These are the first three installments of a planned year-long series on America’s dysfunctional health-care system. They were planned to educate consumers on the problems and gaps in our present system of coverage, and the reasons behind its high cost. Future installments will explore various strategies for fixing it.
Part 1 focused on people with health coverage, based in large part on a nationally representative survey of about 3,000 working-age adults. The survey found that about 40 percent of working-age Americans lack reliable health coverage. Either they are entirely uninsured, or their insurance is so meager that they can’t afford to access care they need. Exploring the reasons for this, the article concluded that the underlying cause was a coverage system so incoherent and fragmented that it lacks meaningful abilities to control what providers charge.
Part 2 went more deeply into the perverse financial incentives built into our present system. These include care driven more by the supply of doctors and hospitals rather than patients’ needs; overprovision of highly profitable interventions and tests; drug companies’ unchecked aggressive promotion of products to doctors and consumers; and a systematic shortchanging of basic preventive and chronic care.
Part 3 focused on the individual insurance market. Based on the same survey used in Part 1, it showed how this market is a nightmare for anyone stuck in it who has actual medical needs. These problems include unchecked medical underwriting that excludes the very people who need insurance the most; a frayed, and in some states completely absent, safety net for people with modest incomes and serious medical conditions; unaffordable prices; and near-total consumer ignorance and confusion.