American Healthcare System Problems Solutions

The natural history of disease is an epidemiological model, showing how an individual’s health condition will progress over time without any interventions. Intervening at the weakest link in the chain of progression of specific diseases sometimes means addressing the symptoms of a problem long after the disease has progressed past a treatable point. Usually, high technology, high-cost solutions are required when intervening late in the stage or progress of a disease. On the other hand, focusing on prevention and the application of lower cost and less invasive solutions to preventable problems can promote public health and reduce burdens on the healthcare system.

Most diseases do have a natural progression or natural history, which can be altered via strategic healthcare interventions (CDC, 2017). The natural history of disease model starts with the stage of susceptibility, the point at which the individual is at risk but has not yet acquired the disease. During the susceptibility stage, a person can receive a vaccination, for example, or practice healthy lifestyle choices like good diet, exercise, and not smoking. Exposure is the first point of weakness. If a person has been vaccinated and is exposed to the disease, their chances of progressing with the disease are almost negligible compared to a person who is exposed. Genetics and other individual factors might determine whether the individual’s natural history progresses further to the next stage of pathological changes and what the CDC (2017) calls the stage of subclinical disease. From the subclinical disease stage, the individual exhibits symptoms. This could be where the child first exhibits signs of gaining weight or being overweight, for example. The manifestation of clear symptoms is usually when a physician offers a diagnosis. An official diagnosis has tremendous implications, not just for the trajectory of the disease but also for access to funding via insurance.
A medical care culture that focuses on prevention helps to eliminate the costs associated with the current model of intervening at the weakest link. Maintaining health through prevention is a far more cost-effective and sensible approach to healthcare. However, hospitals and other health care institutions, whether voluntary or for-profit, make choices based on financial solvency and the bottom line. In order to remain in business, healthcare institutions need to respond to market pressures, which does not necessarily mean promoting prevention. The profit-driven, market-driven model of healthcare in the United States affects public attitudes towards health and wellness. Insurance companies may offer the means by which a person can receive a high-cost, high-technology intervention at the weakest link in the natural history of the disease, but fail to provide the means by which a person can receive the preventative services needed to maintain health. “The treatment-oriented rather than prevention-oriented health care philosophy is encouraged by an insurance system that, before managed care, rarely paid for any disease prevention other than immunization (Sultz & Young, 2011 p. 22). Likewise, doctors and other healthcare workers focus on a disease model. If it is more profitable to market medical tools and services to patients who already have the disease or are at a later stage, then the institution will continue to support those methodologies.
In fact, the “bottom line” approach has led to serious ethical problems in the American healthcare system. Beyond just the unequal access to healthcare services that the profit-driven model entails, the bottom line method makes it feasible for healthcare institutions like hospitals to engage with insurance providers “in joint investments that raise serious questions about conflicts of interest,” (Sultz & Young, 2011, p. 57). Facilities may be owned by the manufacturers of medical equipment, recommended by doctors at related healthcare institutions. Tests, treatments, and procedures, as well as drugs are recommended for profit-driven reasons rather than based on patient best interests. Also, the profit model impacts health care delivery, patient satisfaction, and patient outcomes. The current bottom line model means that healthcare organizations operate and function like any other corporation. Their administrators and C-suite managers make decisions based on profitability, not ethics or patient care. The result is a staff that is motivated more by financial motives and missions than on a model of caring.
Most wealthy, industrialized, liberal democracies like the United States have in place a healthcare system that is based on caring and ethics more than on profit (Nichols, 2012). Even when a healthcare system is not totally single-payer, it can operate independently from the profit model. As Nichols (2012) points out, a single payer system is, however, “the most humane path to a better and more sustainable health system,” (p. 547). A single-payer system reframes healthcare as a universal right, not a privilege. Just as public education is considered a universal right in the United States, healthcare should also be by law accessible and available to all citizens. The healthcare choices a person makes should not be based on profitability at any stage. However, there is tremendous resistance to a single-payer model. Even the multi-payer model with tenuous government support that Obamacare represented was vehemently opposed and strikingly controversial. The reasons for the aversion to the single-payer system are related to brainwashing and social control. A deep-rooted fear in the American psyche over socialism permeates the public consciousness, in spite of the fact that public education, Medicare, and other social services essentially function the same way. Americans are delusional, unable to think critically about public health and public policy. As a result, corporate healthcare interests are given the legal leeway to prevail. Because biotech and the medical services industries have become so profitable, their lobbying power is substantial and difficult to overcome without a massive social movement.







References

Centers for Disease Control and Prevention (CDC, 2017). Natural history and spectrum of disease. Retrieved online: https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section9.html
Nichols, L. M. (2012). Government Intervention in Health Care Markets Is Practical, Necessary,and Morally Sound. The Journal of Law, Medicine & Ethics, 40(3), 547-557. doi:10.1111/j.1748-720x.2012.00688.x
Sultz, H. A., & Young, K. M. (2011). Health care USA: understanding its organization and delivery (7th ed.). Sudbury, MA: Jones and Bartlett.