Health Care in America 101: Part 1- Why is it F#cked Up?

America is a great country. We excel at research and innovation. We are leaders in so many things. Why is health care struggling in this great nation? What is the problem?

Welcome to Health Care In America 101! I wanted to talk not just about our own health in this blog, but  also the health of our community and the nation. Something is not right.  I will spread this over 4 articles and as we try to unravel it and work towards a blueprint solution. First we need to understand what is wrong. This is a primer. I tried to make it a little fun, less words, more pictures. Click on any picture or graphic if you want more information.

I’m a practicing physician in Reno, Nevada and have been a doctor for about 30 years. I’ve worked in 3 different health systems I’ve been a part of U.S. Health Care for the past 15 years and watched healthcare change from the pinnacle of success for a developed nation to becoming a murky, expensive fight amongst corporate entities for middle America’s dollars. Where did we go wrong? Let’s see if we can unravel how we went from nightingale floors and charge nurses with clipboards who rounded with physicians to EMRs, denials of care and bloated co-pays.

This is Part 1 of a 4 part series looking at American Health Care. I’ve written about this before but have updated it, especially after the Coronavirus economic meltdown.

Part one looks at defining the problem; the problem in a nutshell is we pay too much and get too little.

If US HealthCare was a country, it would be the 5th largest country in the world, bigger than 188 countries!

Health Care is big business. It makes a lot of stakeholders a lot of money, but the money has to come from somewhere. We seem to have excellent quality of care and good access yet fundamentally the system appears broken. That’s important to remember as we work through this.


We spend a lot on healthcare:

As a percentage of GDP, we are also the highest. Bear in mind we have the highest GDP in the world at $21.41 trillion which is bigger than China, four times that of Germany, ten times that of Canada and more than China and Japan combined. Given this it’s still shocking that we spend so much on healthcare:

Combining healthcare spending per capita and GDP per capita, we are an outlier:

To get an idea of what spend on healthcare, U.S. health care spending grew 3.9 percent in 2017, reaching $3.5 trillion or $10,739 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.9 percent.

When we look at Total Federal Government spending, Medicare and Health comprises 27% of all spending in 2015, more than total military spending. This amount does not include private sector spending.


What does all this tell us? It tells us that the most prosperous country in the world spends an inordinate amount on healthcare whatever way you cut it and that amount is increasing. U.S. Health Care has become as much an industry as motion pictures, defense or technology.

What do we get for this spending? Not as good as we think.

We pay a lot for our health system but  we lag on many basic metrics of health care. We have great nurses and physicians, cutting edge research, the latest technologies yet for the cost of delivery it is not translating into better outcomes any way we cut it, and guess what,  it’s getting worse:

Middle America is paying for this spending with increase in premiums and deductibles:

Despite all we the hospitals, urgent cares, mid levels, clinics, pharmacies and technologies, for many it’s getting too expensive:


Is it because we the customers use too much? Expense is a function of price and volume. If things are being used too many times, or if things are too expensive, cost goes up. Interestingly in the US patients often spend less time in hospital than in other countries:

Patients in America see their doctors less often:

but, if they have surgery, generally it costs more:

and if they get prescriptions, they cost more:

Every week see stories of Americans with insurance being sent exorbitant bills:


So, despite less doctor visits, if patients need surgery or prescriptions in the US, it costs more. There lies the rub.

The problem with American Health Care  is one of value;  we are getting less for what we pay for and we pay a lot.

This system was laid bare by the Coronavirus pandemic as one that does not put consumers first; it’s profits before people:

This brings me back to what is probably my favorite YouTube video which encapsulates the myth we’ve been living in for the last few decades please take a few minutes to watch and digest it. It’s a good metaphor for where we are:


n this blog and upcoming blogs we will cover the following:

Health Care in America 101: Part 1- Why is it F#cked Up?

Health Care in America 101: Part 2- Who Pulls the Strings?

Health Care in America 101: Part 3- How Are We Ripped Off?

Health Care in America 101: Part 4- The Way Forward


Agree? Disagree? Feel free to like or share. The pictures all link to the original source so please explore. Feel free to leave a comment below.


Lali Sekhon, MD, PhD, MBA| Father | Husband | Neurosurgeon| Hockey Fan | Innovator | Inventor | Educator | ΒΓΣ | Health Care Leader | I'm a neurosurgeon (MD, PhD, MBA, FRACS, FACS) who has been a physician for over 30 years. I'm also a tech junkie and a cynical optimist. Having completed a medical degree, a PhD and an MBA, I can give you an honest opinion on anything related to medicine and health care with tips and reviews and commentaries. Some of the topics are related, others, somewhat related, but all for the layperson: honest, simple and practical. It's not brain surgery!

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