Liu Yuxin, an actor who has starred in film and television works such as "Mulan" and "Step by Step", posted a picture and text on social platforms a few days ago, saying that he did not dare to get sick in the United States, seeing a doctor is ridiculously expensive, and getting sick almost depends on self-healing, because you have already carried the time to see a doctor. She also shared her friend's experience, called an ambulance, and went out for tens of thousands of dollars.
Liu Yuxin's description is not an exaggeration, calling an ambulance in the United States is indeed a very luxurious thing these days. There are many people sharing their experiences on the Internet, which seems to be a joke, but it is the real situation in the United States. For example, if someone faints due to low blood sugar, the last thing they say before they fall into a coma is, don't call an ambulance. The survival rule summarized by some people is the same as what Liu Yuxin said, that is, endure the illness and return to China for treatment.
And Liu Yuxin is not the middle class in the general sense. She thinks that medical treatment in the United States is expensive, and it will only be more difficult for ordinary people, and medical debt is one of the main reasons for family bankruptcy in the United States.
Previously, there were Internet celebrities who went to the United States to break the news that he went to see a dentist, and the doctor didn't even let him sit in the dental treatment chair, let alone do any filming and examination, the doctor just briefly asked about his situation, and then told him that it couldn't be treated here, and asked him to go somewhere else for treatment. But in the end, I received a bill from the hospital, which showed that I needed to pay 2,327.44 US dollars, about 16,000 yuan.
This is the current state of medical care in the United States today, where both the poor and the rich cannot afford to see a doctor. In the United States, when you fall ill and return to poverty, it is really not a nonsense. It's just that our stereotype of the United States as a developed country and an advanced medical system makes it hard for us to believe these facts. So the more interesting question is, why is the price of medical care so expensive in the United States today?
We tend to think that the United States is a highly developed market economy country, and we think that the United States has a relatively high degree of marketization in any field. But unfortunately, this is an illusion. There are historical reasons for the development of the United States today, but the regulation in many areas has made the United States no longer the original United States, and the medical field is one of the hardest hit areas.
Medical associations
The first is the American Medical Association (AMA) setting the entry threshold for doctors as a profession, and they control the number of doctors by setting and maintaining the admission standards for doctors, so as to gain more voice and maintain the high income level of the doctor group. To put it bluntly, this association is a trade union for doctors, and this practice of artificially raising the entry threshold of the industry is essentially an administrative monopoly.
According to OECD Health Statistics 2021, the density of doctors (doctors per 1,000 population) in the United States was 2.6 in 2020, while the median density of doctors in other OECD countries was around 3.3. For example, in 2020, the density of doctors in Germany was 4.3, in France it was 3.5, in the United Kingdom it was 2.9, in Sweden it was 4.1, and in Switzerland it was 4.0. It is clear that the density of doctors in the United States is significantly lower than in many other developed countries.
According to the 2021 U.S. Physician Compensation Report released by Medscape, the average annual income of general practitioners in the United States is $237,000, and the average annual income of specialists is $383,000. And this figure is much lower than its American counterparts in the Netherlands, Norway and Sweden, where their per capita GDP exceeds that of the United States. Not only are American doctors earn more internationally than they do in the United States, but doctors in the United States are also high-income groups. In this case, there will definitely be a potential supply group, and there are many people who are willing to study medicine, but because of the monopoly control of the American Medical Association, many people are kept out.
In addition, the United States is one of the few countries in the world where students cannot apply for medical school directly after graduating from high school, and can only enter medical school after graduating from undergraduate. Medical school typically takes four years, followed by residency training of more than three years, with additional graduate education and professional training for specialists. The lengthy process of education and training not only increases the cost of training doctors, but also limits the number of doctors available. In fact, this problem exists in many countries, including China, South Korea and other countries, and one of the reasons for the long training cycle is that the assessment method is too unified and single.
"See a doctor first and pay back later"
Second, there are also problems with the medical payment mechanism in the United States, and the core problem lies in the "see the doctor first, pay later" model, which leads to a large number of unpaid medical expenses. About one-third of medical bills go unpaid each year, which leads to rising healthcare costs. To compensate for these unpaid costs, hospitals have to raise the price of their services and factor in the "risk premium" that cannot be recovered, which in turn makes those who can afford to pay have to pay for those who can't, entering a vicious circle.
This not only increases the transaction costs of the healthcare system and increases the financial burden on patients, but also increases the complexity and opacity of the healthcare system. The point is that the whole process has not made a substantial contribution to improving the quality of medical care or increasing the supply of medical care, but has added a lot of people who "share the cake" and increased unnecessary costs.
There is no limit to the amount of compensation and medical liability insurance
The third thing that increases the cost of medical care is medical liability insurance, which is not the illness insurance that we usually think of as patients, but the medical liability insurance purchased by the doctors themselves. It is a type of insurance that doctors buy to protect themselves and can be used to pay for legal fees, settlement costs, or compensation due to medical disputes.
It's no secret that Americans are notoriously litigious, and the U.S. medical litigation system does not limit the amount of damages. So if something goes wrong, U.S. doctors not only face the risk of litigation, but also may face high compensation costs. If you don't buy insurance, if you lose the lawsuit, you may be doomed, and these costs will eventually be passed on to the patient, which in turn will drive up the cost of medical care.
The cost of this insurance can range from a few thousand dollars to tens of thousands of dollars per year, and generally speaking, doctors in high-risk specialties such as surgeons and obstetricians will have higher premiums, while low-risk doctors such as family doctors and pediatricians will have lower premiums. There are also significant regional differences, with some states that like to fight medical lawsuits, such as New York and Florida, where premiums are significantly higher than the national average. Obviously, this is a significant financial burden for doctors.
Medical and R&D integration
The fourth factor that increases the cost of health care is the integrated operating model of medical care and R&D in the United States, that is, the American health care system not only provides clinical care, but also plays an important role in driving medical progress and innovation. The innovation and progress of these medical technologies also require huge costs, which is also one of the factors driving up medical costs to a large extent.
Many of the top hospitals and medical institutions in the United States are closely associated with universities, forming academic medical centers. These centers not only provide advanced medical services, but also conduct cutting-edge medical research. For example, the Mayo Clinic, the Cleveland Clinic, and Johns Hopkins Hospital are among the well-known academic medical centers. They are world leaders in medical research and clinical practice with a large number of medical professionals and research teams, but they also mean high operating costs.
According to the National Institutes of Health (NIH), in 2019, U.S. spending on medical research reached $41 billion. These funds support a large number of doctors, investigators, and nurses, and the cost of these research projects and clinical trials is partially subsidized by the medical expenses paid by patients.
Medical insurance for the average family
Finally, let's talk about the health insurance of the average American family. In short, the system design is too complex and too costly, and the average person cannot afford it, and it is not as good as imagined. While Obama's Affordable Care Act aims to expand insurance coverage, according to the U.S. Census Bureau, about 27.5 million Americans still did not have health insurance in 2019.
For most U.S. families, health insurance is provided through their employer. According to 2020 data from the U.S. Bureau of Labor Statistics, the average annual premium for employer-sponsored health insurance is about $5,800 for employees and about $15,000 for employers. People who do not have a job can only purchase individual health insurance, and under the Affordable Care Act, only individuals and families with an annual household income between 100 and 400 percent of the federal poverty level may be eligible for premium assistance. In the absence of subsidies, the cost of individual market insurance is still high, and many people will not buy insurance at all.
So on the whole, the United States is in a state of medical polarization, and the richest people can enjoy the best quality and most advanced medical care here. The middle class is likely to fall back into poverty due to illness and will not even dare to call an ambulance, while the poor will struggle.
Many people may blame the monopoly of capital for the problems of American health care. This possibility does exist, because the American system dictates that capital can sometimes use "political contributions" to lobby Congress to manipulate the direction of policy and legislation. But at the same time, we must also realize that this kind of manipulation is essentially strengthening regulation and monopoly, and is not a problem of medical marketization itself. There is nothing wrong with opening up the market, lowering the barriers to entry, and increasing supply and competition.
• (This article is the author's personal opinion and does not represent the position of this newspaper)
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Editor-in-charge: Chen Bin
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