Fundamental Structural Factors
What ails the health care system in the US is essentially what ails the US in general. All of the major issues causing impoverishment, suffering and grief in our modern society come back to the extreme level of wealth inequality. Charles Hugh Smith has written an excellent analysis of negative network effects. It goes way beyond "winner takes it all." Basically, the most rapacious, anti-democratic corporate and political sociopaths take it all, and then they want more. They find that simple unaduterated evil works wonders for them.
Breaking this down a bit, the first major underlying factor I have identified is income inequality driven by extreme monetary policies from central banks, fueling asset bubbles that only enrich the rich. Annual check-ups used to be a frightful ordeal, getting pricked and prodded, when I was young in the sixties, now they are a luxury or a reason to join the armed forces. Our teachers told us we lived like kings. I had no idea that one of the things I was taking for granted was medical care.
A second factor is the corporate structure of America's medical system that requires it by law to make profits for its shareholders its top priority. This has earned American health care characterization as a "modern form of human sacrifice". While not limited to America, this problem is far more notable in the US. In Indonesia, for example, not otherwise famous for humanitarianism, the government encourages research on traditional herbal remedies to provide an objective empirical body of evidence that can facilitate treatment of the impoverished and improve the health of its citizens overall.* In the US, this is often forbidden.
A third, related to the second but extending well beyond the medical system, is externalities from business activities such as pollution, imposed on all citizens. Giving corporate profits priority over health seems to be nearly global these days. The resulting problems from individual instances of pollution may be small enough to rationalize and overlookor again they might not. Either way, the practice is rampant, resulting in multiple simultaneous assaults on our health, the individual consequences of which remain unstudied, never mind possible synergistic effects. The result is a population whose health is compromised to begin with. The wealthy can escape this to a larger degree than the poor through residential, nutritional and other choices requiring a certain amount of money. But even they cannot escape completely.
A fourth, criticized as "sick care," is the result of misplaced faith in the ability of modern medicine to cure any and all ills. People are encouraged to abandon responsibility for their own health and place their trust in miracle pills from the pharmaceutical industry and the latest medical interventions should they fall ill. A high percentage of America's population are now taking multiple artificial (thus patentable) medications. Not much thought is given to how these meds might interact or what the long-term effects will be. I know of a case in which the patient's own well-founded concerns about her kidneys were unwisely ignored by her doctor, causing her kidney dysfunction to worsen. This kind of malfeasance occurs overseas, too, and seems to be common in economically advanced countries, where people have a particularly positive view of technological advancements. It is exacerbated by the economic-related factors listed above.
All of the above factors, in turn, feed into the fifth: profiteering off of people's helplessness and misery. Unbelievably exorbitant fees can be charged to people facing life-and-death emergencies, but what kind of inhumane society allows this? This issue is also universal and can be seen throughout history because illness is so easy to exploit. Japan's medical system, as I mentioned in Part 1, herds patients toward profitable dialysis. It does this by denying insulin to nearly all type 2 adult-onset diabetes patients, and similarly, women are denied oral contraceptives, feeding Japan's notorious abortion industry.
Yet I know of no case as extreme as that of the US. If families in Japan were bankrupted under these circumstances it would result in a significant outcry. What has been done in this age of sharing information to stifle tis outcry? I think the answer is factor 6, extreme partisan politics in the US, where people are too busy fighting each to address problems they face in common.
The cash flow from all this overpricing and captive profiteering goes toward further empowerment, legal and otherwise, of the profiting interests. The Affordable Care Act (ACA) was such a weak-kneed, long-delayed attempt at addressing these burgeoning issues and propping up this extremely corrupt, failing system just a little while longer, without upsetting corporate sponsors, that it even failed to pan out as a corporate boondoggle. Mitt Romney, a Republican, is said to have first proposed this kind of system, which is ironic since the Republicans were up in arms about it when President Obama did the same. The ACA seems like a sick joke to working class Americans who cannot afford even the lowest levels of coverage and have had to pay the tax penalty out of necessity.
All the other problems I've identified relate back to one or more of these five interrelated fundamental issues. I'll take a deeper look at these in Part 3.
*Soedarso Djojoseputro (2012) Hantam Stroke dan Kanker dengan Kunyit Putih (Beat Strokes and Cancer with White Turmeric), Surabaya: Pernebit Stomata. And see this for another example of a herb the Indonesian government has promoted for general health.