American Healthcare Crisis

The U.S. healthcare system becomes a more embarrassing disaster each year… 

Donald Kennedy, former President 

Stanford University; Editor-in-Chief 

Science, August 15, 2003 

America has the best healthcare system in the world, pure and simple. 

President George W. Bush, 

Addressing the American Hospital Association, 

May 1, 2006 

The American health care system has been both praised and criticized. On one hand, it has provided the world with the majority of innovations and inventions in modern medicine, thus saving many lives; on the other hand it fails to provide its own citizens with the necessary care that they require. 

America’s healthcare system is much too expensive, and its costs are rising at an unstable rate. Furthermore, care is not available to many who need it the most, and it is inefficient and highly variable in quality (Relman 1). 

Besides the unstable increase in costs, the Health Maintenance Organization (HMO) has gained a monopoly over the American healthcare system and often overrides the recommendation of the doctor in order to increase its profit margins. For example, seventeen-year-old Nataline Sarskisyan died waiting for a liver transplant, which was denied by their healthcare provider CIGNA. Although doctors and specialists from University of California Los Angeles Medical Center had recommended Nataline as a potential candidate for the transplant with a more than sixty five percent survival rate, CIGNA refused to approve the procedure until the very last moment (CNN 1). Although before the late 1960s there was no organized private investment in the delivery of health care, today it seems perfectly “natural” to economists and businesspeople to sell health care as a commercial service by profit seeking firms (Relman 1). 

Health care is one of the most critical and fundamental services provided to the consumers and everyone is affected by every minute change that occurs Incidentally, our present health care system is unable to provide necessary care to millions of Americans while the costs of health care rise at an alarming rate. 

Health care has been growing for the last fifty years at over twice the rate of inflation. No item of any budget can grow at over twice the rate of inflation modern American medicine is unsustainable and will soon be unaffordable (Lamm 17). 

According to National Coalition on Heath Care (NCHC), America’s health care expenditure for the fiscal year 2005 was $2 trillion, which is projected to reach $4 trillion by 2015. Consequently, as the cost of health care increases, the cost of insurance co-pays will also increase; this would render “health insurance” an unaffordable commodity for the common American citizen. The United States has now developed the "highest-cost" health care delivery system among the developed nations, which guarantees to bankrupt its Citizens. 

Health Maintenance Organizations (HMO) mostly manage American health care, which were originally designed by both Democrats and Republicans to prevent people from buying individual health insurance policies as make the management and regulation of healthcare more cost-effective and simpler.  The government has discouraged individual health plans since the 1940s. For example, the government offered tax exemptions to employers on employee health premiums and not to the individual. In addition to that, Congress introduced Medicare in 1965, which made health insurance for citizens over the age of 65 "obsolete" as it provided free government funded healthcare to senior citizens. These governmental policies led to an unrestricted frenzy of health care expenditure both by patients and doctors (Holleran 1). More over, President Nixon proposed the HMO Act, through which HMOs would become a key insurance provider in the United States. Through a few clandestinely recorded private conversations between President Nixon and his aide John D. Ehrlichman, it is evident that HMOs, like Kaiser Permanente, had the sole intention to maximize profits by “giving less medical care as the less care they give [to patients], the more money [the HMO] makes” (Woolley). However, (National Coalition on Healthcare)in 1973 Congress passed the Health Maintenance Organization Act, which gave HMOs government subsidies along with the power to challenge the medical judgments of licensed physicians. In addition to this, the HMO Act also bound the patients to their primary care physicians assigned by the HMO. Since the HMO Act of 1973 gave the HMOs the power to deny care to patients, all incentives went toward increasing profits for shareholders. 

In this profit driven managed healthcare system, care is often considered a subordinate to the profit, as the more care HMOs provide to the patients, the less money they would make, and soon would run out of business. According to Dr. Arnold S. Relman, American health care is now considered an “industry” and a majority of its privately owned facilities and institutions are “for-profit businesses”. Today, the system that was once designed to care and aid the poor has lost its personal touch, individualism and personal dignity. Instead cold corporate giants, faceless pharmacies, PPOs, and HMOs have replaced it (Savage 51). Patients participating in HMOs can only see a specialist if (Business Practices)their Primary Care Physicians (PCP) refers it and patients don’t have the flexibility to see doctors they prefer. In addition to that, often patients have to change doctors in the midst of treatment if their insurance provider changes its relations with their Primary Care Physician.

Recently a local medical group practice made the decision not to participate with a local HMO. I knew some of the patients had no other options for health insurance and were forced to change doctors… Much of the American healthcare system places insurance company profits and physician’s incomes over patients’ freedom of choice and continuity of care (Mueller 46).

Compared to Australia, Canada or Great Britain, on average, Americans have shorter patient-doctor relationships. According to Dr. Rudolph Mueller, in a rational healthcare system, patients would change doctors less often and if so, for mostly patient-related reasons (Mueller 46). This frequent change of doctors, results in both monetary loss for the government, HMOs, and patients, as well as losses of patient doctor relationships. In addition to this before the mid 60s, physicians followed the ground rule of the Hippocratic Oath, urging physicians that “whatever houses they visit…[to] come for the benefit of the sick, remaining free of all intentional injustice, of all mischief”, but with managed health care and HMOs a drastic change came in which physicians anticipated reimbursements and returns as physicians now received a fee for every visit, test and prescription. This shifted the medical care agenda from a simple, “patient comes first” to a rather complex one, predominantly based on the repayments and benefits. (Kassirer xiv). More over, at this time, biotechnology and pharmaceutical industry poured huge sums in an attempt to tempt practicing physicians and researchers to collaborate with the companies’ marketing strategies (Kassirer xv).

…Serious conflicts of interest are widespread and with the growth of industry marketing, they continue to increase. Whether intentionally or not, too many physicians have become marketing whores, mere tools of industry’s promotional efforts. Others have engaged in pseudoscientific studies and published biased articles and educational materials that foster industry goals over patient goals (Kassirer xvii).

Pharmaceuticals companies are one of the major lobbyist groups present in the country. They have played an important role in the development of the marvels of modern American medicine but also they have contributed their share in the unprecedented increase in costs of care.  The Medicare Drug Prescription and Modernization Act, which was signed into law by President Bush on December 8th, 2003, gave the pharmaceutical companies complete control over the prices of prescription medicine. Considering this, the same year top ten prescription drugs earned more than 48.3 billion dollars with Pfizer’s Lipitor leading with annual earnings of 10.3 billion dollars (Law 8). Although these new drugs have considerably low side effects and have proven to help with medical symptoms, their costs being too high, often people are unable to afford them even if their physicians prescribe these drugs. In addition to this, since their HMOs refuse to cover their prescription costs, they are forced to stop taking their medicines. HMOs play “games” with the patient’s pocket, which can often cost the patients their lives (Relman 32). In such cases, many physicians often help their patients by providing free sample medicines that they receive from drug companies but, in a majority of cases these samples are not enough for the patients and their condition worsens. Physicians as well as patients feel that getting quality care is a constant battle.

However, many recent efforts have been made to improve the health care management and make quality care easily accessible. The California Senate approved the Patient Bill of Rights on June 29^th, 2001 that made HMOs accountable to the patients and ensures less interference in medical decision-making process. In addition to this, it also ensures accessibility to emergency rooms, clinical trials and specialists. Also, a bill for The United States National Health Insurance Act (HR 676) has been proposed in the congress that would provide free healthcare to all Americans, without any deductibles or co-pay. Similarly, the California Health Insurance Reliability Act has been introduced which, would provide, free health care for all Californians and give them the right to choose his or her own personal physician.

Works Cited

Business Practices. The Kaiser Papers. 11 September 2000. 17 January 2008 <http://businesspractices.kaiserpapers.info/nixononkaiser.html>.

California Nurses Association. Guarenteed Healthcare. 2008. 14 January 2008 <http://www.guaranteedhealthcare.org/about>.

Holleran, Scott. The History Of HMOs. 1 November 1999. 20 January 2008 <http://www.capmag.com/article.asp?ID=2819>.

Kassirer, Jerome P. On the Take: How Medicine's Complicity with Big Business can Endanger your Health. New York: Oxford University Press, 2005.

Lamm, Richard D. and Robert H. Blank. Condition Critical: A New Moral Vision for Health Care. Golden: Fulcrum Publishing, 2007.

M.D., Rudolph Mueller. As Sick As it Gets: The Shocking Reality of America's Healthcare. Dunkirk: Olin Fredrick, Inc., 2001.

National Coalition on Healthcare. Facts About Healthcare. 2008. 19 January 2008 <http://www.nchc.org/facts/coverage.shtml>.

Relman, Arnold S. A Second Opinion: A Plan for Universal Coverage Serving Patients Over Profit. New York: Public Affairs, 2007.

Savage, Michael. The Enemy Within: Saving America from the Liberal Assault on our Schools, Faith and Military. Nashville: WND Books, 2003.

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