Introduction—culture, capitalism, and communication

Prologue

This book is about health care in America and examines how citizens, professionals, institutions, corporations, and politicians are impacting, and impacted by, a system that appears to be in a spiraling crisis. From the dissatisfaction of health care professionals, to the rising death rates from medical errors, to out-of-control costs for products and services, to unequal access and delivery, Americans find themselves in a situation like never before. In order to better understand how these dilemmas are both interdependent and inter-related, we need to identify the key issues that are contributing to the current realities in U.S. health care.

First, it is critical for us to acknowledge that in the third decade of 21st century America, health care has evolved into a major business—focused on revenue-generation. The economics and influence generated by the U.S. health care industry are staggering. In fact, according to the Centers for Medicare & Medicaid Services (CMS) in 2017, America spent over $3 trillion on health care, or approximately $10,000 per woman, man, and child in the U.S. (CMS, 2018). As a result, a business model is clearly illustrated in the way health care products and services are billed, compensated, regulated, and utilized. Consequently, the impact of health care as a business on all aspects of U.S. culture will be a major focus of this discussion. Therefore, in order to explore how we got to this point in our history—this text will focus on three critical topics: culture, capitalism, and communication. To begin, we need to recognize a few of the major problems confronting America’s health care system.

Background

While there are many things that work well in U.S. health care access and delivery there are also many glaring problems. Among the most important is the reality that in 1999 it was estimated that nearly 100,000 Americans died each year from medical errors (Kohn et al., 2000, p. 26). At the time, that report, To Err is Human, shocked health care providers, institutions, and consumers. However, less than 20 years later, new data have shown that “based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors” (Allen & Pierce, 2016, para. 3). Consequently, the death rate from medical errors is not decreasing, but increasing. Another troubling issue related to U.S. health care is the number of Americans, nearly 30 million, who remain uninsured (Martinez et al., 2017, p. 1). And whether there is a direct correlation to the above problems or not, the reality is that “U.S. life expectancy continues to lag far behind other developed countries, despite spending way more on medical treatments aimed at keeping us alive” (Ingraham, 2017, para. 3).

In addition to the problems noted above, “physician burnout—a condition in which physicians lose satisfaction ... in their work—has become widespread ... driven by rapid changes in health care and our professional environment” (Jha et al., 2018, p. 1). However, concerns about the health care environment are not just related to physicians. Nursing research has shown that nearly 50 percent of the Registered Nurses (RNs) who were surveyed considered leaving the profession and it was reportedly because of workload, not enjoying their jobs, and spending too much time on documentation (RN Network, 2017, Leaving Nursing, para. 1). But the culture of health care is impacted by many more issues—including economics. “In the first 9 months of2016, 28.2 million (8.8%) persons of all ages were uninsured at the time of interview” (Martinez et al., 2017, p. 1).

Economics

According to the Congressional Budget Office (CBO), the government’s spending on federal health care programs was rising due to both increasing numbers of enrollees and the cost for each of them (CBO, 2020, para. 1). In a different report, the CBO found that nearly S750 billion was being spent by the government on subsidizing insured Americans and that it was projected to nearly double in the next 10 years (CBO, 2019, At a Glance, para. 1 and 3). Consequently, U.S. health care costs are rising dramatically and it is not just because of the uninsured in this country. However, other drivers for America’s increasing health care expenditures are related to pharmaceutical prices.

Congress investigated Mylan Pharmaceutical after the company nearly tripled the price for an EpiPen that is used by over 3.5 million Americans to treat allergic reactions (Leonard, 2016, para. 1-3). Furthermore, the increase in costs of U.S. health care versus other countries has been attributed to markedly higher prices for drugs, physician salaries, and procedures (Bivens, 2018, para. 1). These rising prices, as well as lower life expectancies for Americans, are not just the result of health care organizational cultures, or capitalistic endeavors—information, sharing also plays a significant role.

Information sharing

Consumer-provider communication and its resulting information sharing, lias been researched and it has been shown that many primary care providers (PCPs) spend more time on the electronic medical record (EMR), than they do talking with patients (Young et al., 2018, p. 91). Furthermore, according to a Kaiser Health Network article, health care consumers in a research stud)’ were frequently interrupted by the provider and unable to finish what they were saying. This difficulty’ in telling the patient’s story’ was perceived by’ the participants as the physician not listening to them (Rabin, 2014, Rushed Doctors Listen Less, para. 8-10). Another study’ by’ Kharait and Yang in 2010, reported that communication failures were a major reason for medical en'ors.