Anonymous
06/05/2024 14:13
Subject: Is the US health system collapsing?
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.
NP. If you don’t mind, can you please tell me what this coordination of care by PCP would look like? Do you mean that your PCP has no idea what your other specialists are doing/prescribing, etc? So you have to update them at every visit? I’m just curious what the concierge doc would be doing differently.
Anonymous
06/05/2024 14:09
Subject: Is the US health system collapsing?
It isn’t collapsing. It has collapsed.
Anonymous
06/05/2024 14:08
Subject: Is the US health system collapsing?
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.
Anonymous
06/05/2024 14:05
Subject: Is the US health system collapsing?
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.
Anonymous
06/05/2024 13:59
Subject: Is the US health system collapsing?
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.
I think FOR-profit health care should be outlawed. Period.
Anonymous
06/05/2024 13:48
Subject: Is the US health system collapsing?
Yep and you know Trump has an amazing bigly plan to replace the ACA right??
LOL
LOL
Anonymous
06/05/2024 13:46
Subject: Is the US health system collapsing?
Anonymous wrote:I’m in healthcare administration. Blame the insurance companies, electronic healthcare record software firms, and physicians, each of which holds administrators hostage when it comes to meeting their exorbitant demands.
There’s also a serious disconnect between public health efforts and healthcare delivery.
It just needs a total overhaul.
What’s the subreddit?
r/medicine
admin weighs in once in awhile, but watch out
Anonymous
06/05/2024 13:19
Subject: Re:Is the US health system collapsing?
Yes, it's absolutely headed for a crash. (And I follow that sub reddit as well). I'm a nurse for 25 years who no longer works bedside. But I've seen the inside of Emergency Departments and hospitals due to an elderly family member. Then, I've also experienced having kids with a mental health crisis (when I had terrible insurance) and significant physical trauma (when luckily I had great insurance).
There is no sense in which insurance serves the greater good, or the patients who pay for it, specifically. It exists TO MAKE MONEY. And it succeeds in that. Sometimes maybe someone gets their treatment on time because the insurance company covers it, and then sometimes they DON'T get their treatment, and they die, but in either scenario, the insurance company makes bank.
Administrators make bank.
Nurses are spread very thin, and hear at every turn "I'll sue you" or threats of violence against them from patients or patients' families. Even back when I was a bedside nurse, it was a good day when I got to use the bathroom and eat lunch. It's tough to focus for 12.5 hours of juggled chaos, when you can't eat or use the bathroom.
There used to be more adjunct staff, like patient care techs. You used to be able to enter a patient's room without having to answer a hospital cell phone attached to your hip, as soon as it rang.
I deeply appreciate those nurses still working inpatient. You are the reason sometimes the hospital functions. I also deeply appreciate physicians, who have a terrifyingly high risk of suicide which gives you some indication of what it's like to work as a physician (maybe especially in med school and in early residency, not sure when the risk is highest), the respiratory therapists who run to vents and to rapid response calls and sometimes actually have time to talk to patients, and extra especially, the front desk staff (the first people to hear about any problem and the "face" of the care for many people) and the very hard-working, highly skilled, underpaid patient care techs.
Please, do something before you have a mom in the hospital. Fix this crazy expensive mess.
There is no sense in which insurance serves the greater good, or the patients who pay for it, specifically. It exists TO MAKE MONEY. And it succeeds in that. Sometimes maybe someone gets their treatment on time because the insurance company covers it, and then sometimes they DON'T get their treatment, and they die, but in either scenario, the insurance company makes bank.
Administrators make bank.
Nurses are spread very thin, and hear at every turn "I'll sue you" or threats of violence against them from patients or patients' families. Even back when I was a bedside nurse, it was a good day when I got to use the bathroom and eat lunch. It's tough to focus for 12.5 hours of juggled chaos, when you can't eat or use the bathroom.
There used to be more adjunct staff, like patient care techs. You used to be able to enter a patient's room without having to answer a hospital cell phone attached to your hip, as soon as it rang.
I deeply appreciate those nurses still working inpatient. You are the reason sometimes the hospital functions. I also deeply appreciate physicians, who have a terrifyingly high risk of suicide which gives you some indication of what it's like to work as a physician (maybe especially in med school and in early residency, not sure when the risk is highest), the respiratory therapists who run to vents and to rapid response calls and sometimes actually have time to talk to patients, and extra especially, the front desk staff (the first people to hear about any problem and the "face" of the care for many people) and the very hard-working, highly skilled, underpaid patient care techs.
Please, do something before you have a mom in the hospital. Fix this crazy expensive mess.
Anonymous
06/05/2024 13:18
Subject: Is the US health system collapsing?
^and Big Pharma
Anonymous
06/05/2024 13:17
Subject: Is the US health system collapsing?
I’m in healthcare administration. Blame the insurance companies, electronic healthcare record software firms, and physicians, each of which holds administrators hostage when it comes to meeting their exorbitant demands.
There’s also a serious disconnect between public health efforts and healthcare delivery.
It just needs a total overhaul.
What’s the subreddit?
There’s also a serious disconnect between public health efforts and healthcare delivery.
It just needs a total overhaul.
What’s the subreddit?
Anonymous
06/05/2024 13:11
Subject: Re:Is the US health system collapsing?
My family mostly uses providers who don't accept insurance at all. We have BC/BC HMO so that we get good rates on blood work and are covered for emergencies. Our insurance is bought from the "exchange" and runs $2k a month with a $5k deductible. So $24k+ for useless insurance and thousands of dollars for providers who don't have waits and give us good service. This is insane. But the care we've received from providers in the system has mostly sucked.
I think we are headed toward private pay for the rich, and endless waits and poor care for everyone else.
I think we are headed toward private pay for the rich, and endless waits and poor care for everyone else.
Anonymous
06/05/2024 12:52
Subject: Is the US health system collapsing?
Yes.
Anonymous
06/05/2024 12:20
Subject: Re:Is the US health system collapsing?
The problem is vast. The funny thing is that the federal government spends billions each year supporting health care systems in other countries. Teaching them how to do primary care, setting up rural health clinics, creating private insurance schemes. And yet, here at home, we are eating ourselves alive.
Anonymous
06/05/2024 12:15
Subject: Is the US health system collapsing?
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.
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.
Anonymous
06/05/2024 11:51
Subject: Is the US health system collapsing?
After some very complicated issues involving a family member I started following a subreddit for doctors and other healthcare professionals. They are highly critical of the situation with healthcare--mostly US but foreign docs chime in as well, sometimes to report what's bad where they are, other times to express their sympathy to docs working in the US.
Issues include corporatization of medicine such as huge mergers and vertical integration (United Health Group being an example), private equity (buying hospitals only to loot them--like the woman in Boston who died postpartum because the medical device to remove a blood clot in her liver had been repossessed), administration demands, treating healthcare like customer service, and also problems with patient populations (sometimes fed up with them, sometimes pointing to social determinants and other factors that affect patients). Also the politics relating to pregnancy and abortion and transgender care.
They fairly consistently say that the system is crashing or has crashed but not acknowledged. I wonder what the lay public (especially the well-informed public) thinks of all this--is it falling apart? If you think so, is it because of stuff you have personally dealt with or stuff on a larger scale you have read about (e.g. investigations of large insurers for Medicare advantage fraud, antitrust investigations starting with regard to private equity, other news related to healthcare).
Issues include corporatization of medicine such as huge mergers and vertical integration (United Health Group being an example), private equity (buying hospitals only to loot them--like the woman in Boston who died postpartum because the medical device to remove a blood clot in her liver had been repossessed), administration demands, treating healthcare like customer service, and also problems with patient populations (sometimes fed up with them, sometimes pointing to social determinants and other factors that affect patients). Also the politics relating to pregnancy and abortion and transgender care.
They fairly consistently say that the system is crashing or has crashed but not acknowledged. I wonder what the lay public (especially the well-informed public) thinks of all this--is it falling apart? If you think so, is it because of stuff you have personally dealt with or stuff on a larger scale you have read about (e.g. investigations of large insurers for Medicare advantage fraud, antitrust investigations starting with regard to private equity, other news related to healthcare).