American Healthcare Is All About Money for Nothing, Nothing for Free

In the U.S., healthcare is very expensive. There’s a bevy of statistics to prove this—we spend $3.5 trillion a year or more than $10,000 per person, which is twice as much as other countries, for example—but you already knew that. You know how expensive drugs are, and how expensive premiums are, and how big deductibles are—if not for you, then for someone you know. You’ve heard about people trying to raise money for their cancer or surgery or insulin on GoFundMe and how their prayers often go unanswered.

But the crucial point in all this is just how little all that spending buys. For people who oppose single-payer, the implicit or explicit argument against is that American healthcare is that it’s “the best in the world,” because it has a lot of fancy machines, advanced research, and doctors at the top of their field (who charge accordingly). It has the Mayo Clinic! For the richest, those who can pick their doctors and fly wherever, that’s surely true. For the rest of America, it’s like if you spent $500 on a sock from H&M.

A post at Axios today underscores this: In one key aspect—hospital quality—American healthcare fucking sucks. Axios quotes Leah Binder, the CEO of the Leapfrog Group, which creates a hospital safety guide, as saying the U.S. is “unnecessarily killing thousands of people every year because hospital quality is not what it should be.” Woo! We’re number one, baby!

The site also pointed to recent specific examples of hospital failures: A Florida hospital dedicated to treating children with heart defects saw its mortality rate triple between 2015 and 2017, with nearly one in 10 patients dying. And an investigation by WebMD and Georgia Health News found that a third of hospitals in the U.S. have violated standards of emergency care set by the federal government.

Even the hospital where Rep. Steve Scalise was taken after being shot last year scored a D in Leapfrog’s ratings, for quite shocking violations (emphasis added):

Because Washington Hospital Center accepts Medicare, however, CMS has their data on issues known as “never events” because they are so serious and preventable they should never occur. On that, which includes “dangerous objects” such as surgical equipment left inside patients, Washington Hospital Center scored well below average for nearly all measures.

Last year, a Politico story about the Cleveland Clinic—a tax-exempt non-profit hospital—highlighted just how unequal access to America’s supposedly world-leading hospitals is. The hospital’s campus is “a world apart, evoking an upscale resort or an airport’s international terminal,” with farmers markets and a 24-hour Au Bon Pain. In the neighborhood next door, “infant mortality is almost three times the national average,” and over “one-third of residents in the census tract around the Clinic have diabetes, the worst rate in the city.”

There are a lot of things that make healthcare outcomes incredibly unequal in America, not least wealth and race. These are things that would not necessarily be totally fixed by single-payer, although they could be significantly improved, depending on how you structured the program. But one thing that makes healthcare spending so utterly insane is the integration at every level of profit (and, similarly, individual greed: Many hospital CEOs make millions, and doctors are vastly overpaid on average). Health insurance companies exist to make the biggest profit possible. Drug companies, too. Pharmacy benefit managers, a useless class of middlemen who make money by hiking the prices charged to your pharmacy, gotta get their money. Hospitals, even non-profits, vastly overcharge insurance companies.

I don’t really want the U.S. to spend less on healthcare. I do want us to spend the money better. Spending money on healthcare is a good thing to do, because it keeps people alive, and I seek to defeat Death and his armies. I’d just like it if, instead of spending that money on lining the pockets of health insurance and drug companies, we could instead spend that on, for example, allocating resources to struggling small and rural hospitals, or mental health services. Generally, I’d like it if we could spend less healthcare money on “CEO needs a new helicopter” and more money on “people not dying.” A small ask, I think.