In this white paper, Michael Carnahan, Senior Director of Client Services, creatively intertwines the complexities of the American healthcare system with the dramatic elements of a Shakespearean play. The paper humorously depicts the challenges faced by individuals like Romeo, who are transitioning from private insurance to Medicare, and those like Juliet, who are seeking accessible healthcare at 65. Mike delves into the humor and tragedy within medical billing, insurance complexities, and the costliness of healthcare procedures.
Please click on the video to the right to learn more about the author, hear his insights on this white paper, and learn what motivated him to write about the comedy and tragedy in healthcare.
To discuss this white paper in detail, please contact Michael using the information provided at the bottom of the page.
Friends, countrymen, lend me your ears. I speak not to disprove of our healthcare system, but here I am to speak what I do know. We all did love the system once, and not without cause. What cause withholds us love it now? While American healthcare and a Shakespearean play are two vastly different subjects, they can be compared in terms of their complexity, the role of human experience, and the impact they have on society.
I imagine a world where instead of Montagues and Capulets, we have private insurance and public healthcare. In this paper, I will explore what happens when the drama of the American healthcare system is seen through the lens of a Shakespearean play. Hold onto your co-pays; this could be a wild ride.
I’ll first set the stage. We are in the realm of Medicare, where the citizens of the United States, after reaching a certain age, find themselves equipped with a golden ticket to their healthcare needs. This is touted as getting VIP, all-access credentials to your favorite sporting event or concert. That is of course, if your favorite event included lab tests, medical visits, and prescription drugs.
Our heroine, Juliet, recently turned 65. She finds herself in the welcoming arms of Medicare. "Oh Romeo, Romeo, wherefore art thou, Romeo?" she asks. In this case, “Romeo” isn’t a star-crossed lover, but her primary care physician, who has seemingly vanished. With Medicare on her side, Juliet thought accessing healthcare would be so much easier. Little did she know her Romeo had joined the throngs of doctors who did not accept new Medicare patients due to its lower reimbursements.
Our next player is Romeo, a hard-working young man who just turned 26 and now finds himself separated from his parents’ Cadillac Plan private insurance. "But soft, what light through yonder window breaks? It is the East, and Juliet is the sun." The light Romeo is referring to is the blinding reality that crashed in and shines on his new predicament. He is now uninsured, and Juliet, his sunshine, was out of his reach, now in the realm of Medicare.
This is shaping up to be a major tragedy, but fear not. Just as some struggle to decipher Old English, we have learned folks tackling the language of insurance and medical billing. "The lack of universal healthcare in the United States is a tragedy that perpetuates inequality,” says David Himmelstein, professor of public health and health policy. "Is this a medical bill I see before me?" Romeo cries, holding a letter that describes why he owes a small fortune for his last doctor's visit. It appears his lack of insurance had ushered in a comedy of errors.
In a comedic turn of events, our love-struck couple attempts to navigate the healthcare system. Romeo attempts to woo Juliet by gifting her an HSA, not realizing she's ineligible as a Medicare beneficiary. Juliet tries to help Romeo by adding him to her Medicare plan, forgetting that Romeo is far too young to be accepted into the realm of Medicare.
Just as in Shakespeare's comedies, the duo finds themselves in tough situations with complex plot twists. They grapple with the paradox of having the world's best yet most expensive healthcare system, leaving them wondering if the true problem isn’t the system itself. Wendell Potter, a leading advocate for insurance reform and the former President of Cigna, states that "The exorbitant prices charged for basic medical procedures in the United States are so outrageous that they belong in a satirical comedy sketch." Mr. Potter is extremely vocal about the failure of the current model of healthcare reimbursement. In our scenario, the characters would most likely say, "That which we call a deductible, by any other name, would still empty our savings account."
The counterpoint comes from Elizabeth Hovde, Policy Analyst and Director of the Centers for Health Care and Worker Rights. She argues that a single payer system in America would be far too costly. She references the VA system as “not only costly with inconsistent medical care results, but it’s also an American example of a single-payer, government-run system. We should run from.”
In the end, just as with any good Shakespearean comedy, there's a resolution. Juliet discovers that her beloved doctor does accept Medicare Advantage plans. Romeo, after a brief stint as a wandering lute player (gig economy of the time), gets a job with a generous employer-provided health insurance plan.
The two houses are made to see the errors of their ways. Our two houses could be anyone, from a frustrated patient and an exasperated doctor, or a payer and a provider. They are forced to acknowledge their incongruities and pledge to work towards a solution.
"Parting is such sweet sorrow," Juliet quips to the complex world of healthcare as the curtain falls. Alas, in this scenario, unlike the Shakespearean one, the characters may find peace, but the system remains a perplexing puzzle, waiting for resolution.
And so, the parallel of US healthcare to a Shakespeare comedy ends, not with a tragedy, but with hope, laughter, and an intense desire for resolution. A resolution where the system now has less comedy and tragedy and provides better patient outcomes. As the characters in this “play” exit the stage, they leave the audience wondering if “All's well that ends well,” but when will it truly end well?
One thing becomes clear, the US healthcare system is indeed a stage, and all us citizens are merely players, each playing their part in a Shakespearean play of epic proportions. "Romeo and Juliet" ends with a bitter lesson, as the two families (insert factions or political parties) reconcile their differences only after the tragic death of their children. They learn that their feud has cost them what they loved most. Similarly, the American healthcare system is headed for a profound reckoning. The current model, marred by conflicts between private and public interests, impacts the country's most vulnerable citizens. The consequences can be widespread and long-lasting.
As we move forward, however, we can’t lose sight of the importance of choice, economic freedom, and personal responsibility. We must embrace a healthcare system that prioritizes innovation and quality of care. Only together can we shape a future where all in the United States have access to affordable high-quality health care.
