Requiem for a health care non-system

Two recent news stories got my attention. The first was about the creation of “Maternity Deserts.” These large areas in America totally lack maternity care and they have become more common because financial entities are closing maternity services in rural hospitals when they don’t make enough profit. The second one described for-profit companies such as CVS and Amazon “buying up” large numbers of primary care practices across the country. If you add to this the growing privatization of Medicare through Medicare Advantage plans and, even worse, ACO-REACH plans (which allow non-medical companies to function as health insurance companies) you can clearly see where our health care “non-system ” is headed.

Our lack of investment in public health made us dramatically unprepared for the Covid-19 pandemic and cost hundreds of thousands of Americans their lives. We will be almost equally unprepared for the next pandemic, which will occur. If these topics seem unrelated, they are not. They all show a total lack of planning except to increase profits. No one planned our health care system. Like a New England farmhouse, it merely added new rooms when there was a need.

Our health care non-system has just evolved over time with the goal of increasing profits for the companies. Health care now costs us all an estimated $4.3 trillion per year and, with no overall plan, private companies including insurance and pharmaceutical companies and large hospital chains are creative in maximizing their share. We have also seen the more insidious effects of the business transformation of medicine in the more impersonal and brief visits we have with our own health care providers. T

The nationwide primary care physician (PCP) shortage is partly responsible and physician assistants and nurse practitioners could fill much of the gap but they are also in short supply. These trends will surely continue and increasingly make us patients into pawns with our health care becoming only a secondary goal. If this is the future we desire, all we need do is remain silent. Changing this will be difficult especially with our political stagnation but every year which passes sees larger profits and further emboldens the moneyed interests. A single-payer system such as is now called “Improved Medicare For All” is the only solution I can see, but my optimism that our legislatures will act is waning. The cost of our collective inaction, however, is clear.

Christopher Flory, M.D.

Williamsburg