Case Study in What’s Wrong With Our Health Care System

by Kimberly Garcia for Courthouse News Service

As I was being wheeled into what would become my first of three Magnetic Resonance Imaging (MRI) scans for a stroke, I thought to myself, “The United States does more MRIs than any other country in the world and charges more for MRIs than any other country in the world. Here I am getting an MRI a week after I presented to primary care, declaring, ‘I just don’t feel right.’”

I am not sure my provider listened.

I ended up becoming a prime example of what’s wrong with the U.S. health care system: Too much fancy technology for acute events, not enough upstream, preventive primary care.

As many of you may know, in the United States we have some of the most sophisticated and expensive health care in the world, but our outcomes lag woefully behind our technological sophistication.

We have the highest Gross Domestic Product in the world, and we spend $3 trillion on health care, which accounts for half of the health care spending in the world, according to the seven-part PBS documentary, “Unnatural Causes: Is Inequality Making Us Sick?” (2008). Yet our life expectancy is 30^th in the world, according to the acclaimed film.

In 2020, life expectancy in the United States was 78.99 years, lower than Puerto Rico at 80.35 years, Chile at 80.43 years, and Slovenia at 81.54 years among other countries, according to a 2020 report from Macrotrends, which did not include increased mortality from Covid-19, in which the United States leads, or lags behind, the world.

Our woefully inadequate medical outcomes reflect our poor life expectancy. Our maternal mortality rate is 9 deaths per 1,000 births, the highest in the world among fully developed nations — nearly double of most high-income countries — according to the 2018 World Atlas. Our infant mortality rate is 5.8 per 1,000 live births: higher than Cuba at 4.4, Spain at 3.3 and the Czech Republic at 2.6, according to the World Atlas. And our death rates are exponentially higher for women and children from historically under-represented groups.

When it comes to death from ischemic strokes, the United States fares better, at 4.2 deaths per 100 strokes, compared to 7.0 deaths in other fully developed countries, according to a 2020 report from the Peterson-KFF Resources Health System Tracker.

This statistic is good news for U.S. women, as stroke is the third-leading cause of death among women in the United States. Stroke kills twice as many U.S. women as breast cancer, according to 2020 reports from the U.S. Centers for Disease Control and Prevention.

Yet we pay exorbitantly more for MRIs, our main diagnostic tool for stroke, than in other countries. MRIs in the United States cost an average of $1,200, more than 12 times the cost in Japan, which charges an average of $98 per MRI, and more than 8 times higher than the cost in Great Britain.

I am proud to serve on the front lines of primary care, as a women’s health nurse practitioner and a certified nurse midwife, and that’s where I will stay. Fancy technology is great when it’s needed, and I teach it to my students. But day after day, I prefer offering good old-fashioned preventative care, by listening to women.

Kimberly Garcia, a doctor of nursing practice, certified nurse midwife and women's health nurse practitioner works as an associate professor at the University of Utah College of Nursing.

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