A Broken Care System
08/10/25 02:25
Citizens of the United States have been aware for decades that our healthcare system is flawed. We pay the highest prices in the world for health care and have much worse health outcomes than other industrialized countries. Rates of infant and childhood mortality are higher than in other high-income countries. Mothers die in childbirth at a rate over three times the rate in other comparable countries. The United States is the only member of the Organization for Economic Cooperation and Development (OECD) that does not provide public health coverage to all residents. It has the highest rate of avoidable deaths of any OECD country. Our country has the highest rate of chronic conditions such as asthma, diabetes, depression, heart disease, and others.
Statistics, however, don’t really tell the stories of citizens who don’t have access to primary care because of a lack of financial resources. Those who lack insurance may also face food insufficiency. Hungry, sick, and no access to care is a terrible combination. Having your children hungry, ill, and without care is much worse.
While there are healthcare losers, our country also has winners when it comes to healthcare. I did not work in a high-paying profession, but my family had our health insurance premiums fully covered by my employer throughout my career. I didn’t encounter the expense of health care until I retired. Like many others, retirement coincided with an increase in illness and healthcare concerns. Unlike others, I continue to have options when it comes to health insurance. However, the last couple of years have produced a shrinking of possibilities due to federal policy decisions.
Our health insurance is currently purchased through our church, as it was during our working years. Since becoming eligible for Medicare, the insurance provided through our church is a Medicare Advantage plan. Like about 33 million other US citizens, our Medicare benefits are offered through a private insurance company that contracts with the Centers for Medicare and Medicaid Services. Medicare Advantage gives services typically provided by the government, along with additional benefits. Those services are covered by Medicare premiums deducted from our Social Security and an extra insurance premium deducted from our pension. The combination enables the private insurance company to generate a profit.
Profit in healthcare is one of the reasons we pay more for worse results than the rest of the world, where healthcare is often provided on a non-profit basis.
Changes in federal policies have left Medicare Advantage plans in a shaky financial position. Despite reaping profits for decades from the program, insurance companies are now reducing benefits and withdrawing from specific markets. Shareholders pay attention to profits, and the companies that provide Medicare Advantage plans answer, first and foremost, to their shareholders. Last year, about 1.8 million people lost their Medicare Advantage coverage, and cuts threaten many more as the open enrollment period opens this month.
Insurance companies explain these cuts as simple business decisions. The combination of funding cuts in the Centers for Medicare and Medicaid Services, rising healthcare costs, and increased utilization of services results in decreased profitability. On paper, the solution is to cut benefits, thus reducing both utilization and costs. It is easy to explain to shareholders.
For consumers, it feels a lot more personal.
We have noticed the cuts in several areas. Our insurance company will still cover the cost of medicines provided by our local pharmacy. However, for regularly prescribed medications used for ongoing care, our co-pay is reduced if we purchase them from an online pharmacy owned by the insurance company. This year, we were able to have our annual wellness check with a local physician. However, the insurance company is urging us to use their telemedicine and paraprofessional services in place of a local provider. Routine health screenings through telemedicine and paraprofessionals often lack continuity. Were we to use the services provided by the insurance company, we would meet with a different provider for each visit.
This fall, we received notice that our local family medicine clinic will no longer be eligible for payment by our insurance provider. We will have to choose between leaving our Advantage Plan and staying with our local providers or changing doctors to those farther away who are still able to contract with our insurance company. Changing doctors is no guarantee that the new providers will be covered in years to come.
The problems we face are minor when compared to those faced by millions of others who cannot afford health care premiums. One provider of Medicare Advantage Plans, not our company, is withdrawing from 109 counties across 16 states in 2026, disrupting coverage for approximately 180,000 people. We are conducting a thorough review of our options. In 2026, we will still be able to obtain coverage in our county, although with a much smaller pool of providers, which means more travel and longer waits to see doctors. It also means establishing care with new providers, a daunting challenge we faced when we moved in 2020. One example is that the wait to be seen by a dermatologist is longer than the recommended interval between checkups for the skin cancer treatment I have been receiving.
The challenges we share with millions of our fellow citizens make us aware of how high the stakes are in the congressional debates over the current government shutdown. It is difficult to obtain exact numbers regarding the impact of the proposed cuts to healthcare. Still, the proposed budget cuts will leave at least five million people without care in the short term, with the number of additional people left without health insurance potentially reaching as high as 17 million over the next several years. Despite the rhetoric from some lawmakers, these people are citizens. Undocumented immigrants are not eligible for Medicare or Medicaid.
Uninsured individuals raise the costs for everyone. Because hospital emergency rooms treat all who present themselves, they become the only accessible healthcare for millions of people. Those expenses must be covered by increasing costs even more.
The system is broken. Writing an essay won’t fix it. Opposing the Affordable Care Act is not a plan to fix the system. And health care is personal. We all have a stake in seeking alternatives, and we don’t have to look far to find countries with systems that work much better.
Statistics, however, don’t really tell the stories of citizens who don’t have access to primary care because of a lack of financial resources. Those who lack insurance may also face food insufficiency. Hungry, sick, and no access to care is a terrible combination. Having your children hungry, ill, and without care is much worse.
While there are healthcare losers, our country also has winners when it comes to healthcare. I did not work in a high-paying profession, but my family had our health insurance premiums fully covered by my employer throughout my career. I didn’t encounter the expense of health care until I retired. Like many others, retirement coincided with an increase in illness and healthcare concerns. Unlike others, I continue to have options when it comes to health insurance. However, the last couple of years have produced a shrinking of possibilities due to federal policy decisions.
Our health insurance is currently purchased through our church, as it was during our working years. Since becoming eligible for Medicare, the insurance provided through our church is a Medicare Advantage plan. Like about 33 million other US citizens, our Medicare benefits are offered through a private insurance company that contracts with the Centers for Medicare and Medicaid Services. Medicare Advantage gives services typically provided by the government, along with additional benefits. Those services are covered by Medicare premiums deducted from our Social Security and an extra insurance premium deducted from our pension. The combination enables the private insurance company to generate a profit.
Profit in healthcare is one of the reasons we pay more for worse results than the rest of the world, where healthcare is often provided on a non-profit basis.
Changes in federal policies have left Medicare Advantage plans in a shaky financial position. Despite reaping profits for decades from the program, insurance companies are now reducing benefits and withdrawing from specific markets. Shareholders pay attention to profits, and the companies that provide Medicare Advantage plans answer, first and foremost, to their shareholders. Last year, about 1.8 million people lost their Medicare Advantage coverage, and cuts threaten many more as the open enrollment period opens this month.
Insurance companies explain these cuts as simple business decisions. The combination of funding cuts in the Centers for Medicare and Medicaid Services, rising healthcare costs, and increased utilization of services results in decreased profitability. On paper, the solution is to cut benefits, thus reducing both utilization and costs. It is easy to explain to shareholders.
For consumers, it feels a lot more personal.
We have noticed the cuts in several areas. Our insurance company will still cover the cost of medicines provided by our local pharmacy. However, for regularly prescribed medications used for ongoing care, our co-pay is reduced if we purchase them from an online pharmacy owned by the insurance company. This year, we were able to have our annual wellness check with a local physician. However, the insurance company is urging us to use their telemedicine and paraprofessional services in place of a local provider. Routine health screenings through telemedicine and paraprofessionals often lack continuity. Were we to use the services provided by the insurance company, we would meet with a different provider for each visit.
This fall, we received notice that our local family medicine clinic will no longer be eligible for payment by our insurance provider. We will have to choose between leaving our Advantage Plan and staying with our local providers or changing doctors to those farther away who are still able to contract with our insurance company. Changing doctors is no guarantee that the new providers will be covered in years to come.
The problems we face are minor when compared to those faced by millions of others who cannot afford health care premiums. One provider of Medicare Advantage Plans, not our company, is withdrawing from 109 counties across 16 states in 2026, disrupting coverage for approximately 180,000 people. We are conducting a thorough review of our options. In 2026, we will still be able to obtain coverage in our county, although with a much smaller pool of providers, which means more travel and longer waits to see doctors. It also means establishing care with new providers, a daunting challenge we faced when we moved in 2020. One example is that the wait to be seen by a dermatologist is longer than the recommended interval between checkups for the skin cancer treatment I have been receiving.
The challenges we share with millions of our fellow citizens make us aware of how high the stakes are in the congressional debates over the current government shutdown. It is difficult to obtain exact numbers regarding the impact of the proposed cuts to healthcare. Still, the proposed budget cuts will leave at least five million people without care in the short term, with the number of additional people left without health insurance potentially reaching as high as 17 million over the next several years. Despite the rhetoric from some lawmakers, these people are citizens. Undocumented immigrants are not eligible for Medicare or Medicaid.
Uninsured individuals raise the costs for everyone. Because hospital emergency rooms treat all who present themselves, they become the only accessible healthcare for millions of people. Those expenses must be covered by increasing costs even more.
The system is broken. Writing an essay won’t fix it. Opposing the Affordable Care Act is not a plan to fix the system. And health care is personal. We all have a stake in seeking alternatives, and we don’t have to look far to find countries with systems that work much better.
