Updated: Dec 7, 2020
“As much as some want to deny it, a public health insurance option – or better yet, well-implemented universal healthcare – is the best solution for the exorbitant costs, inhumane conditions, and worsening quality of American healthcare.” In the midst of the coronavirus pandemic, I interviewed for a company interested in hiring me. When I mentioned that I was also volunteering on a rescue squad, the interviewer tried to convince me to cut my hours there, quoting the company’s CEO as saying that volunteer squads were only “good news for insurance companies that wouldn’t have to pay for the ride.” When I became an EMT, I was excited, filled with enthusiasm because I was going to save lives, or at the very least help someone’s life get better. Three months later, I am exhausted. Working in EMS, I have learned far more about illness, suffering, injury, and sorrow than I would have otherwise learned in a lifetime, but I found purpose in helping those in need get better.
The American healthcare system does not share that view. The goal of healthcare in the U.S. is to extract as much profit as possible from the pain and suffering of human beings, and if the stock market is any indication, our suffering is extremely lucrative. Many of us have been reluctant to embrace radical changes to fix what ails our system, but having seen what I have, I cannot condone the current failure. From the position of a healthcare worker, universal health care is no longer a quixotic political fad – it is a legitimate answer to the high costs, poor working conditions and mediocre care that plague America.
The most obvious criticism of our healthcare system is the money poured into it for the care we receive. According to the Center for Medicare & Medicaid Services, U.S. healthcare spending in 2018 was an astronomical USD 3.6 trillion – a figure that accounted for 17.7 percent of the country’s GDP. The average American family, meanwhile, pays almost USD 20,000 in premiums annually. What does that pay for, however? A 2016 study found that American and European hospitals had similar numbers of physicians, nurses, and hospital beds per capita, but American providers were more likely to order expensive services such as MRI machines and CT scans. This speaks to a larger problem in our system – the overtreatment of Americans and the spurious use of expensive services. Another study interviewing over 2,000 American physicians found that, spurred on by malpractice fears and a glut of services, an estimated twenty percent of healthcare services provided in the United States were medically unnecessary, including 22 percent of prescriptions and 25 percent of all medical tests.
Meanwhile, insurance companies saw revenues of USD 913 billion in 2019 alone, an intake that dwarfs the GDP of many high-income nations. This profitability is excellent for stockbrokers and the market economy, but it relies on the collection of premiums from patients while refusing to pay for their healthcare, a systematic extortion of patients that monetizes their health. This exemplar of price-jacking and lack of concern for human life is matched by another part of American healthcare: the pharmaceutical industry. Although free-market zealots claim that drug companies are leading innovators, the drugs they make are often produced relatively cheaply before being sold at an outrageous markup. A year’s supply of lifesaving insulin cost just USD 71 to produce, but diabetics paid over USD 2,800 in 2012, and USD 5,700 in 2016. Pharmaceuticals in a market economy are rewarded not for developing new and exciting treatments, but for price gouging patients who have no alternative – a status quo that companies are all too happy to preserve, and a dampener on the very innovation used to justify this system.
While the spoils go to companies, health care workers – especially those lower on the ladder – face their own challenges. I worked on both a volunteer rescue squad that served the public and a transport company that primarily handled Medicare and Medicaid patients. On the volunteer squad, we at least had sleeping quarters and a common room to recuperate when not on the job. In private service, I spent most of my shifts in an ambulance, often hungry, parched, or drowsy from the monotony of riding on highways for hours at a stretch. I lost half the weight I gained in college, and it took me six weeks to control the mood swings that came when I entered service. My coworkers had it worse, with most working longer hours and some suffering chronic injuries stemming from the job. It is no secret that health care workers work long hours, but the full effects of those shifts are rarely appreciated. Numerous reviews have linked night and overtime shifts to an increase in errors made by sleep-deprived nurses, along with dozens of negative health outcomes, including obesity, injuries, gastrointestinal disorders, anxiety, depression, cardiovascular disease and cancer. Worse, there is often a callous disregard for other workers in the system. When I rode transport gigs, third-party dispatch services lied to our dispatchers about patients who had COVID-19. I risked my life, and the lives of my family, to do good, and the system failed to tell me if I was at risk. That fact haunts me, as does the prospect that my altruism could have put me on a ventilator – or worse -- because an executive wanted to make a few hundred bucks pushing that risk on a lowly transport worker. Our jobs are inherently dangerous – no one can deny that -- but the pressures of private healthcare forces unnecessary risks upon workers, leading to lost lives and unnecessary injury among both patients and the people who treat them.
Despite the real human and economic costs of our system, Americans have been more or less willing to stick with the present system. Conservatives argue that government intervention in healthcare stifles innovation and lowers the quality of care, claiming that universal health care leads to delayed treatment and underfunded, overstretched healthcare systems. Every healthcare worker who has spent time in such a system knows those claims are tenuous at best. During the pandemic, my transport company served primarily low-income patients on Medicare or Medicaid. The struggle to supply our rigs with PPE and equipment ate up the budget, nearly forcing us to make hard decisions about patient and EMT safety. Across the US, publicly funded health care service and smaller private companies face the same daunting challenge in their fight to save their patients while also keeping the lights on, as a free-for-all capitalist system screws both the businesses and customers with the smallest bank account. The statistics only lay bare how pathetically mediocre American healthcare is. Despite the presence of the world’s best hospitals, American life expectancy is average, ranking 26th out of the 34 developed countries in the OECD, and ranks near the bottom for obesity rates, chronic disease morbidity, avoidable death mortality, and access to care. In quality-of-care analysis, America only ranks above average once, despite spending more than double the OECD per country average on healthcare. These are not the signs of innovation and American exceptionalism that are supposedly flourishing in our market economy-style healthcare system; they are the signs of American mediocrity, a nation that wastes our extraordinary reserves of toil and treasure just to tread water – and even this mediocrity is not the norm. Coverage gaps and underfunded public health care systems have left minority and working-class Americans at the mercy of COVID-19. According to the CDC, Black and Hispanic Americans face disproportionate infection and mortality rates, while the Kaiser Family Foundation found that workers with salaries under USD 15,000 are twice as likely to suffer severe COVID-19 effects as those earning over USD 50,000. The numbers are clear: it doesn’t matter how good our best care is, because healthcare is about what you can do with what you have, and far too many health care professionals don’t have the tools they need to save lives. Our healthcare is average – and that should be unacceptable to every American.
I have always been against universal healthcare. I believed that the existing system was at least feasible, while government health care would represent an exorbitant cost to taxpayers that would ultimately prove impossible to enact on a nationwide scale. Now, I realize my error because the current system has fallen apart where a national system would not have failed. A single government-controlled system could more easily address public health crises such as the COVID-19 pandemic and the opioid epidemic, issuing guidance and policies that would apply to every health care facility and every provider. Our nation’s doctors, nurses, EMTS, and other healthcare professionals would spend less time fighting insurers and billing offices and more time doing what they are trained to do. Patients will no longer have to worry about their financial security before seeking treatment that could not only save their life, but the lives of those around them. The price will be high, higher than any treasure we have yielded, and the system we need will not come unless the leaders of this nation are wise and prudent in planning this endeavor. The reward, however, will be truly priceless – a system that finally affirms that a person’s health or condition does not bar them from America’s promise of “life, liberty and the pursuit of happiness,” an eternal gift for future generations. For this, America must renounce healthcare for the few and commit to healthcare for We The People.