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Bob Ziegelaar is a trustee at Northern Light Eastern Maine Medical Center. His opinions are his own and may not reflect those of other board members or professionals affiliated with the hospital.
In the “developed world,” the U.S. and UK stand out as nations with failing healthcare systems, albeit for distinctly varied reasons. Whereas American healthcare suffers from excessive profiteering, the UK’s system is collapsing under the weight of bungled government administration.
Health insurance, private, public or hybrid, has long been a critical foundation of any healthcare system. In the U.S., mutual insurance companies with policy holders as owners, used to be a winning model, as exemplified by the former Blue Cross/Blue Shield organizations. However, as money flows grew, financial sector interest increased, gradually turning U.S. healthcare into a marketplace for profit-minded corporations and investors.
In the 1980s, physicians worried about the prospect of declining incomes due to growing numbers of medical students, and so they convinced the American Medical Association (AMA) to prevail upon universities and reduce the numbers of medical students. It turned out to be a disastrous miscalculation, the effects of which still haunt us today. As patient needs and physician shortages increased, the U.S. recruited thousands of foreign physicians and medical students to cover the shortfalls, and more recently, the mushrooming numbers of “urgent care” facilities have contributed to the service maze U.S. patients must now navigate.
As medical science advanced and improved treatments came about, many rural hospitals developed their own specialty units, increasing revenue potential. For-profit insurers expanded their reach accordingly, with some larger players venturing into healthcare services themselves. With these trends, corporate quarterly revenue and dividend reports became a driving force in U.S. healthcare, handing a handful of mega-corporations outsized political power in U.S. healthcare policy development.
As the government kept raising oversight and performance standards, aimed at improving slipping outcomes, hospital administration became ever more complex and costly in taking on multiple new layers of financial management and overall documentation. Physicians, who previously spent time with patients as they saw fit, found themselves entangled in webs of recordkeeping and patient scheduling. The net effect was that expertise in finance, planning, quality control, regulatory compliance, legal affairs, human resources, marketing and public relations all became permanent fixtures of hospital administration, with significant cost implications.
If there is an overriding responsibility in national government, it is the safeguarding of population health, not just for humanitarian reasons, but also as pragmatic and critical policy aspects in maintaining healthy economies and functioning societies. While capitalism has its strong points in production efficiencies, the private sector tends to be less effective in providing essential community services at affordable costs, as opportunities for profits and taxation tend to be antithetical to the advancement of public health.
Americans have seen their healthcare “market” yield outsized corporate profits and opportunities for wealth generation. It would be one thing if that had gone together with increased efficiencies, cost reductions, and improved outcomes, but the reverse has been the case. Pharmaceutical and health insurance companies have been among the most profitable sectors on Wall Street, in part because U.S. taxpayers subsidize both. More recently Congress has tolerated further exploitation of U.S. healthcare by letting “private equity” buy up hospitals and specialty medical service providers, all too often to strip out real assets for resale at substantial profit.
U.S. healthcare is imploding under the weight of private sector financial opportunism. While there have been feats of ingenuity in product and service development, falling outcomes and rising costs are of immense concern. The current incompetence at the Department of Health and Human Services would seem to further spell the demise of American superiority in global healthcare. Numerous rural hospitals will fail or become local clinics, with patients having to travel to larger metro centers for specialty care.
The path to recovery seems political at this stage. If American voters can unite to retire the members of Congress who have allowed their healthcare system to approach a state of failure, they can force the necessary changes.
There is room for private profits in healthcare, but only when directly tied to improvements in public health and affordability. Other countries show that affordable universal healthcare can work when combining the best of private and public resources for the benefit of the population at large rather than just for-profit vested interests.
