The demise of American Medicine.
This writing, by its nature, contains a series of statistics, therefore it maybe a bit hard to follow. However, it is imperative to try to read and remember as many of those numbers as possible to understand the issues discussed later.
In the previous section under this title, I alluded to a significant part of the difficulties associated with American healthcare. Presently I shall try to bring to the reader’s attention some of the crucial factors contributing to “the Death of American medicine,” as we came to know it.
What was the goal of the US government by advocating the changes in medical care? To answer this question, one has to keep in mind several factors:
- Medical care offered to and received by the populace, including doctor visits and the participation of Physician Assistants and Nurse Practitioners, ease of undertaking the para-medical evaluations including different tests: blood, excreta’s, radiological, CT scanning, MRI, and other tests that may become available
- The price tag associated with the above
- Hospitalization and care received by hospitalists, PAs, and nurse practitioners.
- Did these changes achieve a betterment of the medical care for the citizen, or were mainly for the benefits of the powerful health care companies, the hospital chains, insurance and drug companies.
Before going deeper into the subject, I like to point out that much could be said and written about the groups or individuals, collectively or individually, known as Hospitalists, PAs, and Nurse Practitioners. I should emphasize that many of them perform their duties as indicated by law and contribute to patient care. However, by expressing the general outcome of the services received by the patients, it becomes clear that the results are far below expectation.
Considering all aspects , I shall address the problems in the following ways:
I shall start with a statistical review of Healthcare; facts, that confront us today. Then we should look at the Healthcare institutions, the providers in the US, ending with a touch on financial aspects.
Statistical Review
For obvious reason, because of the effects of the Covid pandemic on the medical care, the years 2020 and 2021 were excluded in this writing,. Our discussion points shall consist of the healthcare spending, the healthcare providers including the doctors, nurses, physician assistants, and nurse practitioners. In 2019 the Healthcare Spending per capita (H.S/C) in the United States increased 4.6 percent over the previous year, yielding to an enormous amount of $3.8 trillion, or $11,582 per capita. This is 17.6% of 2019 Gross Domestic Product (GDP). To appreciate the problem, it suffices to look at the per capita health care spending for the preceding three decades, table 1:
| Year | Healthcare Spending per Capita | Life Expectancy in Years |
| 1990 | $2,685 | 75.3 |
| 2000 | $4,356 | 76.7 |
| 2010 | $7,880 | 78.6 |
| 2019 | $11,582 | 76.3 |
Table 1- US Health Care Spending per Capita and Life Expectancy for the Past Four decades
Measuring these findings with those of the comparable countries in 2019 where the average of H.S/C was $5,533 and life expectancy of 82.6 years, according to the Organization for Economic Cooperation and Development (OECD). The expenditure of other countries is almost half of the expenses in the US with a better result. Switzerland showed a life expectancy of 82.1, Sweden 81.5, France 79.9, UK 79.4, and Canada 80.0.
In 2019, the US spent 53% more than the country with the second-highest spending per capita, Switzerland ($7,732.00), one of the OECD Countries. The exact expenditure in those countries for 2019 stands as follows:
Switzerland with an HS/C of $7,732; Germany, $6,645; Canada, $5,418; France, $5,375; Sweden, $5,782; the United Kingdom, $4,653; and the US $11,871.
Regarding the mortality rate among comparable nations, indicated by the number of death per 100,000 population, again the United States occupies the highest place. For example: in 2016, this ratio was in: Switzerland 54; Netherlands 60; Sweden 65. Canada 72, UK 84, and the United States 112, almost twice the number in Switzerland. This high mortality rate is despite the higher hospitalization numbers in the US, especially in the domain of preventable diseases.
At the top of the mortality rate is newborn mortality. In Europe, this has decreased substantially since the 1950s. It came down from 80 plus per thousand live birth to three plus in 2019. Among the OECD: in 2019, the ranking of newborn mortality rate of the US was number 33 of 36 countries, with 5.8 per 1000 live birth.[1]
| Countries | Japan | Finland | Slovenia | Israel | Germany | USA | Mexico |
| % of death | 1.9 | 2.0 | 2.1 | 3.1 | 3.3 | 5.8 | 12.1 |
Table 2- Newborn death per 1000 live birth among some of the nations
Among the comparable nations, considering some of the number of chronic and partially preventable diseases, such as diabetes, high blood pressure, lung, and respiratory disorders, again the United States remains at the top, with a percentage of 28%; Canada 22%; France 18%. Obesity is another more pronounced factor in the US 40%; Canada 26.3%; France 17% while Switzerland has the lowest,11.3%. [2]
Hospitalization for preventable diseases again is the highest in the US. Regarding diabetes and hypertension, the number of hospitalization per 100,000 discharges in comparable nations are: Netherlands 58 and 18 for diabetes and hypertension, respectively; UK 76 and 18; Canada 153 and 48.
It is of interest that Americans have a smaller number of visits to healthcare providers compared to comparable countries: US 4; Netherlands 8.3, Canada 6.8; Switzerland 4.3, France 6.1; Germany 9.9[3]/[4].
Medical insurance: for a family of four without subsidizing in 2019 was $1,403 and in 2020 $1,437 per month. Obamacare costs vary by state and ranges from about $328 to $482 per month. As it is not enough, Americans, in contrast with the citizens of other countries, have more denials of their claims by the insurance companies. Also, compared with the performing countries, in getting same day care, the United States is number nine, almost at the bottom. However, the United States does well on preventative care such as vaccination.
Hospital stays: the average length of stay in the US during 2017 was 5.5 days. It is lower than the average stay in the OECD countries of 6.4 days. The average for Austria is 4.2; Switzerland 5.5 France 5.6; Canada 7.4; and Germany 7.5[5]
The hospitalization rate in the US is among the highest, especially in the domain of preventable diseases, mainly diabetes and hypertension. Based on discharge per/100,000 in 2017, US had 204 and 150 for diabetes and hypertension, respectively; Switzerland had 85 and 57; the UK had a score of 78/18, and Germany was the only one above the US, showing a 261/320. [6]
Many Americans cannot get timely care because of cost and lack of means of support. In 2020, according to the government source, 8.6% of the people, or some 28 million, did not have health insurance.
Healthcare Providers and Institutions:
In the following order of the evaluation, I shall concern my discussion to the healthcare providers, meaning the physicians, the nurses, the physician assistants, and the nurse practitioners:
Physicians:
Tables 3 shows physician types, numbers, and percent increase between 2010 and 2020; and table 4 gives the percentage of foreign graduates v/s American and Canadians.
| Year | MD | DO | Male | Female |
| 2010 | 789,788 | 75,627 | NA | NA |
| 2020 | 917,940 | 100,379 | 63.1% (+10%) | 36.2%(+46%) |
Table 3- Physician breakdown from FSMB[7]
| Graduating Country | Percentage |
| US or Canada | 77.0 |
| India | 5.1 |
| Caribbean | 4.4 |
| Pakistan | 1.4 |
| Philippines | 1.2 |
| Mexico | 1.0 |
| Other IMG | 9.9 |
Table 4- Countries Graduating Physicians working in the US[8]
In table 5; I bring you the age distribution of the practicing physicians in the United States
| Physician Age (years) | Percentage |
| Less than 40 | 23.9 |
| 40 to 49 | 23.3 |
| 50 to 59 | 23.3 |
| 60 to 69 | 19.4 |
| 70+ | 11.8 |
| Unknown | 0.7 |
Table 5. Age distribution among physicians[9]
Table 6, shows the number of physicians per capita for 1000 population and compares the numbers from US with those of the comparable nations:
| Country | Number of Physicians per 1000 capita |
| Norway | 4.8 |
| Switzerland | 4.3 |
| Germany | 4.3 |
| Austria | 3.7 |
| Netherlands | 3.6 |
| France | 3.2 |
| United Kingdom | 2.9 |
| Canada | 2.7 |
| United States | 2.6 |
Table 6. The ratio of physicians to patients among developed countries as of 2018[10]
Nurses:
In 2021, the US had 4.2 million registered nurses and 950,000 LPN/LVN. Again in comparison with comparable countries, the US falls the last on the number of nurses: the number per 10,000 population: UK 82.9; US 85.5; Canada 99.1; Sweden 115.4; and Germany 132. Educational-wise, about 30,000 nurses in the US have a Ph.D. degree, which is also on the rise.
Physician Assistants:
In 2019 there were 139,000. However, the total number of certified PAs in the country in 2021 is around 148,500. The certification comes through the NCCPA (National Commission on Certification of the Physician Assistants). The PA program is about an 1112 credit assisted program to receive a master’s degree, Master of the Medical Science, DMS degree. It is about a 24 months course.
Nurse Practitioners:
I have alluded to the formation of Physician assistants and nurse practitioners in my previous writing. At present, there are 325,000 NP in the US. Their function is more or less the same as PAs. Their number is also growing in 2018 there were 270,000.
I shall elaborate on the functions of these groups later on.
Salaries and bonuses for the officials of the health care centers:
One of the most significant expenses in the health care industry is the salaries and perks received by the CEOs, presidents, and high ranking officials of the primary healthcare companies. However, it is not easy to determine precisely how, and how much is directed to their sides. I have tried hard to discern this problem. Unfortunately, there is not a good statistic at hand. What I could find out from a few healthcare networks was mindboggling and unbelievable. I will bring up some of those for our review and use them as an example:
1- Memorial Hermann Healthcare in Texas: A nonprofit and tax-exempt organization, in 2018, they reported an income of 5.4 Billion dollars with an expense of $ 4.9 B. The major part of the expenses was the compensation consuming a whapping $ 2.2 B, as follows: CEO, $ 2,825,000; with him, three others were getting over $2 M., and six over one million dollars. The average salary for the system employees was $ 48,221. [11] A ratio of 59/1.
2- Barnes-Jewish-Christian Healthcare:
In 2019, the center had revenue of $ 5.5 B and reported its expenses as $ 5.2 B. As the other healthcare centers, compensation amounted to $2.0 B. The CEO compensation was $2,687,850, President, $ 1,505,890.00; Director, $1.490,295.00; treasurer $ 1,191,130.00 and so on…[12]
3- UPMC Group (University of Pittsburg, Medical Center) gave its total revenue of $ 13.5 B and total expenses of $ 12.9 B. Compensation makes the most significant expenses (5.6 B.).
President and CEO $ 8,541,652.00; Executive VP, $ 3,521,014.00 and so on. Counting down to the fifteenth, each received over $2 m; and the next nineteen, each received over one million per year!
4- OHSU (Oregon Health Science University: The CEO received $ 1.6 in salary and benefit. In 2018. Out of $ 1.7 M. awarded to the institution, the executive took 1.4 M of the total amount. Twenty individuals at the top received the bulk of the reward. [13]
5- The Providence Healthcare System:
According to the report under the Providence and the St. James Watch, the President and CEO made $ 10,533,384.00, the President made $ 4,024,609.00, and the Executive VP made $ 2,910,666.00[14]
6- CEOs of some other Health Care Center:[15]
Table 7, shows the compensation for CEOs of several companies and the percentage over the medium salaries of its employees:
| Institution | CEO Compensation | Average Employee Salary | Ratio |
| HCA Health, Nashville, TN | 30,397,771 | 54,672 | 556:1 |
| Tenet Healthcare; Dallas, TX | 16,675, 259 | 56437 | 295/1 |
| Universal Healthcare System | 13,246,214 | 54494 | 243/1 |
| Community Health System, TN | 9,066,409 | 56,437 | 161:1 |
| Encompass Health , AL | 6,925,024 | 40,497 | 171:1 |
| National Health Care, TN | 1,278,366 | 31,959 | 40:1 |
| Acadia Health Care, TN | 5,131,395 | 28,890 | 181:1 |
Table 7; Healthcare CEO compensations compared to average employee salaries
Increase costs of the drugs:
Along with other difficulties in the nation’s health care, the price increase of many essential medications threw a most strenuous roadblock in the patients’ care. In several western countries, the governments interfered in numerous ways to monitor this problem. However, there has been no tangible evidence that the US government has taken any steps in tackling the problems. There are numerous example that can be used to elucidate the problems involved, and for the sake of brevity, I shall take INSULIN as an example.
About 8.3 million Americans require insulin injections to control their diabetes. The cost of this medication makes about 20% of the overall cost for diabetes. [16] Cost to Medicare Part D for the elderly patient has sharply increased for the past decade, up from 2007 to 2018 (1.4 B to 14.4 B). Per capita spending in Part D also increased by 18% from $ 900 in 2007 to 4000 in 2016, and out-of-pocket costs increased to 17% annually.[17]
Aside from the expenses incurred in the process, insulin manufacturers have increased their benefit margin more than similar non-medical companies. For example, they added a 20.1% margin of profits v/s similar companies 13.4% margin of profit.[18] These and other problems come from the monopoly in the business. The health expenditure on drugs increased from 7% in the 1990s to 12% in 2015. Estimated pharmaceutical sale revenue from $ 534 B. to $ 775 B in 2015[19].
Three big companies, without solid competition, produce 99% of insulin used in the US. This high price created a situation where some patients had no choice but to compromise their treatment. In a survey conducted by American Diabetes Association in 2018, 39% of the responders mentioned the increase of the insulin, price from the previous year, with 27% indicating the increase caused changes in their life and 28% said that they had to reduce or omit some of the doses of their scheduled treatment.[20]
This short discussion gives us an understanding of where our healthcare stands. In the future issue, I shall bring you the actual documented case studies showing us in detail the poor medical care offered to the American public.
To be continued
[1] – United Health Foundation; Annual Report 2019.
[2] – The Commonwealth Fund: A Global Perspective- Higher Spending, Worse Outcomes. January 3, 2020.
[3] – Data from OECD. Health Statistics 2019.
[4] – Commonwealth Forum; US Health, a Global Perspective; January 3, 2020
[5] – Roosa Tikkanen et al., US health from a global perspective, Commonwealth Fund Jan.2020.
[6] – Data From OCED. 2019.
[7] – Federation of States Medical Boards, census of licensed physicians in the US/ by Aaron Young, Ph.D., et al
[8] – Ibid.
[9] – Ibid.
[10] – Health System Tracker.
[11] – Ann Paddock; January 11, 2022.
[12] – Ibid.
[13] – From The Lund Report.
[14] – NUHW (National Union of Health Workers), Providence St. Joseph Watch.
[15] -According to Hospital Review.
[16] – American Action Forum; O’Neil Hayes and Jose Farmer; April 2, 2020.
[17] – Ibid.
[18] – David Blumenthal; Commonwealth Fund, May 4, 2018
[19] – GAO (General Accounting Office) report: GAO-18-40.
[20] – American Action Forum; O’Neil Hayes and Jose Farmer; April 2020.
Guils of Guilan 
Thank you for bringing these alarming statistics to our attention.
LikeLike