Failing health of the United States

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k496 (Published 07 February 2018) Cite this as: BMJ 2018;360:k496

Re: Failing health of the United States

The authors fail to examine the role of the rise of managed care in the US over the past 50 years. These large insurance entities have become wealthy while claiming that they actually coordinate and manage care. They have reaped $billions in profits while exerting enormous political influence at both state and federal levels to get laws passed which enhance their profits with virtually no oversight of actual patient outcomes while effectively blocking the ability of victims of their bad care to sue them in the courts.

Congress passed ERISA laws and the US Supreme Court interpreted them to defend business interests' ability to ration care to those they regally provide health insurance for. US courts have gutted the protection of EMTALA laws. In my state, Texas, harsh tort reform by now Energy Secretary, Rick Perry, then Governor, in 2003 effectively ended all lawsuits for bad emergency room care and lowered the standard of care for emergency patients. Now Texas has the highest maternal mortality rate in the developed world and experts are scratching their heads and blaming it on bad data.

But if you want to blame it on opioid deaths, look to the Veterans Administration. Go to the testimony of veterans, widows of veterans and whistleblower physicians at a US House Subcommittee on Health of the Committee on Veterans Affairs on October 10, 2013 (one of the last times our government was "shut down") and see how the VA itself addicted veterans with opioids as the fastest way to deal with chronic pain. And see how the VA has failed to follow its written guidelines for managing chronic pain.

Finally "ObamaCare" (the ACA) itself, which on one hand expanded access to care on paper, also brought with it narrow networks of doctors and promotion of large hospital systems buying up doctors' practices which led to as much as 5-fold increases in the prices of already high priced procedures.

Competing interests: No competing interests

09 February 2018
Brant Mittler
17503 La Cantera Parkway, Ste 104-610