The American health care system in 2024

Debra L. Glasser, M.D.

Photo by Olympia Wedding Photographer | Loewyn Behold Photography

This year I took on the challenge to understand the complex forces shaping American health care.

Though my acuity of these forces is not yet 20/20, I have shared how consolidation, corporatization and private equity investment in health care affect us.  

Many of you have commented on these columns. Sadly, it took the actions of a young assassin to bring these issues to the forefront of national news.   

Jan. 30: Our health care system is broken: Part 1

• Our broken health care system leaves none of us untouched. It affects our health. 

• Collaboration and legislation will hold key roles leading to solutions. 

• The goal is for us to have a health care system that is responsive, accessible, available and affordable for all. 

March 12  The corporatization of health care:  Why consolidation matters to all of us

“In this past year writing about the health care system, I came to realize that most of us feel depressed and powerless. Pawns in a system rather than patients, wondering if it will ever get better. We all experience issues with access, care, and cost, which we feel hopeless to change.” 

April 9  Health care bills that passed the Legislature this year — and what you can do for your health

What can you do? Take care of your health, be informed, and vote. 

Oct. 8  Public-sector health insurance rates are approved for a 10.7% increase:  What is going on?

This column took a deep dive into the forces driving cost increases. In the United States, where we have the most expensive health care system in the world, it has been shown that as costs have gone up, access and quality have diminished.   

An unexpected result of Hurricane Helene in late September and a near monopoly in the manufacture of IV fluids resulted in a nationwide IV shortage. Just last week, a friend was denied a liter of needed IV fluid, and was told the ongoing shortage was the reason.  

Nov. 19 How two local healthcare providers are weathering the national shortage of IV fluids

One of the newer trends in health care consolidation is "de-consolidation." We saw this twice locally when Providence St. Peter’s, in efforts to focus on its critical services as a priority (the hospital first and foremost), disengaged in different ways from two less profitable health care services.  

One is the upcoming closure of three of its physical therapy clinics in mid-January. If this change encourages growth in small, locally owned therapy practices, this will be a good thing. It could, however, infuse more energy into the corporate-owned practices. Time will tell. 

Dec. 17 The future of physical therapy with 3 Providence clinics set to close in January

The other trend in health care has been to consolidate specialty care into corporate private equity investment ownership, either separately or partnered with large health care systems. Providence Home Health Care and Hospice Services are in the process of being 50% sold to Compassus, a national private equity-owned corporation specializing in hospice and home health.  

Nov. 5 A major transition in hospice and home health is on the horizon here

Apparently, investors see profits in the running of (and then selling) health care services even when, in our case locally, the hospital found them operating at a loss.   How does this work? Might this have anything to do with the drivers of cost, loss of access and quality?  

In the past, providing medical care and healing services by people trained to do so, earned them a respectable income. That includes doctors, physical and occupational therapists, hospice nurses and more.  No doctors in practice of any specialty earned $1 million or more as the executives of healthcare corporations do with years less training.  

May 21 Primary Care Internal Medicine is dead

This column is an autobiographical story of my primary care internal medicine career and what we have lost with its passing.  

The column was picked up by Medscape, a large online source of medical information that most doctors and nurses read. I received more than 100 personal emails from physicians and nurses around the world, also grieving about the loss of general internal medicine practices and primary care in general. The devaluation of primary care is occurring worldwide, even in countries with socialized medicine.  

On a more positive note 

Collaborating with fellow columnist, Jill Severn, to share the good news about the Kiwanis Food Bank was a joy.   

Aug. 13  Eat your vegetables!

Though the extent of poverty and food scarcity saddened me, learning about this organization that involves numerous volunteers of all ages working together to grow and distribute food was deeply heartening.   

Last year’s New Year’s column bears rereading. 

Jan. 9 What are your 2024 New Year health goals?

To good health, happiness and success with your goals and hopes for 2025!  

Debra L. Glasser, M.D. is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com