Deconstructing America’s healthcare system

When Luke Matthew returned home from the Peace Corps, he struggled to build his life up again. 

“I didn’t have a primary care physician, and I was about a year away from being kicked off my parents’ health insurance. I didn’t know where to turn.”

With help from the organization Healthcare for All, he obtained insurance through the Neighborhood Health Plan, but this proved to be inadequate. After spending weeks searching, he was finally told that the waitlist for a new primary care physician (PCP) was a little over a year. When he did finally get an appointment with his PCP, “every decision related to my health care he made had to be supervised and approved by a senior attending physician. I remember distinctly, several times [my PCP] wanted to order a few extra tests to be thorough, but was constantly told no.”

When he needed an MRI for his knee, he began to panic, given that standard MRIs are very expensive and can cost thousands of dollars. Matthew began making phone calls to Mass Health and spent days reading through a thick manual that explained the details of his health plan, wondering if he would be covered for the MRI. Even on the day of his appointment, he still did not know the answer, and it took a lot of courage for him to go and get the MRI done. “Fortunately,” he said, “shortly after, someone from MassHealth called and told me that I was covered for the MRI – after the fact. I could breathe again.”

Now, Matthew works at Northeastern University’s Center for Community Health Education Research and Services as a program coordinator, and through his job, he has acquired a premium Blue Cross Blue Shield plan. In contrast to before, his current physician, without hesitation, orders and performs countless tests, all of which are covered by his insurance.

Not everyone is so lucky. After all, medical expenses are the top reason for personal and familial bankruptcies in the United States, Matthew explained.  

Along with an increasing awareness of the decreasingly attainable American dream and this year’s controversial presidential election, the COVID-19 pandemic has brought the healthcare system into the national spotlight. Frontline and essential workers, many of which are immigrants and minorities, continue to pay significant portions of their salaries for only basic healthcare plans. At the same time, they are also the population most susceptible to developing underlying conditions like diabetes, asthma and heart and lung disease, which make them most vulnerable to COVID-19.

There is no doubt that healthcare is a vital component of society, but many Americans remain uninformed or confused about the field. As Priyanka Dayal McCluskey, a health care industry reporter for the Boston Globe, noted, the healthcare field is complicated and difficult to navigate.

“America’s healthcare system is a combination of public and private institutions, and policies and health coverage can vary widely from one state to the next,” McCluskey explained. “Unlike many other countries, healthcare in America involves many private, for-profit hospitals and doctors [and insurance companies], and the prices they charge for medical care are not regulated by the government.” 

On the one hand, the private sector offers patients the freedom to choose their health coverage plan, their hospitals, and their doctors, as Matthew now can with the insurance that his work provides. However, private insurance is costly, and many people struggle to afford medical bills and medication. On the other hand, the public sector, in which the federal government plays a bigger role, regulates the price of health coverage and ensures that all Americans receive care. Yet, universal health coverage, often coined “socialized medicine,” is funded by high taxes across all socioeconomic classes.

Although America’s healthcare field remains mostly privatized so far, making it more difficult for minorities to navigate it, there is hope. Social workers provide patient families with insightful guidance about applying for different healthcare and insurance plans they can receive and advocate for change by working with government relations and public health officials. 

“We strive to empower people to become involved in shaping policies that will impact them, either at the point of care or through becoming involved in advocacy,” said Allison Scobie-Carroll, the senior director of Social Work and Family Services at Boston Children’s Hospital. Additionally, government-funded health coverage for low-income individuals, in the form of Medicaid and the Affordable Care Act, has extended health coverage to millions who were previously uninsured.

While it is widely believed that health insurance is the only insurance that everyone is guaranteed to need in their lives, “health care in this country is viewed as a privilege and not a right” Matthew said. “In my lifetime, I have seen healthcare being run less and less by doctors and healthcare providers, but more by MBAs and businessmen whose allegiance is to the shareholders and the bottom line.” 

However, this will likely change, as a more liberal generation that would agree with Scobie-Carroll’s view that “every patient has a right to safe and compassionate care,” uses its voice to make change in the world.