As a pediatrician working in primary care for the past 20-plus years, I have had a front-row seat to the daily joys and sorrows experienced by families in my local suburban community. Parental emotions run the gamut, from the delight of exchanging raspberries with a giggling baby, to the despair of witnessing a depressed teenager cutting her own skin and contemplating suicide. Lately, as families contend with persistent economic challenges, there seems to be more suffering than joy.
American families are struggling to make ends meet. Basic necessities, such as food, housing, healthcare, and education often feel out of reach. Several years ago, when my office started collecting social determinants of health questionnaires, the answers to the questions were overwhelmingly “no.” Now parents are frequently checking “yes” to issues like food insecurity, housing instability, overwhelming childcare expenses and unaffordable medical bills. When the cost of a copay for simply walking into a specialist’s office is fifty dollars, a person genuinely needing care might choose to forgo the visit in favor of saving money. In the midst of these complex issues, how can we strive to fix what is broken?
While I am not an economist, my experience managing a pediatric practice for two decades has given me a few useful things to say about healthcare economics. Everyone knows American healthcare costs are unhinged, and we have arrived at this juncture because our for-profit system has driven up prices over time. Hospitals, pharmaceutical companies, insurers and medical specialty groups are working to make money, ultimately at the expense of patients. Yet healthcare is not a normal commodity. We are all human, and our bodies inevitably break down. The need for healthcare is universal, and frequently that need turns desperate, not to mention prohibitively expensive. Healthcare is fundamentally different from the other products Americans consume. Unfortunately, the foundations of our healthcare system are precarious at best.
In the field of medicine, reimbursement has long favored procedures over prevention, which is why medical students would rather become dermatologists than pediatricians, and our country will inevitably experience a severe shortage of generalists. PCPs like me can lose money vaccinating patients and preventing disease, whereas minor surgical procedures earn hundreds, if not thousands, of dollars. As an example, treating a wart in my office with a single drop of cantharone garners $250, whereas vaccinating patients with Tricare (federal) insurance is a money loser. This imbalance illustrates the nonsensical cost structure of medical care.
Best of luck if you have a major medical catastrophe and lack adequate health insurance because you forgot to fill out your paperwork last month, your spouse was laid off, your active insurance plan doesn’t cover your catastrophe, or your ACA subsidies expired. Recently, our government passed legislation that will make it significantly more onerous for people to maintain Medicaid insurance. Why? Because the current administration would prefer not to fund healthcare for poor people (not to mention old people). If enough individuals lose Medicaid coverage due to missing paperwork, then the cost of federal healthcare spending decreases. In a system designed to fail, when infants die because their parents lack health insurance, who will be responsible?
Go Fund Me accounts abound on social media. Americans have grown so accustomed to encountering these heartbreaking stories that digital begging almost seems normal. It shouldn’t be. No one should be forced to create a Go Fund Me post to avoid medical bankruptcy, yet this happens all the time.
There is only one way to fix our healthcare system, and that is to establish a nationalized system in which everyone receives government coverage, regardless of employment, and insurance never lapses. My personal vision of a single-payor system is one in which our government actively deflates prices by setting reasonable rates of reimbursement for medical care, based upon actual operating costs, as well as the risks and benefits of that care. In such a system, dermatologists would still make good salaries, though not as much as they earn now, and the burdens of running a primary care practice would be lessened.
In the ideal system, private medical providers would be required to accept federal insurance. Sound too radical? As a compromise, federal incentives could be offered to private offices accepting high percentages of individuals with government insurance. Children with Husky insurance in my home state of Connecticut are often forced to wait months for specialty appointments because most local private providers do not accept state insurance. What good is having insurance if no one takes it, or the insurance fails to cover your needs?
Sometimes I joke with my husband that I could never leave him, because we receive our health insurance through his job. Leave my husband, lose my health insurance…not happening! On a serious note, access to health insurance can become the sticking point that prevents people from escaping abusive relationships or soul-crushing jobs, and this simply needs to change.
Part Two
No discussion of the challenges facing the American healthcare system, particularly from a pediatric lens, would be complete without a mention of autism. Autism is vitally relevant to the landscape of healthcare economics in the US.
There are mornings in my office when I encounter a startling number of non-verbal toddlers. The rate of autism in our country is currently listed at about one in 30 children, a percentage that has been steadily increasing over the years, in part due to better awareness and improved diagnostic tools, but also, in my opinion, because more children have the condition.
For reasons that remain unclear to me, our current government, while slashing women’s access to reproductive healthcare, professes to have an interest in understanding the factors underlying the autism epidemic. Decades of research have demonstrated that autism is a multifactorial condition, arising from a combination of genetic and environmental influences. Some environmental factors clearly have no effect on the likelihood that a child will develop autism. For example, multiple large scientific studies have repeatedly demonstrated that vaccines do not cause autism, despite the rubbish suggesting otherwise that was recently posted to the CDC’s website. If vaccines caused autism, then do-gooder pediatricians like myself would not be administering them.
FYI, the publishing of anti-vaccine rhetoric by the CDC is a particularly disturbing indicator that our current government cares little about the welfare of its citizens, and more about its own misguided agenda. Promoting fear of vaccines is an excellent way to make our population sicker. HPV-related cancer is a case in point. In Australia, where almost everyone has been receiving the HPV vaccine for the past 20 years, the rate of cervical cancer is nearly zero. Zero! In the United States, where smear campaigns orchestrated by our present political and healthcare leaders have instilled fear of the HPV vaccine, about 4000 women die each year from cervical cancer. Beyond these deaths, millions of people suffer yearly through the horror of dealing with abnormal pap smears, colposcopies, disfiguring warts, and painful/invasive surgeries for a multitude of cancers.
All this illness isn’t cheap. The cost of caring for people with HPV annually in the US is about eight to nine billion dollars, yet HPV-related disease is 100% preventable. When society chooses not to receive cancer-preventing vaccines, the population is less healthy than it could be, driving up the cost of health insurance for everyone.
Getting back to autism, if vaccines like Gardasil are not the problem, then where should we be looking to delineate root causes? Prior studies have pointed toward prenatal exposure to air pollution, pesticides and heavy metals, such as lead and mercury, as risk factors for autism. Poor maternal health and reproduction at an older age with mutation-prone gametes, particularly sperm from fathers over 40, have also been associated with autism.
Personally, my money is on the combination of older-age procreation, coupled with chemical exposures, particularly chemicals known to alter human gene expression or those that promote genetic mutations. Many of these chemicals are endocrine disruptors that adversely affect fertility, reproductive health, and the chromosomes of human reproductive cells. To which chemicals am I referring? The billions of tons of pesticides/herbicides that we purposefully apply to our suburban lawns and our national/international food sources; PFAS and phthalates, ubiquitous “forever chemicals” found in cookware, clothing, shampoo, cosmetics, flooring, plastics, medical devices, etc.; and microplastics (including their associated chemicals, like BPA), which affect our bodies in ways that we are only beginning to comprehend.
Robust studies have demonstrated that these “everywhere” chemicals dysregulate hormones, alter the gut microbiome, cause oxidative stress and neuroinflammation, and adversely influence fetal brain development. Instead of spending time demonizing benign vaccines and Tylenol, our government should be funding state-of-the art research examining these substances, which by their nature are likely culprits underlying autism.
Sorry to mention it, but the prevalence of ADHD, another pediatric neurodevelopmental disorder, is even higher than autism. About one in nine American children carry a diagnosis of ADHD. Given the clinical overlap between the conditions, the root causes of autism and ADHD could be similar.
Let’s pause for a moment and imagine a universe in which microplastics are identified as important triggers of autism and ADHD. Will our government then start banning plastic products? The idea of our current congress lobbying against the plastics industry is almost laughable.
And yet, this scenario could kill several birds with one stone. Just picture the dominoes falling—ban unnecessary plastic products, decrease consumption of excess calories in plastic soda/juice bottles, ameliorate the obesity epidemic, limit the detrimental health effects of microplastics, and simultaneously decrease the amount of garbage in the world. Noble goals indeed!
Thinking along these lines, perhaps we should add the highly processed, chemical-laden Western diet to the list of potential autism causes. Folks, as much as we love to eat them, it might be time to stop buying Doritos and Pop Tarts.
While I’m daydreaming, here are a few more items for my 2026 wish list:
-Improve youth mental health by banning cell phones in schools from kindergarten through high school graduation
-Ban social media use prior to age 16 (go Australia!)
-Require dentists and orthodontists to accept federal health insurance, because dental care is healthcare
-Make abortion safe, legal, and possible to obtain in all 50 states, because abortion is intricately linked to all aspects of healthcare for women (hard to believe I need to request this one in 2025)
-Work to engage/recruit/train/employ American men who might otherwise drift into depression, doom scrolling, substance abuse, social isolation, radicalization, and violence
-Raise salaries in fields typically eschewed by young men, such as nursing and teaching
-Raise the minimum wage in general
-Cover the cost of egg banking and IVF through medical insurance (alternatively lower the cost of food/housing/clothing/diapers/baby formula/tampons/childcare/education if society would like women to have babies earlier in life—FYI having babies earlier in life would help to decrease autism rates; yes, these issues are all connected)
-Subsidize childcare with federal incentives
-Cap either the cost of higher education or the amount of student loans that college students can borrow to help lower the cost of college nationwide (yes, the BBB will soon be doing this for professional/graduate students; let’s hope this doesn’t widen the wealth gap amongst grad students)
-Shut down puppy mills
-Ban assault rifles and their ammunition
-Ban nonorganic pesticide/herbicide use on suburban lawns; stop growing mono-grass and switch to natural variations, such as clover
Peace and love to all,
Allison Beitel
Dr. Allison Beitel's Pedi Blog 