The three major problems the U.S. healthcare system confronts are concerning cost, care, and access. However, to understand how and why these problems evolved, one needs to know the concept of health first. To be healthy is to be able to live a physically healthy and emotionally happy life. However, the indicators of what constitutes healthy living make one happy change over time (Cutler, 2004, p.1). If an expansion of one’s lifespan is an indicator of good health, then the U.S. healthcare system has improved tremendously (Cutler, 2004, pp.2-4). However, this has happened through a high degree of the medicalization of health that has increased the per capita medical cost from US$500 (at contemporary rates) to US$5,000 by 2004 (Cutler, 2004, p.4). Further, it reached US$9,403 by 2018 (Blumberg, 2018).
Several factors have contributed to the rise in healthcare costs, one of which is the increasing elderly population. This is a paradox as the increase in average life expectancy is an indicator of good health at one level. However, some believe that it has also significantly increased the overall public health spending in the U.S. However, the elderly population constitutes only one reason behind the rising costs of healthcare. Increased healthcare-seeking behavior, combined with cost-intensive treatment regimens, is also a major cause of increased healthcare costs. There are serious academic publications that explore modern medicine’s real contribution to increased life expectancy, questioning the entire paradigm of growing, expensive, and specialized secondary and tertiary care (McKinlay & McKinlay, 1977).
Recent reports have also thrown light on two significant factors of high healthcare costs that have little to do with healthcare outcomes. Drugs and diagnostic tests cost more in the U.S. than in many other countries. The payment of doctors is also significantly higher in the U. S. compared to several other industrialized nations. The administrative costs involved in planning, managing, and rolling out healthcare programs are also considerably high (Blumberg, 2018).
Quoting the Harvard Global Health Institute director, this report says that the U.S. does not spend more than other developed countries on managed healthcare. A significant share of the costs goes to exceptionally high payments for specialist doctors, pharmaceutical products, and the increased use of specialized tests (Blumberg, 2018). This makes it clear that factors like the increase in average life expectancy, a consequent rise in the elderly population, and the federal programs for the poor hardly contribute to the high healthcare costs in the U.S. The real problems lie somewhere else.
The lack of easy access to healthcare services is another serious problem that adversely affects the health outcomes of many public health initiatives. The comparatively poor outcomes of the Medicaid program present an illustrative case. Women registered under Medicaid could not access prenatal services because of the rigidities of the medical system. Poor women mostly were unable to access the services when they could afford the time, for example. Arranging babysitters was not an option for them because of the costs involved. Still, the services were available only within rigidly fixed timings (Cutler, 2004, p.29). Other deeply entrenched racial/ethnic and other biases also contribute to making access to healthcare services a problem for specific populations. For example, one report points out that despite the inclusive policy of San Francisco towards extending healthcare services to illegal immigrants, barriers continue to exist (Marrow, 2011).
On the one hand, San Francisco’s inclusive policy is in sync with most healthcare providers in the city’s public health system. They believe that everyone’s rights to healthcare services irrespective of their legal status as immigrants. However, the fear generated by other negative experiences is so severe that few illegal immigrants dare approach the city’s open healthcare services (Marrow, 2011). Therefore, inclusive approaches are not enough since other rigid systems continue to limit one’s access to public healthcare systems.
A third factor that significantly undermines public health initiatives in the U.S. relates to the quality of healthcare service delivery. The state has initiated several strategies to improve the quality aspect. A 2017 study by the Commonwealth Fund reflects that the U.S. spends almost twice as much as other OECD countries. However, concerning healh outcomes, the country performs poorly. It has a lower life expectancy than the other OECD countries, the highest suicide rate, and the highest number of chronic diseases (Tikannen & Abrams, 2020). This report consistently exposes that poor health literacy, combined with less attention to prevention and more to specialized treatment, are the factors that compromise the quality of care in the U.S. This lopsided approach plays behind the poor health outcomes.