Our Broken System

T.R. Reid’s book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care has a really interesting comparison of different health care systems from around the world, focusing particularly on the nations that rank higher on the World Health Organization’s ranking of health care systems by country. In doing so, Reid is revealing why America’s health care system is so broken. While we’re only halfway through the book, I’m starting to see a major problem that is fundamental to our system of health care.

Health care is a system. It’s a relationship with four major components: the consumer (the one who requires the health care), the provider (the one who is giving the health care), the payer (the one who is paying for the health care), and the product (the actual health care). And, as Reid’s book shows, there are different ways that this system can operate. The major problem with our system has to do with the payer. For most Americans, the payer is a private, for-profit, insurance company. And, as with any economy based on capitalism, the one with the money is in control of the system. This is a problem because these insurance companies have no connection to the actual providers of the healthcare, so their goal is not to provide high quality health care; it’s to make profits for their investors. This is in direct contrast to most other health care systems that rank higher than the US.

For example, in the UK, the NHS is a government-funded operation. And instead of being held accountable to investors, the NHS is held accountable to the people. NICE (the National Institute for Health and Clinical Excellence) decides what the NHS will and will not pay for. And, as Reid states, when they choose not to fund one procedure, that money then goes to help other people, as opposed to being returned to investors. This is an example of a functioning relationship between the provider, the payer, and the consumer - they all have the same end goal of providing quality health care to everyone.

On the other hand, in the US, private insurance companies decide what their policies will and won’t cover in a very non-transparent way. Oftentimes, even the doctors won’t know how much a procedure will cost the consumer. In this system, each player has a different goal: the consumer wants to receive affordable, high-quality health care; the provider wants to make money while keeping their patients healthy; and the payer wants to make a profit. This is a broken relationship.

Furthermore, insurance companies have much more power in the US than they do in any other country. For one thing, they can pick and choose which customers they take on. Before the 2010 health care reform, insurance companies had free will to deny any consumer the right to health care because they were at risk or had a pre-existing condition. The main flaw with this is that those are the people who are most in need of health care. That is perhaps the most mind-boggling thing about the US health care system and really drives home the point that the US system values profits over health care. This goes back to the neoliberal model of health care and the idea that health is an ideal for all but only achievable for some. For the middle-class, “healthy” individuals, this isn’t an issue. But for many Americans, a major health crisis could send them into bankruptcy, and most insurance companies are okay with that. Because insurance companies, and our larger neoliberal free-market capitalist society values profits over everything, our health suffers. Health becomes something so fundamental to our socioeconomic identity that health care is no longer a basic human right; it’s something that has to be bought.

The really depressing part about Reid’s book is that there is no perfect health care system. All of them have flaws. But when we look at ours compared to other countries’, we can see just how flawed ours is. And while this is all relative and there are so many countries with worse systems than the one we have, that doesn’t mean that we shouldn’t make ours better. We have the resources and the power to change it, but the ones with that power don’t have the will to change it. And why should they? Insurance companies and hospitals are profiting off of our broken system. Our health care providers make more money than other providers throughout the world. So the ones with the ability to change the system have no desire to, because it works in their favor. And for America’s health care system to heal, those with power need to give up those profits.