Claire Corkins (Ways of Seeing, Aug. 24) is rightly horrified at the prospects of waiting a year to see an “in-network” optometrist and joining an eight-month waiting list for primary care. But the lack of access she decries is “normal” throughout the U.S. and is only the tip of the healthcare iceberg.

In nearly all other affluent, modern countries, healthcare is a recognized human right, partly or wholly subsidized by the state, and available to all at little or no out-of-pocket cost. In many, medical outcomes and life-expectancy surpass ours.

In the United States, affordable, timely primary and preventive care is out of reach for millions, who are uninsured or “underinsured,” meaning that the only policies they can afford have such high deductibles that they are unusable except in the event of catastrophic illness. Millions simply live with preventable or treatable illness until worsening symptoms send them to emergency rooms and treatment becomes much more complicated, expensive and less successful.

Medical debt is often cited as the leading cause of personal bankruptcy, even for insured Americans, who are mercilessly hounded by hospitals and insurance companies for payment of staggering, incomprehensible bills. Workers who lose their jobs usually also lose the insurance that comes with them — often a whole family’s insurance — at a time when they need it most.

The American healthcare “system” is controlled by and run for the profit of huge insurance and pharmaceutical companies and hospitals and their obscenely compensated administrators. As it becomes increasingly difficult for doctors to survive independently, more and more must sell out to hospitals or large corporate practices. They are forced into networks, determining which patients they may serve, and told by insurance companies how they must describe and code diagnoses and what treatments and medications they may prescribe. 

As employees of hospital- or corporate-owned practices, they are also told how many patients they must see per day and how much time they may spend with them. They have no say in determining fees. Loss of professional autonomy and increasingly stressful working conditions have led many doctors to retire early or change professions.

Even before the Covid pandemic, there was a serious shortage of doctors, with too few graduating from an insufficient number of medical schools. (The shortage of nurses is even greater and their situation is more dire.) 

Vermont actually has a law, Act 48, requiring universal, publicly financed coverage. H276, a bill currently in the Legislature, proposes universal primary care as a first step toward implementation; but despite having 59 cosponsors, it has not been taken up in committee. 

Overwhelming popular support for a publicly financed, national health system is drowned by donations from insurance companies and “big pharma” to lawmakers at all levels, along with relentless pressure to keep healthcare a private, profit-generating commodity. Campaign promises of healthcare reform are forgotten when politicians realize the cost — in time, money and relentless opposition — of any serious challenge to the “medical industrial complex.” Even the best eventually abandon what seems a lost cause. Until a critical mass of elected officials commits to an all-out battle, fewer and fewer ordinary Americans will have access to effective, affordable, timely healthcare.

Judy Olinick

Middlebury