Unhealthy, Unwealthy, Unwise

When I was doing research for a former book–my first sabbatical project, back in 2007– I came across data confirming the relationship between individual and social health.  It turns out that countries with strong social safety nets have substantially fewer social ills–not simply less crime, but also less divorce, fewer unwed teenager mothers, etc.

I thought about that research when I read a fascinating article shared by a reader of this blog.The article from Harpers Magazine was written by the son of a doctor who’d practiced for most of his career in Great Britain’s National Health Service–the NHS–and it compared his observations of that system to the reality he encountered after moving to the United States.

When I moved to New York, many things seemed strange. Among them were the crutches I saw discarded on the street, leaning against the hunter-green fences of construction sites or on the steps of the public library where I had an office. It felt like finding evidence of miracles: the lame had risen up and walked. Later I learned that people were often expected to buy such items, rather than being given or lent them by a health provider. Once finished with them, they naturally enough threw them out. I connected this in my mind to the chronically ill people I saw living on the street, many with mobility issues—people who seemed to need care and weren’t getting it, like the woman nodding out on the corner in a wheelchair, or the man wearing nothing but a hospital gown, looking as if he’d been discharged from a psych ward straight into Tompkins Square Park.

As a freelancer, I bought my own insurance—my second-largest expense after rent. Despite spending hundreds of dollars a month, I still had to hand over something called a copay to be seen by a doctor. When I expressed shock at this fact, my American friends laughed bitterly. Step by step, I was initiated into this strange new health culture, so different from the one I was used to. Why did I need permission from the insurance company if my doctor thought a treatment was necessary? This was a medical decision, wasn’t it? In that first year, I went to see a physiotherapist and realized that he was shamelessly upselling me, trying to persuade me to embark on a complicated and expensive course of treatment that I didn’t need. Oddly, this disturbed me most of all. I was used to a system where there was no incentive to do such a thing, and it felt like a breach of trust. Deep inside, I was still the doctor’s kid, conditioned to see medical professionals as benevolent authorities.

I began to hear horror stories: the uninsured woman who slipped in a gym changing room, knocking herself unconscious, then woke up and tried her best to stop the ambulance from coming, as she couldn’t afford the cost; the young musician who’d tried to set his own broken arm using instructions from the internet. Everything seemed absurdly marked up ($1,830 for a pair of orthotic insoles?), and hovering over us all was the threat of medical bankruptcy. It was mind-bending to think that I was one serious illness away from losing my life savings. I contributed to GoFundMe campaigns and began to experience something new, a low-level background anxiety.

That reference to “low-level anxiety” triggered my recollection of that long-ago research, because it found that individuals’ feelings of personal safety have a marked and important effect on the health of the overall society. People who feel secure in their persons and prospects are less suspicious, more neighborly, and less likely to engage in risky or anti-social behaviors.

Recent unwarranted shootings–the elderly man who shot a teenager who rang his doorbell, the homeowner who responded with a hail of bullets to an unknown car in his driveway–point to the negative aspects of a society in which “low level anxieties” are widespread.

The Harpers article traces the history of America’s health care failure–how we got here. The paragraph that best explains just where “here” is, is the following:

The U.S. health care sector is massive. In 2020, it amounted to 19.7 percent of GDP. In the previous (pre-pandemic) year, that number was 17.6 percent. The United States spends more on health care than any other developed country, and not by a small amount: $12,318 per capita in 2021. In the rest of the developed world the average is under $6,000. What do we get for all this money? Lower life expectancy and higher infant mortality than almost all other developed nations. Despite the huge deployment of resources, the system is, by almost every metric, a dismal failure.

It isn’t just a failure that harms individuals. We Americans pay extra for the social dysfunction.


  1. The “system” is a failure for reasons almost exclusively attributed to Republican policies. Beginning with the Reagan administrations that allowed insurance companies to dictate medical procedures and set the prices for every procedure, the floodgates for profits burst and here we are. Republicans allowed for Medicare and Medicaid to be used as the conveyor of taxpayer money to the silk suits in health care insurance companies.

    “Oh, but competition is good and that will drive prices down,” they said. Another Republican-induced corporate lie. As we all know, the prices skyrocketed. Now, we have the worst health care in the world for a so-called first-world nation.

    Take Texas – please… Texas has the worst human health index in the nation, the highest teenage pregnancy rate, the worst high school drop-out rate, the MOST air and water pollution and the most people being gunned down by other Texans. And as we’ve all discussed on this site, the egregious Abbott/Patrick/Paxton corruption ranch does what all Republicans do with the failed policies they created: Blame the Democrats.

  2. The Republicans worry about the costs of the medical system. The Left is worried about who gets covered. NEITHER party cares about the healthcare system, which we pay into and get less and less from as each year passes. We pay more and get less. Why is that?

    Massive bureaucracies called insurance companies. And kickbacks from each level of the corrupt system. My doctor said Big Pharma runs the show. The kickbacks explain why they aren’t debating about universal healthcare and, instead, find themselves clawing each other over what is considered a transvestite and what bathroom they should use. You know, major issues.

  3. All true. And the executives at the top of this for profit system are paid enormous sums while the health care workers at the bottom struggle. This is a very broken system.

  4. Todd, thanks for corroborating my points. It really isn’t that hard to see, is it?

  5. No, it isn’t Vern!

    Sadly, there are lots of dollars floated about by the healthcare system to keep pesky politicians and journalists away; not to mention the coercion Big Pharma has over doctors with licensing and kickbacks.

  6. During my 80 years I have seen all that American medicine has been and has become, from the caring doctors of my youth who made house calls and an Amish doctor who practiced out of the back room of a small town store, to a twenty first century doctor who needed psychiatric treatment and a few bastards who just needed to have their licenses pulled. We all want our personal doctor to be Hawkeye Pierce. What most get is Frank Burns.
    Hospitals used to be clean, neat, and efficiently run with their total focus on medical care. Today’s hospitals sell themselves as “destinations” complete with lavish lobbies offering boutique gift shops and Star Bucks. The bigger and more elaborate the better.
    Every part of the US medical system is a money maker for someone. Every minute must be accounted for and thus profitable. Specialty care is broken off to independent entities that package themselves as not for profit LLCs yet remain part of the hospital. Who does a patient complain to in those cases?
    The bottom line is that the medical system and all of its participants have lost their mission. They no longer know what they are about…except that they are there to make money. It is money not health that they serve. Money…

  7. So we all know that the system is broken, in fact, the worst in the west. How do we get started on the fix? The only way I see is vote blue. Give the Dems four years to get it done. If they fail, vote them out.

  8. Theresa Bowers is 100% correct in her description of the historical progress/digress of medical treatment in this country. My mother had debilitating migraine headaches; as a child I remember our doctor coming to our home, sitting beside her on the bed to give her an injection of morphine. He would sit with her for the few moments it took for the medication to work, then gently lay her down and pull the covers up over her and tiptoe out.

    Move forward to the mid-2000s and my need for bladder and vaginal wall reconstruction; I was denied surgery (after extensive testing) by three doctors, to perform the surgery because I am deaf. I sent all E-mails to and from the doctors and test information to the Indiana Medical Licensing Board, simply asking for letters of discrimination to be placed in their files; I was denied. One doctor stated writing notes was too much trouble, one stated writing notes was too much trouble and the third doctor stated if she couldn’t communicate verbally with me she refused to accept me as a patient. All had been informed when I requested an appointment about my deafness and apologizing for needing them to write notes to communicate and all scheduled appointments. Then sent all information, including the denial for surgery with their reasons, to the federal Americans with Disabilities Act, Civil Rights Office; four YEARS later I received their response. The two male doctors were cleared; the one woman surgeon was sent information on treating the disabled and they said IF they received another complaint about her they would CONSIDER an investigation.

    As Theresa states; “The bottom line is that the medical system and all of its participants have lost their mission.”

    “It isn’t just a failure that harms individuals. We Americans pay extra for the social dysfunction.”

  9. reagan as governor went to court to release the mentally challenged in calif. his big lie was why should they be locked up,such fine citizens. when his actual greed was the cost. further ideals of privatization went on to allow, investors to own you. its a game of what they want,and their bottom line. the republicans as a whole have now become the profit makers,(and some sinemas).
    this has now become ,who kills who. gun deaths are probably behind this mass murder. money,has and will now forever becomes the decision maker of who lives and who dies. being a blue collar, and never making enough to have health insurance,ive depended upon the now discount death/health plans employers lure ya with. my wife and I had many,hers wouldnt cover a broken arm on a trail ride with her horse. her employer dumped that carrier. seems many a state is conned into,or maybe designed contributions to such lawmakers, to provide such plans to die on. here in NoDak sanford health(death by design)is the major with BCBS(fixed rates anyone?). cut rate plans since trump have returned. i thought obama care was suppose to change that. during obamas time, compelet health care, couldnt be supported by employers. Minnesota had cheaper rates due the competion,NoDak had 3 health care insurers,(this is due the states mandate with its own draconion laws and insurance laws)Mn has 26 providers..in NoDak it satrted at $1200 a month for one with a income of $55K. that was the bronze plan. that so called republican who said obama care would amount to the dems providing a death panel,were right,as they practiced in front of a mirror to say that. i never had health insurance in my 68 years until medicare,(thanks all for supporting it) being lucky to never have a major.(but while incarcerated in the fed system,ya provided a hernia fix and my appendix(prison food)exploding while the small town local med center gleefully accepted the BOP buisness,by design)
    our country is numb to any help(except as a bush meme hero).it has become a profit making,death camp,in any faction. the likes of right wing news and social media has dismantled the what we could have,all by big money design. we have a squeeky little voice,maybe we should be as embolden to have a bigger voice and make this change. discussions are great,but whos ears do they reach? ive begun to love shoving it into these rightwing fanatics,blue collars,face to face..they actully listen,because they never ask or think about it,while being distracted by what they are,sold…remind them of that.

  10. Since I retired about 20 years ago, I’ve been living comfortably, if frugally, on my teacher’s retirement plan and banking my social security. Along with my investments, amassed over the years of living frugally, I now have more money than I ever expected to have when I was working. Still, I can’t be comfortable making any big expenditures because I know all those savings could be wiped out by one catastrophic illness. If we really want to boost the economy, eliminate that possibility by changing our healthcare system and I, and millions more like me, will start spending instead of saving.

  11. It all boils down to an original tenant of western civilisation, the idea that you are responsible for everything that happens to you. Despite being a ridiculous non-truth, it undergirds the foundational belief system of The Church and all the little Churchlings – original sin, be good boys and girls or ELSE, blah, blah, blah. It’s the basis of American conservatism. The Republicans both rely on it to make their arguments seem like “common sense” (get what you deserve, bootstraps, etc.), they also use the relief people feel from being temporarily released from it as a motivator — it’s not just a coincidence that the elation felt by fools at a Trump rally is similar to the elation felt at an old fashioned revival.

    Step forward and have your souls healed, brothers and sisters.

  12. Amen to the comments of Vern and Todd. The moneychanagers in charge of our “health system” have done a masterful job in selling us on the evils of “socialized medicine” ever since Nixon let his buddies at Kaiser back in California monetize the “system.” We are all witness to both print and electronic putdowns of the horrors of Canadian and UK “socialized medicine” schemes with nary a mention of Eli Lilly’s great insulin robbery, a robbery corrected by Biden but now under attack by House Republicans intent on reinstating the robbery.

    We are also witness to what happens when Wall Street is invited into the marketplace of determining both policy (via their Republican compatriots) and finance of a vital public service, and it’s not a pretty picture, as the Harper’s contributor’s essay suggests.

    I have arrived at two tentative conclusions: (1) Perhaps socialized medicine as a choice is superior to capitalist medicine, and (2) Perhaps Nixon’s biggest mistake was not Watergate.

  13. So many thoughts:
    * We’re all in agreement that healthcare should NOT be a for-profit enterprise.
    *In America, if you work hard, live frugally and responsibly, be a good citizen, and through no fault of your own have a serious accident/illness, you WILL be punished and lose everything.
    * My husband is currently an inpatient at a Carmel area hospital where there are no patients or hospital rooms, but rather “guests” and “guest suites” (where I come from, guests don’t pay, but that’s me), and the amount of waste is breathtaking—cold packs used once and pitched.
    * That, after each mass shooting, the Repubs cry that stricter gun control is not the answer, but rather better mental health care. But who the hell can afford that? Even with really good insurance, you’re limited to only a few sessions…if you can afford the copays.

    I could go on…and on and on…but I’m preaching to the choir.

  14. As a Canadian, I find the US system to be obscene, frankly. It seems that too many down there fetishize business, and so the health sector must be treated like one. People need to get rich after all. (Note: It should NOT be treated like a business.) Our system is far from perfect, but I don’t fear illnesses or injuries. They won’t affect my bank account at all. I never have to worry about cost, just participating in the process of treatment and getting well.

    One benefit that Sheila didn’t mention is that in a system like mine, a patient can be proactive. If something feels “off” or strange, you can easily check in with your doctor about it. If necessary, further tests and analysis will be arranged. Otherwise, you go home feeling mental relief. Treating stuff early–before it is terrible or, worse, untreatable–is by far the better option.

    One recent example: my dad was having surgery last August (down in Arizona, where he lives). I had to be on the phone with the hospital to receive updates and provide approval when they needed to go back in after the initial procedure. As in the story, I was astonished to find out that the insurance company would also need to give permission even though the doctors recommended it. I expressed my bafflement by the system and noted that here in Canada I wouldn’t even SEE a bill when I saw the doctor or had a procedure. The nurse on the phone was appalled, and insisted that “You SHOULD see the bill!” It seemed she felt that I didn’t feel enough anxiety about the costs, that I SHOULD be concerned about that, and so I should see the bill to feel more guilt over what I didn’t pay.

    Honestly, it should be like the department of transportation. Can there be improvements in the roads, traffic patterns, public transit? Of course. But when was the last time you worried about whether the system would be there for you? Never. When you need to get to the store or hospital or work, the system is just there and you use it. (Ok. You guys have too many tolls, too. You pay taxes, so why so many tolls? Florida, I’m looking at you.)

  15. Reagan destroyed, what was then the best M.H. program in the country! I had been working in the New York State
    M.H.field when he first became gov’r in California, and was aware of the quality of M.H. treatment in California.
    Reaghan, to whom much of today’s social ills can be traced, lied a little bit less than TFG.
    I was there when Nixon signed the law that brought the HMO’s to power. He did it for his “buddy” Mr. Kaiser.
    One offshoot of this was having HMO’s come into the system and dictating treatment. At an early meeting with the Oxford
    HMO, their staff was virtually giving orders to us!
    It’s all about American capitalism run wild!

  16. HIC (up) er follow the money – Healthcare Industrial Complex. Investment bankers are buying up hospitals. “Middlepeople” are owned by pharmacy giants. Hospitals are buying up individual doctors. When will DEMs speak up? NEVER – their campaign funds come from there. Yes, the GOP is worse, but DEMs are barely better. (Yes, I know about Burnie and Liz, but they and their like are a teeny part of the voter population.)

  17. Our healthcare system is a travesty and it really works for no one except for maybe the wealthy who can afford to pay for medications and treatments if their insurance will not cover it. Physicians have not been in charge of your care since HMO’s have taken over and dictate what they will or will not pay for–and on the medical side there are not enough resources to constantly battle the insurance companies. I have been a registered nurse since 1996 and I can attest that ‘we’ do not have the time that is needed to battle insurance to get them to see reason and provide care–insurance state they are saving money but if I have to spend 45 minutes on the line waiting for a human to answer to see if a $10 medication approved–it is not in the clinics interest to spend $50 to get that $10. How many of you use GoodRX to get your medications? because insurance will not cover your medication.

    The US healthcare system is collapsing and nothing is being done–I am seeing providers now leaving (nurses are always trying to leave) but now providers are trying to get out of patient care. Its all on metrics–are you meeting the designated metrics–has nothing to do about quality but quantity. The PCP has to see at least 40 people per day and carry a case load of at least 3000 pts to make ends meet.

    I just learned recently why a pain scale has to be asked even if you are going to see a therapist. We can thank Purdue Pharmaceutical–the makers of Vicadin and their marketing scheme that lied to providers for years to get way too many Americans addicted to opioids. They somehow got legislators and hospital administrators bought that it is a policy to ask at every visit regardless of the visit or the age of the pt to rank their pain. I am asking a 7 year old at their depression visit about pain?! Not suicide but pain and if you don’t ask and don’t chart it you get in trouble….I thought it was so stupid considering Indiana had a drug problem.

  18. The number 1 reason for bankruptcy in America is medical–medical bills. I am a nurse who has just been diagnosed with 3 auto-immune disorders and now I live in anxiety at all times wondering how long can I work–will I be able to work till I am 70? The expense–I deal w/ patient anxiety all day every day on not just their illnesses but if they can even afford to be human and be ill.

  19. Republicans like to sell austerity as financial responsibility but they are sold austere thinking by those benefiting from wealth redistribution up, the “American Way”. Poorer poor and richer rich. The obscenely wealthy then can be cited as evidence of economic success and upward mobility despite the truth that they are instead evidence of oligarchy and politics for sale only. Among the obscenely wealthy are the foreign born Murdochs offering cut rate advertisement for oligarchy – reminders that it’s un-American to be satisfied with any part of the status quo.

    As we fall downhill building up speed towards our reckoning with reality, advertising keeps us peddling ever faster which will make the inevitable crash more spectacular and devastating.

  20. I’m reminded of the dark comedy Brazil.

    It has been nearly twenty years since Democrats promised they would refine and attenuate the Affordable Care Act. An act that has its roots in a Republican think-tank.

    It’s quite telling the only idea Democrats could come up with were those brought forth via Republican Mitt Romney and right-wing think-tank Heritage Foundation. This example shows how useless the Democratic Party has become.

  21. Ian. Remember how Obama tried to work with Republicans to get health care improved by coming up with a plan compatible with Romney’s but as soon as he proposed it all the Republicans (including Romney) began fighting it tooth and nail? They couldn’t stand the idea that he might get credit for something that actually helped people. Republicans then lied about the ACA and, when it passed in spite of them, swore to repeal it. In all the years since, even when they held the House, Senate,and Presidency, they have never come up with any better plan of their own. And the ACA is now popular because it actually did help people. Republicans then and now have nothing to offer us but lies, character assassinations, fear mongering and corruption.
    By the way, I googled what you suggested a couple of days ago and it just led me down a wrong wing rabbit hole of unsubstantiated conspiracy theories. I’ll consider Joe Biden might have done something corrupt when he, like Trump and many of cronies, has been indicted by a grand jury. In the meantime, I see no reason to pay any further attention to your posts.

  22. I couldn’t care less if you read my posts. However,Biden’s family receivership of funds from a Chinese energy concern is on the website of the US Government Oversight Commitee which I stated. I’ll save you the embarrassment of elaborating further.But,you are being wilfully disingenuous or you’re just not accustomed to using a Google search properly.

  23. Ian – I am wondering if you are some type of troll – or maybe just an impolite contrarian…I, too, googled the site you provided. I could not grasp any (if any) truth in the detail provided. It seemed to be a rehashing of old news by people so determined to make hay out of ugliness, regardless of the reality/truth of their statements, that they will jump into the murkiest water they can find. It is sad that your world is disintegrating around you. Maybe you are comfortable enough to survive anything, maybe you should get out of the water…

    Myself, I (and, I imagine, many responders to this blog), worry about those who cannot survive. I am not really glad I am old – I miss skiing and lots of other activities easier for the younger. I am wholly aware that living in and being a citizen of this beautiful country functions like a lottery win in my life. $80 cost for each child – one with serious surgery afterward, wonderful doctors, and the rest…of course the system has issues and problems, maybe not fixable. It feels to me that too many gullible Canadians believe the hyperbolic non-facts about the system you all suffer under.

    This blog has very many opportunities for learning, for glimpsing the bigger picture, expanding our abilities to see and understand our times. A major benefit for you and the rest of us. Do you want to learn? I wonder.

    Best wishes to you, nonetheless.

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