Assessment: American healthcare system persists as flawed, requires extensive restructuring

The United States healthcare system, designated as "broken" due to its high costs and less-than-excellent quality, spent a staggering $4.87 trillion in 2024, amounting to $14,570 per person. This spending, the highest among wealthy nations, surpasses $13,000 annually per capita, yet outcomes often lag behind due to systemic inefficiencies.

The complex payment system for patients in the US healthcare system is a significant contributor to these issues. Numerous Explanation of Benefits (EOBs) and bills for co-pays create financial burdens and inconsistencies in access. The system's expense and underperformance are rooted in several key factors.

One such factor is the complex public-private mix. The US relies heavily on a combination of public programs and private insurance, leading to complexity and administrative overhead. High out-of-pocket expenses also play a significant role, with many Americans paying large portions of healthcare expenses themselves.

Health disparities and social determinants further exacerbate the problem. Vulnerable communities face barriers such as limited pharmacy access, poor transportation, and socioeconomic challenges, worsening health outcomes and increasing costs from preventable complications. Inefficient care delivery, with underutilization of early interventions and preventive care, also contributes to the issue.

Proposed solutions to address these issues focus on improving health outcomes to reduce overall costs. Emphasizing maternal and infant care interventions to avoid costly complications, reducing health disparities by improving access to primary care, pharmacy services, and social support for vulnerable populations, and implementing system-wide cost reduction strategies by encouraging employers and insurers to seek value-based care models are some of the proposed strategies.

Other countries, such as Greece, achieve lower costs and better access through streamlined financing and increased government roles, offering affordable and quality healthcare via a hybrid system. The move from a fee-for-service model to a value-based model is proposed as a solution to the broken healthcare system.

However, the debate over Certificate of Need (CON) laws continues, with some arguing they help control costs, prevent duplication of services, and maintain quality standards, while others claim they impair competition, encourage monopolies, and increase the cost of care. The charges for healthcare services in the US can range from $.75 to $250.

The resulting approximately 39% of the US population have insurance through their employer or by private pay, while approximately 9% remain uninsured. The absence of transparency in healthcare billing is alarming, with 20 million Americans having medical debt in 2024, and 3 million citizens owing more than $10,000. Some physicians, including subspecialists like gastroenterologists, dermatologists, and dental care providers, have been sold to private equity companies.

The state and federal governments currently pay about 52% of Americans' healthcare costs, with the goal of investors in private equity companies being to make money, not to provide good care to patients. The US healthcare spending represents 19% of the gross national product and is expected to reach 21% by 2030.

In conclusion, addressing the US healthcare system's expense and underperformance requires multifaceted reforms targeting systemic inefficiencies, social determinants, and a shift toward preventive, value-based care. The proposed solutions offer a promising path towards a more efficient, equitable, and effective healthcare system for all Americans.

[1] Baker, D. W., & Sauer, M. (2019). The United States spends more on health care than other countries but has worse health outcomes. Brookings Institution. [2] Health Affairs. (2021). The Future of Value-Based Care. [3] OECD. (2020). Health at a glance: Greece 2020. [4] National Academies of Sciences, Engineering, and Medicine. (2021). Community Health and Economic Prosperity: Assessing the Economic Benefits of Eliminating Pharmacy Deserts. [5] Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83(2), 166-204.

Assessment: American healthcare system persists as flawed, requires extensive restructuring