In the video above, Alexander Stockton, a producer on the Opinion Video team, explores two of the main reasons the number of Covid cases is soaring once again in the United States: vaccine hesitancy and refusal. “It’s hard to watch the pandemic drag on as Americans refuse the vaccine in the name of freedom,” he says. Seeking understanding, Mr. Stockton travels to Mountain Home, Ark., in the Ozarks, a region with galloping contagion and — not unrelated — abysmal vaccination rates. He finds that a range of feelings and beliefs underpins the low rates — including fear, skepticism and a libertarian strain of defiance. This doubt even extends to the staff at a regional hospital, where about half of the medical personnel are not vaccinated — even while the intensive care unit is crowded with unvaccinated Covid patients fighting for their lives. Mountain Home — like the United States as a whole — is caught in a tug of war between private liberty and public health. But Mr. Stockton suggests that unless government upholds its duty to protect Americans, keeping the common good in mind, this may be a battle with no end.
Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.
Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.
The cost is enormous
- High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
- Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.
Access is uneven
- Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
- Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
- Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.
From Bob Grant, The Scientist Magazine (April 1, 2020):
Prevention has been playing a growing role in other diseases, infectious and otherwise, long before this latest global pandemic. Cancer, the focus of this issue, is ubiquitous, and one would be hard pressed to find a person anywhere on Earth whose life wasn’t in some way touched by the complex and vexing malady.
This cancer-focused issue features a cover story in which we explore one facet of cancer prevention: exercise. In this feature story, Danish researcher Bente Klarlund Pedersen explains that studies have shown frequent exercise to be useful in avoiding cancer as well as in helping cancer patients lessen the side effects of their cancers and treatments. Her research and that of others is seeking to enumerate the molecular and cellular mechanisms that underlie the benefits exercise seems to offer cancer patients.
But when one considers the practical ripples that biology sends through societies—issues of public health and the shared goal of minimizing the impact of diseases on a global scale—human behavior and prevention become vitally important.
From Cell.com “Trends In Ecology & Evolution” (Feb 22, 2020):
The value of domestic cats as predators-in-residence certainly played a significant part in their global spread, as they were employed for rodent control on trade ships and in the outbuildings of emerging civilisations.
They are predisposed to form attachments with people during early developmental stages, tolerate the presence of humans, other cats, and other domestic animals far better than wilder felids, and exhibit distinctive behavioural traits (including vocalisations and body language) that facilitate effective interspecies communication…
Cats share a long history with humans but are remarkable among domesticated species in largely retaining behavioural and reproductive independence from people. In many societies, the cat maintains liminal status as both a domestic and a wild animal. An adaptive push-and-pull between wild and domestic traits corresponds with dual roles as companions and pest controllers, and with conflicted treatment in husbandry, management, law, and public discourse. To move forward, we must proceed by understanding that cats are not exclusively pets or pests, but both a central component of human societies and an important, often adverse, influence on ecosystems. Developing a collaborative ‘companion animal ecology’, in which human–animal domestic relations link to ecological processes, will enable sustainable management of this wild companionship.
From a Wall Street Journal Opinion article (Feb 10, 2020):
How to address the elder-care crisis? Ideally, doctors would screen older patients for dementia. An early diagnosis helps patients understand treatment options, plan for the future and receive appropriate care in the hospital.
Other steps include: more preventive care, changes to Medicare’s rehabilitation policies, adopting new reimbursement methods, and developing new measures of success. Primary-care offices can prevent hospital visits, but Americans seeking primary care face an average wait time of 24 days. This might not be a problem for a patient in need of an annual physical, but conditions like chest pain or infections require prompt treatment. Primary-care offices that offer same-day sick visits, home visits for bed-bound older adults, or at-home monitoring of conditions could reduce emergency department volumes.