The Pandemic Is a Microcosm of Ills in U.S. Healthcare
Five of the major problems in the US healthcare system have been prominently showcased in the Covid-19 pandemic:
- Under investment in prevention
- Inequity and bias
- Politics get in the way
- Not invented here
- Not following doctor’s recommendations
To significantly improve the US healthcare system for our entire population, we need to learn from this painful event and make changes in each of these areas as individuals, as communities and as a nation.
Underinvestment in Prevention
The pandemic demonstrated in an accelerated way how under investing in prevention ends up costing more lives and more money. In spite of the US government having identified years ago that a pandemic similar to this one was a probable event, insufficient actions were taken to prepare for it. Although we don’t consider health threats a national security issue in the same way as military threats, perhaps we should. It is likely that by the end of 2021, more Americans will have died from Covid-19, than have died in military combat in all the wars the US has ever fought, 666,441 people.
Inequity and Bias
People with money and power get excellent healthcare in the US, people without it don’t. The pandemic has highlighted this as older adults, minorities and the poor have been hit the hardest. Of the 580,000 Americans who have died in the pandemic, 80% are over 65. Hispanics and Blacks have a 41% higher death rate from Covid-19 than Whites on an age-adjusted basis. A 1.0% rise in a county’s income inequality corresponds to a 3.0% rise in Covid-19 mortality. As the richest nation on earth, we need to measure the quality of our health system on what we provide to those who have the least, not the most.
Politics Get in the Way
Healthcare has been a political punching bag since World War 2. Whether the argument was against Medicare, socialized medicine, Obamacare, or restricting personal freedom, we have seen that politics has kept us from providing effective healthcare. Military spending seems to be the only true bipartisan issue these days. Military spending accounts for 53% of federal discretionary spending, and health spending is only 6%. (Federal discretionary spending does not include Medicare, Medicaid, Social Security, and other committed government benefits.) We would save many more lives if we were as hawkish with health spending as we are with the military budget.
Not Invented Here
In healthcare, we often don’t apply the knowledge and practices that have been shown to work in other states or countries. For too long we have tried to convince ourselves that the US has the best healthcare in the world. The pandemic has made it clear that this is not true. Our performance on many pandemic measures, such as deaths per capita, puts us close to the bottom, not the top. As of May 13, 2021, the US has 1,799 deaths per million (dpm), while many of our largest allies have protected their people much better than we have: Germany (1028 dpm), Canada (653 dpm), Japan (89 dpm) and South Korea (37 dpm). Within the US we also see huge disparities. Compare the death rates in two similar states, both are small, predominantly white, rural and run by Republican governors. South Dakota has 2,248 dpm while Vermont has only 404 dpm. We must look for the best healthcare practices regionally and globally and implement them.
Not Following Doctor’s Recommendations
We spend years training our physicians, we pay them highly as experts and then we ignore what they tell us we should do. We don’t take the healthy actions they suggest and often we don’t take the drugs they prescribe. In the pandemic we saw this when 50% of the population refused to wear masks or practice social distancing, fueling rapid spread of the disease. We always prefer to take a pill to solve our health problems, rather than do the hard work of changing our habits. But even when a drug is available, our medication adherence rate is poor. We see this being repeated in the pandemic with those who say they will not take a Covid-19 vaccine, which is currently estimated to be 25% of the adult population
Solution is to Promote Good Health
These problems cannot be solved overnight. But as individuals, the most important thing we can do for our personal health and the health of the nation, is to focus on prevention. It is estimated that 25% of all healthcare spending is due to preventable causes. We have the knowledge to significantly improve our health, and reduce the cost of healthcare, but do we have the will? The lack of a unified effort to minimize the impact of Covid-19, shows that we currently don’t. This is why we call on everyone to be a leader in promoting good health whether it is at home, at school, at work, in our communities, or in government. We see huge divisions in our country right now. Can this be the common goal we can all get behind that will help us recognize that we do have more in common than we have differences? Start taking preventive measures today for a healthy tomorrow for yourself, your family and your country.