The U.S. Healthcare System's Inability to Serve Its Population Effectively
The U.S. Healthcare System's Inability to Serve Its Population Effectively
The New York City Police Department is trying to gather evidence that could help identify the suspect responsible for fatally shooting UnitedHealthcare CEO Brian Thompson in Manhattan on Wednesday. This was described as a bold, deliberate attack, prompting several major health insurance companies to remove pictures of their executives from their official websites. Thompson's tragic death sparked renewed discussions about the healthcare situation in the U.S., particularly the issue of limited accessibility, with many social media users sharing distressing personal experiences of navigating the country's healthcare system. This article delves into some of the underlying systemic concerns within U.S. healthcare and suggests ways to improve and revamp the flawed system.
There are numerous factors contributing to the systemic inequalities within the American healthcare system. First, the expensiveness of healthcare is a primary concern. According to KFF, the U.S. was projected to spend a staggering $4.9 trillion on healthcare by 2024. KFF's survey from 2024 shows that nearly half of U.S. adults struggled to afford healthcare costs, with medical bills remaining a significant financial worry for many families. One in four adults reported postponing necessary healthcare due to costs, while one in five admitted not filling a prescription because of the financial burden. KFF's data also indicates that Black and Hispanic adults, women, parents, lower-income, and uninsured individuals disproportionately carry healthcare debt.
Prejudices within society play a significant role in health outcomes. Research suggests that racial discrimination (redlining, environmental injustice, biased medical care, food insecurity, maternal health rates, and so on) plays a substantial part in health disparities. For years, numerous warnings have been issued about healthcare deserts—the lack of proper medical care in rural areas. A 2021 study published in the Journal of the American Medical Association revealed racial and ethnic disparities in measures of health status, access, and affordability, with poor, Black individuals reporting worse health than their counterparts.
Since former president Barack Obama signed the Affordable Care Act (ACA) into law in 2010, the number of uninsured people drastically decreased. Research shows that individuals with health insurance are more likely to use preventive services leading to better health outcomes. Data from the U.S. Department of Health and Human Services showed significant reductions in the uninsured rate for non-white populations between 2010 and 2022, signaling that the ACA brought significant advancements in healthcare coverage. However, the U.S. does not offer universal healthcare coverage to its citizens like other developed countries such as Canada, Denmark, France, Germany, Norway, and the United Kingdom. Employer-sponsored health insurance remains a hurdle for many, with 78% of the U.S. population eligible for health insurance through their job, according to eHealthInsurance.
The United States' healthcare system is clearly dysfunctional. To rethink and revamp the system for more accessibility and fairness, the first step is to prevent the repealing of the ACA. Although Trump's stance on the ACA has been inconsistent, under a second Trump presidency, the subsidies introduced under the Biden administration could be eliminated, leading to higher premium payments. Extending healthcare access through insurance is linked to better health outcomes, so it's crucial to take measures to ensure Americans are insured and their premiums remain affordable.
Extending Medicaid coverage can also enhance healthcare outcomes for Americans. Cost remains a major barrier to healthcare coverage in the U.S. The American Medical Association reported that gains in health insurance coverage were largely due to enhanced subsidies for ACA exchange marketplace plans, the Medicaid continuous enrollment provision, several state Medicaid expansions, and improved enrollment outreach.
Another way to transform the faltering U.S. healthcare system is to address the high rate of insurance claim denials. Numerous individuals have shared their experiences on social media about how an insurance claim denial impacted them or their family member. Major health insurance companies, including UnitedHealth, Cigna, and Humana, have been sued for using faulty AI models to wrongfully deny health insurance claims, defying a physician's review or their medical judgement. According to a ProPublica report, insurance denial rates are shrouded in secrecy, and there's a lack of transparency regarding why an insurance company rejects recommended care. Transforming the broken system should include demanding regulators to compel insurers to disclose the frequency of claim denials and provide clearer reasons.
The renewed discussions on healthcare inequities in the U.S. can lead to significant improvements. Besides pushing back against the ACA repeal, expanding Medicaid coverage, addressing biased AI algorithms used for insurance claim reviews, and providing more transparency on claim denials, healthcare providers should also focus on offering equitable care education and support to address healthcare disparities. Increasing access to healthcare through initiatives like mobile clinics can help underserved groups, including minoritized and vulnerable populations. Telehealth services can also overcome geographic barriers and offer comparable medical care, providing a solution for those in remote areas.
Brian Thompson's untimely death as the CEO of UnitedHealthcare has brought the affordability and accessibility of healthcare in the U.S. into the spotlight. Critics point to the high insurance premiums and limited coverage, exacerbated by disparities in healthcare deserts and racial discrimination. Donald Trump's inconsistent stance on the Affordable Care Act (ACA) and the potential elimination of subsidies under a second presidency pose a threat to coverage expansion. The AMA reports that enhancements in Medicaid coverage, subsidies for ACA exchange marketplace plans, and state Medicaid expansions have significantly reduced the uninsured rate, especially for non-white populations. However, addressing the high rate of insurance claim denials is also crucial. Major health insurance companies, like UnitedHealth, have been sued for using AI models to wrongfully deny claims, leading to hardships for many. Transparency in claim denials and advocating for regulators to compel insurers to disclose frequency and reasons for denials could play a role in transforming the broken U.S. healthcare system.