The US healthcare system is broken, no matter how you look at it. Let's look at the history of failed healthcare reform in the United States, how the US healthcare system compares to other wealthy nations, and what we can do to fix the broken US healthcare system.

We already spend more on average on health care than anyone else in the world. We still live shorter lives than the rest of our PE countries, and we have higher levels of health inequality. We pay more for each interaction, the money's in hospitals, and doctor. The president's push to lower healthcare prices has received heavy criticism, the drug industry is spending big to keep that from happening. It really is the minority groups here that are being hit hardest because of lack of access to vaccines and treatments and doctors in the United States. We spend more on our healthcare system than any other wealthy nation. Despite this, we have some of the worst health outcomes. We have significantly lower life expectancy, the highest rate of people with multiple chronic diseases, significantly higher rates of death from avoidable or treatable causes, significantly higher rates of maternal and infant mortality. With a 4.3 trillion DO price tag, we should have the best healthcare system in the world. And yet we're leading shorter. 

Less healthy lives than our counterparts in other wealthy nations where they spend far less on healthcare overall. Why is that? How do we keep pouring money into a system that doesn't work? The answer involves decades of influence from the insurance industry, millions of dollars in Big Pharma lobbying, and an elaborate fear-mongering smear campaign that pushes Americans to vote against their own best interests. This is why the US healthcare system is so broken. 

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When compared with the 38 member nations of OECD the Organization for Economic Cooperation and Development, the US spends twice as much as the average country per person on health carers. This includes out-of-pocket costs and private and government spending. The United States is the only country in the group that does not offer universal health coverage. Life expectancy in the US in 2020 was 77 years, three years less than the average 80 y year life expectancy for OECD countries and seven years less than countries like Japan with the highest life expectancies. It's far more dangerous to be pregnant and have a child in the US than in any other wealthy country. The OECD average maternal mortality is 9.8 deaths per 100 thousand live births in the US. That number is 23.8 deaths per 100 thousand live births. Here are some countries where it's safer to give birth to a child than in the United States.

Turkey.

Oman. 
Tajikistan. 
Saudi Arabia, 
Russia. 
Kazakhstan. 

Kuwait. Qatar. Turkmenistan to name a few, and death from avoidable or preventable causes in the US far surpassed any OECD country. One reason for this is the death toll from deadly assault in the US, largely stemming from gun violence, which was over twice as high. 

As the average for OECD countries and at least seven times higher than nearly all other high-income countries. In 2021, the US spent 17.8 percent of its GDP on healthcare, nearly twice as much as the average OECD country. And yet the US is the only high-income country that does not provide universal healthcare coverage. Let that sink in, we are paying more, and we don't even have the coverage or the outcomes that those European commies have. We visit the doctor less frequently, and we have fewer physicians and hospital beds than the average OECD country by nearly every measure. The investment we make through our tax dollars and out-of-pocket spending on the most expensive healthcare system in the world is not paying off to figure out how we got here and how this system became so broken. We have to go back a bit into time. 

For centuries medicine was more about relationships than about science. The town doctor was present during the very first and very final moments of nearly everyone's lives in the town. They didn't have the latest technologies because there weren't many. Instead, they had the trust of generations of families and did their best with the tinctures and leeches that they had available to them to make people as comfortable as possible in a world where disease and death were incredibly common and nearly impossible to fight. As human understanding of disease and pathology grew and the world began rapidly industrializing, the 1800 s saw an influx of medical advancements from the thermometer to the stethoscope to vaccines and anesthesia. This transformed the practice of medicine from one dependent on relationships and holistic treatment meant to heal the whole person to a stoic science. By 1917, the first US Medical Specialty Board was established for the practice of optimmology.

Since then. Over 100 and 20 medical specialties and specialties have been established. Beginning at least during the Civil War, sickness funds were established by employers, unions, or fraternal organizations whereby workers would make weekly contributions of about one percent of their wages to the fund, and when one of the fund members became too ill or injured to work, the fund would provide the worker with cash, usually around 60 percent of the workers' wages. By the early 1900 s. Around 20 percent of industrial workers were members of a sickness fund. These funds were basically early forms of workers compensation insurance, where companies pay a regular fee for insurance so that if a worker is injured, the company can file a claim and pay out the workers' medical bills and lost wages instead of paying for it outof pocket, and that was typically sufficient because medical costs were relatively low prior to the 1920 s when most surgeries were performed in people's Own Homes the largest cost of sickness tended to be lost wages more than anything else at the time, while other types of insurance like life insurance had been available for a while. Health was considered uninsurable. To be insurable. Hazards tended to have to be both definite and measurable. Health was neither. How do you measure someone's level of health? They hadn't figured that out and arguably still haven't. 

During the Great Depression, need for free or affordable healthcare led hospitals and physicians to implement some of the first forms of medical insurance. Baylor University Hospital in Dallas enrolled 1200 public school teachers into the Baylor plan, where for 50 cents per month, members were allotted 21 days of care in the hospital. In 1932, in Sacramento, another plan was developed that covered services at any hospital in the community. By 1933, just one year later, 26 of these hospital service plans were in operation across the country. Soon, insurance companies found a way around the uncertainty of ensuring a person's health by offering not health insurance, but. Hospitalization and surgery coverage because the fact and cost of those events were definite and measurable. These initial insurance plans were originally created by hospitals and physicians, and they saw dramatic pushback from the American Medical Association.

Many doctors who attempted to establish health plans were threatened and often reprimanded, or even had their medical license revoked by the AMA. This stemmed largely from the threat that these health plans posed to physician incomes at the time. Physicians were paid based on a sliding fee schedule, so wealthier patients were charged more and those with less money paid less. These health plans undercut this system by allowing wealthier patients to pay a monthly fee and in the end pay less overall for their health carers, so the wealthiest patients would go to the physicians with the health plans, leaving the physicians without health plans with only the lower-income patients who couldn't pay much.

The Ama was also strongly opposed to any form of government-sponsored health insurance despite widespread support for such initiatives at the beginning of the 1900 s. The AMA is in part to blame for why socialized medicine didn't catch on early in the US, despite a strong movement in favor of it and despite the fact that many European countries had developed some form of nationalized health carers by the 1920 s. Because of pushback by the AMA and the growing group of private health insurers when Social Security was created in 1935, it did not include any health insurance provisions. In 1945, when the Truman administration began working on a national health insurance plan that would provide insurance coverage to all Americans to be paid by income tax, the AMA and private health insurance companies lobbied against the universal insurance and in favor of a bill that instead directed government funds to subsidizing care for the elderly, leading to substantial construction of hospitals and nursing homes over the next 25 years and effectively taking focus from universal care and shifting it to medical care for the elderly. When. The US became embroiled in World War II. The need for domestic workers increased with wartime production as a means to attract more workers. 

Employers began offering employers sponsored healthcare in 1943. At the height of the war, the IRS Tax Court ruled that health benefits provided by employers were nontaxable. This meant that health benefits became even more valuable to workers because every dollar spent on health benefits was worth more than a dollar in their pocket because it was untaxed. This decision was made in the context of a wartime tax code when workers were desperately needed, and other drastic measures were also in place to increase worker productivity, including a ban on worker strikes and high taxes to avoid companies profiteering from their wartime production. But while many of those drastic provisions were lifted after the war, the tax-free status of employer provided healthcare was codified into law in the 1954 tax Code. 

That is why health insurance is now tied to employment in the United States, while every other wealthy nation offers universal coverage and private coverage options independent from a person's employment. Now, 80 years later, the government loses about 200 and 60 billion dollars annually by not taxing health benefits, and that on top of the 1.4 trillion dollarsllar annual price tag and you should start to see the depth of how much we're losing to keep this ineffective system afloat, and the private pharmaceutical industry grew right alongside the growth in private insurance companies prior to World War II, drug companies often push medical, ethical, and legal boundaries in an attempt to sell drugs that often amounted to snake oil or could be actively harmful to patients taking the drug. For example, in 1900. Bayer, coming off of its success developing Aspirin, introduced a much stronger brand of painkiller in the United States heroin the Company promoted it as a general treatment for whatever Ailsa colds, coughs, asthma, epilepsy, stomach cancer, schizophrenia, and more. It was even advertised as safe for children, and as with any innovation, lawmakers struggled to keep up with regulating the growing pharmaceutical market. During World War II, mass production of penicillin helped pharmaceutical companies do a major rebrand. 

No longer Snake oil salesman of Old Big Pharma remade itself as savior of man producers of innovative life-saving products, and they made a killing while doing so. To earn even more money, they quickly began production of broad spectrum antibiotics, promoting their use to cure all sorts of health conditions. Soon doctors were prescribing the antibiotics not only for bacterial infections, but even prophylactic at the first signs of fever, earache, or runny nose. This led to a growth in unnecessary antibiotic prescription in what at least one researcher estimates to be about 90 percent of cases. By 1950, pharmaceuticals had become the most profitable industry in the United States, and as technological advancements in medicine continue to grow, so too did healthcare costs across the board, and this was spurred on in part by increased specialization in the medical field. Prior to 1940, very few doctors were specialized beyond general medicine by 1975 specialization had grown along with medical expenses which increased from three billion dollars to 75 billion dollars in that time period. Critics point out that this increase in specialization, encouraged by the medical establishment both in the prestige and money that a high specialization brings, has led to a Fordist system where the human body is divided into parts and treated in a piecemeal fashion by different specialists while the wellness of the whole human is overlooked. As a result, and with these rising healthcare costs for expensive technology and specialists has come new and confusing insurance systems. The 1960 s and 70 S saw the creation of HMS or Health Maintenance organizations where members can only get care from specific providers that have already created agreed-upon fees with the insurance company. Then came POS in the 1980 s Preferred Provider Organizations which contracted and helped with logistics between providers and insurance plans, allowing for greater flexibility for plan customers to go to multiple different providers while also increasing the administrative headache of coordinating between all of them by. The 1990 s healthcare costs were at an all-time high and 34 million people 13 percent of the population were uninsured. Bill Clinton campaigned on making healthcare more affordable and accessible. As president, he introduced the Health Security Act, which called for universal coverage for all Americans. Among other things, it languished in Congress for a year before being declared dead in September 1994 by 2 thousand and 6. 47 million americans, or nearly 16 percent of the population, were uninsured. That year, then Massachusetts Governor Mitt Romney signed healthcare reform into law in that state. Romney Care required all residents of Massachusetts to obtain health insurance, mandated that employers with more than ten employees provide health insurance, provided subsidies to those who couldn't afford coverage, and created a statewide agency a. Marketplace if you will to help people find affordable health insurance plans. Mitt Romney did. This and if it sounds familiar, that's because it mirrors many provisions that were adopted four years later by the Affordable Care Act, also known as Obamacare. Obamacare was the largest overhaul to the healthcare system since the enactment of Medicare and Medicaid. It included provisions such as prohibiting denial of health insurance for pre-existing conditions, requiring health plans to cover most preventive care services without any cost to the planned member, the individual mandate, requiring every American to have health insurance coverage, and health insurance marketplaces at the federal and state levels to help people find coverage. Obamacare has been challenged numerous times in court, and specific provisions like the individual mandate have been changed over the years, but it still stands as the primary law governing how much of the US population accesses health carers. Despite all these reform efforts and years and years of squabbling over how to best provide healthcare to US citizens, healthcare costs have continued to skyrocket. 8.4 percent, or 27 million Americans still don't have health insurance and millions more are underinsured and health outcomes are abysmal compared to other wealthy countries who spend a fraction of what we do on their healthcare and offer it universally for everyone.

There are a Number of reasons why this system is failing us because of our convoluted system of insurance coverage and providers, consumers have literally no way of knowing what their exact bill will be for any given medical procedure, even if they call their doctors and their insurers ahead of time. The bill may reflect something wildly different than what they were told depending on billing codes and a number of other factors that go into determining whether an insurance company will cover the bill and how. Much of it they will cover. This confusion also means outrageously high administrative costs both. 

For insurers who have to decipher the plans and doctors who have to confer with insurance companies and code builds properly and handle the constant back and forth with insurers and patiences. These administrative costs, of course, then get passed to patients in the form of higher bills and greater tax burdens. This also means significant delays in procedures and services while awaiting insurance approval or putting off procedures altogether for fear that the bill may be too high, which in turn leads to worse health outcomes. Insurance companies are a business and they lose money the more procedures they cover. This is a clear conflict of interest when a person's medical care is dependent on whether or not their insurance company approves of it. Health insurers often discourage care to keep costs as low as possible, restricting expensive medications, tests, and other services by declining coverage unless extensive forms are filled out to justify the service to the insurer, increasing administrative costs and creating greater barriers to care. This means that your doctor may prescribe necessary care, but the insurance company gets to determine whether or not you actually get that care. Insurers could also require numerous other drugs or services be tried first before allowing a more expensive service which can. 
Lead to short-sighted decisions such as requiring that a cheaper medication be prescribed first, even if it has very little chance of actually working. A recent survey found that 78 percent of physicians report that this has led people to abandon treatment altogether, and 92 percent reported that it contributed to delays in necessary care, and these short-sighted decisions not only create more costly administrative headache, that delay and care could result in even worse health outcomes down the line, ultimately costing insurers even more money and contributing to greater patient suffering. The confusion over health insurance and what treatments to take is compounded by the fact that we have a system that emphasizes doctor specialization leading to miscommunication or a complete lack of communication between various specialists working with the same person. A person's body is compartmentalize into fragmented pieces the heart, the lungs, the brain, the cervix instead of treated as a whole. This emphasis on specialization further enforced by a medical education system that promotes specialization, and a society that deems heart surgeon to be far more impressive than primary care physician, including drastic differences in income potential, means that there aren't enough physicians to go around, so. 
Emergency room doctors are becoming the first line of defense for every single ailment and people are getting passed around to specialists who provide duplicate care or prescribe drugs without having an understanding of the full human and what other drugs they might be taking. This drastically increases costs and worsens patient outcomes.

Even primary care physicians receive woefully inadequate training relating to nutrition and holistic health because of our system's emphasis on defensive medicine as opposed to preventative care. Indeed. Most other wealthy nations invest far more in prevention both in medicine but also in social services that improve health and longevity, requiring less medical intervention in the first place. Instead, in the United States, we treat symptoms by throwing expensive drugs and medical procedures at the acute problem instead of taking a systemic approach before acute interventions are necessary. Overspecialization of doctors is partially to blame, as is the fee structure we use in America, we use a fee for- service system wherein doctors make more money, the more services they provide. Income is not determined based on outcomes or results, but rather on individual procedures and drugs, with no focus on whether those procedures and drugs actually improved patient conditions. This in turn can stifle innovation because there are certain forms of care like in-home care for elderly and cancer patients, for example, that are more cost-effective and actually preferred by patients. But the very nature of their cost effectiveness renders them completely incompatible with a system wherein greater profits are made from greater expenses to patients and where insurance companies bar innovative techniques because they go against the status quo or haven't been approved for coverage. But in the end, the system is functioning exactly how it's been built to function as a. Means of serving the interests of those profiting from healthcare.

Throughout the history of healthcare reform in America, advancements that could have revolutionized health coverage for the general population have been blocked. Time. And again by the interests of those who stand to make the most money off the system as it currently stands, some doctors groups, insurance companies, and Big Pharma as we've covered over and over and over again in every aspect of the way this country is run, money, in the end, is able to trump everything else, including the best interests of medical patients. The pharmaceutical industry is one of the most powerful political forces in America. It has more than 1800 highly paid lobbyists on Capitol Hill.

Last year, drug companies spent over 300 and 75 million dollars to lobby Congress in favor of their own interests. On top of the millions it spends on lobbying, big Pharma gives millions and millions of dollars in campaign contributions to congresspeople from both parties. Representative Kathy Morris Rogers. Republican of Washington, has the dubious honor of having received the most payouts from Big Pharma of any congressperson during the 2021 22 cycle at 100 and 47 thousand dollars in just that one cycle. She's the head of the House Energy and Commerce Committee, which oversees regulations regarding technology and healthcare. Pfizer alone has given over ten million dollars since 2 thousand and seven. The largest recipient of Pfizer donations is Representative James Cliburn. Democrat from South Carolina, at 100 and 37 thousand dollars since 2 thousand and seven he served. 

As the House Majority Whip during both Obama and Trump administrations. Republican Senator Tim Scott, also of South Carolina, received nearly 100 thousand dollars from Big Pharma in the last half of 2021 alone. He has been a member of the Senate Finance Committee since 2015, giving him significant influence over legislation. He's strongly opposed legislation introduced that would allow Medicare to negotiate drug prices with pharmaceutical companies, a practice that's been normalized in virtually all other wealthy countries. As the top Republican in the senate's Special Committee on Aging, he's released reports arguing that legislation that would allow Congress to control drug prices would result in shattered innovation and bankrupt businesses, echoing Big Pharmas fear mongering when he said Democrats proposed the federal government should be in charge of deciding the price of treatments instead of a competitive free marketplace sustained by companies driving innovation.

This. Despite the fact that last I checked a free market required that those participating in the market actually knew how much they were paying and the quality they were paying for, among many other things, not to mention the fact that because all other wealthy nations place limits on drug costs and we don't, there's no free market happening, we are. 

Simply paying a subsidy on these drugs to offset the limits that other countries have placed all while pharmaceutical giants make unconscionable profits when Big Pharma is called before members of various congressional committees who are trying to regulate the pharmaceutical industry like they were in 2019 when execs from Johnson and Johnson. Merck. Pfizer, and Moore were called to testify before the Senate Finance Committee, they know that they're testifying to a room of people that they have bought out. The companies who testified in 2019 had given around 1.6 million dollars total to 27 out of the 28 members of the Finance Committee that they were testifying before. A 2021 report found that two-thirds of all members of Congress received contributions from pharmaceutical companies leading up to the 2020 election alone and the Traceable money that can be counted doesn't take into account the millions of dollars in dark money that pharmaceutical companies give through the leading trade association of the drug industry. Firma. If you remember from my video on philanthropy and also my video on how money is ruining democracy, trade associations like Firma collect money from members and then give that money to dark money nonprofits who don't have to report the source of their donations, and because we can't track that cash, there's no way to know precisely how much money the pharmaceutical industry is injecting into our political system.

We do know generally that outside groups spent nearly one billion dollars on Senate Republican candidates in the 2022 election cycle alone. The years and years and billions of dollars of big pharma money means that pharmaceutical companies are largely unregulated, and any new attempt at regulation, such as allowing the government to negotiate with drug manufacturers on prices, gets millions of dollars thrown at it to make it go away. The common argument is that if we regulate the pharmaceutical industry, we'll stifle innovation. The only. Way that they'll want to continue making new drugs is if they can get stinking filthy rich off of it. And while there are so many academic arguments we could get into about human nature and whether profit is the main motivator behind why people do things, we don't even have to touch on that the pharmaceutical industry would still be profitable if we place regulations on it. A recent analysis by West Health Policy Center and Johns Hopkins Bloomberg School of Public Health found that big pharma firms could lose. 

One trillion dollars in sales over the next decade and still maintain their current research budgets. When there was a bill in 2019 that was introduced to lower drug costs, the Congressional Budget Office estimated that the bill would reduce the number of new drugs developed by about two per year over the next two decades. To put that into context. Firma boasts that there are currently over 8 thousand medicines in development as. 
David Mitchell, founder of the independent nonprofit Patients for Affordable Drugs, now recently put it, you're talking about a tiny impact on new drug development.

We can compensate for that by sending more money to the National Institutes of Health. Because NIH is the engine of innovative new drug development, it's the single largest biomedical research agency in the world. All 300 and 56 drugs approved by the FDA from 20 ten to 2019 are based on research and basic science from the NIH. The Senate Committee on Health. Education. Labor and Pensions recently released a report finding that half of the prescription drugs invented with the assistance of the NIH now cost over 100 and 11 thousand dollars. This means that despite the fact that taxpayers have funded the research through the NIH that pharmaceutical companies have then taken and used to develop new drugs with those same taxpayers are now forced to pay obscenely high prices to the private. 
Pharmaceutical companies to, 

Access that innovation make it make sense, so anyway you look at it. Big Pharma is profiting from the lack of regulation in the US and using those profits to turn around and make sure that no regulations ever happen, and the majority of politicians on Capitol Hill have taken the bait at the. 
Expense of all the rest of us out here just trying to survive. And because of all of this administrative inefficiency, insurance company interference overs specialcialized doctors and not enough physicians and nurses and a pharmaceutical industry run completely rampant with greed. We have the most expensive and most inefficient healthcare industry in the world. In the low life expectancy, high levels of comorbidities, high child and maternal mortality, and high levels of death by preventable causes are made. All the more stark when you control for healthcare disparities in the country because, yes, of course, there is also a layer of racism and sexism and fatphobia laid on top of all of this. Remember how I said at the beginning that the US average life expectancy is 77, which is lower than the 80 -ye average for OECD countries. That's the average. The average life expectancy for Black people is 70/70. 

Black infants are more than twice as likely to die as white infants. Remember how at 23 deaths per 100 thousand births, we had the highest maternal mortality in the OECD. That was an average maternal mortality for black people 69.9 deaths per 100 thousand live births, three times the national average, which is already unconscionable high by international standards, and sexism plays a role too. The Journal of the American Heart Association reported that women who visited emergency departments with chest pain waited 29 percent longer than men to be evaluated for possible heart attacks. Women with acute abdominal pain were up to 25 percent less likely than their male counterparts to be treated with more powerful opioid painkillers. Middle-aged women with chest pain and other symptoms of heart disease were twice as likely to be diagnosed with a mental illness compared with men who had the same symptoms. Tons of research shows racial bias in pain treatment as well. A 2016 study found half of white medical students and residents held at least one false belief about biological differences between blacks and whites and were more likely to underestimate black patients pain.

This on top. 
Of millions of pieces of anecdotal evidence from women, black people, fat people. LGBTQ people who report feeling unheard and dismissed by their doctors or unable to get the treatment or medication they need because of racism, sexism, fatphobia, homophobia and transphobia. In our doctors, insurers and politicians, this system is fucked from the bottom to the top and the thing is that it doesn't have to be this way. There are other countries doing this for less, with better. 

Health outcomes. I don't think that there's a place on earth you'll find where there aren't. Some complaints about various aspects of healthcare and racism and sexism, etc. Exists in these other places with better health outcomes as well. But overall there are better systems out there that provide better outcomes for patients across the board while costing them far less. Creating legislation around this wouldn't require reinventing the wheel and many. Many proposals have been introduced and have failed over the last century that would have overhauled the system in a way that would make it more similar to other wealthy nations today. Instead, legislation. 

Has been stymied at every turn by Say It With Me. Money in politics. The AMA, the insurance industry, and most prominently Big Pharma all have millions upon billions of dollars to continue to buy out politicians and finance dark money organizations that promote misinformation and fearmongering messages about what would happen if God forbid. The pharmaceutical industry was reined in a bit, and the only people who win are the politicians who accept the money, the ceos who take home tens of millions of dollars every year, and the shareholders who reap the benefits off the backs of sick Americans from sea to shining sea. 

There is a Better Way