Today I got a bill from the doctor. The doctor I saw last July. Really?
I stared at it for a minute, trying to remember what that visit was even for. And then I laughed, in that tired way you laugh when something is absurd but also just... normal here. Because this is the United States, and this is how healthcare works. You go to the doctor, you think you're done, and then months later, an envelope shows up asking for money you didn't budget for, for a visit you'd already half-forgotten.
It made me think, again, about how different this all feels from where I grew up.
I grew up in Russia, where healthcare was a public service. You were assigned to a hospital based on where you lived, and that was that. Everyone had the same rights — except, of course, people in positions of power (there's always an exception, isn't there?). The system wasn't perfect. It had plenty of its own problems. But one thing people didn't have to do was lie awake wondering whether they had the "right" insurance plan before they could see a doctor.
Before I moved to the U.S., most of what I knew about American healthcare came from movies. I remember smiling — I don't smile at this anymore — every time a patient in a film got asked for their insurance number before anything else. It seemed like such a strange detail to include. Now I know why it's always in there.
Living here, I've had to learn an entirely new vocabulary just to survive a doctor's visit: deductible, copayment, in-network, out-of-network. Honestly, I still don't fully understand my deductible. I've called my insurance company more than once, sitting on hold, trying to figure out if a specific procedure would even be covered — and coming away more confused than when I started.
It's stressful in a way that has nothing to do with actually being sick. It's a second job just to understand your own coverage.
Sometimes it feels like the whole system — healthcare and insurance together — cares more about profit than about people getting the care they need. And when a bill like today's shows up, months after the fact, it's hard not to feel that way all over again.
So Why Doesn't the U.S. Have National Health Insurance?
The U.S. is the only industrialized country without it, and I've been thinking a lot about why.
One common explanation is culture, at least it is said in sociology books. Americans are more individualistic, they don't want to be told what to do. Many people, especially conservatives, believe the government shouldn't play a big role in people's lives. Well, I saw a version of this during COVID, when a lot of people refused to wear masks in public. But at the same time, some of those same people were willing to take horse medication ivermectin driven by misinformation on social media. So I'm not fully convinced that "limited government" is really the core reason.
I think it's mostly about money - the financial interests of the healthcare and insurance industries themselves. A huge chunk of what we spend on healthcare never even reaches patient care — it goes to hospital costs, drug prices, paperwork, and profits. And insurers spend real money just to figure out how to deny claims, not approve them. Doesn't it sound familiar when your doctor decides what you need and your insurance company decides what they're willing to pay for. Unfortunately, those two things are not always the same thing, and the person caught in the middle is you.
What I Keep Coming Back To
Other countries seem to treat healthcare as something too important to leave to the market — something that should be accessible to everyone, not just people who can afford the right plan. In the U.S., it often feels like healthcare has become a profit-driven industry first, and a basic right a distant second.
Having lived on both sides of this — the imperfect but public system in Russia, and the complicated, profit-shaped system here — I keep coming back to the same belief: healthcare should be about the patient and their health first. Not about whether the treatment is profitable enough to approve.
Anyway, I still have to figure out what that July bill was actually for.
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