You hear many people refer to the United States health care system as being "broken". What does this mean?
For the answer to that question, I refer you to one of my idols, Marty Makary, MD. Dr. Makary is a Johns Hopkins surgeon who has written 2 books; Unaccountable; What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
& The Price We Pay, What Broke American Health Care - And How To Fix It. In these books, Dr. Markary explains the many issues that have made our health care system a non-sustainable, dangerous mess. From the opioid crisis to the estimated 21% of unnecessary care created by a for-profit system, he explains how we got here & what we need to do to put the patient back at the center of health care.
When I have discussions with people about health care, I believe the thing they are most shocked about is the fact that health care is just as corrupt as many other for profit businesses. I have had people say to me "are you saying I cannot trust my doctor?". My answer to them is, "well, that depends on who your doctor is." There are many wonderful, ethical, hard working doctors out there but just like in every profession, there are bad doctors out there. Have you ever heard about the doctors who treat patients with chemotherapy even though they don't have cancer. What about the spinal surgeons who knew they were implanting fake spinal hardware? What about the cardiologist who placed stents in a perfectly normal coronary artery? It happens.
There is also corruption in the system as a whole. Have you ever heard of "pharmacy benefit managers"? These are the entities, many of them directly connected to insurance companies, that drive up the costs of medications. Or what about "group purchasing organizations", these are entities that are responsible for a decreasing number of manufacturers which is causing drug & supply shortages as well as driving up the price of these items while they make billions of dollars. Do you know what a "kickback" is? Kickbacks are bribes or incentives paid to someone who helped them in some way. In health care, this could be to a doctor for using a particular medication or medical device. Or perhaps it is from a hospital to a doctor for sending their patients to their facility. Sometimes it is a direct fee per referral set up. I've seen them all. There are laws in place to prevent kickbacks in healthcare, including but not limited to the Stark Law, Anti-Kickback Statute & the False Claims Act. However, in my experience, kickbacks are still prevalent in health care. This is probably primarily related to the fact that there is just not enough oversight in the industry to prevent it and those of us who see it or suspect it, are too afraid to speak up. Unless the doctor or the facility is audited or reported by a whistleblower, they can get away with breaking the laws for a very long time. Even when the issues become known, in most facilities, it will just be swept under the rug in order to protect their reputation and thus their patient volume.
The same goes for doctors who are unskilled or facilities that are unethical. How are you as a consumer supposed to know that the surgeon you just saw is the one the operating room staff refers to as "the butcher"? How are you supposed to know that the hospital that is rated #1 in your area falsified all their quality data.You can't. Most of the "Top Doctors", "Best Hospitals" and other ratings are basically marketing material anyway. What we really need in health care is objective, transparent data so that we can make informed decisions. What I want to know about my doctor is, how many of these surgeries has he done? what are his complication rates? what is his mortality rate? What I want to know about my hospital is, what are their safety culture scores? what are their readmission rates? complication rates? infection rates? mortality rates? We need much more data to be available to the public. We need 3rd party objective data collection. We need mandatory reporting requirements. We need external peer review. We need mandatory conflict of interest disclosures to patients. We need educated & informed patients. This is the only way that we can fix our broken healthcare system that is currently responsible for the 3rd leading cause in death in the United States of America (USA). Yes, you read that correctly, healthcare errors are the 3rd leading cause of death in the USA. It is estimated that at least 250,000 patients per year are dying from healthcare errors in our broken system as the cost of that care continues to rise. Current estimates say that healthcare costs in the USA are estimated at $11,000 per year per person. In 2017, 3.5 Trillion dollars was spent on healthcare in the USA. It is indeed, a broken & dangerous system.