What's wrong with the US healthcare system?

It's inconsistent.

I have amazing insurance and I recently hurt my back. I spent three straight days in one of the US's top medical centers (the Cleveland Clinic).* I had instant access to an MRI, a super-specialist at the top of her field (neurology) another specialist (a spine surgeon), a team of nurses, a comfortable bed, lots of medication (Mmmmm, Dilaudid!), a private room, four more office visits (one this morning, including a CAT scan) and now 25 physical therapy visits at a chiropractor: all of this for about $500 out of my pocket (which I could just choose never to pay, without any threat to my FICO score, and will eventually just get written off - but of course, I will pay!).  My care was as good and likely better than what anybody else, but very few, on earth can get.

If I had no insurance, I would have been given some pain pills and then sent home.  Only if I had a life threatening ailment, would I have been admitted. My serious injury (Herniated disk between my C6 & C7 vertebrae, and an agonizing pinched nerve), would not have been serious enough to be admitted. I'd be out if work, because right now I cannot function. But I have Short-Term Disability Insurance that also covers my full wages for 6 weeks.  If I were uninsured, I would be out of work, no income, and no medical care to get me back to work.

I have it great. Others are not so lucky.

EDIT:  For those of you wondering, here is my bill (just arrived a few minutes ago).   Three days in the hospital in the US.

The reason why the US cannot have a Universal Health Care system like almost every other first world country is because its Health System has accumulated too many leeches.


My biggest complaints about American medicine are concerned with the movement toward a corporate, profit-making model.

Hospitals have become "systems." Where they used to have a few physicians on the hospital's payroll, with the rest in small independent groups or solo practices, now the physicians are employees of the "system," which sets prices, procedural rules, appointment-making and records-keeping systems, and so on. None of this has patient care as its driving force. The objective is to make as much money as possible, with the biggest share of that money winding up in the pockets of stockholders and administrators who are businessmen, not healers.

Physicians are often pressured to see 20-30 patients in a business day, often shuttling from one exam room to another, seeing multiple patients at one time. They don't have time to listen to or educate the patient. The physician might want to provide more personalized care, but to the system, the patient is one of many cattle that have to be processed so it can collect a fee. The more patients they see, the more fees they generate.

The typical graduate physician emerges from medical school with a student loan debt of $200,000+. They cannot survive setting up a new independent practice and still keep up on those loan payments. So, they are driven into corporate medicine, and by the time they have paid off the loans, they are so entrenched in that system they cannot escape.

Health insurance companies are the other bad guys here. While there appear to be thousands of health insurers, closer inspection reveals that there are a few hundred, operating under multiple brands. Why? If you get burned by one, you might go to another subsidiary, not knowing you're dealing with the same assholes.

The insurance companies routinely deny coverage for procedures and medicines, knowing that a good chunk of their clients will get discouraged and go without. After completing many, many forms and talking to people who know nothing more than to read from a script, they might, just might, get what they need. That their physician says they need this procedure or medicine is irrelevant. The insurance carrier has to play, "How badly do you want it?"

I work in a physician's office. At least once a week, I have to process a "prior authorization" to get the insurer to cover a portion of a patient's medication costs. Recently, they required me to go through 21 years of chart notes, noting every medication the patient had been on, the dates they started and stopped, and the reasons for starting and stopping (the usual one is "it didn't work." Health insurers have not caught on to the notion that there is seldom a one size fits all remedy for illness). Also involved in this is noting how many times the patient has seen the doctor, whether other medications have been considered (see the above), and if we have coordinated care with other physicians the patient has seen (we have). Most of the time, after 2-3 hours of telephone calls and paperwork, I get them to approve payment for the medication for a year. In the most recent case, the medication in question cost $14 for a month's supply, and the patient had been taking it for over five years. Yes, the patient could have paid for it themselves, but if the insurer covers this and they have paid their premiums, why should the patient be any more out of pocket?

Other responses here have noted that the U.S. is the only first-world country without a nationalized health care system. This very much needs to change, but it won't until health insurers lose the control they have over elected officials, who make laws that allow the insurers to get away with this.

In 1947 Europe was recovering from World War II. Countries had to decide how health care would work post war. All the Europeans began from the position that heath care is a right, not a privilege.

So they set out to develop national systems which would:

  1. Cover their entire populations.
  2. Control the cost of health care.

These European systems are still working well today.


Your insurance company has an army of lawyers and accountants trying to maximize their profits while minimizing payouts, which means getting as much as they can from you, and paying out as little as possible when you use services.
The hospital you go to (likely) has a department of specialists and a couple of lawyers who are there to maximize the hospital's billings and trying to get the most payout from your insurance companies. Part of the way this is accomplished is by massively inflating the cost of everything, because the insurance company is going to cut the billings down significantly. Another way is by providing tests and treatments that the consumer doesn't know if they need or not.

Your doctor may share one person who's job it is to just fill out the paperwork required by insurance companies so they can get payment.  That "biller" is just there to try to keep up with paperwork and payments.

You have only yourself, and you're likely not an expert in any of the above, plus your insurance company knows your time is limited and if they don't squeeze you too hard you'll let them get away with stuff because you're busy with other things, like your life and your job.

I'm not unique, but let me give you three personal examples:

Once I blacked out at work and woke up in an ambulance. My insurance refused to cover the ambulance because I hadn't called first to get authorization. It didn't matter than I was unconscious apparently. I had a number of arguments with them about it. The insurance was part of a union provided benefits package. When I mentioned it to our union rep, he had the union lawyer call. Suddenly it was covered. The union lawyer said they were just trying to reduce their payout and likely thought I would just pay it.

When my daughter was born, the OBGYN decided part-way through delivery that an emergency c-section was necessary.  My insurance refused to cover the emergency c-section because no one (at 3am) had called to get it approved. The hospital and insurance company went back and forth. When both of them got tired of arguing over it, they dumped the balance in my lap.  Since I couldn't afford to hire a lawyer to represent me in the battle, I got left holding the bag, which amounted to 2 years of $700-a-month payments.

I injured my shoulder working out. My friend recommended I have it examined by a sports injury therapist he had been to before. The cost of the examination was going to be $90, so I called my PPO to get approval.  They would not approve it without me first going to my GP.  I went to my GP ($40) who ordered x-rays ($120) which showed nothing. Then the insurance company wouldn't approve my visit to the sports injury therapist until I went to a specialist ($40) who ordered an MRI ($600), who then told me I needed surgery ($1900+).  The insurance company was willing to pay for the surgery, but not the examination by the therapist. I ended up paying the $90 myself, after nearly $800 out of pocket to go though the insurance company's process. The therapist examined me and told me I had torn something (can't remember), put my arm in a sling for a couple of weeks, then did a couple of therapy sessions on it ($90 each) and it was as good as new.


My family is healthy, and in the last couple of years the four of us haven't been to the doctor/dentist for anything other than checkups. None of us take prescription medications. We have an average PPO, and healthcare is our largest single expense. Our insurance premiums alone are nearly more than our housing costs. Co-pays push it above housing.
Having experienced the health care systems of Taiwan, Singapore and Thailand, honestly everything about the US is self-evidently broken beyond belief. FUBAR in the original cursing form. 

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