The Swamp Exists: It is Just Not What You Think!
Pervasive Medical Debt and Predatory Capitalism
Wendell Potter is another Substack writer who published a guest post October 20, 2023 on the pervasive medical debt so many Americans are facing. That post is worth your time. Here is a quote: “Last year KFF Health News published a stunning multi-part investigation called “Diagnosis: Debt,” which exposed the financial plight of America’s debt-ridden families, revealing that 100 million people, including 41% of adults in the United States, are “beset by a health system that is systematically pushing people into debt on a mass scale.” Much of that debt, KFF reported, is hidden in credit-card balances, loans from family, or payment plans to hospitals and doctors.
That bleak assessment is not likely to get brighter. In the last five years, more than half of U.S. adults said they slid into debt because of medical or dental bills. Even grimmer is the news that 20% of people with any amount of debt expect to be in hock to the medical industry for the rest of their lives. “We have a health care system almost perfectly designed to create debt,” one California doctor told KFF reporters.”
These appalling debt statistics are driven by the fact that our care costs twice as much per person as the average cost of care in other developed countries. Our health care system design is determined by wealthy healthcare executives who primarily answer to stockholders. They do not answer to patients or communities. It is a perfect example of the swamp. The system is rigged to make wealthy and powerful people even more wealthy and powerful.
Americans sense that our institutions are rigged. They are not part of the medical system and so it is very difficult to understand how the system works against them. Fixing a system that does not work and creates lifelong debt for the people it serves should be a national priority. The businessmen running the current system will never fix the American healthcare crisis. They don’t understand it and it is against their interest for them to understand it. They make more when healthcare costs more.
The most vulnerable Americans for huge medical debt are those with multiple chronic diseases. A 55-year-old with type 2 diabetes, high blood pressure, a prior heart attack, and chronic kidney disease is a perfect example. Eighty-six percent of American medical costs come from people with multiple chronic conditions. Our population is getting older and sicker. If we don’t change our system, medical debt can only increase and its wrecks the lives of the most vulnerable. We are in an unsustainable position.
The best medical people in the country make policy recommendations at the National Academy of Medicine. This is the medical arm of the National Academy of Sciences. Twenty-two years ago they wrote a blistering indictment of our healthcare system that pointed to a failure to design systems to address chronic diseases more effectively. The entire book provides a roadmap to better health at lower cost. Nothing has changed!
In fact, if you look at our current system, it is not designed to solve your health problems and keep you whole and healthy. It is designed to extract as much money from you and those who pay your medical bills as possible. Heart disease and related diseases like high blood pressure and diabetes generate roughly one-third of the healthcare costs for employers who pay for the healthcare of employees. As our system becomes more and more intolerably expensive, these costs are harder for the employer to bear, and more costs have been shifted to employees. Deductibles of $5,000 to 10,000 are common.
The lower cost health plans are the ones with higher deductibles. Those are the plans poor people can afford. Treating high blood pressure, high cholesterol, and type 2 diabetes effectively requires frequent but inexpensive visits to primary care to treat nerve damage, eye damage, and kidney damage more effectively. This care prevents expensive specialty visits, ER visits, hospitalizations, and dialysis. But huge deductibles are an immovable barrier to that care. They mean that many Americans cannot afford to see the doctor or take their medicine. No deductibles for primary care visits to manage chronic disease would save self-insured employers money all day long.
We spend nearly 20% of gross domestic product on healthcare. Europe spends 10% and Singapore spends 5% of gross domestic product on healthcare. They live longer. By covering everyone for primary care visits they save 15% of gross domestic product and medical debt is much less common. Doing the same thing and expecting a different result is crazy. We don’t provide basic inexpensive care to blunt the effect of chronic disease but then we provide very expensive dialysis to people who did not get treatment for high blood pressure and diabetes.
Capitalism is a great system to produce consumer goods like more and better phones, televisions, and other devices that we can all understand. I am in favor of it in those settings. Capitalism is an extremely poor system for providing water, sewer, firemen, police, and electricity services. Our communities own these vital services or we regulate them heavily. We all understand if a businessman owned these vital services, they would not provide them at affordable prices and there are few other options. Health care is a vital service like water and electricity. Health care is too complex for most people to understand and the people in charge keep the good old boy arrangements and finances secret. Even your employer who sponsors your health plan can’t see where the money goes. We can no longer afford a system that benefits the middlemen and businessmen at the expense of everyone else.
If this piece sounds personal and intense, that’s because it is personal and intense. I have always been an outdoorsman. There are swamps in coastal South Carolina that I know like the back of my hand. I have been in internal medicine for 50 years. I know the predatory capitalism medical swamp like the back of my hand too. I practiced in a small town. I was on call every other night and every other weekend for 25 years. There were several times that I worked 36 hours in a row. I worked hard, but if it were not for the Affordable Care Act, Medicare, and my wife being on Medicare because of disability, we would be bankrupt, stuck in East Tennessee, or she would be dead. She has a rare autoimmune disease called relapsing polychondritis that had an average survival of 5 years a couple of decades ago. She has antibodies against her own cartilage and that is very painful. Without new treatments, she would be very disfigured. I have had an aggressive cancer and have been hospitalized once or twice a year related to side effects of treatment that saved my life. I have high blood pressure, obesity, prediabetes, gout, asthma, severe nerve damage from chemotherapy, and related problems with my balance. I understand being afraid of being ruined by medical costs. There have been times when we wondered if we would be financially ruined.
A serious discussion of this topic must involve policy and politics. We are not mired in the swamp because of the deep state, mainstream media, Antifa, abortion, an attack on Christianity, liberal leftists, or the crisis at the border. We are bogged down in the swamp by the wealthiest and most influential Americans. Medical businessmen rig the medical system by making large political contributions to our elected officials and demanding that they pass laws and regulations that make the very wealthy even more powerful and wealthier. Check out the political contributions to your congressmen and senators. Some of them are raking in six figures from medical organizations. That means they serve their contributors, not the people. At its core, politics is and always has been about power and money. You have been distracted and losing the fight for forty years. Many of our institutions are not serving you and you are right not to trust them. Direct your anger and effort at the right target. Find out how much money your elected officials are getting from predatory healthcare capitalism, and then demand they vote for a system that serves you better. It they don’t provide healthcare reform that protects you. Vote them out. Send them home. That is the way to drain the swamp.
Very wealthy businessmen and their political allies are at the core of this rigged system. They made the quicksand in the swamp that is crippling Americans with medical debt. It is past time to demand change and a medical system that works to serve everyone. I can tell you there are people within the system who are eager to help. If your community wants to make healthcare more like a utility that serves you, get in touch.
The other diagnosis is a monopoly created by the swamp that’s deprived of safe and effective innovation, especially in early detection of the root causes of chronic diseases and applying primary lifestyle optimization techniques to prevent, deter, and reverse early signs of disease.
A multiple boosted friend in perfect health who rode his bike 50 miles a day suddenly developed a cardiac problem. He went in to the hospital thinking he would be home in about 4 days. That was 8 weeks ago. The initial surgery went well but then everything fell apart as he picked up hospital germ after hospital germ and different things began to go wrong. He's ended up on dialysis and a huge fistula. He is still in the hospital after 8 weeks. I cannot even begin to imagine their bill. When he went in they were living modestly but comfortably in early retirement And both in good health except for vaccine injuries. Now I'm not sure what they face. But the bill will be horrendous and his health is no longer 100%.