Decoding the Complexity of Healthcare: Unraveling the United States Healthcare System and the Imperative for Reform

The United States healthcare system is a needlessly complex web of providers, insurers, and policymakers, often leaving the rest of us grappling with confusion and facing a bizarre set of bureaucratic challenges. It’s a headache, and there is also no question that most Americans (and outlanders alike) have lost faith in the integrity of the United States healthcare system. However, do most of us understand the conversation about healthcare? If we are on the same page, why is it so difficult to get our policymakers to create the policy we expect them to make?

The United States relies on a mix of public and private providers, with a significant role played by employer-sponsored health insurance. Our healthcare model often leads to variations in the quality and accessibility of healthcare services based on employment status, income, and geographic location. There is something overcomplicated, and inconsistent that is hardwired into the nature of our general healthcare, and most of us recognize that, however, we don’t understand the underlying issues at the foundation of where these problems exist. And so, we speculate. I’m not yet sure if it’s humans in general or just Americans, but we have an inherent problem when coming to immediate conclusions about the faults of a thing, then we stop brainstorming a problem once exploring just a single idea and then focus resolutely on defending that belief. Unfortunately, many of the conclusions that we’ve come to regarding our healthcare system are wrong.

We compare our healthcare system to the healthcare systems of other nations, almost all of which hint at some universal healthcare scheme. The greatest difference between our healthcare system and that of Canada Sweden or even China is not within the same conversational realm of how we approach healthcare reform here in the States. In part because many people are not making, what would otherwise be, basic connections about the insurmountable challenges that would exist for a country with the population the size of the United States to provide comprehensive universal healthcare to all in the way that many Americans are proposing. The thing that we have to remember, and that we continuously ignore, is that Americans, for the most part, do not recognize 1.) that most of us are knowingly, and worse even, willingly disregarding our health, and 2.) that there is a difference between healthcare services and healthcare coverage—the role that health insurance plays in our healthcare narrative.

The healthcare systems of Canada, Sweden, and China are all sponsored in ways similar to our own, a mix of public and private funds. One of the things that makes Canada’s and Sweden’s healthcare systems so unique is that 1.) they each have a population comparable to that of a large U.S. state, and 2.) their political synergy is notably more stable than ours—even when we are at our best, and they are at their worst. We cannot compare our needs with the needs and resolutions of anyone else, simply because we do not think the same way as anyone else. We have to be creative and respectful. I’m writing this under the basic assumption that most people understand that even though a service might be free, it still has to be funded, and that’s equally true of communist and socialist states. I know many people would like to imagine a society where money is no longer the impetus of our efforts—hell, I think about it all the time—because we are capable of such utopian ideals. However, one necessary reform is that we are going to have to learn how to enjoy the work that we do. The work that would be responsible for keeping a functional society revolving. I can’t go outside or get online without hearing someone complaining about work, and how human beings were not meant to, I’m paraphrasing here, do anything functional in a cultivated society. Human beings were meant to follow their passions. Society is an example of how we, for generations, have learned how to make our passions applicable so that we might creatively and collectively, monetize the pursuits of those passions. People are too politically charged to focus inward, on anything other than the next egregious thing. To explore who we are as individuals, and then to figure out how to express that applicably. …OK, what was I talking about?

…right; proponents of a universal healthcare system in the United States argue that universal healthcare could improve health outcomes, reduce administrative costs, and promote social equality. Critics express concerns about increased taxes, government intervention, and the impact on medical innovation. One of the primary advantages of universal healthcare is the potential to create a more equitable system, where healthcare is considered a fundamental right rather than a privilege. The thing here is that although healthcare is a fundamental right, it’s also fundamentally your responsibility as a human being to practice and maintain a healthy lifestyle. Otherwise, it’s the equivalent of giving a lifelong smoker a lung transplant, there’s no good reason to provide healthcare to people who refuse to take care of themselves (the secret to just about everything, is that it starts with you and then begins to spread outward).

Other than a shift in thinking, during the Great Sanitary Awakening, basic healthcare didn’t exist to any degree before the end of the 19th century, and to only varying degrees throughout most of the 20th century. Before then, people practiced a presently ignored form of self-care known as preventative healthcare. Preventative healthcare is far easier and much more manageable today than it has ever been throughout human history; still, we haphazardly care for ourselves, and then demand that a surrogate be responsible for our less-than-conscientious well-being. Nothing screams, authentic American experience like a grocery cart full of foods requiring a warning label. I don’t know how we can expect a rational conversation about healthcare in the United States if we can’t be bothered to care about our general health at the individual level. We have to maintain at least some accountability.

It’s not the fragmented nature of many of the largest populated, universally accessible healthcare systems in the world, including ours, that contributes to higher administrative costs, limited access to some populations, and, in many cases, substandard or even care at all. Health insurance plays a pivotal role in the American healthcare system. The general purpose of health insurance was to act as a nonprofit financial intermediary between patients and the healthcare provider. The first legitimate insurance provider came from the Baylor University Medical Center in Dallas, Texas in 1903. With the intention of offsetting mounting hospital debt, the university offered the local teacher’s union a deal. For $6 a year, teachers who subscribed were entitled to a 21-day stay in the hospital, all costs included.

Within a decade this insurance plan spread across the country, and by 1939 3 million people were insured by the newly dubbed Blue Cross Plan. It’s important to note that The Blue Cross Plans were at this time not-for-profit. Throughout the next few decades, medicine witnessed tremendous breakthroughs and progress, and medical services began providing actual medical care as opposed to experimental trial and error procedures or outright “quackery.” It’s hard to imagine, I know, but sometime between the 1940s and ’50s, hospitals were becoming trusted places where Americans, only a few short years earlier, were going almost exclusively to die. 

In the 1940’s the world changed. Science and medicine began to allow for various new avenues of thinking, in part because the world wanted to stay ahead of the disparate holistic breakthroughs the Nazis were engaged in among the sciences, arts, engineering, and alternative medicines. In the meantime, World War II created severe labor shortages, with a new and immediate need for better healthcare. And, to compensate, the United States government created what was intended to be a short-term policy offering tax breaks to companies that paid for their employees’ health benefits. At the time, Blue Cross Plans would pay for extensive care, not routine doctor visits, because health insurance policies were intended to mitigate personal financial problems brought on by serious illness—health insurance was never meant to make healthcare cheaper. Health insurance made serious injury or illness manageable. Recognizing the untapped profitability in the late ’40s and ’50s, especially once the U.S. government encouraged employer-sponsored health coverage, for-profit coverage providers started developing to take advantage of the rapidly increasing demand for coverage. The insurance industry became synonymous with healthcare.

Today employer-sponsored insurance covers a significant portion of the population, but many Americans, especially those in lower-income brackets or self-employed individuals, still struggle to afford coverage. The Affordable Care Act (ACA) of 2010, aimed to address some of these issues by expanding Medicaid, creating health insurance marketplaces, and prohibiting insurers from denying coverage based on pre-existing conditions. Despite these smoke and mirrors efforts, gaps persist, and millions remain uninsured or underinsured, highlighting the need for continued reform. However, when we talk about reform we are talking about insurance reform, which doesn’t remedy the underlying problem. When the underlying problem is, in fact, for-profit health insurance. The issue of affordable healthcare in the United States is not whether we can afford medical care, it’s whether we can afford medical insurance. This is a notable difference, and yet one that we ignore day-in-and-day-out.

For-profit insurance companies are responsible for high medical costs. We’re willingly paying into an endless loop with no terminating conditions, when we talk about healthcare reform as a whole in the United States, we talk about it as though health insurance was a constant variable. The question should not be how to make health insurance more affordable; the question should be how to make healthcare more affordable. And when you ask that question, the answer is to ban for-profit health insurance providers. The system should be a hybrid of public (NFP) and private healthcare providers, where hospitals, clinics, and doctors actively compete for our business.

For example, NFP health insurers provide coverage for basic medical care for American citizens, and private healthcare companies—now actively competing for, and dependent on our business, without being supplemented by health insurance companies and cash payouts—cover extensive care. Or vice versa; NFP health insurers provide coverage for extensive, long-term, and serious illness care while private healthcare companies provide affordable, competitive basic healthcare. In either case, healthcare would be affordable to all Americans. And worthless FP health insurance providers disappear into the night. What this model does is strike a balance between accessibility, quality, and innovation creating significant, albeit simple reform in the ongoing discussion of healthcare reform in the United States.

          In the meantime, the United States healthcare system will remain at a crossroads, grappling with challenges that impact millions of lives. As the nation considers its future path, we need to understand that the greatest threat to the U.S. healthcare system is not the cost of medical care, it’s access to medical care, and the greatest threat to access is FP health insurance providers (and how we think about healthcare coverage). A hybrid of public NFP and privately funded healthcare is a worthwhile starting point; a plan for NFP health insurers to cover basic medical needs, while competing, and dependent private healthcare providers cover extensive, long-term, serious illness/injury seems to be the most practical and affordable way to manage healthcare in the United States ensuring the health and well-being of all citizens. So, there you have it, like most seemingly hopeless problems in the world the answer rests with Communitea Books, Online Bookstore, Writing Digest, and Gallery.