Health care is expensive.
It is unnecessarily expensive in this country due to the sheer amount of private insurance middlemen, and the pressures of the profit motive, as said motive incentivizes capital gains for owners and shareholders at the expense of efficiency, but this is not the only way capitalism drives up the cost of healthcare.
When I worked as a personal trainer, I was constantly frustrated by the economics of preventative health care. Because there are few systems in place that allow investors and capitalists to profit from “elective” and preventative interventions, such interventions would simply be ignored until a non-elective health issue presented itself, something that a doctor could bill a patient’s insurance for. In short, the system as it stands is more than happy to pay for a triple bypass surgery, but is unwilling to pay for a consultation with a nutritionist, or for sessions with a trainer, things that might provide a patient with the tools and information necessary to make a preventative intervention that postpones the aforementioned triple bypass surgery a few decades, or even makes it completely unnecessary… yet somehow the system we exist under sees that visit with the nutritionist or the half-dozen sessions with a NASM or ACE certified trainer as a luxury, something a patient must pay for out of pocket, regardless of how much effort and hospital hours will be saved and how much suffering will be prevented. It simply isn’t a profitable model under capitalism, no matter how efficient and effective preventative medical care is.
To be fair, we see some preventative efforts being made by insurance companies, at least when it is profitable for them to do so. The classic examples are incentive programs, usually provided by an employer, who also provides the individual their health insurance. Under these programs, an employee who lowers their BMI (body mass index, a calculation based on an individual’s height and weight) is rewarded, either with a small cash incentive or a reduction in insurance rates. This falls terribly short for a number of reasons: it still puts the onus and responsibility on the individual, without providing anything other than token tools and references, incentives are usually insignificant so as to keep costs down, and these programs almost always rely on either body weight or BMI. Body mass index is useful for insurance companies, because when BMI is averaged out over a sizable population of individuals it provides data, but as an individual metric, it is not merely worthless, but creates unnecessary obfuscations. I currently have a BMI of 22. I am right smack dab in the middle of the “healthy” range, but I can’t walk up a flight of stairs without getting winded, and I can’t go backpacking, or engage in the athletic pursuits I have participated in for my entire life. Basic household chores and things like gardening or working on a vehicle are made more difficult by my physical limitations, but when I was competing in mixed martial arts at 145 pounds (and was “underweight” and sickly according to my BMI) I could run a 6:30 mile, deadlift twice my bodyweight, and do dozens of consecutive chin ups. Conversely, when I got a bit obsessive with my resistance training and weightlifting, and my BMI indicated I was overweight, (and nearly obese) I could still run a 6:30 mile, deadlift twice my bodyweight, and do dozens of consecutive chin ups. Huh.
Even when I had “good” insurance through my employer, I often had to battle my insurance company in order to see specialists, or even have routine blood tests done. I am currently in the process of disputing a 700.00 bill for routine blood testing ordered by my primary care physician. My current health insurance is through the state of California while I remain on disability, and it does not allow me any semblance of preventative care, or even the kinds of testing that would allow me to assess and plan necessary interventions.
I have been trying to mitigate some of the effects of my long haul issues by engaging in as many preventative interventions as possible. I am loading up on leafy greens, microgreens, lean proteins, Omega 3/6/9 fatty acids, berries, and mushrooms like hericium erinaceus. I have been exercising, using methodologies from both sports medicine and pulmonary rehabilitation. It has certainly helped, although major respiratory issues persist, and any improvement seems to require the amounts of time we normally associate with glacial movement.
Nonetheless, I can count myself extremely fortunate. I have a both vocational and academic background in exercise science and nutrition, and have a great deal of experience in navigating medical systems. I am also a cis/het white male that tends to talk to medical providers in an educated and formal dialect, and am not subject to the kinds of racial or sexual discrimination many people face under the American medical system.
The difficulties I am having despite my advantages and privileges are sobering. If accessing effective preventative care is this difficult for me, I can only imagine how overwhelming it must be to people with less advantages of birth and/or education.
This cannot go on.
(Follow my thoughts and experiences regarding Long COVID recovery in my SubStack email newsletter: https://substack.com/profile/58917637-sean-vansickel?utm_source=user-menu)
