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To the editor:
Lots of talk about healthcare reform and most assuredly we need it. Despite skyrocketing costs, America’s healthcare has steadily declined for over two decades. A deeper dive suggests the problems are fundamental, deeply rooted and will require far more than a few tweaks to fix.
Despite spending nearly twice as much per capita, America’s healthcare system is consistently ranked a distant last vs. other high-income nations. It’s driven by poor metrics for access to care, administrative efficiency, equity and health outcomes including life expectancy. Interestingly, all have varying forms of government managed universal coverage vs. America’s private sector, employer-based, profit-driven system. Globally, America’s health pillar ranks 69 out of 167.
Our state doesn’t fare much better. Per Forbes, NC has the highest cost of healthcare in the country but the quality of that care is ranked as third worst. Talking this one step further, North Carolina has the most expensive healthcare in the world yet state legislators are pondering more price increases.
Fundamentally, our healthcare is highly fragmented across 50 states and thousands of insurers, providers, employers and plans. Each has its own infrastructure and gets a slice of the profit pie. As such, it’s costly and fraught with massive redundancy, inefficiency and fraud potential. The U.S. General Accounting Office estimated that $100B was lost to fraud, waste and abuse last year with $20B of improper payments going to insurer-run Medicare Advantage Plans. United Healthcare is now being investigated for potential fraud. Mismanagement extends to securing our confidential personal information and medical records with data breaches too numerous to mention.
Healthcare profits are so lucrative that private equity firms own 8% of private and 22% of for-profit hospitals and are buying healthcare systems and senior care facilities. Their playbook is to quickly pocket the equity by selling buildings, land and equipment and replace it with unsustainable leases and debt. Staff, services and quality are cut to minimums. The impact has been devastating with 21% of all large-scale healthcare bankruptcies in 2024 and 88% of those over $500 million linked to private equity firms. Communities have been left with shuttered facilities and nowhere to turn. Meanwhile, the firms are eyeing their next targets. This is all perfectly legal.
The profit-driven mindset has greatly reduced the time doctors spend with their patients and dictates the care they prescribe. Since compensation is tied to revenue generation instead of successful patient outcomes or satisfaction, this is unlikely to change and especially when many young doctors are saddled with hundreds of thousands of dollars in medical school loans. Upcoming cuts to Medicare will make matters worse for seniors.
Patients are held captive because NC and 34 other states highly restrict any real free-market competition and innovation by requiring onerous Certificates of Need for any new facilities, services and equipment. Please “Google” Dr. Gajendra Singh/ MRI machine and Mission Health/ ER West Asheville for more on this.
Profit-focused Big Pharma cannot be trusted to replace FDA oversight for ensuring America’s drug supply chain is safe, effective and secure. Longtime filler ingredients with robust safety profiles have been swapped for much cheaper and riskier petroleum-based dyes and PEGs, metal oxides/ dioxides, Polysorbates etc. Many are banned elsewhere because they’ve not been proven safe. Similarly, petroleum-based ingredients are well known to release carcinogenic byproducts when exposed to heat such as during manufacturing, storage and transport.
It’s no wonder drug recalls reached a 19-year high in 2023, soaring 42% from 2022. With the fox now watching the hen house, more issues fly under the radar. Such as with valsartan, losartan and irbesartan, doctors often have no choice but to continue prescribing these drugs because no alternatives exist. Since approximately 85% of the drugs sold in America rely on ingredients originating in China, this is particularly troublesome amidst rising global tensions.
I could go on but you get the picture. After spending 25 years at a Fortune 100 corporation and another 5 years consulting for private sector investors, I’d argue that America’s health system is doing exactly what it’s designed to do, making lots of money for its shareholders. I also think it foolish to believe investors, many of whom are not even American, will ever prioritize our welfare over their profits. It’s simply antithetical to who they are and why they invest.
Perhaps Einstein’s definition of insanity as “doing the same thing over and over again and expecting different results” holds merit. Maybe it’s time for a real overhaul that finally puts our healthcare dollars to work instead of into other people’s pockets. Despite scandalous headlines about “socialized” medicine in Canada and the UK, their programs consistently deliver much better health outcomes and cost metrics than ours. No medical debt either versus the 100M fellow Americans who currently owe $220B. Shame on us and good ole’ American ingenuity if we cannot figure it out and do it better.
Regardless, we all should be greatly enraged and embarrassed by how badly our healthcare is being managed. As North Carolinians and Americans, we deserve better, a lot better. After all, what is America without its people and who are its people without their good health.
Nancy Monda, Advance