PROVIDENCE – American health care is between a rock and a hard place and full of contradictions. It delivers some of the most advanced lifesaving care on the planet, but life expectancy in the U.S. is among the lowest of any industrialized country.

It is by far the most expensive care in the world, 50 percent more per capita than the next most expensive system, but hospitals are going broke and providers are quitting due to low pay and long hours.

States are also unable to provide for care for the lowest income people, either cutting public benefits or just abandoning the poor, like Texas did recently when it cut 2.3 million people from Medicaid.

But venture capitalists and buyout firms have been making millions and billions buying hospital chains, looting them of assets, selling off buildings, loading them with debt, taking big payouts, and then closing them and throwing everyone out on the street, patients and workers alike.

Of course, with the most expensive health care, it is really no surprise that medical bills are one of the biggest causes of bankruptcies in the U.S. and that millions of people skimp on health care because they cannot afford to pay for it. The rich seem to be quite good at looting the poor and filling their pockets with government dollars in the name of capitalism.

Rhode Island personifies dilemmas, contradictions.  
Rhode Island personifies some of these dilemmas and contradictions. Several of our hospitals have come very close to closing, and occasionally run out of basic supplies because the venture capitalists that own them refuse to pay.

The primary care system is falling apart as there are too few primary care physicians and they are overworked and underpaid.

The medical schools are turning out very few primary care and family medicine doctors because who wants to carry a huge debt burden into the practice of primary care, since the reimbursements are so low.

But the biggest hospital chain in the state advertises on TV that they have every specialist under the sun.

The Attorney General is trying to help by blocking mergers and acquisitions and requiring hospitals owned by big corporations to put money in escrow to cover their bills, but that does nothing for the lack of primary care, and, in fact, exacerbates it as all the money is going to hospitals instead of prevention and primary care, which keep people out of hospitals by preventing them from getting really sick.

And, it does nothing to actually bring the cost of health care down to something even close to the countries that have much longer life expectancies. Some 800 people die from poverty every day in the U.S. The crazy health care system is a big part of it.

The Governor keeps saying he will raise Medicare and Medicaid reimbursements which is necessary to keep primary care doctors working, though it is likely that most of it will go to other parts of the system.

But the state keeps trying to get investment in high-tech medicine, which drives up the cost of the overall system, promotes gentrification, and takes resources away from prevention.

An example is asthma. Asthma is not just one thing, it is a whole complex of things, but a great deal of it is driven by pollution and exacerbated by excessive heat driven by burning fossil fuels.

But are we doing enough to clean the air in high asthma neighborhoods? You tell me.

I would say we do almost nothing to get cars off the road, nothing to eliminate fossil fuel industries near low-income, high-asthma neighborhoods, and we under-fund the Department of Environmental Management so it cannot enforce the clean air laws in Environmental Justice neighborhoods.

Single payer?  
There is an answer to our dilemma, but the politics and politicians of this country, bought and paid for by the very richest, including the leveraged buyout industry focused on looting hospitals, have declared that single payer is absolutely off the table.

Interesting that the very folks who say single payer is communism are the same folks who seem to be supporting Putin as he tries to destroy democracy.

Remember that Putin is a veteran of the KGB. Though these days he seems to be just a run-of-the-mill fascist and matches the racism and patriarchy of the Republicans to a T.

Usually when I write an essay, I can offer some sort of way out of the dilemma and contradictions, but I get the impression in this case we are going to keep going round and round in a death spiral.

The cost is too high, the workers are paid too little, the rich keep looting the system, the poor keep dying, and the politicians seem to really like it this way.

Greg Gerritt is an occasional contributor to ConvergernceRI