As the 2020 election edges closer, one of the major issues is health care, with all its intricacies and confounding variables, and which has no obviously simple solution. But while the debate over the economics of health care rages on, one thing remains clear: nearly 33 percent of Americans report that they do not seek medical care. That’s a problem.

The reasons why people avoid medical care are as varied as the individuals themselves. It is not just about fear of doctors or needles, although that is a very real phenomenon. There are individuals who have normal blood pressure and feel fine at home but in a sterile room with a clinician their blood pressure soars. It's the so-called “white coat syndrome." This rise in blood pressure and anxiety in the presence of doctors has been reported in 13 percent of patients.

It is difficult to study patients who do not seek medical care, but the largest study performed in the U.S. identified three broad categories of avoidance: the obstacles to receiving care, overall dislike of receiving care, and a patient’s perceived need to see a medical professional. It's important to remember that within these major categories there are several subcategories. And while it may be tempting to claim a straightforward solution to one of these issues, rectifying one aspect may increase pressure on another.

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According to the study, the most common reasons individuals do not seek care are the obstacles that, unfortunately, are so frequently encountered in our health system. These issues vary tremendously, from transportation to language barriers to financial burdens. In addition, 58 percent cite factors such as high deductibles and copays and finding time to take off from work as obstacles to care.

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Some claim that a nationalized health system will eliminate many if not all of these obstacles. But, remember, if you shift the stress from one aspect of this complex system, another may get worse.

One-third of the respondents claim they do not like the bureaucracy they must endure to get an appointment with their doctor or for a blood draw. Dissatisfaction with wait times, as well as decreasing time spent with their physician, often contribute to the frustration. Unfortunately, increasing physician regulations and workloads, coupled with an almost annual decrease in physician reimbursement, have contributed greatly to these criticisms.

Patients who avoid doctor visits also fear receiving “bad news,” even though ailments discovered earlier can be easier and less costly to treat.

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Some people simply don't believe they need treatment. They trust that the issue will pass or the body will heal itself, or they choose to pursue alternative health measures. Others hope to avoid being told to modify lifestyles that may be contributing to their medical issues, such as alcohol intake and lack of exercise. By delaying care, the situation may become worse, complicating the issue and driving up the overall cost for everyone.

Two very common and treatable conditions come instantly to mind: high blood pressure and breast cancer. Both issues are prevalent among Americans and often remain asymptomatic until they are already advanced, wreaking havoc in the body. This is one of the greater tragedies of medicine, when a disease that could have either been cured or prevented is not because the person did not undergo routine screening or present at the earliest sign of disease.

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Regardless of the reasons for avoiding care, we want to reinforce the importance of seeing your primary care doctor on a regular, preventative basis and seeking guidance the moment symptoms of disease occur.

Whether personal hesitation or system-wide barriers, we need to do better as a society to create a healthier America.

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Paul Saphier, MD is a board-certified neurosurgeon specializing in brain tumors, aneurysms and stroke. He practices in New Jersey. Dr. Saphier is actively involved in clinical research and is the principal investigator of various ongoing trials. Follow him on Instagram @paulsaphierMD