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Health care in the United States

overview of the health care system in the United States of America

Health care in the United States is provided by many distinct organizations, made up of insurance companies, healthcare providers, hospital systems, and independent providers. In 2016, 58% of community hospitals in the United States were non-profit, 21% government-owned, and 21% for-profit. According to the World Health Organization (WHO), in 2018 Total health expenditure per capita in 2018 PPP international U.S. dollars were: United States $10,624, Canada $5,200, Australia $5,005, United Kingdom $4,620, Spain $3,576, Cuba $2,519, Russia $1,488, and China $935. The United States does not have a universal healthcare program, unlike most other developed countries.

QuotesEdit

 
Physicians’ and pharmacists’ first and foremost ethical obligation in situations of epidemic, disaster or terrorism is to provide urgent medical care and ensure availability and appropriate use of necessary medications. ~ American Medical Association
 
So to summarize the health-care crisis:
Our current system for providing medical care is insane.
But a majority of Americans understand that the federal government, if given the opportunity, would figure out a way to make it worse.
Therefore, the odds are that nothing will be done. ~ Dave Barry
 
Homer Simpson: America's health care system is second only to Japan … Canada, Sweden, Great Britain … well, all of Europe. ~ Gary Apple and Michael Carrington
 
Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane. ~ Martin Luther King
 
The head of Indianapolis-based insurance company OneAmerica said the death rate is up a stunning 40% from pre-pandemic levels among working-age people. “We are seeing, right now, the highest death rates we have seen in the history of this business – not just at OneAmerica,” the company’s CEO Scott Davison said during an online news conference this week. “The data is consistent across every player in that business.” ~ Margaret Menge
 
The U.S.'s privatized for-profit health care system had long been an international scandal, with twice the per capita expenses of other developed societies and some of the worst outcomes. ~ Noam Chomsky
  • Now I know what you're saying. You're saying, "Dave, you have painted a distorted and inaccurate picture of the American health-care system. Not all patients wind up being as wretched as Mary! Many of them wind up being dead." True, but let's not get nitpicky. The point is, our health-care system is a terrible mess. It's expensive, wasteful, inefficient, unresponsive, and infested with lawyers. Which is why there has been a big push, in some quarters, to place it under the management of... The federal government. This is like saying if your local police department has a corruption problem, the solution is to turn law enforcement over to the Sopranos. Nevertheless, there are people- intelligent, educated, well-meaning people- who seriously believe that we should let Washington redesign our health-care system. It goes without saying that these people live and work in Washington; that's the only place where you're going to find intelligent, educated, well-meaning people who are that stupid.
    • Dave Barry, I'll Mature When I'm Dead (2010). New York, G.P. Putnam's Sons, p. 170-171
  • The rest of the country is not so thrilled about trusting their health care to the same government that produced, for example, the U.S. Tax Code. Most Americans outside of Washington don't really trust Washington to do anything except screw up. This is the fundamental reason we have a two-party system. We put the Republicans in office until they have totally screwed things up, then we vote them out and let the Democrats take their turn totally screwing everything up, then we switch back to the Republicans, and so on, back and forth. It's like a Ping-Pong game in which neither player ever actually makes contact with the ball.
    So to summarize the health-care crisis:
    Our current system for providing medical care is insane.
    But a majority of Americans understand that the federal government, if given the opportunity, would figure out a way to make it worse.
    Therefore, the odds are that nothing will be done.
    So your best bet, until further notice, is to do what 83 percent of all licensed American physicians do, according to a recent survey: Avoid medical care altogether. This means you need to stay healthy. Exercise regularly, get plenty of rest, avoid contact with humans, and never inhale or open your eyes in a public restroom. Above all, make sure you at a balanced diet. By which I mean: broccoli and alcohol.
    • Dave Barry, I'll Mature When I'm Dead (2010). New York, G.P. Putnam's Sons, p. 171-172
  • It has been a rotting corpse for decades, with heinous medical experiments carried out throughout our modern history. The administration of LSD to prepubescent children by the intelligence services in the 1950s; the widespread use of psychiatric drugs, lobotomies, electric shock, and involuntary commitments in the decades after; and the deliberate butchery of over 60 million infants in America since 1971. We are only now paying a bill that was racked up over several generations. We tolerated medical injustice because most of us did not know any better. More of us know more now, but the truth is withheld from the masses under the COVID-19 censorship regime.
  • I don't think I know enough to say, well, here's the plan. It's not my specialty.... But I don't think there's any way not to have that debate about how much we're going to spend on health care.... In finding our way forward, we've got to be able to find ways to deliver the quality care that everyone expects and that we're capable of providing to the maximum number of people.
  • If Americans are to have the courage to change in a difficult time, we must first be secure in our most basic needs. Tonight I want to talk to you about the most critical thing we can do to build that security. This health care system of ours is badly broken, and it is time to fix it. Despite the dedication of literally millions of talented health care professionals, our health care is too uncertain and too expensive, too bureaucratic and too wasteful. It has too much fraud and too much greed.
  • In the wake of slavery’s end, skilled Black midwives represented both real competition for white men who sought to enter the practice of child delivery, and a threat to how obstetricians viewed themselves. Male gynecologists claimed midwifery was a degrading means of obstetrical care. They viewed themselves as elite members of a trained profession with tools such as forceps and other technologies, and the modern convenience of hospitals, which excluded Black and Indigenous women from practice within their institutions.
  • To better understand racial injustice in the anti-abortion movement, remember that American hospitals barred the admission of African Americans both in terms of practice and as patients.
  • Sarah Kliff spent the last year looking at over 1000 ER bills and has found outrageous facility fees, high costs for OTC drugs, and charges for simply sitting in the waiting room. Medicare for All would take these excess costs out of the equation...
  • Un pre-ACA days, a bout with a virus might not have been considered a preexisting condition. That's because many people tend to recover quickly from viruses.
    But in a blog post last week, researchers at the Rand Corp. suggested that COVID-19 could be seen differently by insurers. "Given the chronic problems [which can include organ damage, fatigue and confusion] associated with some COVID-19 cases, it is possible that some insurers would place restrictions on anyone who had a confirmed case of COVID-19," wrote Carter C. Price, Rand's senior mathematician, and Raffaele Vardavas, a mathematician at Rand who specializes in infectious disease models.
  • Twenty years ago, Kaiser surveyed health insurance underwriters and asked about a similar situation: a hypothetical applicant in perfect health except for "situational depression" following the death of a spouse. According to the survey, "in 60 applications for coverage, this applicant was denied a quarter of the time, and offered coverage with a surcharged premium and/or benefit exclusions 60% of the time."
    So both experts and consumers are concerned that invalidating the Affordable Care Act could mean that once again, individuals with preexisting conditions might not be covered — and such conditions could include COVID-19.
  • Modern observers accustomed to thinking of the medical profession as prestigious technically effective and highly paid are sometimes shocked to learn that it was none of those things in the nineteenth century. On the contrary, much of its history during that century was an uphill struggle to attain jut those attributes. Whereas European physicians entered the modern era with at least the legacy of well-defined guild structure-structures that took responsibility for teaching, maintained the right to determine who could practice, and exercised some control over the conduct an craft of the profession-American physicians did not. Because of its history as a colony, the United States attracted few guild-trained physicians, and consequently a formal guild structure never developed. Healing in this country started out primarily as a domestic rather than a professional skill (women and slaves often developed considerable local reputations as healers), and therefore anyone who claimed medical talent could practice-and for the most part could practice outside of any institutional controls of the sort that existed in Europe.
    It is true that some early colonies did establish different fee structures for “trained” as opposed to “folk” doctors, but these regulations were not supported by “enabling” legislation. “Trained” physicians had the right to charge more, but there were no regulatory mechanisms by which they could enforce their higher fees or, ore importantly, deny others the right to practice medicine. From the earliest days of the medical profession in this country, therefore, physicians wanted effective licensing laws that would do for them what the guild structures had done for their European colleagues, namely, restrict the competition.
  • In the early part of the nineteenth century, the fate of trained physicians became even worse. What few regulations had existed in the colonial period were swept away in the era of Jacksonian democracy, and medical practice became one vast free market. Moreover, during the second quarter of the century, deep doctrinal divisions appeared within the rank of trained physicians themselves. For the first third of the century, physicians had depended on a model of illness that called upon the use of drastic medical treatments such as bleeding or the administration of harsh laxatives and emetics. By the 1850, a new group of physician (including such luminaries as Oliver Wendell Holmes) rejected the use of this “heroic armamentarium” and earned for themselves the sobriquet of “therapeutic nihilists” inasmuch as they seemed to argue that anything a physician could do was probably ineffective and might be dangerous as well.
    Two other developments during the course of the century kept the social and professional status of medicine low. First, as the effectiveness of “heroic” medicine was called into question by some physicians themselves, there was a proliferation of healers who advocated new models of treatment. Thomosonians, botanics, and homeopath among others all developed “sets” of healing and claimed the title of doctor for themselves. These nineteenth-century sectarians flourished, perhaps in part because they tended to support relatively mild forms of treatment (bath, natural diets) instead of the “heroic” measures used by many doctors. Thu, regular physicians (those who had some semblance of formal training and who subscribed to the dominant medial model) found themselves in increasing competition with the sectarians, whom they considered quacks.
  • Concurrent with the emergence of the sectarian, there was an explosion of new medical schools: an estimated four hundred new ones opened during the course of the century. Unlike modern-day medical schools, whose strict admission standards are legendary, the majority of these schools were proprietary. Like modern-day vocational schools, they were open to all who could pay their fees, and precisely because they depended upon fees to survive, they were reluctant to fail anyone who could be counted on to pay tuition regularly.
    Members of the regular medical profession were therefore caught in a dilemma. In order to upgrade the profession’s status, they had to upgrade not only the standards of practice but also the education and qualifications of those who wished to practice. However, the prerequisite to such an upgrading-the restriction of the title of “doctor” to only the bet and the best-trained physicians-was difficult to meet because of the lack of licensing laws. Physicians faced the paradox that they could not obtain licensing laws until they were “better” than the competition, but becoming “better” depended on having licensing laws. The way in which physicians solved this problem was to bring them to the center of the abortion debate in America.
  • We are the richest country in the world. We spend more on health care than any other country. Yet we have the worst health care in the Western world. Come on. We can do better than this.
  • The head of Indianapolis-based insurance company OneAmerica said the death rate is up a stunning 40% from pre-pandemic levels among working-age people. “We are seeing, right now, the highest death rates we have seen in the history of this business – not just at OneAmerica,” the company’s CEO Scott Davison said during an online news conference this week. “The data is consistent across every player in that business.”
  • Sanders is still fighting the battle for single payer, Medicare-like coverage for all, even as fellow Democrats capitulated to the siren songs of the health and insurance industries. President Obama, himself a one-time advocate of single payer coverage, buckled to the insurance companies and its lobbyists and minions in Congress and agreed to health care legislation (the Affordable Care Act) that would continue to treat healing the sick as a profit center instead of a basic human right.
  • So if you believe in guaranteed high-quality universal healthcare, because you have seen the cost and the consequence of millions of our fellow Americans who have no healthcare or do not have enough healthcare, then let us come together around a policy that begins by prioritizing affordability in prescription medications that ensures that we bring down the cost of our premiums and our deductibles. And in a country, and in a country where too many of our fellow Americans are dying of diabetes in the year 2019, dying of the flu, dying of curable cancers, in a community, in a state, in a country where one of the largest providers of mental healthcare services is the county jail system, and in a nation that is in the midst of a maternal mortality crisis three times as deadly for women of color, then let us ensure that universal healthcare means all of us can see a primary care provider, all of us can get mental healthcare help, and that universal care means every woman makes her own decisions about her own body. We can give every American, every business in this country the choice to enroll in Medicare without eliminating plans that many Americans like for their families because those plans work for their families. Everyone able to see a doctor. Everyone able to afford their prescription. Everyone able to take their child to a therapist. No one left behind. No one priced out. We must get to universal guaranteed high-quality healthcare as soon as surely as we possibly can.
  • The New York State Department of Health appeared to announce this week that non-white New Yorkers would receive priority over whites in receiving “extremely limited” Covid-19 therapies for people at risk.
  • D.C. Women's Liberation succeeded for the first time in making informed consent a national issue. In the aftermath of the hearings, the U.S. government would require the pharmaceutical industry to include a patient information sheet with complete information on side effects in every package of birth control pills sold. The growing women's movement was prompting women to assert control over their bodies, and in doing so it changed forever the way Americans take prescription medications.
  • We're going to ask the wealthiest people and the largest corporations to start paying their fair share of taxes. We're going to take on the pharmaceutical industry and have Medicare negotiate prices. We're going to finally deal with child care and pre-K. Can you imagine in this country where you have free pre-K for every working family in America? We're going to have — end the disgrace of the United States being the only major country on Earth not to have paid family and medical leave. We're going to expand Medicare to cover dental, hearing aids and eyeglasses. We are going to got home health care... We're going to have — end the disgrace of the United States being the only major country on Earth not to have paid family and medical leave. We're going to expand Medicare to cover dental, hearing aids and eyeglasses. We are going to got home health care.
  • Let Mr. Barrasso go to the folks in Wyoming and ask them whether they think it's a good idea that they should be paying a third of their income in child care. Ask elderly people who don't have any teeth in their mouth whether they should be able to get dentures through Medicare. Ask the scientific community whether the time is now in a big way to deal with climate. Ask the ordinary American consumer whether we should take on the greed of the pharmaceutical industry, which charges us the highest prices in the world for prescription drugs.
  • For historical purposes remember, I was able to get rid of the INDIVIDUAL MANDATE, the most unpopular and expensive part of ObamaCare. You are no longer forced to pay a fortune for the “privilege” of NOT getting bad healthcare. This ended ObamaCare as we knew it. Thank you!
  • Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds.
    Pre-pandemic, rural Americans had 20 percent higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to the Centers for Disease Control and Prevention’s 2019 National Center for Health Statistics.

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