My class and the US healthcare system

I am teaching a class this semester focused on the use of quantitative methods to improve the delivery of healthcare. Such things as: How can patients get faster access to medical appointments with their primary care doctors? What are the dynamics of supply and demand? How can emergency room operations be improved? Can medical practices be reorganized and if so how much improvement will it bring?

I like what I am teaching, but I don't want students to get bogged down just analyzing models and crunching numbers. I'd like them to know the big picture as well -- especially what's going on currently in the US healthcare system, how it compares to other countries. I want to bring social aspects into consideration. Some may say this borders on activism and should be avoided in a class meant for engineers. But are engineers not supposed to work for the greater good?

Anyway, in my second class, I screened this documentary -- available free online. Sick Around the World compares the health systems of developed countries -- Britain, Japan, Germany, Taiwan, Switzerland -- and reveals the glaring flaws in the US healthcare system. As to how those flaws should be fixed -- well, that's too difficult a question. Recently, an academic whose research is on improving healthcare in developing countries said to me: "You can improve and make things better in poorer countries. But the US health care system - well, I don't think that is going to change."

Three key shortcomings emerge from the documentary. In the countries listed above 1) No one with a pre-existing condition is denied insurance 2) Everyone is covered one way or another 3) Pricing mechanisms are transparent and nobody goes bankrupt because of medical bills. Are these basic things too much to ask in the United States?

And last week, I had students read and discuss this essay by Malcolm Gladwell in The New Yorker. The essay is a few years old now, but the the issues raised are still relevant. Gladwell asks the question: Why doesn't the US have universal healthcare coverage? He posits that US policy-makers fear moral hazard, the idea that people may overuse the healthcare system if they have insurance. But is moral hazard really an issue in healthcare? Would you really increase the number of times you visit the hospital if you had better insurance?

Gladwell begins the essay with an intense description of tooth decay, a seemingly peripheral condition. But as he shows, those without insurance often ignore their teeth - with no health insurance, a dentist's visit is too expensive. Their teeth rot as a result. Their social skills plummet as they become increasingly conscious of the decay.

People without health insurance have bad teeth because, if you're paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn't, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you're not going to get a job as a receptionist, say, or a cashier. You're going to be put in the back somewhere, far from the public eye.

Bad teeth, thus, become an "outward marker of caste" -- the caste of the uninsured. Disturbing stuff. Go read the full essay.