US Health Care Sucks
I worked in US Health Care IT for 20 years and I can say confidently — the health care system sucks and is rotten to the core. Here’s why.
US Health Care Sucks: A Rant
I’ve been dealing with a back injury since January, and given that my health care provider has made it clear that my only options are opiates, surgery, or nothing — I wanted to take a moment and write out exactly why US health care sucks. This isn’t just from the perspective of someone who works with cannabis, but also the perspective of someone that gave 20 years of my career to health care.
For those that are used to my usual well-researched essays — this isn’t going to be it.
It’s been nearly a year since I last worked in the health care industry. I’ve always felt that more Americans need to understand how the system works, and now more than ever I feel the need to share my thoughts on why I had to leave the job I worked so hard for. I’ve been struggling to put into words all of my problems with the industry, and I’m sure once I’m finished with this, I still won’t feel I’ve covered it.
The United States health procedure industry has a primary interest in generating profit. Its intent is not to create health, but to create the need for billable procedures. It is a capitalist institution that has more in common with Amazon.com than the Hippocratic Oath.
This doesn’t mean that individual actors within that system aren’t invested in ensuring that patients receive the best of care. There are some amazing people in healthcare — but they are exceptions, not the rule. They are also outnumbered and outranked by the vast amount of people who only went into health care because it was a “recession-proof industry” that also offered them more: more money, more attention, more presumed morality.
I spent twenty years curating a career that was meaningful. My resume included organizations such as Cedars-Sinai, Kaiser Permanente, University of Pittsburgh Medical Center, and the NHS in Scotland. I selected jobs that would allow me to be the caretaker of the largest sets of data that healthcare created. I selected jobs that would foster my understanding of the institutions and history of health care in the United States and the legislation and regulations which ruled over them. All of that time has taught me one vital lesson: We are not as far from the Victorian Snake Oil salesmen as we like to tell ourselves.
One of those renowned health care systems I worked for was financially invested in things like Coca-Cola. Remember, those doctors get paid when you’re sick, not when you’re healthy.
The goodwill of employees towards the organization’s mission is exploited.
Health organizations in the United States know what their PR does for their image as respected, caring companies. They use the goodwill towards their mission to attract highly talented people, and then exploit that goodwill towards the mission to keep the employees there.
When I started to realize how little I meant to my organization, I started to break down exactly why I kept letting them treat me poorly. This escalated until every day, I was reminding myself of all the lies I told myself to keep going. There was the one about how I was fighting the system ‘from the inside’ (Truth: I got swallowed). There was the one about how I was respected (Truth: we all know how that ended up for me). And then, of course, there was the one about how I was using my skills to help people (I was only helping my bosses). . .
University health systems have exploited their position in order to create massive, monolithic strangleholds on entire geographical areas, and have enormous clout in driving legislation in those regions and the country.
They also exploit goodwill towards their mission of creating the next generation of health care providers. In a horrifying illustration of my point, I, along with many other women, were subjected to pelvic examinations without our consent carried out by medical students. This practice continues today.
Regulations that favor the large corporate entities are being implemented. This is a common story in all industries, but is exceptionally deleterious in health care.
The problem isn’t just that smaller clinics can’t keep pace with larger institutions. It’s that the level of services can be vastly different. In those with full-scale Electronic Health Records, patients are able to receive lab results in a timely fashion — but smaller clinics without the budget or employee bandwidth to complete such tasks are exempt which leaves patients in the lurch (and the smaller clinics just fall more and more behind).
Gone are the days of the stand-alone physician’s office: they were bought out by university systems long ago. If you have the idea to go off to give corporate health systems a run for their money, the regulations of the industry are aligned in such ways that the capital investment it would take makes entry into the field impossibly high.
The philosophical underpinnings of health care are based in the dismissal of the patient’s experience.
These tendencies have lead to disproportionate death among black women seeking maternal care. Here.
When I worked for one organization in the early naughties, they were establishing a committee to look at health disparities in the black community. To that committee for the entire health system, they assigned three people. A statistician, his assistant, and and overworked IT analyst (that’s me). The organization, when asked for more resources (whether it was time or server space) would drag their feet. It took me a long time to understand why, but it’s easy now — the organization was never invested in the project’s success, just the appearance of a project’s existence.
Performative.
Speaking of performative, patient privacy is actually pretty far down on the list for most places. As long as they meet the bare minimum for HIPAA (or whatever they’ve declared that to be for their organization), they don’t think about privacy more than “well our network will take care of that.” They often will just blankly perform actions without actually thinking about them, or the patient impacted by them.
Nepotism has rotted health care.
Health care’s interest in profit made it an effective creator of opiate addicts.
I am currently waiting to see a physical therapist. I’ve been waiting since September, and have two more months to wait. Sometimes when I sit down for too long, my head goes numb. I could alleviate these symptoms, if I would just take two addictive medications.
In a system where wait times for treatment can be months, it is easy to create addicts — and it names those of us skeptical of those treatments as ‘non-compliant.’
The cruelty may well be the point, since it might require medical attention.
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My 20 year career.