Sadly, it appears our healthcare delivery system is in a perpetual state of crisis. Millions of our citizens live in rural areas served by small hospitals and those hospitals are closing at an ever accelerating rate. At the same time, mismanagement and corporate greed are forcing the closure of hospitals in metropolitan areas as well. Venture capital is buying up the practices of individual doctors and groups of doctors and jacking up prices as soon as they have the economic power to do so. Across the healthcare landscape, costs are going through the roof. This cannot go on much longer. It is unsustainable. We are reaching a tipping point. It is long past time for the people to stand up and insist that health care is too important to be left to market forces.

Rural hospitals get paid by patients, who may or may not have insurance. The government may help these hospitals a little bit but does not provide enough support to enable them to continue full operation. Doctors, especially specialists, gravitate to metropolitan areas because that is where the paying patients are concentrated.

All of this has a terrible effect on health care delivery in rural areas. There are not enough insured patients in rural areas to support full-service hospitals or doctors, who would like to be paid enough to have a comfortable lifestyle.

Many women of child-bearing age now live in what have been called maternity deserts. There are no hospitals near them that provide labor and delivery services or that have neonatal intensive care units. The hospitals that used to provide these services have been forced to close due to market forces. There are many rural communities, especially in poorer areas, that have almost no or only a few primary care physicians. Getting sick in one of these areas is definitely bad for your health. Getting sick in the cities is bad too, unless you are well-off.

Our health care delivery system is closely related to our system of health insurance. Unlike most of the rest of the world, our system, which has its roots in WWII price controls, is private pay, fee-for-service, with the majority of people receiving their health insurance through their workplace. The cost of that insurance must and does increase as the cost of health care rises. While employers used to pay most or all of the cost of health insurance for their employees, more and more of that burden is being shifted to the employee. Many employers are no longer able to afford any insurance for their employees.

The bottom line is that the cost of health care is rising faster than the rate of inflation as new treatments become available and new medicines reach the market. Those costs directly impact the ability of people to afford the healthcare they need, whether they have insurance or not.

Some of the forces pushing healthcare costs higher are not market based, but are the result of big players pushing up prices to increase the money they can remove from the system. Big Pharma, hospital chains, venture capital, large health insurance companies, and pharmacy benefit managers exert a huge influence on what happens to the price of health care delivery. Given their size and market power, they are formidable foes with armies of lobbyists, who work hard and donate lots of money to make sure the system does not change enough to damage their economic interests.

As a country, we cannot afford good health care for all our citizens while at the same time allowing these big players to siphon billions out of the system each year. There just is not enough money. Something has got to give. The solution must, of necessity, be a national one. Unfortunately, the gridlock in Washington pretty much guarantees that big changes like the ones needed to get our healthcare system on track are not going to happen anytime soon. Watch for things to get worse.

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