The Collapsing Healthcare System in the US

[KalipsoRed21, BSN, RN]

I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back. 

I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE. 

You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps). 

I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.

[Emergent, RN]

I think Canada has problems as well. Having said that, I do agree our current system is piecemeal and systemically disorganized. It also is consumer oriented in a negative way. And, the general public is extremely entitled. I've worked in the ER for many years until recently.

The system is forced to cater to the underclass, who have no compunction about coming in for trivial things. And, the ER that I worked in had the opposite problem that you are reporting. The clinics had left no openings for walk-ins, and would routinely send patients to us who are not emergency patients.

Urgent Cares help with that, but a lot of them are privately owned and can pick and choose which insurance they accept. As I said earlier, the whole system is a disorganized mess in my opinion.

[Hoosier_RN, MSN]

So many jump on the socialized medicine bandwagon. My cousin is a nurse in a German hospital. She says there are shortages of so many things, staff and supplies. Wait lists are a norm, as they are here and in Canada, and other countries. There isn't a perfect system anywhere. It's sad, there shouldn't be shortages of resources anywhere, and there are plenty of licensed staff to care for the masses. We're all just tired of the understaffing, while the admin collects huge bonuses for the deliberate understaffing 

[subee, MSN, CRNA]

Emergent said:

I think Canada has problems as well. Having said that, I do agree our current system is piecemeal and systemically disorganized. It also is consumer oriented in a negative way. And, the general public is extremely entitled. I've worked in the ER for many years until recently.

The system is forced to cater to the underclass, who have no compunction about coming in for trivial things. And, the ER that I worked in had the opposite problem that you are reporting. The clinics had left no openings for walk-ins, and would routinely send patients to us who are not emergency patients.

Urgent Cares help with that, but a lot of them are privately owned and can pick and choose which insurance they accept. As I said earlier, the whole system is a disorganized mess in my opinion.

I worked with a doc who immigrated here while her sister chose to go to Toronto.  She told me that her sister thought nothing of having an MRI scheduled for 4am because they want expensive technology working 24/7 which makes total sense to me.  Americans would kill someone before they'd do that.  

[toomuchbaloney]

Hoosier_RN said:

So many jump on the socialized medicine bandwagon. My cousin is a nurse in a German hospital. She says there are shortages of so many things, staff and supplies. Wait lists are a norm, as they are here and in Canada, and other countries. There isn't a perfect system anywhere. It's sad, there shouldn't be shortages of resources anywhere, and there are plenty of licensed staff to care for the masses. We're all just tired of the understaffing, while the admin collects huge bonuses for the deliberate understaffing 

The cost of our profit focused health system is simply not sustainable and it does not lead to improved outcomes.  

[Hoosier_RN, MSN]

toomuchbaloney said:

The cost of our profit focused health system is simply not sustainable and it does not lead to improved outcomes.  

I agree, but there are reasons that others come from the socialized medicine countries to receive care here. There has to be a balance somewhere 

Sadly, many think nurses, CNAs, radiology techs, etc are just greedy *** and that's why the cost of care in the US is so expensive. I don't know why most folks can't see the administrators, CFO, CEO, insurance bigwigs, etc, and their large salaries anc bonuses. If that fat could be trimmed, it would make a tremendous difference 

I wish outcomes was the driving force for our system...

[toomuchbaloney]

Hoosier_RN said:

I agree, but there are reasons that others come from the socialized medicine countries to receive care here. There has to be a balance somewhere 

Sadly, many think nurses, CNAs, radiology techs, etc are just greedy *** and that's why the cost of care in the US is so expensive. I don't know why most folks can't see the administrators, CFO, CEO, insurance bigwigs, etc, and their large salaries anc bonuses. If that fat could be trimmed, it would make a tremendous difference 

I wish outcomes was the driving force for our system...

Outcomes will never drive the bus that runs on profit. We have soundly proven that our fractured method of providing Healthcare for We the People,  that protects profits better than it protects patients, is not the way to maintain the health of a population.  Our system does well for people who can afford it.  

Medical tourism also includes an increasing number of Americans traveling abroad for their care.

https://www.amjmed.com/article/S0002-9343(18)30620-X/fulltext

Quote

Patients who travel to another country to seek health care are referred to as medical tourists. The term arose because many Americans seek less expensive elective surgical, dental, or cosmetic procedures while vacationing abroad.

 Of course, US hospitals and physicians have also long cared for medical tourists from other countries. Now, many medical tourists are going the other way—from the United States to other countries to receive health care. In 2007, it is estimated that 750,000 Americans traveled to other countries for health care.

 In 2017, more than 1.4 million Americans sought health care in a variety of countries around the world.

The reason more Americans have become medical tourists is simply that they are seeking less expensive health care. Because we have the most expensive health care system in the world, it is not difficult to find countries that offer various procedures at 30%-65% of the cost of care in the United States.

 Other countries can charge less because of lower pay to physicians and other health care workers, much less overhead because patients pay cash, and subtraction of the substantial cost of malpractice insurance.

[Emergent, RN]

subee said:

I worked with a doc who immigrated here while her sister chose to go to Toronto.  She told me that her sister thought nothing of having an MRI scheduled for 4am because they want expensive technology working 24/7 which makes total sense to me.  Americans would kill someone before they'd do that. 

I think Canada has overall a better medical system.

[KalipsoRed21, BSN, RN]

Hoosier_RN said:

I agree, but there are reasons that others come from the socialized medicine countries to receive care here. There has to be a balance somewhere 

Sadly, many think nurses, CNAs, radiology techs, etc are just greedy *** and that's why the cost of care in the US is so expensive. I don't know why most folks can't see the administrators, CFO, CEO, insurance bigwigs, etc, and their large salaries anc bonuses. If that fat could be trimmed, it would make a tremendous difference 

I wish outcomes was the driving force for our system...

"There are reasons that others come from socialized medicine countries to receive care here…” So that would be what I have noticed over the years. At the beginning of my career that statement was more true than I have noticed lately. 
I also use to take care of a lot of wealthy medical tourists that came from Arabian countries, not much any more. And while I understand the exhaustion that comes from caring from the under served; I too worked ER for 8 years. I saw how often they plainly could not afford "basic care" at a clinic or otherwise. The ER is "free" basically. 

I've worked several years with a young (30 year old) phlebotomist at my hospital. She works full time. She also does Uber Eats after work. She recently shared with me that she had applied for a habitat for humanity house. She has no children or husband. She was denied for the house because even though the construction of house is "free" she will still have a mortgage for the materials and $1100 a month is more than 30% of her income, therefore she didn't qualify. Basically they determined she is too "poor" to qualify. She pays $1400 in rent. 

My sister and her husband make $150k a year and have insurance, yet spent more than half their income in 1 year for care for their daughter. And her daughter has several more years of surgeries ahead. 

These are tales of a system on the verge of collapse, not just issues with an unorganized system. It isn't sustainable for middle and upper middle class people to pay over half their income for care...with insurance. It isn't sustainable for professionals with certifications who work full time plus and have no families to not be able to afford a home...or rent. 

[Tweety, BSN, RN]

Where I live in Florida there are a lot of Canadian tourists and snowbirds and I have a couple of Canadian friends.  I've also worked with Canadians who say the salaries here are better.   I've never had a conversation with a Canadian that they didn't eventually mention their healthcare.  While it has its problems it's the one thing surveys show they like most about their country.

One of the big problems with our healthcare system besides the burden on the insured middle class that pay the bulk of Americans health care through high insurance premiums and co-pays so our healthcare system can make a profit, as well as high taxes so the poor can get healthcare, is that we don't have "healthcare", we have sick care.

There is a movement towards lifestyle medicine and preventative care, but people generally don't listen to advice and don't take care of themselves.  We eat highly processed foods,  95% of people don't get the recommended amount of fiber, less than 10% of people eat the recommended amount of vegetables, 25% of adults aren't physically active, 40% of of us are obese.  This leads to a myriad of preventative diseases that tax our healthcare system to unsustainable levels.  

If there were a movement to bring these costs down, I imagine things would get better for the middle class, for the ERs, for everyone but those who profit on sick people.   Maybe we can have conversations about universal healthcare if the price tag wasn't so high.

Quote

.....in absolute terms, the sheer cost of these preventable illnesses is staggeringly high, estimated at US$730·4 billion 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524435/#:~:text=Therefore%2C in absolute terms%2C the,but the 19 richest countries.

[Peter Davids, DNP]

? It's heartbreaking to witness the challenges our healthcare system faces, especially over the last 15 years. As a nurse, your dedication speaks volumes. Your desire to be there for your sister and the millions affected is truly commendable. Remember, your efforts make a difference every day, and your compassion shines through. ? #HealthcareHeroes #TogetherStrong #CompassionInAction

[TonyaMarie, MSN]

I'm noticing it too as a case manager. Not only is there a nursing shortage but the older docs are retiring and the number of medical school enrollees has declined. APRNs are overworked. PCPs are booked for months because none of the medical students are choosing primary care. Thankfully our ER is not that bad but I have definitely seen a shift in the last few years. These problems existed before COVID. The pandemic made it worse.