This morning’s Star Ledger reports on New Jersey Governor Phil Murphy’s order to seek a new vendor to operate New Jersey’s state-administered veterans’ homes.  This comes as a direct result of a statement by the U.S. Centers for Medicare and Medicaid Services (CMS) that patients at Menlo Park’s Veterans Memorial Home are living in a state of “immediate jeopardy.”  CMS has cut off funding for new admissions to that facility based on observations last summer of improper care, incompetence, negligence, and abuse.  The agency warns that it will eliminate all federal funding for the center if problems are not resolved by March.

While it is a disgrace that these circumstances threaten the well-being of elderly veterans, perhaps it will draw more attention to the negligence, waste, fraud, and abuse that pervades our health care system nationwide.  According to a separate CMS report, the amount Americans spend on health care reached $4.1 trillion in 2020, 19.7 percent of our country’s gross domestic product (GDP).  Given this bizarrely extravagant expense to us all, we might investigate where all of that money goes.

Questionable care afflicts nursing homes nationwide, both publicly and privately administered.  Quite simply, the nurses and health aids working most closely with patients are poorly compensated for work that demands patience, compassion, and professionalism.  As the radius widens, senior staff, physicians, management, and executives receive salaries much more conducive to continuity and a sense of feeling valued.  Regrettably, the decision makers receive greater remuneration for keeping costs down, primarily by underpaying those who make the most meaningful contribution to patients’ wellness.  At the level of direct engagement with those receiving care, this leaves a core of dedicated workers struggling desperately to provide quality care alongside colleagues who range from undertrained to poorly qualified to disaffected to disinterested.

And even beyond the sector that cares for our elderly, exorbitant prices glare egregiously out at any patient who takes the time to examine a bill for his or her care in any medical facility.  The most fortunate among us have insurance that covers most of the charges, and this obscures the true costs of our system.  As employers offer health insurance as part of compensation packages, and as insurance premiums rise more precipitously than the rate of inflation, few employees ever consider or investigate how much more monetary compensation they would receive if not for exorbitant premiums.

Meanwhile, insurance companies justify their premiums based on drastic increases in the costs of pharmaceuticals and medical equipment.  Beyond that, physicians must pay for malpractice insurance; hospitals claim they must overbill for procedures and mark up medication in order to cover charges that they will never be able to collect from the uninsured.  As all in this system rationalize our country into squandering the value of nearly a fifth of its production on fragmented, incoherent medical care, the public institutions responsible for the most vulnerable members of our society–the poor, the disabled, and the elderly–are drawn ever deeper into the overall system of extortionate costs.

We would seem, then, to have little choice because of today’s story in the Star Ledger but to acknowledge abject failure of the current state of things.  We might dare to hope that the danger to veterans who deserve dignity and devoted care will provoke the necessary outrage to bring about reform.

More realistically, though, and perhaps cynically, our distinctly American medical-care crisis will continue to elude the informed, resolved understanding of all but a few people–just as it has done for more than five decades–deepening itself ever more in the process.