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Christopher Butler

Professor Hunter

English 1201

23 November 2019

The Failing American Healthcare System and How to Fix It

While working in the medical field for seven years, I have seen the downfalls of our

healthcare system. Patients who rely on treatment and medication cannot afford it and are lost in

the unknown of how to find it. I have been on the giving and receiving end of healthcare, and

anyone who has dealt with their own health insurance knows it is a nightmare. Something needs

to be done. American Healthcare is failing due to the unaffordability, pharmaceutical company’s

business tactics, and the abuse of the emergency room. Luckily, there may be solutions to some

of these problems.

What is healthcare? Simply put, healthcare is the organized provision of medical care to

individuals or a community. Theoretically, one could just save his or her money up for medical

purposes, but that seems a little farfetched. For this reason, health insurance is offered. Today,

because of the affordable care act, health insurance is actually required or else you will be

penalized with a fee. American healthcare was set up to better provide for the sick and injured at

an affordable price. Healthcare has since then turned into a business and has lost its sense of

purpose.

If one cannot afford healthcare, Medicaid is a program that assists low-income families or

individuals in paying for doctor visits, hospital stays, long-term medical, custodial care costs and

more. There are many other components to the American healthcare system, but these are the

main ones that I would like to focus on. Regardless of what happens in America, there will
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always be sick and injured people who need help and our healthcare system should be a top

priority.

Pharmaceutical prices are a big factor in why healthcare is so unaffordable. Nobody likes

having the government control more than they already do, but there at least needs to be a better

oversight in the pharmaceutical industry. One of the most popular cases of increasing the price of

medications for profit happened back in 2013 when Martin Shkreli, Turing Pharmaceutical’s

CEO and former hedge fund manager, changed the price of a 61-year-old medication from

$13.50 per pill, to $750. This medication is the standard prescribed treatment for a food-borne

infection that can be life threatening to people with weakened immune systems such as patients

with AIDS.

Utilizing the concept of supply and demand is a key tool to make money for any

business, but when the demand is due to people being in need of life saving treatment; you cross

a thin ethical line. This is not the only example of driving up the price for medication. When

Insulin was invented in the early 1900’s the patent was basically donated to the University of

Toronto. Before the discovery of insulin, having type one diabetes was a death sentence.

Frederick Banting, the inventor of insulin, felt it was unethical for doctors to profit from such a

live saving medication. Today, the cost of insulin has almost tripled since the year 2002 and is

unaffordable to many patients without health insurance.

Health insurance companies, pharmaceutical companies, and hospitals have all been

increasing their profits over the past thirty years while Americans have dealt with higher costing

premiums. In 2011 the top five health insurance companies have made 3.3 billion dollars in

profits. This money has made them more and more powerful with political leverage when it

comes to laws regarding healthcare.

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Fig.1. Medications, treatment, and health insurance premiums are becoming more unaffordable.

The increase in cost for healthcare has caused a snowball effect on other components of

the medical field. When people cannot afford medical expenses, they turn to free means of care.

The emergency room has taken the blunt force of this effect. According to Robin Weinick who

write for the U.S. National Library of Medicine, 13.7%- 27.1% of all emergency room visits

could have been adequately treated at an urgent care. Although that does not seem like a lot, that

is a national annual cost of $4.4 billion.

Hospital’s emergency rooms treat anyone and everyone for anything and everything.

Patients who cannot afford a primary care physician will call 911 to be transported to the hospital

so the emergency room can treat them instead of going to the appropriate care facility. The ER
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will then treat and prescribe medication for the patient in a timely manner to open a bed for the

next patient in readiness for an emergency.

The sad thing is that the patients who use the ER as their primary source of healthcare

cannot afford the hospital bill. The medications that the ER prescribed is usually only for a few

days to stabilize the patient till they can schedule an appointment with a true primary care

physician. Unfortunately, EMS and the ER tends to see frequently flyers that continuously use

the ER over and over to receive free treatment and medications. It truly is a sad cycle for health

providers and their patients.

This sounds like a broken system but what is the ER supposed to do? Sick and hurting

people are coming into the emergency department every day because they cannot afford to go

anywhere else and it is completely overwhelming the doctors and nurses. You cannot make an

appointment at an emergency room. So, the staff has no idea when or how many patients are

going to come in on any certain day.

Because of this, the emergency room is often understaffed which affects the quality of

care for patients. This also causes other issues in the emergency department for patients such as

longer wait times. Filling the ER with patients who are not having an emergency also causes

staffing issues when a true emergency actually comes through the door.

Emergency medical services such as fire departments are also suffering from this abuse

of emergency medicine. Fire departments and EMS are funded by municipalities and EMS

transport billing. The large majority of calls for a fire department are now emergency medical

calls.

When fire departments were first invented, it consisted of only firefighters. As time went

on and cities realized they also needed some sort of emergency response to medical calls, the fire
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department evolved into a hybrid firefighting/emergency medical service department. Most

firemen around the country are now trained as firefighters and emergency medical

technicians/paramedics.

According to the National Fire Protection Association, fire departments responded to

10.8 million emergency calls in 1980 with about 3 million of them being classified as fires. In

2016 the total call volume increased to over 35.3 million calls with only 1.3 million of them

being fire related. How has the emergency call volume more than tripled for fire departments

when there are only a third less fires a year? The answer is that people are calling 911 to be

transported to the emergency room more than in the past.

Talking with local firefighter Ross Green, he states that most of the transports to the

hospital are not true emergencies. “People definitely abuse emergency medicine.” He claims,

“out of all the calls I’ve been on I’d say 8/10 did not need to go to the emergency room. Some of

these people have no other choice because they cannot afford to do anything else. I just wish they

realized they could receive way better treatment from a primary health physician because ER

doctors are not specialized in treating these ongoing medical issues that people want to be seen

for. Their specialty is emergency medicine. Some people just don’t know any better. In this day

and age, the answer to a medical issue is to just go to the emergency room. You see it in

commercials for medications and doctors tell patients to call 911 and be transported if they have

any complications after an appointment. It is more of a cover your own butt type of mentality.”

According to an article written by the University of Maryland School of Medicine,

Nearly half of US medical care comes from emergency rooms. Dr. Marcozzi and his colleagues

at the University of Maryland School of Medicine conducted a study examining available data

from several healthcare databases. Dr. Marcozzi states, “Patients seek care in emergency
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departments for many reasons. The data might suggest that emergency care provides the type of

care that individuals actually want or need, twenty-four hours a day.”

The study looked at data from 1996-2010 and over the fourteen-year period, emergency

care visits increased nearly forty-four percent. In 2010 there were 130 million emergency

department visits, compared to 101 million outpatient visits and 39 million inpatient visits.

Certain patient groups were more likely to use the emergency room over others such as patients

with Medicare and Medicaid, women, residents of the south and west regions of the US, and

African Americans.

Dr. Marcozzi goes on to say how he has seen how often emergency care patients end up

being see for nonemergent medical issues. He believes the reason for this is because the

emergency department is making up for the deficiencies in our healthcare system such as

inpatient and outpatient care. Unfortunately, he does not see the misutilization of the emergency

room decreasing any time soon. Instead, he thinks we should better connect the care between the

emergency department and the rest of the healthcare system.

Another reason why healthcare is so expensive is because insurance companies are not

being transparent with their prices. In certain instances, what they are willing to pay for certain

procedures is hidden to the patient and other insurance companies. Disclosing prices could put

hospitals and insurers at a competitive disadvantage with its rivals.

That is why they hide the cost. Raising the curtain on the prices will produce a more

competitive market for health insurance. It will also help the medical industry by having

insurance companies willing to pay more for treatment. Healthcare should be more about what is

best for the patient instead of money.

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Having a competitive market for health insurance is crucial for making healthcare more

affordable. Everyone in America should be given multiple different health insurance options to

weigh which one is best for them instead of a “one size fits all” mentality. By opening up the

market, insurance companies will compete to offer the best prices at the lowest costs to entice

customers.

A single payer healthcare system is the exact opposite of a competitive market. A single

payer healthcare system is when there is just one general healthcare plan for everyone. Yes, this

sounds like such an easier plan but if anything, it will drive the cost for healthcare up even more.

The prices will be determined by the supplier with no repercussion of losing customers.

America’s market is controlled by capitalism and that is why a single payer healthcare

system will never work. We have seen in other industries in America where companies have

bought out other companies to control the market and drive up prices. It happens every time.

Hospitals are now changing the way surgeons can treat patients. In past years, surgeons

would have a private practice where they see patients and set up appointments to perform

surgery in a hospital. They sign contracts to use hospitals of their choice.

Although they use the hospital, they are not technically employed by the hospital, so the

doctors are able to prescribe the meds they see fit for the patient, preform what procedure they

think is best for the patient, and have a strong doctor to patient connection. Doctors and surgeons

who are employed by the hospital are limited to giving the meds and doing the procedures that

the hospital wants. Pharmaceutical and medical sales companies will go into the hospitals and

sell their products and give them a discount if they make it a hospital wide medication/procedure.

Some doctors are more comfortable with certain brands medical equipment. They train

and become proficient with the equipment they prefer and see fit for the surgeries that they do. If
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they are employed by a hospital that makes them only use the product that they endorse then that

doctor is stuck using that type of equipment.

For instance, if a patient needs a total knee replacement, there are multiple medical

companies that provide the equipment. Depuy Synthes and Stryker have stood out to be the big

two rivals in the total knee market. Depuy Synthes and Stryker both offer total knee

replacements that work best in different types of total knee cases.

A good surgeon will switch which product to use based off the case to have a better

outcome for the patient. If that doctor is employed by the hospital, he/she can only use the

products that the hospital approves. Same goes for medications and expensive procedures that

the hospital thinks are too expensive to perform. Hospitals do this to have more control over the

doctors and make more money by signing deals with pharmaceutical and medical sales

companies.

Currently, most doctors and surgeons are employed by a hospital, and the numbers keep

increasing every year. This is the most profitable way for the hospital to make money, but it is

not the best option for surgeons or patients. Hospitals need to stop signing contracts with

pharmaceutical/medical sales companies and give the doctors the freedom to prescribe and treat

how they see fit.

Hospitals also will not transfer or refer patients to the proper physician/facility to try and

keep their business. Hospitals are usually owned by some sort of corporation or network that

runs multiple other hospitals. If a patient is seen at a hospital that is under, for instance, the

premier health network, they will try to only refer doctors and facilities that are affiliated with

the same network.

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This type of business tactic may not be the most beneficial for the patient as there may be

a better physician or facility that is more qualified to treat that patient. Some networks are

strategically placing hospitals as close to other hospitals to try and put them out of business.

They also offer emergency helicopter transport, also known as air medical services, to EMS to

try and have patients transported to their facility.

Air medical services is a great utilization of modern technology in the emergency

medical field. Rural communities that are far away from medical facilities are able to be

transported in a reasonable time by a helicopter that would otherwise take up to an hour via

ambulance. Certain EMS departments transport to only one facility which cuts down the patient

numbers for the surrounding hospitals. Some networks utilize their helicopters to pick up critical

patients in these cities and transport them to their own facilities instead.

Some argue that the affordable care act is the answer to all of our healthcare issues. The

Democratic congress passed the affordable care act in 2010 to better expand healthcare access

across America. Unfortunately, many have found that the care provided is inadequate and it is

only affordable to those who qualify based off of their income.

Also, the affordable care act lacks truly effective cost control. It does not address the

main a cause of increasing healthcare cost which is the unit price for health care services. No one

can deny that the affordable care act has made healthcare more accessible, but the expensive

prices are still there. The general economic growth rat cannot keep up with the increasing rate of

healthcare cost. In fact, the growth rate of healthcare cost is twice that of the economic growth

rate. It is predicted that by 2037, one in four dollars will be going towards paying for healthcare

costs which according to the Congressional Budget Office, is unsustainable.

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If America wants affordable healthcare there has to be regulations on big pharmaceutical

companies, insurance companies, and hospitals. They are the ones benefitting from the

overpriced costs for care and the American citizens are suffering for it. The government needs to

step in and stand up for its people.

Big pharmaceutical companies should not be allowed to increase medication prices for

profits. There should be a cap on how much they can make on selling their products. Some of the

profit does go towards research for new medication. Pharmaceutical companies should be

rewarded for doing this as long as they do not abuse it.

Insurance companies need to be limited on how much they can charge and profit as well.

The government needs to step in and makes against overpricing for health insurance. Insurance

companies also need to pay more for the treatment while lowering their deductibles to make it

more affordable and help the economy.

Last but not least, hospitals should not be allowed to sign deals with insurance

companies, pharmaceutical companies, and other medical sales companies to profit from their

products while potential lessening the quality of care for patients. Hospitals should not try to

keep patients within their network and instead transfer them to the proper physician/facility for

the best outcome for the patient.

In conclusion, American healthcare should not be about dollar signs; it should be about

what is best the patient. America has so many great things to offer and is filled with so many

great citizens who deserve quality, affordable care. There are currently millions of people

suffering in America because they have insufficient healthcare. American Healthcare is failing

due to the unaffordability, pharmaceutical company’s business tactics, and the abuse of the

emergency room. Although there are a lot of problems with healthcare, being optimistic and
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looking towards a brighter future is key. We can fix this broken system. Changing some simple

rules and regulating big pharmaceutical/insurance companies is just the start but will point

America in the right direction to an efficient affordable healthcare system.

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“Work Cited”

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