The Ongoing U.S. Health Care Crisis: A Data Update

Abstract

While efforts to repeal the Affordable Care Act were narrowly defeated, grave problems in health care persist. Twenty-eight million remain uninsured, a number that is likely to increase. Millions more who have coverage cannot afford care because of high cost-sharing requirements. Meanwhile, the corporate takeover of medical care in the United States is at a gallop. This article provides a brief précis of recent data on U.S. health policy.

Disconnections between medical education and medical practice: A neglected dilemma

“…Health insurance organisations, pharmaceutical companies and the medical devices industry, within a 'medical-industrial complex' (Relman, 1980), have increasingly pervaded and undermined socially oriented services by skewing the structure and functions of health care services and allowing considerations of profit, rather than of what is needed, to shape new medical facilities (Callahan & Wassuna, 2006;Himmelstein et al, 2018). The proponents of this approach believe that reducing government control and cutting taxes will divert control of more resources to the private sector, resulting in job creation, improved health and reduced debt.…”

“…The development of private hospitals and the pharmaceutical industry, primarily as profitable enterprises, has further entrenched the market model of health care through incremental emphasis on the quest for profitable drugs, scientific recognition of researchers and financial success for investors in healthcare, all with powerful effects on the practice of medicine (Angel, 2004;Himmelstein et al, 2018). The thrust towards the market model has also subtly shifted the role of medical research.…”

“…The thrust towards the market model has also subtly shifted the role of medical research. For example, consider that: (i) almost 90% of medical research focuses on diseases that account for 10% of the global burden of disease, (ii) up to 50% of medical research funding is from private or industrial sources (Viergever, 2013), and (iii) the drug industry garners the majority of health industry profits (Himmelstein et al, 2018). Big Pharma's innovations are protected legally through the use of patents and other monopolistic strategies that increase the prices of its proprietary drugs, favouring access (including for life-saving medicines) to those who are able to pay.…”

“…Of note in 2015, 449,864 U.S. physicians (50.8% of all male doctors and 42.6% of female doctors) received $2.4 billion in industry payments, most of that amount from drug and device makers. Surgeons received an average of $6,879 each vs $2,227 for primary care doctors (Himmelstein et al, 2018).…”