Being killed by the US healthcare system

Top of the morning to y’all! It’s me, the United States Healthcare System, and I thought I’d hijack Liam’s column to tell a story to you Irish, with your much maligned universal healthcare of public hospitals, GPs and medical cards. It’s about Crystal Carson: brilliant actress, revered acting coach, and one of the most determined fighters I’ve ever had the pleasure of exhausting.

Crystal Carson is a native of Nebraska, best known for her role on General Hospital from 1991 to 1993, earning her the title of ‘Best New Female’ by Soap Opera Digest and a feature on their cover as one of ‘Television's Most Beautiful Women’. Her acting career spans TV shows such as Dallas, Cheers, Ellen, JAG and Thirtysomething. She also built a career as an acting coach in Los Angeles That’s where Liam met her over a decade ago and they struck up a firm friendship, with Crystal visiting Mayo with Liam in 2016. That year, she taught actors in Dublin and loved Ireland so much she returned in 2017, intending to make it a regular event, but aggressive stage three breast cancer intervened - and that’s where I come in.

Since those beautiful days of Covid-19, Crystal has been engaged in a high-stakes survival game, wrestling with me - her Kafkaesque, bureaucratically tangled, emotionally void healthcare leviathan. And let me tell you: I’ve had years to prepare for this. This wasn’t sudden. I’ve been falling apart for decades. Long before Donald Trump first swaggered into the White House, I was already in pieces. The cracks in America’s governance, civil administration and public services didn’t start in 2016. They were chiselled deep by decades of political trench warfare, underinvestment and bureaucratic sabotage. I was but one aspect of this.

From Reagan’s ‘small government’ charm offensive in the 1980s to the Republican’s ‘Contract with America’ in the 1990s, led by Newt Gingrich, the federal government has been strategically downsised and demoralised. The civil service - once a bulwark of competence - has been hollowed out and vilified, especially during Trump’s efforts to install partisan loyalists. As Democrats tell of their opponents, “Republicans say government doesn't work and then get elected to prove it”. Yet, Clinton, Obama and Biden failed to do much more than paper over the cracks at best, but often - as in the case of Clinton’s deregulation of banking constraints - they made it worse.

The common goal? ‘Deconstruct the administrative state’. The result? You get me. A fragmented, inefficient mess where essential services like Medicare (the federal health insurance program primarily designed for those aged 65 and older) function in disjointed confusion. Where life-saving medicine can come with emotional - if not financial - bankruptcy.

Back to Crystal. Doctors delayed 18 months to reveal to her that she had cancer, when early treatment would have made her survival odds very high. So instead of the inspirational General Hospital kind of illness, diagnosis and recovery in a couple of episodes, she got the kind that crawls back repeatedly like zombies in a bad Walking Dead franchise you didn’t ask for.

Verzenio chemo pills tore through her system. Then came Letrozole, which gave her bleeding, high cholesterol and bones brittle enough to compete with Samuel L. Jackson’s villain Mr Glass, whose bones are easily shattered in the 2000 film Unbreakable. Crystal routinely applied to her medical insurance to cover her treatments. They routinely refused. She set up a GoFundMe to pay for her care while her friends paid for her time in a hyperbaric oxygen chamber after each surgery to aid her recovery.

She begged for help, flagged the side effects, asked for alternatives. Her gastroenterologist shrugged and pointed to a previous all-clear colonoscopy from 2023 like it was some sort of diagnostic talisman. Only by sheer force of will did she demand a stool test. Only after raising her voice and refusing to be gaslit did anyone listen. They did another test and changed the meds.

Through it all, she wanted to get back to coaching actors and last October she pretended she wasn’t in such pain and began organising acting classes. Until a chiropractor fell on her and broke her collarbone. He offered a free massage in compensation. Undaunted, she turned up to class in a sling.

The cancer - or rather, the damage - returned. Crystal’s reconstructed breast developed new calcifications. She opted for DIEP flap surgery and seven hours on the table, resulting in a banana-shaped abdominal scar and a lump on her chest she now massages daily like a trauma totem. She followed her doctor’s advice to go for walks after surgery. Her stitches burst open and she nearly passed out from blood loss on the two-hour drive home.

And me? I offered her endless wait times, unreturned emails and phone calls with voicemail loops and bills… many, many bills. Her doctor’s office didn’t answer calls for two days, later admitting they just didn’t want to talk to her - after faxing her paperwork to the wrong number. As her three oozing wounds threatened to open into a seven-inch gash under her belly, Crystal had to wait 10 days for insurance authorisation to get it cleaned. Ten days.

Yet, despite my delays, inefficiencies and a system that kills quietly through neglect, Crystal is still here. She is not just a survivor but living proof that while courage and grit don’t cure systemic failure, they do expose it. But I don’t really care, why should I? At least I’m better than your Irish HSE. No?

Yours dysfunctionally, 

The American Healthcare System.

***

Recently, a reader based in the United States but with strong Irish connections, admonished my (yes, Liam’s back) criticism of the US healthcare system. From their perspective, their family’s positive experience with doctors and hospitals exceeded that of their Irish relatives. So much so, my reader said they always had their passports with them when visiting Ireland in case of a potential rush to the airport to get back to the USA during a sudden medical emergency - not trusting the local Irish hospitals.

However, as my durable friend Crystal has found out, my reader’s experience is certainly not true for her nor also a likely majority of the American public. Over 70% of American adults feel US healthcare system fails them, citing high costs, insurance inaccessibility and confusing logistics as major issues. Many delay or skip needed care due to cost or time constraints. Without universal healthcare as in Ireland, about half of US adults say it is difficult to afford healthcare costs, with one in four reporting problems paying for care in the past year. Drug costs also prevent some from filling prescriptions or cause them to ration medication, which Joe Biden did ameliorate by reducing prescription medicine costs and improving medication access. Yet, even those who are insured face significant financial burdens from premiums and out-of-pocket costs.

American healthcare is often described as fundamentally broken, with rising costs, poor health outcomes compared to other wealthy nations and significant inequities in access and quality of care. US healthcare consumes 17% of GDP but ranks poorly on life expectancy and maternal mortality. Experts warn the system may implode without major reform and that’s before Donald Trump gets fed up of his tariffs and turns to ‘fixing’ it.

But I will let my friend Crystal’s own words to her supporters end my article:

It's human to want to cry out, "if only I was told about the tumour when they first found it. I would have only needed surgery! It was stage one". Instead, it took 18 months before I was told, when it had already passed through all my armpit lymph nodes... bordering on Stage IV. 

But what would crying out solve? This is my journey. I've learned a lot. I've met a myriad of amazing people. And I'm certainly not alone in dealing with health issues! You never know what a person is going through. Thanks to you; your calls, your texts, your gifts/soup/tea, your songs, your walks, your prayers, and so much more, I mostly feel blessed by this experience.