Conway McLean, DPM, Journal columnist

People are fed up with our health care, doctors included. US policy makers struggle to placate the powerful health care lobbies. The cost of health insurance is dominating the average American’s paycheck, more so than ever before. Meanwhile, the number of “medical bankruptcies” occurring is the highest in the history of humanity, sending too many to financial ruin. The American health care system is broken.

Doctors are bearing the brunt of much of these changes. Many physicians have become workers on an assembly line, with strict quotas on the number of patients seen. These physician employees must deal with all manner of incentives and disincentives related to their “production.” This is one of the consequences of corporate health care. It only makes sense: an executive running a health insurance company cares about the bottom line, their profitability, but quite secondarily about the quality of the care provided. They have to watch the numbers, that’s their gauge of success.

Meanwhile, the solo practitioner is a dying breed, with reimbursements plummeting over the last few decades and costs soaring, staffing included. Adding to their misery, a tremendous amount of time must be devoted to the numerous demands of the insurance companies, who too often require prior authorizations for numerous procedures, medicines, and therapies. These require the time of a doctor’s staff, as well as the physician himself, who must plead with a nurse or medical assistant for the permission to perform the treatment the practitioner has recommended.

The U.S. spends more on health care, as a percentage of their GDP (gross domestic product), than any of the market-based democracies. Understandably, part of this is our higher use of expensive technologies like MRIs, as well as the performance of specialized procedures, such as hip replacements. But the difference in expenditures is not insignificant and works out to nearly twice as much as the other developed nation.

What do we get for our health care dollar? A shrinking bang for our buck. Americans have the highest rates of avoidable mortality, i.e. death from those chronic, potentially fatal conditions resulting from an unhealthy lifestyle. Studies have revealed an inadequate amount of timely, high quality medical care, partially explaining why we have the highest death rates from these common, chronic diseases.

Despite the exorbitant dollars spent, US residents experience the worst health outcomes of any high-income nation. We are more likely to die younger from the avoidable illnesses than those residing in other similar nations, like France, England, Switzerland, etc. Additionally, America has the highest suicide rate among the industrialized nations, while also holding the number one position in chronic disease burden (referring to the number of Americans living with one or more of the common chronic conditions, e.g. hypertension, heart disease, diabetes, stroke).

The differences may be seen in an examination of obesity rates, which are doubled in the United States versus any of the other nations evaluated. Most theories place the burden for this on diet, with Americans consuming a greater percentage of their daily caloric intake from fast food and ultra-processed foods, trans and saturated fats. By way of an illustration, one might look at how much of the average diet is composed of foodstuffs that can sit on a shelf for ages without spoiling. On this topic, we are clear “winners.”

Several characteristics distinguish the US health care system from all the other developed countries. Perhaps the most glaring difference is they provide universal health care coverage. In effect, they have Medicare for all, not just those over 65 years of age. This means the government is paying for a health insurance plan for everyone. In addition, the other nations have invested in an effective primary care system, ensuring that high quality medicine is equitable and available to everyone.

In significant contrast to the US, they have reduced the administrative burdens on physicians and patients. In the United States, these requirements have served to divert time and effort from beneficial health improvement measures. Also consequential, they have developed a complex social services system, providing for emotional and social support, considered especially vital for children and working adults.

Many Americans are coming to realize physicians in this country are not the ones practicing medicine. A bureaucrat somewhere, typically far away from the site of care, is deciding what kind of specific procedures and medicines you may have access to. Those physicians practicing for more than a decade or two will say this is not what they signed up for. Many are thinking of quitting medical practice. Doctors are experiencing a moral conflict: how do they provide for their patients when an insurance company tells them they can’t.

What are we getting for our health care dollar? We spent 4.5 trillion dollars on it in 2021, a staggering figure, which has been increasing every year for decades. Health care providers are disgusted, frustrated with the roadblocks to good medical care. How to fix what many consider a broken system? There are no easy answers, this much is clear. An objective comparison of similar nations would indicate extending health care to all seems a viable step.

Because there are billions at stake, at least partially controlled by the private, for-profit insurers, Americans aren’t going to see a change to nationalized health care without a fight. Will the people rise up and demand changes? Or will the big insurers maintain their stranglehold on America’s health?

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.