US Healthcare – Beauty and The Beast

The pandemic has exposed the strengths and weaknesses of the American healthcare system, the pharmaceutical industry, and collaboration between public and private health.  Epidemiologists are outspoken about different rates of infections, and Big Pharma can engage in price gouging while they rush to develop a vaccine and cooperate with FDA.

The American healthcare system has been under scrutiny. In 2017, we spent 17% of GDP on healthcare; the state-funded NHS in the UK spent 10%. The quality of care provided by the NHS is arguably better.   

I had my first encounter with the US healthcare system 20 years ago when my husband was hospitalized for a month with bleeding in his colon.  After 3 weeks, we had to decide between letting a suspected viral treatment take its course, or resorting to surgery, which would have a lifelong impact on his quality of life.

A surgeon and a GI specialist disagreed when they saw the condition of his colon, in the end. The surgeon recommended removal of the colon, while the specialist noticed signs of recovery and recommended against surgery. The primary care physician after consulting us decided to wait.  Three days later, the medication took effect and he was discharged.

It is hard to imagine open discussions being shared with patients back in India. In my personal experience in running a company, tough business problems get solved when the CEO hears the pros and cons and calls the shot.  Decisions made through open discussions are more likely to be right.

Was this hospital stay expensive?  Yes, but our private insurance paid for most of it. Was the care methodical and evidence-based? Yes.  Were the doctors caring and knowledgeable? A resounding yes.

Fast forward 20 years. In January this year, on a pleasant Monday afternoon, I rented a Lime scooter at Pier 39 in San Francisco. While enjoying the scenery and the wind blowing through my hair, I sideswiped a truck that was making a right turn from a side street.

My head struck the pavement. Unfortunately, I was not wearing a helmet — nor were other riders.  An ambulance was called, and the paramedics immobilized my neck. They asked me if I was dizzy or if I thought I had broken any bones.  I felt okay, blood was oozing out from the back of my head, but I had no pain.  I did not lose consciousness.  Instead, I asked them to make sure that the scooter and my iPhone were inside the ambulance!

I was transported to the trauma center at Zuckerberg San Francisco General, then to Stanford and from there to Valley Medical Rehab Center. I spent about a week at each facility.  I had a skull fracture, and CT scan showed a fair amount of bleeding inside the brain due to the impact.  TBI (traumatic brain injury) is not well understood.  My long term prognosis was not clear. They detected and treated many medical issues to stabilize me physically. I was sleepy all the time without any sedatives.  I received excellent care and made a full recovery, but I do not have many memories of that time.

These were some of the best medical facilities on the planet.  Both SF General and Valley Medical are nationally recognized public hospitals, while Stanford is an outstanding private university hospital.   

With philanthropic support, they all have five-star facilities.  They also attract the best physicians because of their prestige but also their public service mission. All three admit patients, regardless of their ability to pay. 

Because I am over 65, I am covered by Medicare.  The government pays less than half of private insurers. Government payments are insufficient to cover the cost of care. As a result, privately insured patients help subsidize government-paid patients. In that sense, there is a contentious collaboration between government and private payers.

Another problem with healthcare is that doctors are overly busy rushing from patient to patient. Methodical diagnosis requires a careful review of medical records, chronic conditions, and family history of the patient — which can be time-consuming.  Physicians also have to keep up with new treatments.

Mistakes and errors happen. Once I underwent unnecessary surgery for an ectopic pregnancy. On another occasion, my husband waited in an emergency room for three hours before the doctor on call realized that he was undergoing a heart attack.

Data analytics and AI can help aid physicians in diagnoses and treatment options.  Algorithms are trained by real patient data and then they can get smarter at predicting. “AI for health care must be balanced by the appropriate level of human clinical expertise ..,” states Harvard Business Review.

The usage of DNA data can further lead to individualized treatment.  According to Dr. Rochelle Long, a pharmacogenomics expert at NIH, “If doctors know your genes, they can predict drug response,”. 

If machines can help physicians, fewer medical errors will occur and productivity will increase, leading to superior outcomes and lower costs.

In a nation of technology innovation, we are not there yet with AI, but our approach to healthcare is methodical and research-based.