‘It’s a death sentence’: US health insurance system is failing, say doctors – The Guardian US
‘It’s a death sentence’: US health insurance system is failing, say doctors The Guardian US
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Sustainable Development Goals (SDGs) and the US Healthcare System
Introduction
American doctors are accusing US health insurance giants of causing deadly delays to vital medical procedures and care – and putting profits ahead of their patients’ health. Firms including United Healthcare have denied basic scans, and taken months to reconsider, according to physicians who spoke to the Guardian.
“There’s good evidence that these kinds of delays literally kill people,” said Dr Ed Weisbart, former chief medical officer for Express Scripts, one of the largest prescription benefits managers in the US. “For some people, this isn’t just an inconvenience and an annoyance and an aggravation.
“It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits. The fact that they might be killing you is not in the equation of what they care about.”
The US Healthcare System and Sustainable Development Goals
- Americans spend the most on healthcare in the industrialized world – an estimated $4.9tn in 2023 – but have the worst health outcomes, according to analysis by the Commonwealth Fund.
- The fatal shooting of UnitedHealthcare CEO Brian Thompson last month prompted an outpouring of public anger toward the healthcare industry. While private insurers report billions in profits every year, many patients – and their doctors – struggle to navigate a complex financial system to get what they need.
- Lobbyists for the insurance firms insist they are “working to protect” people from higher costs, and stress that everyone in the space, including doctors, are responsible for making the US healthcare system care more affordable and easier to navigate.
Challenges Faced by Medical Professionals
Dr Cheryl Kunis, a board member at the Physicians for a National Health Program and nephrologist in New York City, still thinks about what happened when one of her patients needed a PET scan. He had a tumor, and before deciding on how to treat it, Kunis and her colleagues wanted to establish if it had spread.
“The surgeon was very honest that he only wanted to operate if the tumor was localized, and without the PET scan, he really would not be able to make that decision,” said Kunis. “The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have.”
After an initial denial, the patient’s appeal for the scan was ultimately approved six months later. By that time, the patient had died.
“We assume that if he had been diagnosed earlier, he may have been able to do better,” said Kunis. “There’s no way of proving it, but there was a reasonable chance he would have been in better shape had there not been a six-month delay in getting the scan.”
Health insurance companies often require “peer to peer” reviews, where doctors are required to speak with a medical representative from a health insurance company to justify treatment. But the insurance representatives are often far less experienced, according to physicians who spoke to The Guardian, and may not even have training in the specific field they are weighing in on.
“When I have engaged in ‘peer to peer’ review, the peer is never a physician that has my training,” said Dr Philip Verhoef, an Intensive Care Unit physician based in Honolulu, Hawaii, and former president of Physicians for a National Health Program. “It’s kind of a farce to even call it ‘peer to peer’. I’ve never had a ‘peer to peer’ conversation that was actually with a real peer.”
Verhoef said he often sees patients coming into the intensive care unit for preventable illnesses caused by health insurance company denials, such as refusing to cover required medication, like insulin, or an inhaler for asthma.
The Need for Systemic Change
Many doctors have recently expressed similar issues with private insurers. Physicians are “forced to become insurance experts on top of our medical expertise, spending countless hours on paperwork instead of patient care,” Dr Bayo Curry-Winchell of Nevada wrote in an article for Katie Couric Media, while Dr Claudia Fagan, chief medical officer of Cook County Health, wrote in an article for Common Dreams that she had “seen patients suffer and die in order to pad the bottom lines of corporate health insurers – and in recent years I have seen this problem getting much worse”.
Doctors who spoke to the Guardian suggested fixing problems with the US healthcare system will require more than tinkering at the edges.
Both Weisbart and Verhoef argued the solution would require moving away from private health insurance, toward a single payer healthcare system, similar to other wealthy countries that provide healthcare to all.
“The solution is effectively to overhaul the system entirely and then start from scratch with the national health insurance system,” said Verhoef. “Solutions that depend on trying to regulate the private insurance industry are simply going to fail.”
There is “no way to modestly reform a fundamental flaw in a business model”, added Weisbart. “Their business model is designed on delaying, denying and redirecting healthcare We know a much better way: the much better way is to build a system on the traditional Medicare program. Fix the things that are wrong with Medicare … and then simply provide that to everybody.”
Moving to a single-payer, universal healthcare system would likely cost less than current national healthcare expenditure, according to a 2020 academic analysis – and save tens of thousands of lives each year.
SDGs, Targets, and Indicators
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 10: Reduced Inequalities
2. What specific targets under those SDGs can be identified based on the article’s content?
- SDG 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines.
- SDG 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Indicator for SDG 3.8: Proportion of the population with access to affordable essential medicines and vaccines on a sustainable basis.
- Indicator for SDG 10.2: Proportion of people living below 50% of median income, by age, sex, and disability status.
Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines. | Proportion of the population with access to affordable essential medicines and vaccines on a sustainable basis. |
| SDG 10: Reduced Inequalities | 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | Proportion of people living below 50% of median income, by age, sex, and disability status. |
Analysis:
The article addresses the issues of delays and denials of medical procedures and care by US health insurance companies, which have potential implications for achieving SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).
Under SDG 3, the specific target 3.8 of achieving universal health coverage and access to quality essential health-care services is relevant. The article highlights how insurance companies’ delays and denials can hinder access to essential medical procedures and care, impacting patients’ health outcomes.
Under SDG 10, the specific target 10.2 of promoting social, economic, and political inclusion is relevant. The article discusses how the insurance industry’s practices can create inequalities in access to healthcare, with patients and doctors struggling to navigate a complex financial system.
The article implies indicators that can be used to measure progress towards the identified targets. For SDG 3.8, the indicator could be the proportion of the population with access to affordable essential medicines and vaccines on a sustainable basis. For SDG 10.2, the indicator could be the proportion of people living below 50% of median income, considering factors such as age, sex, and disability status.
Overall, the issues highlighted in the article align with the goals, targets, and indicators of SDG 3 and SDG 10, emphasizing the need for universal health coverage, equitable access to healthcare, and reduced inequalities in the healthcare system.
Source: theguardian.com
