21: Healthcare
There are primarily two conflicting perspectives about the American healthcare system, recognized both aboard and domestically. First, that the United States offers the highest quality of medical care and is at the vanguard of research and practice. Second, that American healthcare is exceedingly expensive and generally accessible only to the wealthy, and that many Americans cannot afford the level of care they arguably need.
Rhetorical posturing aside, it is generally true that doctors in America (the author pauses to stress that they are not necessarily "American doctors" as many come from abroad to practice in the United States) have the most sophisticated training and access to the most advanced medical technology in terms of equipment and pharmaceuticals. And it is also true that the cost of any given treatment in America, even when adjusted to reflect its relationship to income, is the highest in the world.
Both phenomena, as usual, can be traced to cultural factors.
UNDERPINNINGS
In a board sense, the American notion of healthcare is based on the practice of "Western medicine" with the notion of individual independence, freedom, and free enterprise.
Western medicine is a scientific approach to the treatment of patience, focusing on the disciplines of anatomy and physiology - the structure and function of the body's systems - in terms of physics (mechanical operation) and chemistry. It generally assumes that illness can be attributed to a very specific cause, and that those causes are capable of being addressed, usually by means of pharmaceuticals and surgery.
Specifically, the concept of Western medicine dismisses the notion of animistic or spiritual forces, the concept of balance and spiritual energy, that are present in medical practices in the East or among Native American tribes. While some Americans turn practitioners, it is ascribed to religion, superstition, or other factors - it is not considered "real" medicine.
Practitioners of medicine in America undergo extensive university and medical school training, followed by a period of training and internship, before gaining licenses to practice medicine. The cost of training, as well as the high price of sophisticated equipment, is seen as an underlying factor of the expense.
(EN: The author does not mention the cost of litigation: sporadic rashes of lawsuits against practitioners have a longer-lasting effect through the prices of malpractice insurance. One account I am aware of indicated the cost of insurance for a surgeon came to the cost of $250 per hour of practice, not to mention a separate layer of insurance carried by a hospital or clinic, which results in a very high hourly fee charged for any service.)
it is also perceived that Americans' desire to persevere - to extend their lifespan or battle against conditions that would be accepted as a death sentence in other cultures - also increases the overall cost of health care. Treatments of the elderly or those with severe conditions are extremely expensive, in terms of the labor and equipment cost of each treatment as well as the number of treatments over a given span of time.
The author also mentions elective surgeries, such as plastic surgery, liposuction, Botox injections, and lumps such activities in with treatments of injury or disease. (EN: Because cosmetic surgery is "elective," it is not covered by most insurance, and because it is generally deemed to be unnecessary, it is priced as a luxury good, and should not be considered part of "healthcare" - though it is often included to skew statistics to show a higher cost of care.)
POLITICAL RAMIFICATIONS
In many countries, the welfare of the people is considered to be the concern of the government, and healthcare is deemed to be a public service that people should expect their government to provide for them, and relegate decisions related to healthcare to authority.
This is in contrast to American values, especially the notion of rights and responsibilities of the individual: a person's body is their property, a person is responsible for pursuing their own benefit, and a person is neither compelled to support or make decisions for others. A notion that Americans find objectionable is being compelled to undergo medical treatment because anyone but themselves has decided it is necessary for their physical or mental well-being.
There is also the general American distrust for governmental authority. It is generally assumed government intrusion into healthcare would favor some at the cost of others, and be given or denied to patients based on political agenda rather than need.
So while debate continues, it seems unlikely that Americans will consent to much government intrusion or assistance in their healthcare system.
One exception seems to be in providing a basic level of care to the poor or the elderly, through the Medicare program. Even in that case, there is constant debate over whether the system provides an adequate level of care, or whether it is excessive and, as a result, excessively expensive to taxpayers.
There are various approaches Americans use to mitigate the personal cost of healthcare:
- Most employers provide some level of health insurance, or pay a portion of the premium, as a benefit of employment. Though this tends to cover only necessary care for the treatment of injury and disease, minimal preventative care, and almost never elective surgery.
- Americans pay the cost of much medical treatment that is not provided as a benefit of employment out of pocket.
- Americans increasingly turn to "alternative medicine," including practices that are not orthodox to Western medicine such as acupuncture, chiropractic care, herbal medicine, etc.
- Americans may travel to other countries to obtain elective surgeries and minor treatments such as dental care
- There is a growing trend toward discount medicine and medical supplies via phone, catalog, and online sellers
- They forego medical care when it is arguably needed, assessing whether a condition is serious enough to require formal medical attention, and especially neglecting regular or preventative care
Americans who cannot afford medical care generally must rely on government or charity aid, though it is generally known that hospital emergency rooms are required by law to provide treatment, regardless of the patient's ability to pay.
However, it is also conceded that there is also a degree to which Americans are able, but unwilling, to pay for medical treatment, and a number of Americans who will not seek treatment because they are suspicious of commercial motives - that "unnecessary" treatment will be given in order to get money from healthy patients.
In general, there is a concession that medical care is expensive, and it as often described as being "in crisis," though this is highly politicized and generally unsupported by statistical fact. In terms of the treatment of injury and disease, few Americans are seen to be coping with untreated conditions and there is not a widespread morality rate - though there is some merit to the argument that mortality would be lower and the general health of the nation improved with more frequent and attentive care.
Much of the argument is based on differing opinions about the level of care that should be available - so terms such as "basic," "elective," "preventative," and even "necessary" are defined according to a wide range of standards. Likewise, arguments of cost are highly subjective as to what is a reasonable expense and what is excessive for a given treatment. Between the two factors, little consensus has been reached or seems likely in the near future.
SUGGESTIONS FOR INTERNATIONAL VISITORS
Those visiting the US are encouraged to obtain health insurance to a degree reflecting the amount of time they will spend in America and the degree of care to which they are accustomed. While they will not be denied assistance for life-threatening injury or illness, they will likely receive a minimum standard of care if they do not demonstrate a willingness and capability to pay.
Such insurance can seem expensive, but the cost of medical treatment is even more so, and treatment for a serious injury could be financially crippling to a visitor or a family whose income is very modest in conversion to American dollars.
Visitors interested in a more complete understanding of the healthcare system in America may converse about the topic with American acquaintances, and some are not reluctant to discuss their healthcare stories, as they tend to be dramatic incidents in a person's life, and can be highly emotional.
However, even innocuous questions may lead into topics that are considered inappropriate for casual conversation - a person's bodily health, political opinions, and what they have paid for things - not to mention that the topic is so politicized of late that it may not be possible to get an objective or unbiased opinion.