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Title: Unveiling the Unseen Cracks: The Questionable Quality of U.S. Healthcare

The American healthcare landscape translates patient distress into increased earnings: tactical delays, concealed billing tactics, and escalating costs are the disconcerting reality of subpar care.

In the hospital, a person takes a seat on their bed, time seemingly standing still as they await...
In the hospital, a person takes a seat on their bed, time seemingly standing still as they await their turn.

Title: Unveiling the Unseen Cracks: The Questionable Quality of U.S. Healthcare

As President Biden's term winds down, an astounding 24 million Americans are now covered by Affordable Care Act (ACA) health insurance, marking a significant increase from the number enrolled during his early tenure. Despite this expansion in access to healthcare, many question whether we're truly fixing the system or simply magnifying its flaws. Our healthcare industry, still rooted in its initial structure, hasn't seen substantial transformations since its inception.

A prime example of the system's inherent issues is illustrated by my friend's experience with appendicitis. Despite urgent need for surgery, his appendectomy was delayed due to prioritized emergency cases, resulting in a longer hospital stay and substantially increased bills. Much like other sectors, poor care in healthcare often translates to higher revenue, a peculiaristic trend.

The healthcare industry primarily operates under a fee-for-service model, where the more services provided, the higher the revenue. This determinant nevertheless offers no incentive for superior quality. Remarkably, if this situation had unfolded in any other industry, my friend would have been compensated for the subpar service. After all, his condition was jeopardized, along with his finances and emotional well-being.

Although the No Surprises Act aims to rectify billing issues, it has inserted complications, including potential insurer abuse, inflated arbitration costs, and financial strain on underpaid healthcare providers. The essence of this model remains unchanged - in healthcare, undesirable care may still equate to greater revenue.

It is unlikely that medical professionals intentionally degrade care for the sake of higher earnings. However, the U.S. healthcare system is organized to allow, even encourage, dubious billing practices. Misrepresenting patient health status or a higher level of service in medical charts, known as "upcoding," resulted in over $14.6 billion in additional hospital payments in 2019. As more electronic health records and AI are deployed, these questionable practices thrive, raising concerns about AI's accuracy and physicians' limited oversight.

Insurance plays a vital role in providing Americans access to necessary healthcare. Regardless, we must modernize our payment model to transform every dollar spent into enhanced health rather than escalating bills.

Despite the expansion of ACA coverage, many contend that the healthcare system is merely magnifying its existing flaws rather than fixing them. For instance, poor care in emergency rooms can lead to expensive medical bills for patients with private insurance. Despite the delayed appendectomy, the No Surprises Act, intended to rectify billing issues, has introduced complications such as potential insurer abuse and inflated arbitration costs. The fee-for-service model, prevalent in the healthcare industry, promotes revenue growth by providing more services, not necessarily of higher quality. Unfortunately, subpar care can still result in increased revenue, with practices like "upcoding" leading to over $14.6 billion in additional hospital payments in 2019.

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