The U.S. Healthcare System is Going to Hell

It's no secret to anybody that the U.S. healthcare system is bad, but it's important to point out from time to time just how bad it is.  I am an asthmatic and have had asthma since I was five or six years old.  Around age ten, I began taking regular medicine, which I have taken daily since then and will likely have to take for the rest of my life.

Part of my motivation in deciding to become a doctor is to work on seemingly "intractable" problems like asthma, because every time I really think about it, it pisses me off.  Despite the genetic reductionism gripping our society (in stark contrast to the scientific community), asthma is a disease having near entire environmental causality.  There was recently a study conducted in China where the rate of asthma decreased in predictable fashion the farther one was from an urban center.  People who lived near factories and cars had mathmatically modelable high rates of asthma correlated with ppm of various pollutants, while people who were farmers and lived in the countryside had near zero incidence of asthma.  The patterns produced matched the patterns produced by infectious diseases, suggesting strong environmental correlation.  

This week as I fell sick and the supply of albuterol which I brought with me began to dwindle, I remembered the scene from Michael Moore's film Sicko where his Canadian relatives bought Canadian travelor's health insurance before going to the U.S. since the U.S. system was just so bad.  I remember at the time thinking that perhaps it was a bit extreme, but now I'm wishing I had purchased Japanese travelor's helath insurance before coming to the U.S. to visit my family for the holidays.

The last time I had a regular physician it was a pediatrician at a pediatrics office near my house.  After I went off to college, I utilized the Duke Health System, and in Japan, I have seen Japanese doctors.  Obviously.  I was home for the holidays and I needed to buy more asthma medicine here for the first time in eight years, so I called the pharmacy where I had always purchased it in high school.  I was told that prescriptions were only valid for a year, so I would need to get in touch with the office that had prescribed me asthma medicine, which was Quincy Pediatrics. 

I called Quincy Pediatrics and explained that I was home for the holidays and asked if I could get a new prescription.  They told me that they were a pediatric clinic and that I was twenty-six and that I could come by and pick up my medical records and take them to the emergency room.  You want me to go to the emergency room to get a prescription for the same medication I've been taking since I was ten?  Wouldn't the people with emergencies be pretty upset by that?  Can I talk to my doctor? 

The woman in charge responded sarcastically that I hadn't been there in like a million years and that big people see big people doctors.  I told her that literally all of my medical records were in her office, because they had been sent there before I went to Japan.  She told me I could come pick them up on my way to the E.R. 

I called the pharmacy again and asked if they had a walk-in clinic they could recommend and how much the whole process would cost since I didn't have U.S. health insurance (despite Mass Health and Obamacare apparently).  The pharmacist said she couldn't tell me how much a walk-in clinic visit would cost, but the medicine alone was $49.95 without insurance. 

In Japan, an albuterol inhaler without insurance costs about $6.00 - there also isn't any insulting price-pointing.  I can just imagine it...

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On a related note, my lovely Grandmother fell down the stairs a few months ago and has been rehabing since.  She must wear a neck-brace indefinitely.  She went all the way to the hospital in her condition the week before Christmas for an appointment with her doctor, who didn't show up.  They had no time to fit her in that day, since there is a primary care shortage in the U.S. because telling someone they have a cold requires eight years of formal education. 

My grandmother was quite upset about it on Christmas, and my blood boiled (as it does) when I heard her story.  Don't they do house calls for outpatients? I asked my Grandmother.  She laughed.  House calls!  In fact, everyone in the room laughed.  What?  I asked. Why is everyone laughing?  In most other countries this would be seen as an entrepreneurial opportunity.  In America, it is probably a crime.  (Malpractice lawyers might see it as an entrepreneurial opportunity.)  

I realize that my medical situation is not exactly dire - which is why I am so morally opposed to going to the emergency room to get a two-dollar inhaler - I know my Grandmother is on the road to recovery at this point, I realize these stories are both personal and anecdotal, but I'm also quite confident that everyone with any kind of medical condition whatsoever experiences problems like these in our broken system.

I don't know how to fix it (I can imagine that pretty much everything else we've recommended at the Inductive would have positive externalities for Americans's health.), but nor do I want to spend my career in medicine filling out forms, avoiding lawsuits, conducting full physicals for procedural reasons, or treating non-emergency patients in the emergency room.  I'm not at all interested in healthcare.  I am interested in medicine.  So I'm seriously contemplating practicing medicine somewhere like South Africa (Are South Africans less deserving of medical care?) or New Zealand or Argentina - even Cuba or France. 

And there's always finance.

Comments

[Christopher Carr]

Let me add on an unrelated note that Americans are as unhealthy as we are despite scientific advances. In terms of sheer lifestyle comparison with our peer nations, if it were possible to quantify such a thing, I imagine we'd finish dead last.