The Cynical Reality of US Healthcare: A Profit-Driven Illusion

In a country that prides itself on being a global leader, the state of healthcare in the United States serves as a perplexing contradiction. The majority of citizens grapple with spiraling costs, lack of access, and a system that undoubtedly prioritizes profit over the very health it claims to safeguard. If one were to look for a place where the phrase "healthcare" is little more than a marketing slogan, the US is a glaring example. The question we must first ask ourselves is: How can American citizens expect to participate in a world-leading healthcare system when the very representatives responsible for shaping it accept contributions from the ‘healthcare’ industry? 

A Profound Disconnect: Congress and Healthcare

Let’s get one thing straight: if Congress genuinely cared about healthcare, we would already have a comprehensive, affordable plan akin to those in less wealthy countries. Instead, what we see is a system riddled with corporate interests, where lawmakers prioritize the needs of their donors over the well-being of their constituents. It’s almost as if Congress has turned a blind eye to the suffering of millions, instead opting for a cozy relationship with health insurers and pharmaceutical companies. This isn’t a one-sided political party challenge either. Constituency of both parties are exposed to exorbitant healthcare costs - preventive and otherwise - and ever-increasing, less beneficial insurance premiums. 

The irony is thick. Senators and Representatives enjoy generous health benefits and access. Some of the public assume their care is ‘free’ - it isn’t - but it is seemingly comfortable enough for them to sidestep the very issues that plague the average American. Comfortable enough for Americans to think their representatives sit in their plush offices discussing policies that keep healthcare costs soaring while their constituents can face financial ruin over medical bills and insurance premiums. How can Americans believe Congress is genuinely advocating for affordable healthcare when they are cushioned by a system that provides and supports for them without question? It’s easy for Americans to believe the falsity of Congress members having free care. Truth be told, maybe if they can use donor campaign funds to off-set their share of health insurance premiums, directly or indirectly, maybe in some ways it is free. For Congress members accepting donations from health insurance companies? Sure…it becomes real easy to think our representation in Congress is removed from their constituency’s healthcare experiences and needs.

The Corporate Grift: A Profitable Business Model

Let’s peel back the layers of this healthcare onion and expose the grift at its core. The US healthcare system is not just flawed; it’s a profit-driven business model that thrives on misfortune of the sick. Though attention has been paid much more recently to preventive care, the attention has done nothing to curb the cost of preventive, or any other type of care. Consider the staggering cost of a hospital stay in the US, which the AMA has projected to be over $14,000 per capita in 2024.*. In contrast, countries like Germany reportedly are about 65% of the US, while Australia and Canada manage to provide similar care at less than half the price. This disparity is not a mere coincidence; it’s the result of a system that incentivizes hospitals to inflate prices for services while minimizing patient care. In ‘defense’ of the hospital administrators (a challenging group to defend), there’s undoubtedly a process that’s more akin to ‘gaming’ the system than simply inflating prices. Difficult to imagine this not being the case when insurers set not only prices but determine actual need. That’s just backward and probably criminal.

Take the case of the drug Trelegy Ellipta.** It’s a drug prescribed primarily for asthma. It’s classified as a Tier 5 drug. Which really means some insurers won’t pay for it. Many private insurers will however. As of the writing here, there’s no generic. If there were a generic, there’s often policy in coverage that requires the prescription for the generic only. As an employee participating in a good company health insurance offering, co-pays can range from $0 to $50 or more, in many programs for this drug. The actual retail price for Trelegy Ellipta at CVS? $781! What’s the same drug out-of-pocket cost in Portugal and even Greece? About $70 without insurance. That’s not a co-pay. It’s the price of this drug which is available in 30-dose inhalers and typically, 1 inhale per day. So, a monthly drug. A monthly expense. 

Comparatively, co-pays paid in America for the same services exceed the actual cost of the private healthcare. As is the case with prescriptions, Americans are charged a multiple factor for, per many of the most credible ranking services, less than exemplary services. 

This is not just a failure of policy; it’s a moral failing of a system that allows pharmaceutical companies to prioritize profits over life-saving medications. If we truly cared about health, wouldn’t we have a system that ensures everyone can afford their medication? Blatantly not happening in the US. Just flat out not happening. But it does elsewhere. God forbid if the ‘cool kid’ ever thought someone else does it better and tried to learn from them.

A Lack of Transparency: The Hidden Costs of Care

Transparency is a cornerstone of any functional system, yet the US healthcare landscape is mired in confusion and hidden fees. Patients often receive bills laden with unexpected charges, leaving them bewildered and financially burdened. The complexity of insurance plans only serves to exacerbate this issue, as individuals may not even be aware of what services are covered or how much they will need to pay out of pocket. 

The complexity of the insurance coverage claim processes only compounds the issue. An endoscopy screening is not out-patient surgery. They have different ‘codes’ for service charges and coverages. As an example, endoscopy screening is covered in full in some plans. Out-patient surgery, something different certainly, is not fully covered in many of those same plans. Code an endoscopy as out-patient surgery, and you have a co-pay you weren’t planning on. Especially if all that was done was a screening. Doctor’s office maintains they did more while screening…removed a polyp or two, or however many…and that constitutes ‘out-patient surgery’. How do we know they did anything more than the screening? And how is taking a polyp out with the same tool the doctor is screening with, change the process to ‘surgery’? The automobile repair industry is required to show you replaced parts if requested. But we just have to believe the American medical system at face value?

In stark contrast, countries like Sweden and the UK have crafted healthcare systems that prioritize transparency and accessibility. Patients can better understand their healthcare costs and can focus on their recovery rather than stress over bills. If Congress genuinely cared about the health of its citizens, wouldn’t it strive to adopt such principles? 

In most European countries, where some Americans may assume there is only ‘socialized medicine’, public healthcare with long-waiting periods, etc., the long-lines may be a reality in some cases, but there is usually private healthcare also offered. The off-hand perception of ‘long-lines’ often clouds the reality of much broader spectrums of care. The combination of the ‘social’ framework and private services results in much more affordable, and as accessible, if not more so than the American healthcare system. 

A very important aspect of this is the required clarity on services rendered and related charges before any services are provided by private healthcare. Inherently, private healthcare operates as much within a socialized system, subject to publicly managed drug prices and government policy on some costs, as it does in enhancing the healthcare available.

Insurance Coverage: The Never-ending Negotiation

So why is it if an insurance plan for which the premium is paid and current, stipulates specific coverage would an “approval” for the service be needed? What did the doctor diagnose or prescribe? How many of us have heard an insurance company say the doctor was ‘coding’ it wrong? What?! 

“Deny, defend, depose.” Maybe one of this country’s most tragic social statements made in a grotesque display of righteousness. It’s indefensible. But should be understandable. Claim negotiations, the idea of which strikes being absurd in itself, are really not negotiations, but rather an acknowledged process to ‘guard the house’.

And yet, in such a short time following such a tragically wrong but none-the-less provocative protestation as the murder of a healthcare company executive, the discussion for a better system remains mostly dormant. A man is dead, and may risk having died in vain, not for what he did, but rather for what he represented. Yet, much like Congress’ limited efforts to get anything substantial done following Sandy Hook, it’s feeling like our folks in Congress have gone back to the sidelines opting for the status quo. Which in both cases, healthcare and gun-control, in the wake of tragic, attention-grabbing, potential tipping points for change, Congress continues to show abject failure.

The Role of PACs: Money Talks, Health Walks

Political Action Committees (PACs) have become the lifeblood of American politics, particularly in the realm of healthcare. These organizations collect and distribute funds to candidates who align with their interests, often at the expense of public welfare. Both Democrats and Republicans are eager to accept contributions from PACs associated with health insurers, pharmaceutical companies, and other healthcare businesses, creating a cycle of influence that perpetuates the status quo.

Health-related PACs pour millions into campaigns, reinforcing a system where the needs of the few outweigh those of the many. Simply, the largest health insurers and pharmaceutical companies donate millions of dollars. This kind of funding creates a conflict of interest, where lawmakers may feel more obligated to their donors than to the very people who elected them. How is this not plain to see? Even if it were not to be true that even a single member of Congress felt swayed by the donors, the propensity for a conflict exists. A true leader would walk from the money and toward the health of their constituents. Period. 

Profit Margins: A Disturbing Reality

The profit margins of major health insurers, pharmaceutical companies, and pharmacies reveal the disturbing truth behind the facade of healthcare. In 2021, UnitedHealth Group reported a profit margin of approximately 6.4%, with pre-tax earnings nearing $20 billion. Meanwhile, pharmaceutical giants like Pfizer and Johnson & Johnson boasted profit margins exceeding 25%, largely due to the exorbitant prices of their medications. 

Pharmacies such as CVS Health also showcased impressive profits, reporting pre-tax earnings well over $7 billion. These figures underscore the fact that the healthcare industry is not merely about delivering care; it’s a lucrative business designed to enrich shareholders rather than improve health outcomes. If we were truly trying to make America great again, wouldn’t we prioritize a system that fosters health and well-being instead of lining the pockets of corporate executives and shareholders?

A Comparative Analysis: Healthcare Costs and Quality

When we turn our gaze to other developed nations, the differences in healthcare costs and quality become glaringly apparent. Countries such as France and Japan offer universal healthcare systems that deliver high-quality care at significantly lower costs. France, for instance, spends around 1/3 per capita on healthcare fo what the US spends. Ironically, despite this higher spending, the US consistently ranks lower in health outcomes, such as infant mortality and life expectancy.

According to the World Health Organization, the US ranks a dismal 37th in overall healthcare system performance, while countries like Switzerland and Sweden consistently achieve higher rankings. Without question, these countries smaller and less dynamic in many ways, but these nations have prioritized access to care and patient-centered approaches, leading to better health outcomes. If Congress truly cared about the health of Americans, wouldn’t it take a page from their playbook?

The Role Law Suits Play: Americans’ Litigiousness 

To be fair, some of what likely gets built in to the difference in comparative costs versus other countries is America’s profound reliance on litigating almost anything. This is not just a component of inflated expenses in the healthcare field. It’s culturally American alongside this country’s consumerism and propensity for idolatry. The greatest challenge to this aspect is the impact on the human providers. The doctors and nurses…the health care professionals and employees. Understatedly, yet understandably, we are in dire need of healthcare professionals going forward. This is not to say all doctors and health care professions are exempt from increased costs or lack of quality services. We’re not really discussing plastic surgery for the vain here. We’re talking about the professionals that provide pediatric, general, preventive and emergency diagnosis, medicine, surgery.

The Cynical Question Remains: Is Health Just a Commodity in America?

The reality is that the US healthcare system is a glaring example of how corporate interests have infiltrated and corrupted a fundamental human need: health. The disconnect between Congress and the average citizen is staggering, revealing a system more concerned with profit margins than with providing care. As long as lawmakers continue to accept contributions from the healthcare industry while enjoying their own generous health benefits, we should not expect meaningful change.

If we genuinely seek to make America great again, we must begin with the health, well-being, and education of our citizens. A society that prioritizes profit over people cannot claim to be a leader in any arena, least of all healthcare. Profit is a result of a formula of an environment built to succeed. For all humans, most all else becomes fairly moot without addressing our health. Sickness is expensive and distracting. It should be prevented and cured. Health, in it’s most general sense, should be attainable. It’s time to challenge the status quo and demand a system that values health over wealth, transparency over confusion, and compassion over corporate greed. Only then can we hope to create a healthcare system that truly serves all Americans.

Until then, when we speak of ‘healthcare’, nobody in Congress seems to truly care about health. Nobody. All they have accomplished is to expand the classic American narrative, though really a tall-tale, that we are the greatest, best, biggest. We’re not. It certainly could be true. But to believe that Americans are offered affordable, exemplary healthcare today, or that Congress has done anything close to their job to provide comprehensive healthcare for its citizens, is simply foolish.