us more, but are helping us provide quality care. My gripe here is the role insurance plays in the healthcare spend. A significant part of US healthcare spending falls under administrative costs. Because we have so many different companies providing coverage, health systems must employ people to manage patients’ insurance through things like claim management, clinical documentation, and diagnosis coding. A universal healthcare system would consolidate this spending since there would be fewer insurance programs to manage.

When we spend so much to manage insurance then patients don’t even get coverage or have high out-of-pocket costs, surely there’s something wrong. All signs point to insurance companies being predatory and driving worse outcomes for patients. I recognize insurance can help lower costs and prevent medical bankruptcy in some cases, but we deserve a system that serves all people. Universal healthcare system is the obvious, easy answer. One would think the United States’ obsession with being the best would translate to healthcare, but even in a calmer political environment than today, Bernie Sanders was considered crazy for running on a platform of universal healthcare in 2016. Now, the concept feels impossible from both Democrats and Republicans. The government is content with the current system that provides quality healthcare yet runs the risk of detrimental medical costs to its citizens. Most people are one emergency away from bankruptcy, with medical bills or illness related income loss contributing to most of these filings. Under a universal system, we could save money and provide better care for everyone, but nobody in power is ready to admit that and take actionable steps toward implementing it. If anything, we’re on track to shrink or lose Medicid and/or Medicare in the next few years. Everything is an uphill battle and everyone is tired. The future looks bleak.