What is the #1 healthcare problem in the USA?

[nurse_wannabe]

Hello! I think most of us can agree that healthcare here in the good ol' U.S. of A is lacking in some areas. In fact, many think that we are facing a crisis.

My question for you is, in your very own opinion, what is the single most important problem with our healthcare system, and what would you like to see happen to improve it?

[MS._Jen_RN, ASN, RN]

Poor personal health habits on the part of citizens who then expect doctors to come up with a magic pill. Pharmacetical companies with too much political clout pushing those pills. Unfair distribution of healthcare services due to lack of basic coverage for many citizens. Paperwork nightmare due to patchwork of insurence plans and regulations, and litigation prone society.

Can all that count as 1?

Amen to that!!!! YOu stole most of my answer(s).

Sometimes the magnitude of these problems seems insurmountable.

~Jen

[grannynurse FNP]

i'm sure it has been said already, but i think it is the lack of people taking responsibility for their own health care.

diabetics/hypertensives that don't take their medication or watch their diets. people who come to the emergency room but never follow up with their pcp or specialist. people who are discharged home from the hospital but never fill thier dc scripts. people who are scheduled for outpatient education but never show up.....i could go on and on but it is time for me to leave for work.

these things are a real drain on the healthcare system. the drive the costs up, because they are most likely to come to the er frequently and/or be admitted frequently.

we have one patient, a crack addict, whose visits are so cyclical in nature you can predict her visits with ease: she is dc home, leaves, hits the crack house, calls 911, comes back in with respiratory distress, gets adimtted to icu on a vent, gets weaned and sent to step-down, gets better and is sent to the floor, then gets dc home again....

every time ems brings her back in, she cries for help in getting off the crack. when she stabelizes and social services offers it to her, she wants nothing to do with it. her care is costing a fortune, and she will never pay a dime for it. so frustrating.

i would like to address some of your comments. and perhaps, i am in the unique position to respond, as i suffer from asthma, am an insulin dependent diabetic and am hypertensive, as well as having a seizure disorder. my only health insurance is medicare and i live off of ssdi and a small annuity. my medications currently cost me approprixmately one quarter of my monthly income. i try to wtach my diet but the steroids i frequently have to go on because of my asthma, make my blood sugars go out of control. my hypertension luckly is in good control and i have not had a seizure in ten years, althou i did have a tia seven years ago. i frequently ask my prescribing physicians not to order the newest drugs, i really cannot afford them. and if they do, i will be unable to get the prescriptions filled. they generally cooperate although a few do not. i live alone and at times find it extremely boring to cook for myself or to stick to my diabetic diet.

my asthma acts up cyclically and necessiates trips to the er, for treatments, and inpatient admissions. at times i am such a frequent flyer, i can almost request my room. do i enjoy it? no. do i get attitude from some of my peers? yes. do i attempt to educate them? i try but some are unwilling. it is easy to sit and judge a patient until you walk in his/herr shoes. you teach the patient then discharge them. you do not have any knowledge nor do many make the effort to gain some, as to why patients do not fill prescriptions, or follow discharge instructions, or follow special diets, or what their home situation is like, or how many live in their home, or how much money they can spend or where they can shop, or how their cultural or ethnic oe relgious backgrounds impact on their health care needs. or even how their jobs and child care needs impact on their free time and their ability to attend outpatient education sessions.

i am not lecturing any of you, just asking that you walk in our shoes for a while. when i first graduated from my nursing program, i understood the impacts on a person's ability to deal with their chronic illnesses because it was taught in my program. as i worked, i found my peers did not have the same understanding. they frequently blamed the individual and seldom look at their own impact on that person. it appears that nothing has changed, since i have become disabled. i can only hope that this post makes a few think about their own attitudes and their own approaches to their non-compliant patients. and i hope it has a positive impact.

grannynurse :balloons:

[obeyacts2]

The biggest problem in our current system is lack of insurance coverage and accessability. I have real problems because I am considered unisurable by the insurance companies because I had ARDS and some common complications (renal failure, stress ulcers among others) back when I was 18.....Im n now 37 and have developed asthma, then r/t the asthma, hypertension, all controlled by meds. I was on a special state program for people in my situation, but the program only lets you be covered for three years and they switch you to naother program that has premiums so high (higher than my mortgage) that I was forced to drop it. :angryfire So, I just pray I stay healthy, I work full time doing CNA work and studying nursing. Dh job does not cover me either. I can't afford my PCP so I have found a FNP that only charges 50/visit. I find it unrweal that most every industrialized nation manages to have basic healthcare services for its people but the US.

Laura

[mysticalwaters1]

I don't know if it is a "healthcare" problem, but it probably leads to it- lack of insurance coverage.

Without it folks neglect the small things that could be fixed because they lack the money. Small things turn into big problems.

... and obesity.

Poor personal health habits on the part of citizens who then expect doctors to come up with a magic pill. Pharmacetical companies with too much political clout pushing those pills. Unfair distribution of healthcare services due to lack of basic coverage for many citizens. Paperwork nightmare due to patchwork of insurence plans and regulations, and litigation prone society.

Also a general societal attitude that taking care of yourself should come last. Just look at the way hospitals expect nurses to pull down so much (often mandatory) overtime. These are health care organizations that think nothing of destroying the wellness of their own employees.

I agree with all of those comments and as soon as I read the OP my first thought was insurance coverage. I hate it it's awful and whether a person's own personal habits contributes to the rising costs there are so many factors involved that make insurance coverage poor. I'm in an HMO and can't stand how I can't select my own doctors or have to see my main doctor first before I see another professional when I know and i think a lot of people know who they need to see (ex I had a cyst on my back and had to see my primary before I could see the dermatologist needed a referel). And I joined the HMO because I could afford it rather than only 50/50 coverage or less in some aspects!

I think what I hate about insurance coverage or people that can't even get is how billing seems to have evolved. And it's all parties causing this crap. What I'm talking about is how it used to be you had insurance and see the md for something or have a hospital visit and the insurance would pay what it felt was sufficient for the task. Then the difference was let go. NOW mds, and other hospitals no longer adhere to this. If the insurance only pays this one amount because it feels that that should be the cost the md or instution charges the pt the diference and RACKING HUGE bills!!! it's totally not fair and i find it disgusting. I'm not blaming mds and hospitals. It's a combination of everything. Some times the insurance may not cover what it should. Ha I had a workers comp claim and my hospital tried to charge me the difference that the insurance would not cover for an injury at their facility!!! I complained and they removed it b/c the staff complained that we should get privilage since we are employees. But what about people in the community! It really feels at time that this may be exploited to try and get money. I am really confused maybe I have not interpreteded how insurance works but i allways remembered the insurance paying the cost of things and that's it pay a copay or some premium.

As far as health problems causing issues I feel its smoking, obesity, sedentary lifestyle as well and I'm sorry but I think lot's of us our guilty of this. It's like someone else mentioned I used to play outside all the time and hardly any tv but now working I am allways in my car on the go fast food. I've recently tried walking in my community and it's summer time and I know there's lots of kids in my neighborhood and i barely see them.

It's funny. I used to complain so much as a teen having to walk 1-2 mi home from the bus stop (b/c my mom was working as a cna, and school for nursing) but now looking back jeeze it was awesome exercise and was not ever all that bad! Infact needed!

[CritterLover, BSN, RN]

i can only hope that this post makes a few think about their own attitudes and their own approaches to their non-compliant patients. and i hope it has a positive impact.

while i appreciate your comments, my post was not directed at people like yourself who make an effort at taking care of themselves. i am acutely aware of how difficult it can be for people to afford their drugs. i was a home health nurse in a very poor county for several years. there were times i found myself buying my patient's medications because i couldn't figure out any other solution -- they had used up their allotment of medicaid "punches" for the month and couldn't afford the drugs. what else could i do? i loved that job, and loved my patients, but eventually burned out because it could be so heartbreakingly frustrating at times.

i am talking about the people who make no effort to follow their diets, take their medications, follow up with their doctor, etcetera. the ones who come in hypertensive with a headache and a nosebleed. you get the pressure down, give them a script for meds, instruct them on the importance of taking them as scheduled, and point them in the direction of the 24 hour pharmacy on the corner......they come back in the next night with the same problem. did they take their meds? no. why not? because they didn't get the script filled. why not? because they didn't feel like going to the drug store and waiting to have it filled.

there will always be people who have brittle medical conditions that are in and out of the hospital because they are so difficult to treat. you know what? that is what we (health care professionals) are here for.

i am sorry (though not surprised) about the attitude you get from some people about your frequent admissions. i'd like to think that some of what you encounter is frustration at their inability to help you stay well. sometimes that can come across as a bad attitude.

[ceecel.dee, MSN, RN]

The "non-compliant" label makes me cringe too.

That said, I am frustrated by a general lack of self-care in many patients.

[grannynurse FNP]

while i appreciate your comments, my post was not directed at people like yourself who make an effort at taking care of themselves. i am acutely aware of how difficult it can be for people to afford their drugs. i was a home health nurse in a very poor county for several years. there were times i found myself buying my patient's medications because i couldn't figure out any other solution -- they had used up their allotment of medicaid "punches" for the month and couldn't afford the drugs. what else could i do? i loved that job, and loved my patients, but eventually burned out because it could be so heartbreakingly frustrating at times.

i am talking about the people who make no effort to follow their diets, take their medications, follow up with their doctor, etcetera. the ones who come in hypertensive with a headache and a nosebleed. you get the pressure down, give them a script for meds, instruct them on the importance of taking them as scheduled, and point them in the direction of the 24 hour pharmacy on the corner......they come back in the next night with the same problem. did they take their meds? no. why not? because they didn't get the script filled. why not? because they didn't feel like going to the drug store and waiting to have it filled.

there will always be people who have brittle medical conditions that are in and out of the hospital because they are so difficult to treat. you know what? that is what we (health care professionals) are here for.

i am sorry (though not surprised) about the attitude you get from some people about your frequent admissions. i'd like to think that some of what you encounter is frustration at their inability to help you stay well. sometimes that can come across as a bad attitude.

actually, it is mostly a blame game. i live with my daughter, sil and three grandchildren, plus four cats. cats that can cause asthma attacks for me. i generally manage to avoid them but when the temperature suddenly drops, from 76 to 53, then back up, off i go. and this past winter and spring seemed to be my worse time. one of my physicians and some of the nursing staff keep telling me to move out or have my daughter get rid of the cats. she may love me, but she loves those cats more . at any rate, i am moving back to nys in august. i generally try to ignore them and my physician's comments. as far as being a frequent flyer, in the er, the staff knows me, what to do and when i generally need to be admitted.

we had a rough time following charlie. both the staff and myself. the roof was blown off the hospital, the top two floors unusable. i had to be bought in by rescue squad, once, and was very happy to see that 'my nurses' had managed to live thru everything. i have generally been satisfied with my care and treatment by the staff. there has been just a few and i ignore them. for some, no one can change their attitudes. i will certainly miss some of them and my pcp. but i expect i may see them wqhen i come down at christmas :)

grannynurse :balloons:

[nurse_wannabe]

I just wanted to let everyone know that I AM reading these and learning from them. I hate it when posters ask a question & then disappear! :chuckle

I've gotten great responses so far. I can only think to add Medicaid abuse by patients, Medicare fraud on the parts of practitioners, and extremely over-inflated hospital charges (like the infamous $12+ for 2 OTC Tylenol).

I went to the ER for chest pains back in February (everything checked out fine), and the bill was $3,000! Thank goodness we have great insurance. Our part is still $300 though, and I think I would've risked a heart attack if I'd known it would be so expensive. I don't know what an uninsured middle class person without Medicaid would do in such an instance, and I hope I'm never faced with that.

Our new Republican governor is trying to shape up Medicaid by raising the income requirement, which will result in less people qualifying and even more of the working class being uninsured. He is also making it more difficult for the elderly and disabled to get home health care by increasing the points it takes to qualify for services. IMO, this is not the way to go about it. I would rather see some kind of restrictions placed on what Medicaid will and will NOT pay for, for example, needless trips to the ER via ambulance, expensive prescriptions when a cheaper one would work instead (my aunt gets Paxil or something with Medicaid, which pays $180/month for it and she doesn't even need it!), etc. Also, I think small copays, maybe $5 - $10, for ER visits would really make a difference. They might actually think twice about visiting the ER for some of the ridiculous things I've heard nurses on here talk about.

[Mystery5]

I just wanted to let everyone know that I AM reading these and learning from them. I hate it when posters ask a question & then disappear! :chuckle

I've gotten great responses so far. I can only think to add Medicaid abuse by patients, Medicare fraud on the parts of practitioners, and extremely over-inflated hospital charges (like the infamous $12+ for 2 OTC Tylenol).

I went to the ER for chest pains back in February (everything checked out fine), and the bill was $3,000! Thank goodness we have great insurance. Our part is still $300 though, and I think I would've risked a heart attack if I'd known it would be so expensive. I don't know what an uninsured middle class person without Medicaid would do in such an instance, and I hope I'm never faced with that.

Our new Republican governor is trying to shape up Medicaid by raising the income requirement, which will result in less people qualifying and even more of the working class being uninsured. He is also making it more difficult for the elderly and disabled to get home health care by increasing the points it takes to qualify for services. IMO, this is not the way to go about it. I would rather see some kind of restrictions placed on what Medicaid will and will NOT pay for, for example, needless trips to the ER via ambulance, expensive prescriptions when a cheaper one would work instead (my aunt gets Paxil or something with Medicaid, which pays $180/month for it and she doesn't even need it!), etc. Also, I think small copays, maybe $5 - $10, for ER visits would really make a difference. They might actually think twice about visiting the ER for some of the ridiculous things I've heard nurses on here talk about.

Good thoughts. We need to have individual responsibility for everyone, based on their ability to pay. But, I think it's unfair to cover the penniless, and leave the working poor up a creek without a paddle. I'm for a European style medical system.

[SmilingBluEyes]

Good thoughts. We need to have individual responsibility for everyone, based on their ability to pay. But, I think it's unfair to cover the penniless, and leave the working poor up a creek without a paddle. I'm for a European style medical system.

I agree. I can't understand a country like ours that can finance so many things (like a war w/o end for billions of $$$, corporate welfare and bailouts and writing off the debts of other nations ---that is another story) yet can't see to it all WORKING poeple are medically insured! Does anyone not see the greater costs in the end for the uninsured? It would be cheaper and better to insure them all along than to pay for the health crises that arise later from lack of basic medical care. "Pennywise, pound foolish", is the old saying that comes to mind. I will never understand this at all. :angryfire

[Mystery5]

I agree. I can't understand a country like ours that can finance so many things (like a war w/o end for billions of $$$, corporate welfare and bailouts and writing off the debts of other nations ---that is another story) yet can't see to it all WORKING poeple are medically insured! Does anyone not see the greater costs in the end for the uninsured? It would be cheaper and better to insure them all along than to pay for the health crises that arise later from lack of basic medical care. "Pennywise, pound foolish", is the old saying that comes to mind. I will never understand this at all. :angryfire

Amen!:yeahthat:

[nravey]

I agree with all of you. Our small town is trying to do something about that by instituting a pharm assist program and now we're working on FQHC status. The problem here is that I am an advanced practice nurse with my own clinic (RHC) right in the middle of town and am the only one in town who takes adult Medicaid. I have 65% Medicaid. Despite this fact, I recieve nothing but grief from the docs who don't want me here. It's like "how dare me a mere woman have a doctor's office without a doctor in with me". LA law requires that we have a doc come into our office every week and sign charts and make sure we are doing everything we are supposed to be doing - if we are RHC, then its every 2 weeks. And, to have privileges at the hospital - have my patients admitted, do labs and x-ray - I have to have a local doc agree to be my collaborative doc. It is so frustrating to have them blackball me so that I can't get my patients admitted - so they'll leave me and go to another doc.

This is part of the healthcare problem as I see it - the docs not wanting to give an inch to get help on the front lines and some of them are plain greedy - they won't even look at a patient unless they are rich. If laws governing NPs would loosen up and get rid of the collaborative agreement, we could do a lot more for our patients instead of always fighting for something and the docs have a lot more money to pay lobbyist to get our laws stopped or to write new laws against NPs. LA is still a "good ole boy" state.

nravey