The U.S. Healthcare System from an Outsider

Bertila Bruka

The prospect of the American dream was the most exciting thing about moving to the U.S. The concept was very well echoed in broadcast media, which varied from well-established high school students on the Upper East Side to white-collar-facing Central Park law offices. Being exposed to a world of wealth, fast-paced, seemingly intelligent conversations, and the best views of New York City, I was wrapped in a bubble of misconceptions about what life in the U.S. really was. There is a common assumption, amongst Albanians especially, that once you’ve come to the States, the government provides you with a place to stay, medical resources, and a job. This truly couldn’t have been further from the truth. 2 months before moving to the States, my family and I realized that there were no services to facilitate apartment searches for foreigners unfamiliar with the housing market. It took two months after we had moved to find jobs. And then we understood how challenging it was to cover living expenses even with the four of us bringing in income. Then came the uncertainty of medical insurance. To enter high school, you need certain vaccines and doctor checkups. But to have these vaccines and checkups administered, you need health insurance. To get health insurance, you need a job. And the most unfortunate circumstance: not all jobs offer medical insurance. With no medical insurance, you are asked to cover fees out of pocket. But how can it be expected of recent immigrants to cover unreasonably priced fees in the land of dreams and opportunities? This chain of events made me realize that maybe, sometimes, the U.S. does not represent the perfect portrayal shown in media. While I recognized my privilege of living here, I felt that I was misled into believing in an unattainable dream and didn’t acknowledge the benefit of universal healthcare back in my homeland. This was until my grandmother fell ill. Three years ago, she suffered a brain hemorrhage. The brain bleed left her paralyzed, followed by a decline in her memory. Given the continental distance, we felt that the only way to contribute to her recovery was by finding a capable doctor. What we found instead was that it wasn’t a capable doctor my grandmother needed, it was the facilities - advanced facilities available in a free market economy, such as the U.S. In a competitive pursuit of better treatments and services, the U.S. has become a global leader in administering life-saving procedures. Unlikely of a small country in southeastern Europe. Yet despite all the innovation around me, this technology was not accessible to the patient who needed it. Then I wondered who this healthcare was accessible to. It turned out that “life-saving” medication and machinery were unavailable to the average-earner family. It turned out that one unfortunate accident or unlucky gene sequence could lead to your untimely financial collapse. The burden of medical care seemed to consistently fall on patients. The most recent example being patented anticancer drugs often priced at $6-12k a month (Collado L, 2019, The crippling financial toxicity of cancer in the United States). But if this care was not made for patient relief, what was it made for? I circled back to the so-acclaimed innovative free market economy and recognized that this innovation is coming at the cost of health and quality of life. But are health and quality of life the drivers of innovation when you can market anything as a breakthrough and price it 10 times higher than the production rate? When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. James Collip then sold the insulin patent to the University of Toronto for a mere $1. He wanted everyone who needed their medication to be able to afford it. In 2017, Alec Smith was 23 when he was diagnosed with type 1 diabetes. He worked as a restaurant manager in Minnesota. At age 26, he could no longer stay on his mother’s health care insurance plan and needed to find his own coverage. The insurance available to him came with a $7600 deductible and a monthly premium of approximately $440. Because he could not afford this, Alec decided to temporarily forego insurance coverage and purchase insulin with cash. Unfortunately for him, the cash price of insulin was far beyond his means. He decided to try and ration the amount of insulin he took till he had enough savings to purchase insurance. Sadly, on June 27, 2017, he was found dead in his apartment due to diabetic ketoacidosis (Belluz J, 2019, Why insulin is overpriced - The absurdly high cost of insulin, explained). Often, debilitating diseases are branded as misfortune, and “there’s only so much modern medicine can achieve.” But we fail to see that the path we have chosen for advancing healthcare in a competitive environment will forever impact the quality and accessibility of our medication and eventually lead (if it hasn’t already) to a shift in who this medication truly serves. With an exponential cost increase in necessary healthcare services, the Mozaic of the American dream we all so believe in is one misfortune away from collapsing.

Citations:

Belluz, Julia. “Why Insulin Is Overpriced.” PNHP, 7 Jan. 2020. 

Collado, Loren, and Isaac Brownell. “The Crippling Financial Toxicity of Cancer in the United States.” Cancer Biology & Therapy, U.S. National Library of Medicine, 2019.