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An American abroad returns home to healthcare he doesn't recognize

America's healthcare system is broken

(This is the opening essay from this week's edition of my Sunday Note, which is brought to you by Armory Square Ventures. See their message in this week's newsletter.)

AMERICA’S HEALTHCARE SYSTEM is more complex and expensive than any other rich country’s. That’s not news to anyone reading this newsletter, but it’s always interesting to see the shock of those who have seen the wonders of a functional public health system. Yes, our doctors, nurses, researchers and other medical staff have saved countless lives during the pandemic, but the system they operate in is broken.

My newsletter co-producer Zach is an American who lives in the Czech Republic but has been in the US for a few months. After a dozen years with socialized healthcare, his recent run-in with the U.S. system left him aghast.

From Zach:

My daughter (7) had a medical issue over the fall that required what ended up being a couple of visits to consultations with doctors, and a little more. She’s fine, and everything we did was worth it simply for peace of mind — but the system here is so completely barbaric that I just don’t know where to begin.
The thing that really strikes me is the whole idea of having to really consider the costs of what are very normal and regular “go to the doctor” things. In the Czech Republic, where you either have health insurance or the state pays for your health insurance, or you don’t live in the Czech Republic.
Most visits to see a doctor are free or close to it, and all of things we did for my daughter — all very much routine — would have cost us no more than $100 out of pocket, and likely all would have been free. This is, of course, fantastic and the way it’s done in all of Europe.
Here in the U.S., that certainly isn’t the case — but luckily the app for the provider we used (the only one we could possibly use where we are) has an “Estimates” section! In the end, we’ve spent thousands of dollars here for care that I’m sure a lot of people need, can’t afford, and don’t get.
After seeing the estimates and bills, I simply cannot imagine the sorts of conditions people in the U.S. just sort of…sit on…for no other reason than money — it’s insane! The Kaiser Family Foundation has so much on this, and it needs to be read in the context of most of these problems simply not existing in other wealthy countries.
I can’t emphasize this enough, my fellow Americans: Socialized healthcare is great, affordable, and would change your life immeasurably. It would mean the end of GoFundMe as a provider of last resort; it would mean insulin is affordable and available; and people under 45 could actually afford to have children!

Here in the U.S., we just sort of got used to insurance being tied to employment, deductibles, estimates, and the general labyrinthian nature of our system — it’s amazingly cruel, and its shortcomings (if not already blindingly clear) have only been exacerbated by the Covid19 pandemic.

This chart tells you all you need to know:

This is simply unconscionable. When people get sick, they should focus on how they can get better, not on if they’ll go bankrupt dealing with our awful system (62% of all bankruptcies are tied to medical bills; in 1980, the percentage was just 8%; by 2001 it was 50%).

Giving the last word to Dr. Atul Gawande (@atul_gawande), whose thoughtful pieces in The New Yorker always illuminate health topics. The 2015 tweet below is about how “millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.” In 2018, he teamed up with three of the biggest names in corporate America, Amazon, Berkshire Hathaway and JP Morgan, to tackle the healthcare crisis. Sadly, in 2021, they had to shut it down their entity, Haven. Gawande explained why the effort failed: “The vulnerability we have of tying your healthcare to your job, that remains still a big hill to climb, and the government has to solve it. This is a public core issue that we still have not faced up to.” If Gawande, Jeff Bezos, Warren Buffett and Jamie Dimon couldn’t fix it, then I am not holding out hope someone else could.

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What is your experience with healthcare systems in America or abroad? Would love to hear your thoughts. And watch our Sept. 2021 #NYTReadalong episode with Jeanne Pinder, who runs ClearHealthCosts, a journalism company bringing transparency to health care costs.


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