Is the US health system collapsing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It isn’t collapsing. It has collapsed.

100%

When someone goes to the ER with chest pains & is waiting in the waiting room for 9 hrs instead of immediately being taken to triage, it's a broken system.

When an elderly person is diagnosed with having had a stroke in the ER & discharged with orders to follow up with a neurologist within 7 days, but the earliest appointment you can get them is 8 months out, the system is broken. My sibling and I sat calling with our mom to try to get my dad an appointment & this was the result. We have him on a dozen different waitlists but we're still 4 months away from his appt. Terrifying.

A friend went through something similar in finding a Derm. Her Derm couldn't get her in until FEBRUARY 2025 and she had a worrisome spot appear that was rapidly changing. After finding none that could get her in, she went the concierge Derm route. Luckily she had the funds to do so, but what about those who can't go that route? We're going to get to the point where those without the funds to seek alternate treatments get sicker or die while waiting.

So much truth. I'm also helping my elderly parents navigate health issues and it's insane. You can't reach actual humans have have to wait for return calls. When you do get to speak with someone, there are no appointments for necessary specialty care in the time you need it. Patients are told to go to the ER if things get too bad. When you do that, the patient has to deal with long waits and is not able to get a room for days. It's terrible. I never want to hear people complaining about patients using the ER again - there isn't care available anywhere else.

My mother abroad had to wait for the health system to send her letters for appointments. They sent her one for a CAT scan for a very bad headache. It arrived a week after a brain hemorrhage - the headache was an indication of the looming hemorrhage. She should have been sent straight to the ER by the doctor, which is where she ended up anyway in the middle of the night.

I’m so sorry she went through that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yep and you know Trump has an amazing bigly plan to replace the ACA right??
LOL

Anything is better than Obummer's Unaffordable Care Act.
But hey, "free" health care for all these illegal migrants tight?

Just shut up. The ACA has nothing to do with migrant healthcare. Undocumented people do not get Medicaid, although some states provide medical benefits to them. The feds partially reimburse hospitals who are required to treat anyone who shows up at the ED.

Because the ACA exists, my son, who was on Medicare due to a disability, was able to get health insurance when he was able to get off SS disability benefits via self-employment, without denials or waiting periods for pre-existing conditions. Prior to the ACA, if you did not have insurance and had pre-existing conditions and were turned down, you could get comprehensive insurance, which was a regular policy funded through a pool to which insurers contributed. But the premium was 20% higher than the rated premium for age and you had to wait 6 months before any pre-existing conditions were covered. When I was younger, any time I changed jobs my pre-existing conditions were not covered by employer coverage for 12 months. My cousin stuck it out in a crappy job in a small town he hated for two decades because his wife had rheumatoid arthritis and a lot of complications (she eventually died from it) and he had to stay in order for his wife to avoid gaps in the medical care she needed. Eventually Congress created portability requirements so you could change jobs, but for people on the bottom, whose jobs sometimes provided health insurance and sometimes did not, or who went through periods of unemployment longer than 45 days, they had to start over with the 12 month business when they did get benefits.

Apparently the ACA prohibited doctors from owning hospitals, which opened the door to the profiteering we have now (the idea was that doctors could have a financial interest I guess, but everyone has a financial interest)

Non-profits may be better, otoh they still pay big bucks to CEOs and instead of profits they go for acquisitions and asset-building, plus they often have profit-making entities tied to them. And are run by the same suits as for profits are.

[Anonymous]

Anonymous wrote:Is it really good anywhere?

Last week there were big complaints in the UK about the NHS computer system that led to unfavorable health outcomes and deaths.

My friend couldn't find a PCP in Toronto for months.

Other countries are losing doctors to higher paying countries and don't produce enough specialists. People wait years for joint surgery, or months for oncology appointments.

How much of this is because medical science can do more so demand is higher for an increased number of treatments.

I don’t buy about medical science doing more because life expectancy is not impressive in the USA.
If I have to guess Scandinavian countries might be doing better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It isn’t collapsing. It has collapsed.

100%

When someone goes to the ER with chest pains & is waiting in the waiting room for 9 hrs instead of immediately being taken to triage, it's a broken system.

When an elderly person is diagnosed with having had a stroke in the ER & discharged with orders to follow up with a neurologist within 7 days, but the earliest appointment you can get them is 8 months out, the system is broken. My sibling and I sat calling with our mom to try to get my dad an appointment & this was the result. We have him on a dozen different waitlists but we're still 4 months away from his appt. Terrifying.

A friend went through something similar in finding a Derm. Her Derm couldn't get her in until FEBRUARY 2025 and she had a worrisome spot appear that was rapidly changing. After finding none that could get her in, she went the concierge Derm route. Luckily she had the funds to do so, but what about those who can't go that route? We're going to get to the point where those without the funds to seek alternate treatments get sicker or die while waiting.

So much truth. I'm also helping my elderly parents navigate health issues and it's insane. You can't reach actual humans have have to wait for return calls. When you do get to speak with someone, there are no appointments for necessary specialty care in the time you need it. Patients are told to go to the ER if things get too bad. When you do that, the patient has to deal with long waits and is not able to get a room for days. It's terrible. I never want to hear people complaining about patients using the ER again - there isn't care available anywhere else.

My mother abroad had to wait for the health system to send her letters for appointments. They sent her one for a CAT scan for a very bad headache. It arrived a week after a brain hemorrhage - the headache was an indication of the looming hemorrhage. She should have been sent straight to the ER by the doctor, which is where she ended up anyway in the middle of the night.

This is a legitimate issue for countries that have a single payer system.
I think France has a good model, however. Everyone has access to socialized medicine. But there is also a 2nd tier where you can pay out of pocket. So when my relative had to schedule a surgery, instead of going to the public hospital he went to a private clinic.

[Anonymous]

The fact that the AAMC can limit the number of doctors is absurd. There should be an unlimited number of a schools allowed to be accredited for creating MDs. Let the board exams weed them out.

Stop artificially keeping the number of doctors low. It is getting absurd. They just want to keep their salaries artificially bloated by limiting the numbers of supply. End 5e monopoly killing this country.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Is it really good anywhere?

Last week there were big complaints in the UK about the NHS computer system that led to unfavorable health outcomes and deaths.

My friend couldn't find a PCP in Toronto for months.

Other countries are losing doctors to higher paying countries and don't produce enough specialists. People wait years for joint surgery, or months for oncology appointments.

How much of this is because medical science can do more so demand is higher for an increased number of treatments.

I don’t buy about medical science doing more because life expectancy is not impressive in the USA.
If I have to guess Scandinavian countries might be doing better.

Of course they’re doing more. In 1986, there were 9,000 kidney transplants in the US. In 2022, there were over 22,000.

[Anonymous]

There was a pretty shocking article in the NYT about a private equity backed company called Multi Plan which insurers use to assess out-of-network claims. The bizarre part is Multi Plan’s feed are based on the amount it denies. You’d have to be stupid to not see the problem with that sort of incentive arrangement.

“For a New Jersey trucking company called New England Motor Freight, UnitedHealthcare used MultiPlan to reduce a hospital bill from $152,594 to $7,879, then charged the company a $50,650 processing fee.”

https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills-takeaways.html

[Anonymous]

Anonymous wrote:Drug companies and insurers have too much influence in how the system works (ie they pay off politicians through “contributions “). .

I think FOR-profit health care should be outlawed. Period.

+1. And pharma and insurance exec salaries should be regulated and capped.

[Anonymous]

We have tricare. It collapsed years ago. It takes months to get appointments, assuming they approve your referral and if you get a referral often they refer you off base and to really bad doctors. Doctors at the hospital don't care and do the minimum. I've been trying to get a diagnosis for years. It took me many years to get something simple like refux treated but I got one appointment and told I could not be seen for six months regardless of how I was doing. I called the dr. and he said too bad wait.

CT's and MRI's are a few months - you are lucky if 6-8 weeks, same with ultrasounds. Mamograms take months too and if you have a lump, they will do a follow up in a month or two. I have to wait 8 weeks for a follow up mammogram when I told them there would be a positive finding as it was on a CT. So, if I have breast cancer from the finding from the CT to the mammogram will be about 8 months.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I was on a girls trip and all of them were doctors from the UK and Canada, except for my friend who is an American in the UK and a clinical psychologist. They could not wrap their heads around our healthcare system. They did not know how any America could sleep at night when one illness could send you into bankruptcy.

+1 for all that's wrong with the NHS and Canadian healthcare, most of their citizens don't worry about medical bankruptcy.

Great medical care in the US is for the rich.
Good or decent medical care in the US is for the UMC who have good insurance.
Everyone else is just screwed.

A few years back I had a Canadian co-worker who complained about long waits to see doctors. I compared notes with him. My employer BCBS with HMO had similar waits for similar things.

[Anonymous]

Yes

And if Trump wins forget about pre existing conditions

Forget about health care period

Hello polio on a regular basis

[Anonymous]

Anonymous wrote:There was a pretty shocking article in the NYT about a private equity backed company called Multi Plan which insurers use to assess out-of-network claims. The bizarre part is Multi Plan’s feed are based on the amount it denies. You’d have to be stupid to not see the problem with that sort of incentive arrangement.

“For a New Jersey trucking company called New England Motor Freight, UnitedHealthcare used MultiPlan to reduce a hospital bill from $152,594 to $7,879, then charged the company a $50,650 processing fee.”

https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills-takeaways.html

I am somewhat familiar with multiplan — what you’re describing isn’t claim denial, it’s negating for a rate that is similar to an in network rate. (What you’re described about their fee is not consistent with what I’ve seen.). Part of the problem is that hospitals and doctors have all these fake rack rates that no only actually pays. If you read your EOB, it often says your provider charged $500, insurance paid $125, and you owe $20. The rest is just a ghost charge. When you go out of network, they charge the fake rack rate and wait for someone to negotiate it down. It’s an insane system but the answer is not that the insurers should just pay the crazy rack rates.

[Anonymous]

Anonymous wrote:It's an absolute sh!tshow.

I am a patient. Because of my condition, I have had several organs removed and my altered anatomy is often a consideration in treatment of other issues.

Because of this condition I need regular access to specialists. Primary care doctors typically punt anything even remotely related to my underlying condition to specialists. I have not seen an adult primary care doctor attempt to "coordinate care" among these specialties in decades (our kids' ped is better at this.) We recently attempted to find one who would actually do this work, at concierge rates, and could not.

About a month ago my GI attempted to prescribe a medication. This required a prior authorization, an appeal, and my giving my physician "power of attorney" to appeal for me--via fax. This was the only way they accepted the documents: fax.

The Rx was successful. I had a "discount card" for the copay so I paid $0. The charge to my insurer for the drug, which is available for $100 for a 30-day supply in generic in India, Canada and other nations where generic meds are routinely produced at high quality, was $5600 for a month.

Several other medications I use, which are not obscure, have been in shortage states or unavailable entirely in the last couple of years. (None of these are stimulants, by the way--I know folks are aware of those shortages; these are additional.)

Another family member has post-acute COVID and is seen by a doc in the GW Long COVID clinic. The doc is great but absolutely swamped. This family member has also needed care from across a range of specialties: cardiology, pulmonology, gastroenterology, urology, neurology, physical therapy. There is a protracted wait for each. The integrated institutional supports are nonexistent (I'm actually watching a National Academies webinar on this right now--their report is here: https://nap.nationalacademies.org/read/27756/chapter/1#ii) and I expect this to get worse and not better.

The waits are longer. Many specialists are leaving practice. My insurance (United Healthcare) just experienced a hack that prevented adjustment of claims for almost three months.

I am white, heterosexual, highly educated, and have made handling our health care an additional quarter-time job (sometimes more). The experiences of people who are also experiencing racial and other bias in docs' offices must be tens of times worse--let alone people who do not have platinum-plated health insurance (I have throughout) and/or lots of experience navigating this system.

It's falling apart. Large parts of it are irredeemable already. I don't know of a provider who doesn't also think this.

Amen

[Anonymous]

Anonymous wrote:

Anonymous wrote:It's an absolute sh!tshow.

I am a patient. Because of my condition, I have had several organs removed and my altered anatomy is often a consideration in treatment of other issues.

Because of this condition I need regular access to specialists. Primary care doctors typically punt anything even remotely related to my underlying condition to specialists. I have not seen an adult primary care doctor attempt to "coordinate care" among these specialties in decades (our kids' ped is better at this.) We recently attempted to find one who would actually do this work, at concierge rates, and could not.

About a month ago my GI attempted to prescribe a medication. This required a prior authorization, an appeal, and my giving my physician "power of attorney" to appeal for me--via fax. This was the only way they accepted the documents: fax.

The Rx was successful. I had a "discount card" for the copay so I paid $0. The charge to my insurer for the drug, which is available for $100 for a 30-day supply in generic in India, Canada and other nations where generic meds are routinely produced at high quality, was $5600 for a month.

Several other medications I use, which are not obscure, have been in shortage states or unavailable entirely in the last couple of years. (None of these are stimulants, by the way--I know folks are aware of those shortages; these are additional.)

Another family member has post-acute COVID and is seen by a doc in the GW Long COVID clinic. The doc is great but absolutely swamped. This family member has also needed care from across a range of specialties: cardiology, pulmonology, gastroenterology, urology, neurology, physical therapy. There is a protracted wait for each. The integrated institutional supports are nonexistent (I'm actually watching a National Academies webinar on this right now--their report is here: https://nap.nationalacademies.org/read/27756/chapter/1#ii) and I expect this to get worse and not better.

The waits are longer. Many specialists are leaving practice. My insurance (United Healthcare) just experienced a hack that prevented adjustment of claims for almost three months.

I am white, heterosexual, highly educated, and have made handling our health care an additional quarter-time job (sometimes more). The experiences of people who are also experiencing racial and other bias in docs' offices must be tens of times worse--let alone people who do not have platinum-plated health insurance (I have throughout) and/or lots of experience navigating this system.

It's falling apart. Large parts of it are irredeemable already. I don't know of a provider who doesn't also think this.

The grim reality is that if you require long-term medical care and services, it is more financially profitable for you to die.

I’ve heard of long term care insurance that delays and delays awarding a claim until a few days before the patient dies and I wonder if this is a deliberate tactic.

[Anonymous]

I have a 5 year old with an incurable form of epilepsy.

I ended up having to quit my job (after taking FMLA) because just dealing with insurance, Medicaid, pharmacies, docs, therapies, etc. is a full time job for me. It’s mind boggling how terrible the system is and how much work it takes to navigate. It sucks.