The United States, for all it has to offer as a top industrialized country and a global superpower, cannot provide quality healthcare to a majority of its residents. The U.S. healthcare system suffers from many ailments, including a shortage of healthcare workers, poor workplace conditions and disconnected sectors. All this adds up to worse outcomes for patients, as the system leads to inconceivable costs, poor accommodation of patient needs and unequal access to care. The U.S. healthcare system is beyond broken, and many people are now starting to realize this. 

However, something more concerning in all of this is that we are the only major industrialized country without universal healthcare, despite how much we spend on it. In fact, according to an article in the National Institutes of Health, the U.S. spends almost twice as much on healthcare compared to other industrialized countries—such as Japan, Australia, Canada, etc.—but is unable to achieve the same standard of care. Why? 

First, the U.S. has a complicated mix of both private and public insurance plans. These include federal Medicare programs for the elderly, state Medicaid programs for children in low-income households, employer-based private insurance and individual insurance. These programs covered 91.4% of Americans as of 2020, but 8.6% of the U.S. population remains without insurance. While the number of uninsured Americans has gone down drastically since the signing of the Affordable Care Act in 2010, millions still remain uninsured.

Uninsured individuals are less likely to seek medical care due to the costs as they are often charged the full price, compared to those with insurance who receive provider discounts. Additionally, because of the lack of communication between specialties, patients may receive unnecessary charges that could have been avoided. For example, you could be getting a referral from your primary care provider to see a specialist, who then does a brief scan of you and asks to see you again for the actual procedure or exam. They may also ask for your previous labs and results from your primary care, which might take up to several weeks to get to the specialist. Throughout this whole process, it may cost you several hundred dollars just to see them for each visit. These costs build up, which is why universal healthcare, as well as appropriate communication between providers, is essential. 

Unfortunately, while universal healthcare should be considered a fundamental human right, it has been increasingly politicized in the U.S. Some clear partisan trends show that the Democratic Party favors expanding public healthcare programs and employer-based coverage. On the other hand, the Republican Party advocates for a more market-based healthcare system, encouraging consumers to pay out-of-pocket costs while also increasing those same costs. These stark differences in healthcare solutions explain why federal legislation cannot even begin to repair the state of the healthcare system in this polarized country. Additionally, uninsured people are at a lower social advantage than the rest of the population, and they are less likely to vote on such issues or organize to advocate for themselves. 

That being said, there are currently a few reforms in a couple of states aimed at improving the quality of healthcare by reforming provider payments. These reforms reward efficiency and quality patient-centered care in terms of monetary compensation. As a medical scribe at the Cleveland Clinic over the summer, I saw these reforms in action. I was responsible for documenting a provider to ensure they were compliant with the healthcare checklist, which included how much time a provider spent consulting a patient, if they demonstrated cultural competency and whether they conducted any depression/social needs questionnaires. By documenting if the physician has touched base with the patient on all these matters and appropriately paying them based on their results, we can move from service-fee-based care to a more quality-based healthcare system. 

While these reforms are taking place in various states, a more widespread reform is needed to put every hospital and private practice on the same standard. Ultimately, federal legislation is needed to ensure that this happens by overcoming various economic and political challenges. It is certain, however, that this growing fragmentation of the U.S. healthcare system will only get worse in the future. With a grossly uncoordinated medical system, we are inadvertently accepting tens of thousands of preventable deaths each year. If we hope to solve this, the time to start is now.