Burden in My Hand: The U.S. Medical Industrial Complex

 Years ago my husband and I were traveling out of town when he noticed a very itchy red blotch growing around his elbow. By dinnertime, the redness had migrated throughout his arm. We knew that it could be an infection, so after dinner, we were luckily able to stop at an urgent care clinic where we immediately saw the physician on duty who diagnosed it as a bacterial infection. She prescribed a course of antibiotics and told us to return in 24 hours for follow-up to be sure that the infection had receded. All of this cost between $5-7 - an inexpensive and satisfying medical visit.

Several weeks later we had settled into our temporary home and decided we were overdue for physical exams. We called a nearby doctor's office. They scheduled appointments for us in about a week and facilitated the visits so that my husband and I could each see a doctor at the same time. Moreover, the office was within a few miles of our home, so we could easily walk there. When we arrived, the only paperwork necessary was a form to list our names, addresses, and some personal and family medical history. The doctors greeted us both and were taken aback when we spoke to them with the formal "Dr." before their last names. They preferred to converse on a first name basis. Each viewed themselves as just another working stiff. After those medical appointments, we had some additional preventative and diagnostic exams and services, including x-rays. The primary-care physicians apologized that it might take up to two to three weeks to see a specialist. We, on the other hand, were flabbergasted at the expediency of the whole process.  Once we were through with our physicals and further exams, we received the bill.

No, wait just a moment. We didn't receive any bill at all, because we were living in New Zealand. Despite the fact that we were not citizens, nor (yet) residents of the county, we received all of the aforementioned medical care for free.

Unfortunately, our stay in New Zealand had to be curtailed for a number of reasons. We have never had such sufficient, efficient, and pleasant medical experiences before or since.

In our youth, whether uninsured or underinsured (which most people in the U.S. tend to be), we normally avoided seeing doctors because of the high co-pays and deductibles involved as well as the complete opaqueness of the cost of any sort of care. 

When care became more necessary as we aged, we reluctantly visited medical professionals, but the costs were usually shrouded in secrecy. For example, I was diagnosed with cancer (which was very likely, in part, iatrogenic) and needed surgery. Having extremely insufficient medical insurance, I expressed my concerns to the billing personnel at the hospital before the scheduled operation, but they could not divulge any of the prices of the known procedures. Instead, they told me that it was not something I should worry about. And you wonder why lack of health care coverage is the leading cause of bankruptcy in the U.S.?

Is there any other business in which you pay for services or products - and extremely expensive ones at that - but are not told the price beforehand, and moreover are told not to worry about the cost? It is absolute insanity and should be illegal. There are no standard prices for medical treatments and services and there is no transparency about costs. Indeed, medical care is the only service for which you are forced to buy the product prior to knowing its price. Consequently, patients are gouged with exorbitant fees over which they have no control whatsoever, particularly when they lack insurance and when they are people of color. Bottom line: those with the least pay the most and those with the most pay the least, as per usual in the United States.

Quantitative data clearly demonstrate the shortcomings of the U.S. medical system:

• The quality of health care outcomes in the U.S. is among the lowest of all developed nations
• The U.S. medical system is one of the least efficient in the world
• The U.S. spends more per capita on healthcare than any other industrialized nation
• Even after the Affordable Care Act, there are still over 28 million American without health insurance, down from 45 million before the ACA
• Even though more Americans are insured, many still cannot afford to access medical care and the majority of those who pay out of pocket go into debt or lose their entire life savings

 Forget about being in-between jobs, forget about moving from region to region, let alone state to state - medical insurance in the United States does not account for the real life situations we all face. Though many applauded the Affordable Care Act's extension of coverage to children up to the age of 26 under their parents' medical plan, this provision only helped if those young adults could live at home with or stay within the same general vicinity as their parents. All of the vagaries in the lives of actual Americans are left unaccounted for within our tortuous system of health coverage.

But all of these statistics do not fully illustrate what it is like to sort through the costly, convoluted U.S. medical system. I, like most of my fellow Americans, can recount innumerable exasperating stories throughout my lifetime of dealing with health insurance. I could talk about how, after hours of phone calls seeking medical care for some alarming symptoms that could have been related to my prior cancer diagnosis, it took three months to find a physician to see me. I could talk about how my health insurance provider just completely dropped all dental coverage with no explanation, even after numerous phone calls and letters inquiring as to why. In the past year alone, this ridiculously labyrinthine scheme of accessing medical care has left me resolved to not bother seeing a doctor at all.

Most recently, after having moved to a new state and, fortunately, obtaining health insurance through my husband's job, I tried to set up dental appointments. The only dentists in the area covered by our insurance said that the next available check-up could be scheduled TEN months from now. Then I tried to find primary care physicians. I spent hours and hours and days and days calling doctors' offices only to be told that they were "not accepting new patients." I gave up and called the health insurance provider to help me. The nice woman at the other end of the line said she'd be happy to find a physician for me and would email me a list of those available. The next day, I received a list with the name of ONE physician within a thirty mile radius who would take new patients. However, not only does it take a minimum of two months to get an appointment with a physician, but the physician wants all of your prior medical history (which is nearly impossible to compile for someone like me who has moved around so much) and then, after examining your history for anywhere from one to six weeks, will then decide whether he or she will actually take you on as a patient. This is the scenario with what is supposedly the best medical insurance in the region. Imagine what it is like for those with "lesser" insurance plans or with no insurance at all.

Early this summer, my husband severely injured both of his knees, leaving him barely able to walk without tremendous pain and assistance from a cane. Since we had no doctor and no ability to get an appointment for months, we attempted to see if his injuries would heal on their own. When the hoped-for healing never materialized, we finally had to go to the emergency room since no other physician would see us, despite our supposedly excellent health insurance. We waited four hours just to get a referral to an orthopedic specialist, because the orthopedics on our health care plan would not see a patient without one, even though our insurance does not require a referral. No medical treatment, one referral, and four hundred dollars later, we were next denied care by two of the local orthopedic group practices for apparently no reason whatsoever. In all my life, I had never heard of such a thing - a patient needs care and a physician denies service even WITH health insurance. I finally obtained an appointment with an orthopedic about 40 miles away after I explained our dilemma and basically begged the nurse to help my husband. I suppose we were fortunate, though, given that the nurse at the ER told us that she, herself, visits a specialist six hours away from our town.

These tales, of course, are not unique, nor do they even come close to approach the worst of what has occurred to Americans attempting to navigate such a corrupt medical system, if they even have any access to it at all. My troubles pale in comparison to those who have suffered physically and emotionally, lost their life savings, and worse, lost their loved ones due to the unethical, immoral medical industrial complex in the United States that values profits over people at every turn. In every place I have lived in my adult life, I have seen flyers and advisements fundraising for local community members who have fallen ill, unable to afford to pay for their necessary and often lifesaving care. And it is also not uncommon for citizens to have to try to raise money to pay for medical bills for their deceased family members as well. What kind of a psychopathic nation would allow this? Ours, of course.

Unfortunately, too few people want to complain publicly about the system. Americans are told that the strong just grin a bear the burdens they face. Furthermore, the preponderance of anecdotes in the media do not even begin to explicate what a colossal clusterfuck - and that is truly the only fitting word - the U.S. medical system is. Anyone who claims that health care in the United States is good or even tolerable, let alone the best in the world, either has far too much wealth and privilege to warrant a voice,  has not been anywhere else on the planet to experience the contrast to our woeful structure, or has sorely low expectations.

Universal health care is not only feasible, it is the least expensive, least bureaucratic, most straightforward, most efficient, and only moral solution to our heath care crisis in the United States. To those who balk at how universal health care can be paid for, I ask how we can fund the past 16 years of illegal, atrocious, global wars, the trillions of dollars spent (and lost into thin air)  to supply the military-industrial complex, and the incessant tax cuts to millionaires, billionaires, and multinational corporations? Universal, single-payer health coverage for all Americans is long overdue. All of the bullshit excuses and obfuscations will no longer fly. It is high time for the United States to join every other sane, humane government in every other industrialized nation by removing this burden from our hands.

Kristine Mattis holds a Ph.D. in Environment and Resources. She examines science, health, and environmental communication within the context of social and environmental justice. She is no relation to the Mad Dog general. Email: k_mattis@outlook.com.