Healthcare in America

Dr. Kaup Rajmohan Shetty, MD., FACP., FRCP(C)

Distinguished Endocrinologist | Diabetes Specialist | Author | Healthcare Advocate |

Emeritus Professor of Medicine at the Medical College of Wisconsin, Milwaukee, WI.

Dr. Kaup Rajmohan Shetty

Dr. Kaup Rajmohan Shetty is a distinguished endocrinologist and Fellow of the American College of Physicians with extensive experience in clinical medicine, diabetes care, and patient advocacy. An accomplished author and passionate healthcare advocate, he is dedicated to promoting preventive medicine, healthy aging, and equitable access to quality healthcare. Through his medical practice, writing, and public outreach, Dr. Shetty continues to educate, inspire, and positively impact patients, healthcare professionals, and communities.

More info: https://www.doximity.com/pub/kaup-shetty-md

US Healthcare is in disarray. As per 2024 statistics by Peter G Peterson Foundation, USA spends $ 14,890 per person yearly, compared to the average of $7,370, which is nearly half, for next 14 wealthiest countries. Moreover, our administrative costs are 5 times more than others. In our complex system, in spite of this high spending, our healthcare quality, outcome, and life expectancy are the lowest compared to these countries as well as many others.

What is the major difference?

All these wealthy countries are democracies with capitalist system. However, when it comes to healthcare, they practice socialism with price control for procedures, tests, and drug costs. This alone makes all the difference. Most Americans are not aware of this. We have the best trauma centers, superb healthcare professionals, advanced care hospitals and we excel in research. But this does not reach the general population. All developed countries have universal health coverage, but we have one quarter of the population either uninsured or under insured. One major illness can cause financial ruin or bankruptcy. We lack continuation of care by a primary care physician. Access to medical care is difficult and keeps changing yearly. For immediate care, we visit urgent care or emergency room or treated by a hospitalist paying extra. There is a combination of increasing premiums, excessive charges and denial of services to increase profits. Moreover, most physicians nowadays are employed by the Corporations and have lost autonomy to act in the best interests of their patients. They are buried with paperwork with little time left. There is an exodus of older experienced physicians due to frustration, worsening the shortage. Any wealthy country has an ethical obligation to give healthcare to all individuals. There are innumerable problems in our system, which is beyond the scope of this article. Most rich countries have a simple single- payer system like United Kingdom, paid by taxation, or dual system, partly paid by the government and individuals like our Medicare and Canadian system. They have price controls and administrative costs are minimum. In US system we have 3 major entities, Healthcare corporations, Insurance industries and Pharmaceuticals, all competing with each other for the maximum benefit of the shareholders. This is American free market system and for them profit is the ultimate goal. You may choose a good plan, but afterwards you have to pay whatever they charge since there is no price control and you are stuck.

An insulin vial for diabetes costing $10 was being sold at $400. Drug GLP-1 agonist semaglutide used to treat obesity is charged $1000 per month, while it is available at $90 in Europe. Drugs produced by our research are much cheaper in Canada and rest of the world. Price for surgical and medical procedures may vary by thousands of dollars between our hospitals. Although American greatness is due to free market system, it does not work in healthcare. How did we come to this debacle? Medicare for seniors was signed by President Lyndon B Johnson in 1965 to help seniors. It was felt younger people will be in a free-market system and competition will control prices, but it did not. The system grew over the years and without price control became a $ 5 trillion Healthcare Medical Industrial Complex employing millions of people who depend on it for livelihood and very difficult to dismantle. It is a big business. Moreover, politicians do not know how to deal with this huge entity, especially in the phase of powerful corporate lobbies. If we can, Medicare for All is a solution, and we can have a very efficient system with half the cost and access to all.

What do we do in the meanwhile?

Be an informed voter. System has to be dismantled slowly with public pressure. For now:

1. Review all the plans and choose one making sure your physician and the hospital is “in network” and easily accessible. Using out of network entities anytime may cost 4 to 5 times more.

2. Discuss with the physician the need for expensive medication, tests, or treatment and is there an alternative. Watch for accuracy of charges. Check Medical Bluebook for price shopping when expensive elective surgical or medical procedure is needed.

3. Avoid excessive screening and testing since false positives are common and can cause extra expenditure. Follow USPSTF and National Academy of Medicine recommendations.

4. Information is also in my eBook and paperback in amazon.com under Kaup Shetty. Titled “Longevity myths and facts”. All proceeds go to American Red Cross.

The opinions and views expressed in this article are solely of the author and no other organization is responsible for it.