On the deep crisis in American medicine - and the broad societal anger and cynicism it is driving
Healthcare is the place where scientific expertise meets lived experience most intimately. The problems have no easy answers, but we can all see for ourselves how badly the system is failing.
If a plane ticket to Florida cost $5,000 and a jet went down every day, would any of us “trust the science” from Boeing, United, and the Federal Aviation Administration?
A couple of weeks ago, one of my kids wound up in the emergency room for a minor but painful problem. The doctors prescribed ibuprofen while they tried to figure out how to treat it.
After an hour, someone realized the answer might be an over-the-counter product the hospital didn’t have in stock. They sent us out to get it. The product worked, and the hospital quickly discharged my child.
This week I received the “statement of benefits” related to this episode. The hospital billed our insurer almost $3,000; our deductible is $150.
Best health care in the world!
—
(Forget the shoes, baby needs another month of COBRA!)
—
As American medical horror stories go, this one is minor.
It’s not a cancer diagnosis missed for months because of a high deductible to see a specialist. Or - conversely - psychiatric patients held against their will until their insurance benefits are exhausted.
Or a “nonprofit” hospital paying its top executive millions of dollars while suing poor and uninsured patients. Or an expensive new drug being pulled from the market after causing tens of thousands of heart attacks.
Yet it perfectly captures the insanity of medical and hospital pricing — which is divided both from any reasonable cost basis and from any outcome measure. Hospitals are like casinos. Money loses all meaning inside them.
This year, the United States will spend over $5 trillion on healthcare.
The figure translates into almost one-fifth of national income, over $15,000 for every American, double what we spend on cars, clothing, and food combined, and far more than other countries. Crushing medical costs are a big reason many Americans feel so broke even though the economy has actually grown solidly since the 2008 financial crisis.1
—
(Meet Howard Kern. In 2022, Virginia-based Sentara Health - the nonprofit hospital system he headed- paid him over $10 million, just one in a string of very good years for Kern. Did I mention Sentara’s a “nonprofit”?
If it makes you feel any better, Sentara paid eight other executives over $1 million in 2022. Charity really does begin at home!)
—
The costs would be unconscionable even if our system worked.
But it doesn’t.
Americans die years younger on average than people in other advanced countries. And the gap is widening. In 1980, the United States and Britain had the same life expectancy, about nine years longer than Mexico. By 2022 the United States had fallen almost five years behind Britain - and was only two-and-a-half years ahead of Mexico, a country with one-sixth our per-capita output.
Life expectancy is the simplest and broadest measure of a population’s health. But by any other standard — from obesity to maternal mortality to overdoses to self-reported mental health — American outcomes are equally dismal.
We have the newest, most expensive medical technology and prescription drugs, the highest-paid hospital and insurance company executives2, the most complex reimbursement rules and insurance plans, and the most lavish new hospitals.
The insane spending extends to the public health establishment. Federally funded researchers — at every stage, from scientists who do basic “bench” research to frontline epidemiologists — constantly whine for more money.
In fact, the budget for the National Institutes of Health was over $48 billion in 2024, a 14-fold increase since 1980. Even after accounting for inflation, it has grown almost four-fold over that period. The Centers for Disease Control budget is another $10 billion.
For this money, since 2020 we bought ourselves a deadly virus that the NIH almost certainly indirectly produced by supporting risky research, school closures and lockdowns that the CDC undoubtedly worsened, and a novel “vaccine” that worked - if at all - for a few months, with long-term consequences we still don’t fully understand.
—
(Seriously, about that COBRA)
—
No wonder so many Americans no longer trust public health, or medicine more broadly.
The fact that so many people are looking forward the potential elevation of Robert F. Kennedy - who isn’t even convinced that HIV causes AIDS3 - to the most important job in American healthcare is proof of how angry we’ve become.
But I am increasingly convinced that the crisis in medicine is feeding toxicity about every part of society. After all, healthcare isn’t supposed to be just another industry. Doctors are told to “do no harm,” drug companies once called themselves the “ethical pharmaceutical” industry, and hospital systems run seven- and eight-figure advertising campaigns to brag about how much they care.
In reality they are not merely rapacious but too often dangerous to the patients they are legally bound to protect. They take advantage of opaque pricing and a trillion-dollar government honeypot and most of all fear, the fear we all have of sickness and death, to line their pockets without conscience.
Many physicians, nurses, and other frontline medical workers mean well and do their best for patients. Many scientists genuinely want to find cures for the infirmities and diseases that will afflict us all sooner or later. I believe that.
But the American healthcare system has become a grotesque carnival.
Everyone knows it, even if no one can fix it.
But we have to stop the bleeding.
We can’t go on like this.
The second reason is ballooning housing prices, but since most American families own their houses, the math is complex. Rising prices help owners, but they can also hurt by driving up taxes and insurance.
Higher housing costs are unequivocally bad for renters, though. And since renters tend to be poorer, they have been hit by both rising healthcare costs and housing prices. On the other hand Obamacare offers giant hidden subsidies for poorer people getting health insurance, somewhat mitigating their costs, while shifting the burden to everyone else. The details are complex, but the overall picture is not: healthcare costs are crushing for anyone who is a) not very rich and b) fully or even mostly exposed to them.
Yes, we have by far the world’s most highly paid physicians too. American doctors hate to hear this, but it’s true.
Spare me, I don’t want to hear the conspiracy theories.
Count me as someone whose perspective has completely changed on this issue post Covid. Sure, did I know that healthcare was absurdly expensive and that price transparency was a fool’s errand? Of course. But I had no assumption that anything but the very outer fringes of healthcare was for anything but the benefit of humanity. How wrong I was. The majority of the industry seems equivalent to the “military industrial complex” Eisenhower so famously warned about. But now it’s the medical-government-insurance complex that has no compunction to do anything except enrich its elite, wherever that elite may be.
Very well done. Your frustration is clear. When I first graduated from college in the late 70s I worked for a small, local insurance company and I paid group health claims. I know how to read a hospital bill. And Dr's bills. These bills are totally incomprehensible today. And Obama care is a disaster. My husband and I are on Medicare now but for 3 years we paid $20k annually in premiums for which we each received a free flu shot each year, period. Our deductible was so high we also paid all our medical expenses out of pocket. We were fortunate we could afford that (barely) but many people cannot. I recently broke my shoulder. We didn't pay anything for it but the total billing for it was $120k. I basically had 6 x-rays and about 10 doctor visits. No surgery, no procedures. This is ridiculous!