John R. Fischer

Hey everyone, Happy Easter and Ramadan!

Been a while? A month, actually.

Apologies for being gone so long. I was dealing with some medical issues. Don’t worry, nothing too serious, but I had to take some time off to focus on my recovery. Now that I have, let’s pick up where we left off.

Speaking of health problems, earlier this month former U.S. Surgeon General Dr. Jerome Adams tweeted about a recent trip he had to ER that cost him almost $5,000…AFTER Insurance.

Yes, you heard me right. Adams, who is also an anesthesiologist, was on a business trip in Arizona when he became light-headed and was taken to Mayo Clinic Arizona hospital where he was treated for dehydration. Here is the bill to prove it:

His treatment included three IV bags, a chest X-ray to rule out a heart attack, a blood test, an EKG, and overnight observation before being released the next day. “No wonder medical debt is the top cause of bankruptcy in the U.S,” he said in his tweet.

He followed this up in an interview with USA Today, saying, “If I had known how much it would cost, I would’ve said, ‘No thanks. I’ll just go home and drink some Gatorade.’”

For Adams, who has a high deductible, the bill was way higher than expected because the hospital treated his dehydration as a level 5 event, which is more serious and costs more, despite the American College of Physicians classifying such events as a level 4 service. Additionally, it charged him 11 times the growing rate in the region for his blood test, three times more for the EKG, and twice the rate of a standard X-ray. He may have been out-of-network, but this is just plain robbery. The cost was so hefty that he opted for a financial plan to pay off the debt over time.

Sadly, his experience echoes that of the majority of Americans, including my own. Back in January, I went to the ER for a bad pinched nerve. I was there for five hours, during which time I received an X-ray, some Tylenol, morphine, and a steroid. Two doctors oversaw my care. The bill cost me over $2,100, and that’s in-network and after a discount in my plan. Like Adam, I also have a high deductible, that I have not yet met this year (or ever before with my current plan). Without adequate reimbursement from my company, it would have taken months to pay off this debt…and that’s if I did not have other health issues, which have in fact occurred (no surprise there).

But you know when the former leader of the U.S. Public Health Service Commissioned Corps, a team of 6,000 frontline doctors whose job is to respond to public health emergencies and support public health initiatives, can’t pay his medical debt off all at once, it’s bad. And his acknowledgment that medical bills are the number one cause of bankruptcy further highlights the exorbitant financial toll that the U.S. healthcare system levies on its citizens and anyone else who dare falls ill within its borders.

In the most recent study on this issue, Medical Bankruptcy: Still Common Despite the Affordable Care Act, published in 2019 in the American Journal of Public Health, 66.5% of all bankruptcies were due to debt from medical bills. This is only made worse by the bankruptcy process, which also comes with its own set of hefty attorney and filing fees.

In 2022, the Centers for Medicare and Medicaid Services estimated that healthcare expenditures would rise to approximately $6.2 trillion in 2028, a 50% increase from 2020, which will drive people already struggling with current pricing into a deeper hole. Additionally, more people will avoid care, with one in four adults already choosing to because of cost, according to a March 2024 Kaiser Family Foundation poll. In a separate report from the month before, the independent health policy research organization found that Americans collectively have amassed at least $220 billion in medical debt they cannot pay.

But despite the massive amount of evidence in front of them, both Democrats and Republicans continue to spout the same old tactics for lowering peoples’ overhead when it comes to medical debt, from stimulus bills to more funding for the HHS and financial aid programs. What good are these when they do not address the main problem, the rising cost of care. While I am not saying these strategies don’t have their place, they do not bring prices down or address the cause of these hikes, which are primarily driven by increased costs for new technologies and pharmaceuticals that hospitals and other healthcare entities cannot afford due to many of them already being so deep in the red. This inevitably leads them to jack up the price of their services, which in turn leads insurers to cut back on coverage or raise premiums to compensate for the additional cost.

The whole thing is ultimately a deadly domino effect, and I say deadly because it’s the reason why we have higher mortality rates compared to other countries. In 2022, the U.S. had the lowest life expectancy among large wealthy countries at 77.5 compared to an average of 82.2…and all while spending the most on healthcare at $12,555 per capita, which was nearly double the comparable average of $6,651, reported the Peterson-KFF Health System Tracker.

Yet, the country continues with the same old tactics and will not consider any other options, including the one that every other large, wealthy Western civilization has: UNIVERSAL HEALTHCARE. Why? Because the government feels that it is not responsible for managing the healthcare of its citizens, even though a 2023 Gallup poll showed that the majority (57%) of U.S. adults said it should ensure healthcare coverage for all citizens. This is slightly less but still in line with a Pew Research study in 2020 that found 63% of adults agreed.

Additionally, a 2022 study by the Yale School of Public Health said that a universal health system would have saved nearly 212,000 Americans during the pandemic in 2020, along with $105 billion in COVID-19 hospitalization expenses alone. During a non-pandemic year, it would have saved $438 billion. The researchers compared people with and without health insurance, examining death rates from COVID-19 and overall, finding that 211,897 COVID and non-COVID patients would have been saved in 2020. From that time to March 2022, that figure rises to 338,594.

Interestingly, when asked how the government should provide universal healthcare coverage, 36% of respondents in the Pew Research study said it should do it through a single national government program, versus 26% who say it should be done through a mix of private insurance companies and government programs. In the Gallup study, 53% said they would prefer a universal healthcare system based on private insurance, compared to 43% who were for a government-run system.

For those who don’t realize, there are many different types of universal healthcare systems, and not all of them are publicly run by a country’s government. For example, in Switzerland, the government requires all people to be covered by a private health insurance company. The system is funded through enrollee premiums, cantonal taxes (taxes levied by small territorial divisions), social insurance contributions, and out-of-pocket payments. Residents purchase insurance from private nonprofit insurers, and pay yearly deductibles and coinsurance (with an annual cap) for all services. They can also buy supplemental private insurance for services that are not mandatorily covered or for better hospital accommodations, according to the Commonwealth Fund.

The same is true in The Netherlands, where people are required to purchase statutory health insurance from private companies, which are required to accept all applicants. Premiums, tax revenues, and government grants are the primary funding sources, with the government setting health care priorities and monitoring access, quality, and costs. The only people the government covers under this system are children up to the age of 18.

As Americans, when we think about universal healthcare, our minds automatically go to the U.K. or Canada, where healthcare is government-run, due to our historical roots, cultural similarities, and our native language being English. Another that comes to mind is Russia, which I feel is ultimately what turns people (mostly boomers and Gen Xers) off to the idea of a universal healthcare system because they equate it to Russia’s historical communist background as well as to socialism.

In doing so, we unknowingly are embarrassing ourselves by showing just how ignorant and unintelligent we are about the world. For one, most countries today are capitalist and STILL implement universal healthcare systems, including Germany, the U.K., Italy, Spain, Austria, and France. According to the Centers for Medicare and Medicaid Services’ annual report, published in December 2023, American taxpayers spent at least $1.8 trillion in federal and state healthcare expenditures in 2022, about 41% of the nearly $4.5 trillion that year in both public and private healthcare spending. We also spent another $600 billion on third-party and public health programs. This was more than what these other governments spent COMBINED for their whole populations, which together are equitable to the size of the entire U.S. population.

Many will argue that these countries actually have mixed capitalist-socialist economic systems, which is true, but the U.S. is no different if you think about it. While we tout ourselves as a completely capitalist, free-market society where businesses and individuals control the means of production, we also have adopted socialist policies as well, including social security, minimum wages, and energy subsidies. We also finance our public school systems primarily with our taxpayer dollars as well as our firefighter crews, police forces, libraries, and certain museums.

Part of the problem is that many refuse to acknowledge our financing of these services as socialist because we erroneously equate socialism and communism as one and the same. While both emphasize the transfer of economic power over the means of production to the working class, communism aims to do so through revolutionary means whereas socialism seeks this out through gradual, peaceful means. Socialism today is also constructed to include the continued existence of capitalism in various parts of the economy, as seen in many of Europe’s mixed societies and our own. So, in essence, acknowledging the existence of socialism in our economy does not erase capitalism but helps us understand the benefits that each brings to our society and others.

I am not saying that we have to adopt identical systems like Switzerland and the Netherlands, or that we should just completely ignore programs like the U.K.’s or Canada’s. But the U.S. government should at least conduct a study on different universal healthcare systems and explore what the U.S. would look like under each one to determine which would be the best fit. Unless we do that, then we will never fully know if the U.S. will benefit or be worse off under any such system compared to its current one.

Getting to this point, and in turn, truly understanding and considering a universal healthcare system requires Americans to first remove themselves from the post-war/Cold War era that we have trapped ourselves in. We must acknowledge that the world then is not the world that we live in today, with socialist Europe no longer in shambles and primarily made up of countries that like the U.S. are primarily capitalist in nature with socialist elements. We also must stop equating socialism to communism, as the two, while similar, are not the same, and socialism, as I said, is part of the fabric of our country and how it operates domestically and internationally.

The United States has exhausted all options for revamping the current healthcare system. Even when faced with evidence that shows the current system does less for its people compared to other countries, it still refuses to budge on its position about universal health systems, putting out excuses that it’s not fair to ask people to pay for other’s healthcare even though studies show it would reduce the amount that everyone spends individually on their own care and save them more money substantially in the long-term. They also say that such a system could not be replicated here, despite evidence showing on the contrary that it could, and also because of narrow-minded views that focus only on government-run systems in predominantly English-speaking countries and ignore ones that are a mix of both private and public in non-English speaking ones.

Both the UN and the European Union in 2015 were noted to recognize healthcare as a basic human right, whereas the U.S. did and still does not, despite most countries agreeing with the former. South Africa started universal healthcare two years after Apartheid ended in the 1990s but the U.S. has yet to do so since the passage of the Civil Rights Act in 1964.

Should we not take a hint from the rest of the world and start looking at healthcare for all as a right that not only ensures that everyone has access to some form of care, which in turn would stimulate the economy by reducing labor shortages due to more people being able to work? Should we not look at the vast amount of evidence that shows such a system would astronomically curb the amount we spend on healthcare annually? And should we not look at all options of how a universal healthcare system can be established, and which one works for us best?

While policies such as the Affordable Care Act have helped steer us in the direction toward a universal healthcare system, the attitude of the government in treating healthcare as a privilege rather than a basic human right ultimately prevents us from being able to at the very least try out this system on a trial basis or assess it in a study to determine its potential value to the U.S. It is an excuse for the government’s many failures, including its poor performance in helping people, especially those in marginalized communities, gain employment that can provide them with not just the means to grow financially but access to quality healthcare, a task already difficult for many employers under the deeply flawed healthcare system currently at play.

Instead, it has left the fate of people’s healthcare in the hands of private medtech, pharmaceutical, and insurance companies, many of which are concerned completely or more so about making a profit over providing quality and affordable care to people, thus establishing the deadly domino effect. Greater regulations and monitoring by the government are necessary for curbing the abuses of power that these companies wield.

By choosing not to embrace new ideas, the U.S. government has damned the people to endure endless financial and medical duress and suffering. Its refusal to even consider a study on how a universal healthcare system in the U.S. would look like, even a privatized form of one, and how it may or may not potentially benefit us long-term only speaks to its ignorance and cowardice in admitting that it was wrong with the current system at play. It is because of its pride and closed-minded attitude that millions of Americans will continue to sink deeper into debt and experience medical hardships and potentially worse outcomes that could be avoided if the U.S. government would do the right thing and consider a universal healthcare system.