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Why Healthcare is So Complicated in America.

Updated on December 24, 2012
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“ObamaCare,” has caused scrutiny on our healthcare system. If enacted, 34 million people acquire access to healthcare. Why is America not prepared for the task?

We have all seen the horrible numbers. One in Six Americans doesn't have or has substandard health insurance coverage. Injured and sick people are using the emergency room for access to healthcare, and hospitals are becoming bankrupt with uncompensated care costs. Premiums are rising so high that employers can’t share the costs, and are cutting down employee’s hours so they don’t have to pay for healthcare. So why is healthcare so wrong in America?

Medical School in America is Expensive

Although many research studies conclude that medical students are overwhelmingly from wealthy families, the remaining students acquire an average of about $135,000 in school loans. If a physician decides to continue into a specialty, such as radiology, neurology; the debt can double by graduation. Regardless of high grades and a high desire for medical college, only those with the ability to afford it or the willingness to accept the substantial high balance due can enter medical school.

Salaries for physicians are way above the average for most professions in America. Although salaries range from $150,000 -500,000, or more depending on specialty, it can take 20-25 years to pay off student loans. Doctors also may struggle with the costs of starting a private practice, excessive equipment and staff costs, and don’t begin to earn until in their late 20’s or early 30’s.

In Europe, medical students with high grades and a dedication to medicine are trained for very low costs—even free. France trains their students for practically free, while Germany encourages their university students to enter medical school with a promise to forgive school loan debt. Students in the United Kingdom can expect tuition at about $5,000 a year.Australia and Canada also have significantly lower costs.

The Doctor Shortage

The high cost of med school discourages many potential applicants, especially minority and middle-lower income students. This discrepancy in diversity limits not only the amount of physicians in practice, but the diverse backgrounds of those in practice. For example, a physician with staggering debt cannot possibly afford to practice in a small rural town after graduation, thus, many people in rural areas do not have access to medical supervision.

The primary care physician shortage is growing at an alarming rate, with an estimation of only 3 in 10 doctors selecting that field. Even with a wide variety of school loan forgiveness programs available, the trend begins to rise with a shortage of 40,000 primary care physicians predicated by 2021.

For various reasons, fewer and fewer students are applying to medical school every year. One out of three practicing physicians is over the age of 55, and is expected to retire in the next 10-15 years. This exodus represents losing 30% of the workforce, and American med schools have not supplied vacant spots with med students. At the same time, the US Census Bureau estimates the 46 million people over the age of 62 will increase to 83 million by 2030.

Physicians increasingly feel they are no longer autonomous in a patient-centered approach as insurance companies deny coverage for blood tests, diagnostics, and scans. The lack of access to patient needs increases the physician’s liability for a chance of malpractice. Doctors are finding their reimbursement payments from insurance companies more and more difficult to collect, and many are leaving their practices for administrative positions or retiring.

American Health Insurance Companies are For-Profit

American insurance companies design policies for optimum return and profit on healthcare, and have the highest administrative costs of any industrialized country. Twenty percent of every dollar goes to administrative and marketing costs. Acting as middle-management, they dictate the health care people are entitled to under a policy. Pre-existing disease and conditions may not be covered, even in children. In attempts to lower health care costs, insurance companies deny coverage for certain procedures, treatments, and surgeries.

When for-profit insurance companies began to buy non-profit companies, like Blue Cross and Blue Shield, healthcare in the US became a business.

Universal Health Care in Europe

Healthcare insurance in Europe is a non-profit and for-profit venture. Administrative costs equal about 5 percent of every dollar.In countries like France, Germany, and Austria, private health insurance is sold with fixed rate charges, no restrictions for existing conditions, and are able to make profits on certain fees for extended coverage. People in Japan, Germany, France, and Sweden get insurance through their employers, share the premium with employers, and if they lose their job, the government picks up the insurance cost.

Higher Accidental Deaths in a Healthcare Setting

The United States experiences many deaths related in a healthcare setting. Americans have frequent medication and dosage errors, blood transfusion incompatibilities, and lab errors. For people with chronic illness and frequent hospitalization, this problem is more likely to occur.

The Commonwealth Fund did a survey of the top 10 countries with accidental deaths while in hospital and under a physician's care.

Commonwealth Fund International Survey 2007

*Per 100,000 in population

Common Wealth Survey 2007

Source

Although it is very clear that we need to address the costs, limits, and quality of our healthcare system, an immediate answer doesn’t seem clear. With nurse and doctor shortages, increasing age and chronic disease factors, we are all left scratching our heads. After 60 years of passed and failed legislation concerning healthcare, it’s obvious that our solutions cannot be decided easily and readily. Where are our great thinkers when we need them?

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    • profile image

      luis 4 years ago

      this is a bit scary for someone who has a chronic condition such a kidney transplant. it seems people like myself and others who have a condition that requires constant medication and check ups. i hope the new health care law will better this for people like myself.

    • eHealer profile image
      Author

      Deborah 4 years ago from Las Vegas

      Thanks tirelesstraveler, your are so right. PA's are great but they need more power and autonomy to be replacements for docs. Thanks for your comments, I really appreciate your personal experiences, so sorry about your friend. See you soon!

    • tirelesstraveler profile image

      Judy Specht 4 years ago from California

      Many of the young folks I know are becoming PA's because becoming a doctor takes too long .

      The high cost of litigation in the US makes you wonder doesn't it. If you make 150,000 a year you have to be within an HMO that pays your Mal-practice insurance.

      I don't believe in Europe doctors are allowed to be sued. At least 35 years ago when my friend was paralyzed in a botched surgery they weren't allowed to sue.

    • eHealer profile image
      Author

      Deborah 4 years ago from Las Vegas

      Very good points, "we're paying for procedures, but not outcomes." very insightful and poignant. It is a real mess, and it will take years to fix.

    • tipstoretireearly profile image

      tipstoretireearly 4 years ago from New York

      Very interesting comments on the sad state of healthcare in the U.S. Another big problem is we're still paying for procedures rather than paying for outcomes. Until that changes, the healthcare providers will continue to have strong incentives to merely do more procedures rather than make people healthier. Can anyone imagine a car repair business operating in the same manner as our healthcare system? They could increase their profits simply by charging for a botched repair and then charging again when they fix the problem they caused.

    • eHealer profile image
      Author

      Deborah 4 years ago from Las Vegas

      Hello Rajan, thank you for your insights. I had no idea health insurance was expensive in India. I did know that medical school was very, very expensive though, many of the doctors I've worked with from India told me. thank you so much for your comments. See ya soon.

    • rajan jolly profile image

      Rajan Singh Jolly 4 years ago from From Mumbai, presently in Jalandhar,INDIA.

      We are worse off in India with prohibitive medical education and non existent medical healthcare in the private field. The so called medical cover offered to those in a government job, only offers satisfaction in the mind and for all practical purposes is a big zero. Taking private insurance policy is very expensive.

      Great informative read. Voted up and interesting.

    • xstatic profile image

      Jim Higgins 5 years ago from Eugene, Oregon

      If it only it really were the best healthcare system...look at infant mortality rates and many other stats that prove otherwise. Many of our own citizens are going to Thailand and India for excellent care that costs many times less.

    • tirelesstraveler profile image

      Judy Specht 5 years ago from California

      Did you mention that doctors pay exorbitant malpractice insurance? The reason fewer students are applying for medical school is medical schools in the US only take at max 120 students a year. I believe the American Medical Association is the only physician licensing organization in the US . They have been limiting the number of medical schools as well. Family Docs are few and far between because you can hardly make a living as one.

      I know 3 young adults that wanted to go to med school . Now they are content to be Physicians Assistants or Chiropractors. I keep hearing that there is a shortage of nurses too, yet getting hired out of school is almost impossible in CA. It is not cost efficient to hire a nurse just out of school when you have to still put more time into training them.

      You made a good start with your hub, but there are more reasons the convoluted mess health care is in now. But it is still the best in the world. Why would anyone come here if they could get better and cheaper elsewhere if it weren't.

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Hi Learn Things Web, and welcome! Why can't we take our best and brightest and make them doctors for minimal college costs? Doctors would then return to urban cities, rural areas, and other places doctors are in short supply. Doctors need big bucks to pay back student loans, pay medical malpractice insurance, invest in a practice, etc. We need to change the price of our medical schools. Thanks for your comment and your support.

    • Learn Things Web profile image

      Learn Things Web 5 years ago from California

      I saw a list of the 10 highest paid jobs in America a while back. All of the jobs listed were different types of physicians. I was very surprised by that. Considering what it costs to actually become a doctor and how long it takes, they'd better make good money when they start working. Otherwise, no one would want to become a doctor.

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      I don't agree, I think you bring important views to the table. I like your hubs and I can follow the information just fine. Your hubs give me some good thoughts, and some good ideas.

    • ib radmasters profile image

      ib radmasters 5 years ago from Southern California

      eHealer

      Thanks for your kind words.

      We do touch on the same subjects, but with a little bit different approaches. Your approach here is much more coherent than my hubs. My hubs on healthcare are more like circles of zones, making it much more difficult for people to follow. And any circle that they didn't agree with might cause them to exit without reading further.

      Well at least we would cover more readers with our net.

      Thanks

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Hey ib, thanks for the comments. We kind of touch on the same social and political subjects in our hubs. Keep writing, your stuff is real good. Very thought provoking and current. See ya soon!

    • ib radmasters profile image

      ib radmasters 5 years ago from Southern California

      eHealer

      Great hub on healthcare and its problems.

      I agree with you that win profit is the prime directive, then healthcare comes in second.

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Thanks for visiting Pam, it is a sad state. Our healthcare system is in a shambles, and no one knows how to fix it effectively. The best we can do is try. At least we are trying something, if it ever gets off the ground. Your comments are appreciated.

    • Pamela-anne profile image

      Pamela-anne 5 years ago from Kitchener, Ontario

      Very informative hub sad topic that the health care is in such a bad state; it seems it really is time for a change. Thanks for sharing. take care pam.

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Hello Lotus, you are so right. Our healthcare system is horrible, and it's time to fix it. Even if it's not a perfect solution, it's time to give people in the US their access to affordable healthcare. We truly need to educate our best and brightest, instead of paying private prison builders, we could put that money into our young people. We need to stop driving insurance up and paying the big bonuses to the health insurance CEO's.

      Thanks for posting. I always enjoy your hubs as well.

    • Green Lotus profile image

      Hillary 5 years ago from Atlanta, GA

      Thanks for syndicating your article eHealer, it's so important to let people know the "facts" without the political hype.

      Very few in this country are in a comfortable place when it comes to good health care...even the good doctors! My doc went MDVIP just so he could give his patients more quality care, but I would have preferred he joined the few really forward-thinking physicians who charge lower prices and don't accept health insurance.

      Most people who do have insurance have moved to very high deductibles, so they wind up paying for most office visits anyway. Voted up.

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Right on timorous, health care is a mess in America. People always complain about their care, no matter what country or system, it will, as you say, never be perfect. The wait times for care are always exaggerated in the US, because the political machine doesn't want universal care, the health insurance companies will no longer make money off the sick. Canada is striving for the best possible care, and it's a continuous process as all policy building is.

      The reason the wait time in America is so short is because few of us are being treated. 50 million Americans have substandard or no insurance. So, the wait time is cut down.

      Yes, America has the highest rate of chronic illness out of all the developed countries, and we need, as you said, preventative education. Thank you so much for your thoughtful and insightful comment. I look forward to reading your hubs.

    • timorous profile image

      timorous 5 years ago from Me to You

      America seems to have dug themselves a great big hole, as far a health care is concerned. Unfortunately, the pharmaceutical companies seem to wield too much power, and want to keep things the way they are, even to the point of providing misinformation to senators and congress men/women.

      While I haven't been following the issue that closely, I do recall reading about some misinformation put forward by many congressmen about Canada's healthcare system. Since I live in Canada, I can tell you... True, it's not perfect, but the wait times are not anywhere near what was claimed.

      One of the problems with Universal healthcare is that people with very minor issues abuse the system, whereas they may think twice if it was going to cost them a lot.

      The real solution is a serious health education program, encouraging people to wean themselves off the garbage they eat, and onto a healthy diet. This would save billions in healthcare alone.

    • eHealer profile image
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      Deborah 5 years ago from Las Vegas

      Thanks Mhat, I actually wrote this for Associated Content on Yahoo, but I just had to post it here. I wanted to be sure it was shared with the right people. like you. Thanks Mhatter.

    • Mhatter99 profile image

      Martin Kloess 5 years ago from San Francisco

      A very "straight forward" written report. thanks for sticking to issue

    • eHealer profile image
      Author

      Deborah 5 years ago from Las Vegas

      Hey Xstatic, I tried to be as neutral as possible in this hub, but the facts cannot be ignored. Our healthcare system is just horrible. A now for profit healthcare business is as susceptible as any other. It's not fair to gain profit off the backs of the ill. Thanks for visiting and I appreciate your well informed comments. Let's do this, and see were it takes us.

    • xstatic profile image

      Jim Higgins 5 years ago from Eugene, Oregon

      A thoughtful study of a knotty problem. With over 30 million citizens uninsured in this country, what we need is Universal health care like other industrial societies. The Affordable Health Care Act as upheld by the Supreme Court is the next best thing. Its opponents offer nothing as an alternative except more of the same old stuff. An examination of infant mortality will show that the US ranks much too low there too.