Fact and Fiction: Debunking Myths in the US Healthcare System

Umut Sarpel, MD; Bruce C. Vladeck, PhD; Celia M. Divino, MD; Paul E. Klotman, MD


Annals of Surgery. 2008;247(4):563-569. 

In This Article

Abstract and Introduction

The United States has the most expensive and complex healthcare system in the world. Despite the magnitude of funds spent on the system, Americans do not achieve the high standards of health seen in other developed countries. The current model of health insurance has failed to deliver efficient and effective healthcare. The administrative costs and lack of buying power that arise out of the existing multipayer system are at the root of the problem. The current system also directly contributes to the rising number of uninsured and underinsured Americans. This lack of insurance leads to poorer health outcomes, and a significant amount of money is lost into the system by paying for these complications. Experience from other countries suggests that tangible improvements can occur with conversion to a single-payer system. However, previous efforts at reform have stalled. There are many myths commonly held true by both patients and physicians. This inscrutability of the US healthcare system may be the major deterrent to its improvement. A discussion of these myths can lead to increased awareness of the inequality of our healthcare system and the possibilities for improvement.

Although most people readily agree that the US healthcare system is deeply troubled, there is little consensus on how to resolve its problems. The current system is so cumbersome and confusing that anything but the most superficial discussion seems to require an advanced knowledge of medicine and public policy. As a result, both patients and their physicians are alienated from trying to understand and improve the system. Debates about the plight of the uninsured and the rising costs of health insurance tend to end in an exasperated sigh of resignation to the status quo.

Our peculiar system of employment-based private insurance has been called an accident of history. During World War II, a wage freeze prevented employers from attracting workers by offering higher salaries. However, fringe benefits were not controlled and employers soon discovered that they could compete for workers by providing health insurance packages. This benefit was highly valued by wartime Americans and enrollment in insurance plans soared. Employers willingly participated in this new union because they received financial benefits from the tax-free status of health insurance. Job-linked health insurance gained momentum and evolved into the system that stands today.

Many of the problems encountered in the system are deeply interconnected with other complex issues. For example, it is hard to talk about the reason for the growing number of uninsured without also discussing the history of Medicare/Medicaid, funding for medical education, government lobbyists, and tort reform. These are worthy topics that cannot be addressed within the scope of this paper.

The goal of this article was to give physicians the groundwork to launch conversations about the US healthcare system. The format for this discussion has been adopted from Dr. Robert Lebow's Health Care Meltdown: Confronting the Myths and Fixing Our Failing System.[1] Lebow identified many myths that are commonly held by both patients and physicians; for this discussion we have focused on 5 common misconceptions. The following myths are not intended to be an all-inclusive list of the woes of our healthcare system. However, they represent key and common misperceptions that are stumbling blocks on the path to improvement.

Perhaps it is important to state up front that this effort makes certain assumptions; it is understood that 1) members of a civilized society agree that there is an obligation to provide healthcare to those who need it, and that 2) there cannot be a tiered class system for access to healthcare, although people who are willing to spend more could have the option to do so. Our goal is simple: to spark discussion and focus attention to the issue of inequity of healthcare.


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