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A Single Payer Healthcare System Might Make Us More Like Puerto Ricans

Why do Puerto Ricans live longer that we do here in the 50 United States? Just perhaps it is because they have a better healthcare system than we do. The US trails 35 other countries or territories in life expectancy, including Puerto Rico, Costa Rica, Martinique, and Guadeloupe (we are in a tie with Cuba). The “For-Profit” healthcare industry advocates like to blame America’s low life expectancy on “demographic factors” such as race and “pockets of poverty”. Sometimes they also blame the lavish unaffordable excesses of European styled socialized medicine.

Ethnic demographics do affect life expectancy statistics and we are an ethnically diverse nation, but there is nothing unique about that. Many other countries have any one of our ethnic groups as a larger proportion of their population than we do and still do much better in terms of life expectancy. Puerto Rico, Costa Rica and Cuba are very ethnically diverse and do better. Martinique and Guadeloupe are less diverse with a clear Afro-Caribbean majority, and they do better. You can’t blame America’s poorer life expectancy on our diverse ethnicity.

What about “Pockets of Poverty”? The US per capita income is twice that of Puerto Rico, more than 5 times that of Costa Rica and almost 10 times that of Cuba, and they do better. Their “pockets of poverty” have to be worse than ours. You can’t blame America’s poorer life expectancy on our “pockets of poverty”.

What about the lavish budgets that socialized medicine healthcare systems have? They actually spend much much less on health care than we do. The US leads the world in healthcare expenses per person, typically by a factor of 2 or more compared to even the high end European countries like Germany,  and dramatically more than the poorer Caribbean examples above. You can’t blame America’s poorer life expectancy on the large size of foreign healthcare budgets.

If life expectancy is clearly not just about race or income or healthcare budgets, than why does the US rank only #36 in terms of life expectancy?

The US low life expectancy is first of all a result of our corrupt for-profit healthcare system. Our system is fundamentally corrupt because we allow doctors, just like our politicians, to work in an environment where “conflicts of interest” are not only tolerated, but they are a fundamental part of the system. The life and death decisions that doctors are being entrusted to make on our behalf are tainted by the motive for personal profit, just like politicians. What we have accepted as business as usual here at home is criminal in many, if not most, other civilized countries. The New York Times reported:

U.S. Inquiry of Drug Makers Is Widened

“At least a dozen major drug and device makers are under investigation by federal prosecutors and securities regulators in a broadening bribery inquiry into whether the companies made illegal payments to doctors and health officials in foreign countries.

…In the United States, companies routinely hire doctors as consultants to market drugs and devices to their colleagues and other health professionals at medical conventions and small gatherings. Such consulting arrangements are legal in the United States as long as the companies do not pay doctors directly to write prescriptions for their products.

But in much of the rest of the world, doctors are government employees. And even consulting arrangements that would be considered routine in the United States might violate the Foreign Corrupt Practices Act, particularly if the payments are outsize or the arrangements are not disclosed to the governments.“

Imagine the shock on the faces of the American executives when they found out that creating a conflict of interest for a doctor in other counties is illegal, unlike here at home.

It is not just about conflicts of interest that are driven by bribe like payments. It is inherent in the fee for service model that we rely on. We have relied on this system for so long that we have forgotten that simple fact of human nature; most people tend to act in our own best interest, devil be dammed.

Many of our doctors order unnecessary CAT scans, even though each has a radiation exposure of 350 chest standard X-Rays.

Some are installing unneeded cardiac stents even though it is often unnecessary and it involves a somewhat risky Roto Rooter like procedure.

It is common to take money from drug manufacturers who then do their best to track individual doctors prescribing habits by buying your healthcare records from your pharmacist so that they can target “under performing” doctors, a tactic recently approved of by the Supreme “Open for Business” Court.

Some doctors are even now owning laboratories and imaging tools, or even hospitals, and some of them seem to specialize in driving up costs as high as possible.

Between most doctors inherent conflict of interest, and the ruthless profit motive of many insurance companies and hospitals, most decisions made today in healthcare are tainted. Forget Marcus Welby, he’s history. Whenever a physician makes a decision that is affecting income it is a conflict of interest. In the typcial private sector, an employee that makes a decision that is tainted by a personal conflict of interest gets fired.

Setting up a national health plan modeled on the VA hospital system, or a single payer plan like “Medicare for all” could all help to the extent that it puts doctors on salary, if it also prevents them from having a financial interest in their treatment decisions. In theory hybrid systems with a strong public insurance option might help but it would be critical to eliminate the conflicts of interest.

We are dying younger that we need to because our doctors and over priced healthcare system are corrupt. We need to take the profit out of the decision making.

A longer (1500 word) version is cross posted at

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