What “The Wizard of Oz” Tells Us About Transforming US Healthcare

Centering heart, brains, and courage in the US healthcare system may be our yellow brick road.

Much like the tornado that swept Dorothy from her Kansas home and into The Land of Oz, many of us have found ourselves in a disorienting spiral throughout the course of the pandemic.

As the COVID-19 pandemic has abundantly show-cased, the United States healthcare system is no exemplar. Confusion around personal protective equipment (PPE) protocols, intensive care units filled to capacity, and supply chain challenges with vaccine rollout are a few of many challenges faced nationwide throughout the pandemic. Imagine the terrifying scene with all the flying monkeys and that about sums it up.

Additionally, many are feeling a personal toll due to lost time, social isolation, sickness or death, and economic hardship. It goes without saying that our hearts, minds, and courage as individuals and a collective have been put to the test.

This whirlwind made for a sobering realization, or re-iteration, depending on your familiarity with matters of the US healthcare system: healthcare needs a hero, or wizard, if you prefer. Frankly, it has needed one for a long time.

Let’s be clear. COVID-19 illuminated and exacerbated inefficiencies and inequity in healthcare, but it certainly did not invent them. Just ask any of the 1 in 5 insured adults who have received a surprise medical bill in recent years, or those rationing their insulin in order to make ends meet. Issues associated with the rugged patchwork that is US health insurance have been around for decades.

From a consumer standpoint, healthcare is unnecessarily difficult to navigate. Inexplicably high costs, “junk” plans, private equity lobbying and corruption, oh my. Even those who are aware of the pitfalls of the US healthcare industry are not immune to surprise bills and the like. Take for instance Dr. Zachary Sussman, who was billed $11,000 for receiving a COVID-19 test at his own work facility, or Sarah Kliff, a health policy journalist who regularly reports on the issue of Surprise Bills who was nearly subject to one herself.

Without a “yellow brick road” of sorts to guide us, it is easy to see why many consumers struggle. The process of obtaining and utilizing healthcare coverage is convoluted. Between navigating the marketplace, having insurance tied to one’s employment, finding the right amount of coverage, or ensuring all providers fall within a respective network, there is a lot to get right.

Factor in intentionally predatory schemes of some private equity firms and insurance companies that put profit over people, and it begs the question whether “doctor knows best” after all. We are taught to trust that the care we receive is provided in our best interest, yet there are often questionable strings attached and many feel they cannot risk a high medical bill unless survival depends on it. One mother was advised by poison control to take her child in after taking an unknown amount of Dramamine; instead, they sat in the parking lot just outside the emergency room, waiting it out to see whether immediate care was absolutely necessary.

It is the mark of a broken system that parents must weigh their children’s survival with the cost of care, and another person’s final words are ones of distress about how their medical bills will be paid.

(In case you want to take a longer spin on the Wicked Witch’s broom through the world of healthcare corruption, the Lown Institute put together a clever expose on the bad eggs profiteering and creating dysfunction in health care with their annual “Shkreli Awards” — Check it out here.)

Inefficiency and fragmentation in healthcare are problematic for a multitude of reasons. Despite spending more on healthcare than any other developed country, life expectancy in the US has declined, with more disparate gaps in outcomes for Black and Latino Americans. Further, with medical debt accounting for as many as 60% of bankruptcy claims in the US, one’s ‘health’ comes at a high cost. It would be one thing if high cost, difficulty accessing care, and diminished quality somehow led to positive health outcomes, but it clearly does not. Instead, it comes at the expense of our collective physical, mental, and economic well-being.

According to surveys by West Health and Gallup, half (50%) of all United States adults are concerned that a major medical event could lead to bankruptcy, an increase from an already-troubling 45% in 2019. What is more is that this figure has risen from 52% to 64% for non-white adults, indicating more dire financial and health concerns all-around, and especially for historically underserved populations.

Consider the not-yet-fully-understood health complications and financial devastation associated with COVID-19 (e.g. job loss; loss of employer-funded insurance), and one can infer that this hardship has only been exacerbated by the pandemic. All this is to say that any issue with the healthcare system, let alone ones of this magnitude — loss of insurance coverage, fragmented access to care, prevalence of out-of-network bills, high prescription drug costs, predatory private equity firms, and beyond — are highly consequential for the nation’s comprehensive well-being.

In the detritus of the storm that is this pandemic, we are left with serious considerations for equity and well-being moving forward. We are at a precipice where moving beyond ‘bandaid solutions’ is called for in more ways than one. Countering the issues of affordability, access, and quality of care is a formidable task, but not impossible.

Addressing wicked problems and transforming healthcare will require us to relinquish the notion of feasibility. All too often, we limit ourselves by operating within constraints presented by those dedicated to maintaining the status quo, or we expect some powerful player to grow a conscience and wave their magic wand, saving us. Unfortunately, no one is coming to our rescue on this matter, and we are not in Kansas anymore. In order to surmount the challenge of health care fragmentation and inequity, we must dare to imagine courageously and act as a collective.

Fortunately, we are not completely rudderless in this pursuit. With the help of patient-centered organizations, consumer health advocates, and other champions of health equity, we have the fundamental pavestones needed to rise to the needs of the moment — hearts, brains, and courage.

“I thought Oz was a great green Head,” said Dorothy. “And I thought Oz was a lovely Fairy,” said the Scarecrow. “And I thought Oz was a monstrous Beast,” said the Tin Woodman. “And I thought Oz was a big ball of fire,” exclaimed the Lion. “No, you are all wrong,” said the little old man meekly. “I have been making believe.” “MAKING BELIEVE!” cried Dorothy. “Are you not a real Wizard?” ―The Wonderful Wizard of Oz (1900)

Much like Dorothy, The Lion, Tin Man, and Scarecrow bravely banded together to understand the Wizard, the same is required of us. The COVID-19 pandemic has showcased our collective humanity and interconnected nature, and the impetus is on us as a nation to respond together. Extraordinarily challenging circumstances call for extraordinary responses. While it has not been a perfectly seamless pursuit by any means, rollout of the COVID-19 vaccine has showcased that making healthcare accessible and affordable for all has positive implications for managing public health and safety. Think of what else is possible when we look out for one another’s well-being and think about what is best for society at large.

We all have health in common, and keeping our population as healthy as possible is a key determinant in our success as a country, namely the longevity of our citizens, our economic output, and our social prosperity. Perhaps by putting our heads, hearts, and courage together via collective action, we may eventually be able to once again take pride in saying “there’s no place like home.” We already have the brains with the best trained medical professionals and modern medicine. But we need a little more heart to re-center the care of patients and their livelihoods, and a lot of courage to repave the hazardous road of healthcare.