Exposing the sickness at the heart of our health care system
America has the best health care money can buy. Instead, we need a system that works for all of us.
I’m writing this on a rather hectic day for me and my family. My sister just got out of major surgery in Chicago, and she’s in recovery just feet from me. We’re staying at an AirBnB near the United Center because the journey back home to the South Suburbs would have been far too long so soon after my sister’s procedure.
I want to take this opportunity to thank all the doctors, nurses, and staff who helped my sister and our family at Northwestern Medicine. I can’t say enough about their bedside manner and professionalism. I also want to thank everyone who has prayed for my sister and our family all along the way, including my And Campaign family who prayed with me just this morning before we started our Civic Revival planning meeting.
My sister has been extremely open about her diagnosis and health journey, but I won’t go into too many details. Those are hers to share. I did ask her if I could share with you some important context for why we were at Northwestern rather than back home in the suburbs.
Based on her diagnosis and the outcome of her surgery today, my sister had quite clearly been misdiagnosed and under-diagnosed for years. While she now has world class care at Northwestern, all along the way, she experienced missed opportunities to deal with her issues in far less radical ways.
The journey has also meant a considerable financial burden for our family. This AirBnB was a necessary but not inconsiderable expense, and every trip to Chicago for the last few months has meant time away from work, gas money, parking fees and more expensive meals away from home, to say nothing of the expense of the health care itself.
We live in an era of medical marvels unheard of even a few decades ago. The pace of innovation seems to be taking exponential leaps and bounds. That said, unlike in every single advanced economy around the globe, and even some nations far less advanced and wealthy than we are, access to the benefits of all modern medicine has to offer mostly depends on the income bracket, age or zip code of the person who needs care.
While rates have dropped since the implementation of the Affordable Care Act, around 26 million Americans still have no health insurance. More than half the insured population gets health insurance through their employers, and both the stability and the quality of that insurance varies based mostly on the stability and quality of the job. ACA expanded Medicaid, but nine states still have not implemented that expansion. The share of uninsured people is nearly twice as high in those states among both adults younger than 64 and children and teenagers 19 and younger.
One population where uninsured rates are incredibly low and have been since long before ACA is adults aged 65 or older. Why? This is patently obvious. Adults in this age bracket qualify for Medicare, a single payer system we’ve had in this country since 1965. More than 57 million people aged 65 and older and about 8 million younger people get Medicare.
On average, Americans spend about twice as much on health care as every other advanced economy. Despite this, we have a lower life expectancy than peer nations and worsening health outcomes since the outset of the COVID-19 pandemic, which exposed serious deficits in our health care system.
In many ways, my family is quite blessed to be in close proximity to an urban center, though health care in the far South Suburbs where we live isn’t entirely dissimilar to health care in the rural areas of America, where more than 60 million Americans, around one-fifth of our population, lives. Health outcomes for people in rural areas are worse than those who live in urban areas. Meanwhile, one out of every 25 rural hospitals closed from 2013 to 2020, meaning rural Americans had to travel an average of more than 20 miles farther for basic inpatient care and an average of nearly 45 miles farther for specialized care.
As many reading this can likely attest, even having insurance doesn’t mean you can afford to use it. Get a serious illness or get diagnosed with a major disorder, and you’ll find out quickly whether that diagnosis comes with the added burden of crushing debt.
So, how do we fix this problem? What we need is free-at-the-point-of-service, single-payer health care for all, direct subsidization of provider networks, subsidized education for medical professionals willing to work in rural areas, support for cost-sharing programs and mutual aid societies, home-care grants, simplified regulations, and reduced restrictions on the importation of prescription drugs. We need community-owned hospitals and we must oppose the merger of hospitals, which generally results in less access for patients to life-giving care.
Health policy must include regulatory protections for those with preexisting, chronic, and terminal conditions, those who have no means to save for an emergency, and those who have medical needs at every stage of life from prenatal care to hospice care.
We must engage in efforts to help prevent the tragedy of self-harm, including universal access to affordable mental health care, de-stigmatization of mental illness, and the full funding of psychiatric institutions for serious cases.
The federal government should negotiate pricing to end corporate exploitation of the captive audience of patients. Medical licensing must also be reformed so that licensing supports quality care, and does not impose straitjackets on health care workers or work only to support health care industry cartels. We also need tighter regulation of pharmaceutical advertising.
My friend John Médaille, a former businessman who now serves as a theology professor, and who has studied alternative economic systems extensively and wrote a book on the subject called Toward a Truly Free Market, has written on the subject of high medical costs. Among his proposals: use patent reform and price negotiation to end the oligarchies and monopolies driving up costs, and licensing reform and the reintroduction of medical guilds to help increase the supply of well-trained medical professionals.
What we most certainly can’t do is to continue on the path we’re on right now. We have the best medical care money can buy in America. What we need is a system that delivers world class care to all our citizens, regardless of their age, their location or their station in life. We can get there together, but not without confronting the systems in place that keep quality medical care locked away for all but those with high net worth. We’re all worth more than that, and we all deserve a health care system that works for all of us.
How would you fix our health care system? Share your ideas below.
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Good job. Important reminders about health care costs. Just a note on legalizing "sex work." The term, of course, is an effort to mainstream prostitution. On a deeper level, it misrepresents what work is, and it's far more than any activity for which one receives payment.