Can we talk about how much the American healthcare system sucks?
So I have an ulcer. I dry heave at least once a day and I haven't eaten in 21 days. (Please do not give me advice, I hate it, I don't want medical advice from people over the internet. At best, if you do, I'll respond with a "thanks.")
I'm in a somewhat smaller town, not really small, about 80,000 people maybe. There is exactly one gastroenterologist in this town. I went to him when I hadn't eaten in 6 days. For a $50 copay, he said to take some Mylanta along with the Protonix I was already taking and call him in two weeks if I wasn't better. So I call him yesterday. I talk to the nurse. I tell her all my symptoms, none of which have changed. She sounds very concerned.
I hear nothing all day. This morning, I call again. The doctor hasn't even gotten to my information. So the nurse sends a message that I called again, which he probably also won't see.
I have tried to get a second opinion, or just another prescription for something, but there is not a single gastroenterologist within a 90 minute drive that would see me within three months. I'm pretty sure if I don't eat for three months, I'll be pretty dead. I mean, I'm living on Ensure and Gatorade, but I doubt that will get me to three more months.
Oh, and this is the second time this has happened. The first time, I had to take a bunch of tests like a CT scan and an X-Ray and a blood panel and they found nothing. I had a scheduled colonoscopy anyway, so they just went down my throat as well and that's when they found the ulcer. No one even suggested an ulcer before that.
Why am I saying all of this? I'm not even complaining about all of this. I'm complaining about the fact that this has cost me almost $2000 already and I feel lucky because I have good insurance. I'm not poor, but I don't really have $2000 to spare. I'm paying it off in installments, but god damn, I have to pay all of this money and they have stopped even giving a shit about me.
What would someone in my position without insurance even do? Die? That's what conservatives fucking want.
We need universal healthcare and a complete overhaul of the healthcare system now.
And any time you hear someone complain about how long a wait you have in Canada or the UK to see someone to help you and how America has the best healthcare system in the world and how people from other countries come here for treatment, send them to this post before telling them to get fucked.
TL;DR No one gives a shit about you in American healthcare except maybe the nurses and all they do is suck money out of your bank account.
My doctor's nurse called me up and said I had a high liver enzyme.
"What does that mean?"
"You can't drink alcohol."
"But what's going on with my liver?"
"I don't have the details, you'll have to talk to the doctor."
The doctor moved away before I could get in to see her.
I called her partner.
"New patients are six months out."
Six month's later: "Sorry the doctor moved away."
Pick a random doctor in the phone book.
"New patients are six months out."
Six months pass. I miss the appointment.
"I want to reschedule."
"Sorry, the doctor won't see patients who miss their first appointment."
I'm trying to get in to the next doctor. So far I have no idea what's wrong with my liver.
Among other problems, it turns out our local health care group was bought out by venture capitalists. Their mismanagement is part of why so many doctors are leaving.
When I talked to the nurse yesterday, she asked how much Ensure I was drinking. I said I had a bottle twice a day. She said, "that's all you're having?" I asked if I should drink it more often and she said, "I would, but don't take my advice because I'm not the doctor." Gee, thanks lady.
I know you don't want advice. I know, but, there are meal replacements, that aren't nothing but sugar, corn and soy crap, and are much more nutritionally complete. May be worth looking into them. Huel and Soylent (sold in Target for sure) are the first that come to mind. I understand if your reply is "thanks" just wanted to throw that out there, because I feel your pain.
I have ALL kinds of GI issues. The latest GI I saw, after waiting like 2 years during covid (had one appt before lockdowns, and then had to wait), and then another like 4 months after I called to book an appointment, ran a HIDA scan, which came back as low/abnormal. His answer? Oh, well it's too close to normal to do surgery, so just take miralax and don't eat fatty foods. Gee thanks, why didn't I think of that, professionally trained guesser extortionist? When asked if there were going to be long term effects from taking a laxative, like, idk making constipation worse, his answer? IDK, maybe?
Not defending the American medical system, or your specific provider, some are truly just in it for the money. However, the system kind of makes you complicit if you want to keep your doors open.
Providers are leaving the field in droves, especially the specialist. Management usually has full control over your time, and tends to pack in more patients than it's really possible to treat and follow up on. The compensation isn't really a huge motivating factor, especially for younger providers. There are plenty more financially rewarding jobs out there that require a lot less schooling and working hours.
I'm not saying that you need to do this, but if there are others in your situation who would like some advice.......
Two teaspoons of sodium alginate, one teaspoon calcium carbonate, and one teaspoon of baking soda mixed together via electric hand frother will create a thick slime that helps coat your stomach lining. It's been proven to reduce the symptoms that cause ulcerations, and proven to aid other treatments for peptic ulcers.
It also has the benefit of expanding in your stomach to make it feel as if you have eaten, which tends to help with some of the nausea.
You're the person that made the "shitting out the neck of their shirt" comment that had me dying laughing. 🤣
I've started just getting bloodwork done out of pocket instead of: going to a doctor, getting the blood work order, going to the lab, getting the draw, making an appointment with the doctor again, returning, and then getting the results.
Now I just pay $50, get the results myself, and then go to a doctor if I need to address something in the results that I can't figure out by googling. I know it's absurd, and I have insurance, but to get one blood test is an hour to go to the doctor, wait, go to the clinic room, wait, talk to the doctor for 5min, leave, go to the lab, repeat, then go back to the doctor abs do it again. It ends up being like 3-4 hours over multiple days and in the middle of the workday. For the doctor, it's two 5min conversations that are PART of their workday.
So, yeah. I tend to just run my own diagnostic blood tests and Google. That's how inconvenient and frustrating the medical system is even WITH insurance.
And, to be clear, I don't suggest anyone else do this.
There are small pockets where it doesn't suck. My current company has amazing benefits where my youngest had to have major surgery and it literally cost $100. My previous company however my wife had to have minor surgery and 6 years later we still owe them $23k. We're paying it off slowly.....
Honestly, I got much better and more attentive medical care when I was broke and on Medicaid than in the years since I got private insurance.
Like you said, it takes forever to get an appointment (which might get cancelled without rescheduling) and when you do go in, they just refer you somewhere else, possibly out-of-network. At the Medicaid clinics, they do it all in-house and typically same-day.
I'll commiserate with you on the fact that the healthcare system is totally broken. My Mom has had a problem with one of her leg nerves for over a year and a half now, and she has been going in to see specialists, getting told "this is what you have, here's what we can do", getting the prescription/treatment, having it not work at all, and then gets told to get back in line for another appointment with several weeks, if not months, of lead time. Even when she gets put on a priority list for when there are cancellations, there's almost never a cancellation that let's her get in earlier than her original appointment.
In her case, I'm not blaming the doctors. They are trying their best. I just don't understand how it can take 1-2 months per visit, or even upwards of 6 months, and meanwhile she is in agonizing pain whenever she stands or walks too long.
Meanwhile, I just paid out $6k in dental bills this year alone because my regular dentist missed a cavity until it became bad enough that it required a root canal, but they tried to fill it first and it didn't work, so then I had to pay for the botched filling procedure (partially covered by insurance), and a root canal that sadly doesn't seem to have made the tooth any less sensitive, and copayment fees to other dental providers for second opinions because my tooth still hurts even after all they did to it and I want to know what else could do to help, and now I am looking at paying another $3000+ to have the tooth extracted and replaced with a prosthetic implant, which was an option in the first place but they encouraged me to try the fillings and the root canal to "save" the tooth first. Now, I'm trying to wait until January 1st to have my benefits reset so it softens the blow significantly, but until then I'm suffering with this zombie tooth rotting away in my mouth.
The healthcare system in America is fucking garbage and needs to be destroyed and rebuilt with a human-first mindset, not a for-profit mindset.
I hope you are able to get the treatment you deserve. Stay strong and stay positive.
What would someone in my position without insurance even do? Die?
Even those who have good insurance and can afford ….. my doctor’s office stopped refilling my prescription, stopped returning my calls, after he had expressed concern about not wanting me to “stroke out” over my condition. I doubt it magically fixed itself, but I’m still having a hard time overcoming inertia to find a new doctor
As a former healthcare support staff professional and current medical student, I want you to know that I hate it just as much as you do. I can't make any explanations for that GI, but my least favorite part of medicine is when there isn't a good answer, or enough time, or the right treatment is just too expensive...I hate it when the capitalist bullshit medical system gets in the way of actually practicing medicine.
I know you don't want advice, but I want to share some information that may be important and helpful for you: recent studies have shown ulcers are essentially an infection and antibiotics have some success in treating them.
For too long doctors thought it had to do with stress or diet, but it's an infection.
Yes, should be tested for this at the very least as it's pretty treatable. Note though that this is the case of many ulcers but not all, an H pylori infection specifically.
I've never heard anyone say that the American healthcare system is the best in the world. Even from critics of universal healthcare.
The best systems are mixed systems like you see in Germany or the Netherlands. As someone from the UK, don't fall for the propaganda about the NHS. It's really not very good.
Second this. I've heard it many many many many times. "You may have to pay but you won't wait and it's the best in the world! People come from all over the world here for treatment!"
It's not very good now that the Tories have starved it of funds for over a decade with a view to selling it off.
In 2005, Direct Democracy: An Agenda For A New Model Party was co-authored Jeremy Hunt Michael Gove, David Gauke, and Kwasi Kwarteng, among others.
On page 78, it states that
Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.
And on page 74 asserts that
patients, either through the tax system or by way of universal insurance, [should] purchase health care from the provider of their choice
The one area of public policy in the UK that has unanimity between the parties is the NHS. Any party that "sold the NHS off" would be out of power for a long time. It would be electorally foolish.
Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.
So like the two countries I listed earlier then. Where they have universal healthcare provided by affordable insurance systems. Nothing like the US.
patients, either through the tax system or by way of universal insurance, [should] purchase health care from the provider of their choice
Wow. Patients given choice_? Perish the thought! You should be forced to have mediocre healthcare, peasant!
NHS c. 2009 was excellent. Don't forget that.
Healthcare outcomes for diseases like cancer, heart disease etc were as low as countries in Eastern Europe. I don't care how "efficient" a healthcare system is if it isn't doing it's main job of keeping people alive.
This probably won't help you since you live in a small town.
Finding a doctor in the united states sucks. Literally the worst experience I have ever had was transitioning to a PPO insurance policy after being in a combine managed HMO / healthcare group.
People told me for years "oh, that health care provider sucks. You get sub par care and nobody ever knows your name." You know what else I got? Same day doctor visits and same day specialists, literally anytime I wanted or needed anything. I had reasonable medical care at a reasonable schedule for a reasonable price.
When my insurance switched to a PPO, people told me "oh, you will love this doctor! He is so great!" And... every... single... time... it is exactly as you described. "New patients are 6 months out." And when I finally got a primary care doctor, they would recommend specialist who were their friends also in private practices with 6 months waiting lists.
Private practice medical care is an absolute joke. It's another shitty system the boomers saw their parents use successfully that simply doesn't work today.
The solution was to find a high quality medical group in my city. It took me nearly a year to figure it out. Same day doctor visits? Done. Same week specialists? Done. Same system / in network urgent care at the same price as a regular doctors visit? Done.
I don't care which doctor I see, I just need medical care.
Sorry to hear about everything you're going through and how much it costs for no treatment. I think a lot of doctors do care but they are overworked and have to constantly battle hospitals and insurance companies. A lot of them seem to be seeing less patients which is not going to be good, and many are retiring or burning out. There are also now more seniors than people under 17, the seniors require more care. Article on the doctor shortage: https://time.com/6199666/physician-shortage-challenges-solutions/
Thanks. I understand what you're saying, but when I tell a doctor I'm not eating twice and he says to me keep taking your pills before you eat, I don't think he gives a fuck. He seems like a nice enough guy, but he's apparently a terrible doctor. And I don't have anyone else I can go to. I mean I know why. This is one of the shittiest towns in the country, Terre Haute, Indiana, but still...
Huh. That doesn't seem like much for something that stops you from eating, but I guess I'm not a doctor, or privy to the details of your ulcer. I remember when I went in with an ulcer they acted like it was full red alert.
Anyway, I sympathize. I still have to bounce around between gastroenterologists because I have the same problem getting in - and half the doctors in my area leave after a short time here. "You need a new gastroenterologist" invariably ends up with a lot of "We're not taking new patients, please call back in a couple of months".
Unless this is ever addressed, the symptoms will only get worse over time. The system is designed to siphon the nation's capital to the owner class, they aren't interested leaving you enough to get medical care, quality food, acceptable education, etc. You are nothing but livestock to the people that control this nation through the economy and the fully captured government, and they use it to make sure you don't have a scrap for yourself.
I'm so sorry you have to go through all this crap. I'm lucky that I live in the Houston area, so tons of doctors and even luckier that I have amazing health insurance. Still had to pay thousands of dollars for a surgery since the insurance didn't want to cover it (it was slightly "experimental", but it also worked). The US system is screwed up, favors the wealthy, and has lots of profit motives that are counter productive for the "consumers".
What I hate is that people defend it. I hear arguments about how if there was a one payer system then doctor choice and quality would go down, or that it would hurt rural hospitals. And it's just all false, but no matter how much you show studies or explain they just keep pivoting. It's not even a majority of people, but since it's a vocal minority that votes more, it still hasn't changed.
My problems aren't anywhere near as bad as yours, but I'll add my own complaints to comiserate at least.
My wife is a type 1 diabetic. I have a pre-diabetic A1C (type 2) that i inherited from my mom. My insurance (Blue Cross Blue Shield) claims they cover preventative care. But they refuse to cover our regular A1C tests - it's not preventative because they already know what you have. As a BCBS support person told me, if they're throwing spaghetti at the wall, its preventative. If they're aiming for a spot - it's no longer considered "preventative". So thats like $600 - $1000 a year. Chump change compared to many in this thread, I know.
Also, for some reason, they only offer coverage for one type of insulin - novolog - which happens to be the one insulin that causes my wife issues. She's type-1, so her immune system killed her insulin production at around 5 years old. She's dependent on insulin to survive and uses an insulin pump. Novalog is less effective than literally every other insulin for her - which means she has to take more - which means more risk of long term problems. This insulin also requires a pre-bolus (basically taking insulin) of 1-2 hours before every meal. That means every meal has to be preplanned and prepared for or she starts a rollercoaster of highs and lows. Humalog, aphidra, fiasp? All work more efficiently and within like 15-30 minutes.
The local HMO my work used before offered tiered options. We could pay a bit more for a better option. I would have no problem paying double to get her Humalog. BCBS says no. Novalog or pay out of pocket.
I have occasional headaches that start in the back of my neck that turn into bouts of depression followed by mania a few days later. My neurologist wanted to do a full MRI panel to look for issues. Insurance denies it - medically unnecessary. The neurologist appeals and they're like "fine fine, but we'll only cover the head, not the neck" even though the pain started from my neck. They don't find anything in the head. So the neurologist says, "well unless you want to pay out of pocket, we can't check the source so.....assume it's just migranes?"
Oh and by "cover", I mean they paid a small part of it. It still cost me $1,500 to do the ones that were "covered".
That's a smattering of the interactions I've had with my insurance that I can remember right now.
My parents are retired and on medicare. They pay far less and get way better medical care than I do with one of the biggest private insurance chains in the country. Go figure.
What's hilarious is that the government recently passed legislation to cap the cost of most formularies of insulin to $35.....for medicare recipients. I've checked, the vast majority of formularies are participating now.
But if you are reliant on private insurance (because medicare is for seniors), you can fuck right the hell off. You pay what we tell you to. BCBS has not expanded their preferred formulary list beyond this one shitty formulary and I don't expect them to.
Oh and if you're like my wife and your insurance only covers a formulary that causes you problems and a demonstratively higher A1C as a result, well you can buy vials out of pocket for $600 - $1000 for a month's supply.
I'm glad that medicare is as great as it is and have no problem paying into it as a tax-paying citizen, but private insurance is the problem that most of us are dealing with and nobody is doing anything to address it.
I canceled my dermatologist appointment last winter because it was a 30 mile drive to the clinic and it was the worst blizzard we'd had all year. The soonest I could reschedule was 7 fucking months out. In truth all I needed from that visit was for him to renew my prescriptions, but I'm forced to go in and pay $300 for an office visit to do it.
Wow. Pay money to have prescription renewed.
Here in Sweden I just send a message online to my doctor that I need it renewed. No charge or anything like that.
Does your dermatologist not offer telehealth as an option? I'm usually able to just have a phone or video call with my PCP to see how things are going and renew my prescription. Not offering telehealth seems very odd in our post-2020 world.
Edit: Unless you needed to go in for a scan or test. Sorry, I didn't even consider that possibility.
OECD data actually puts the USA in the middle of the pack for wait times for specialty care for developed nations. I believe it could largely be solved by companies switching to advanced access/open access scheduling models, but most are too afraid to upend their business model.
Lmk if you have any questions about navigating appointments, I’m actually in grad school studying healthcare business. My only real suggestion at this point is to use your doctor’s electronic portal for communication. In many cases it’s more effective than a phone call, plus you have written records.
I know you said no medical advice, but I’d ask a doc about H Pylori. Always something that should by ruled out in cases like these.
To your point about delays, I waited over two years to see a psychiatrist in a huge university hospital system -- one of the only places which would even accept my shitty insurance -- as a person with suicidal ideation. It's so fucked.
Chronic GERD. Talk to family doctor, who refers me to a gastroenterologist (one that is "in network" for my insurance"). My insurance is from my wife's job, who works at a hospital, which you'd think was good. More on this tidbit later.
Go to Gastro doctor (took 2 months to get in), recommends an Endoscopy, which is scheduled for 1 month later. Initial visit is covered (mostly/kind-of) by insurance.
One day before Endoscopy, get a call saying my insurance won't cover the procedure there, and I'd have to pay out-of-pocket if I proceed ($5k estimate). I say no thank you.
I call insurance company about better location, and am referred to another gastroenterologist. I tried to just get an Endoscopy at new location, but they refused to do so with an Gastro doctor visit with THEIR doctors. I schedule visit at new office (1 month to get in).
Go to NEW Gastro doctor, recommends an Endoscopy, which is scheduled for 1 month later. Visit is covered (mostly/kind-f) by insurance.
One day before Endoscopy, get a call saying my insurance won't cover the procedure there, and I'd have to pay out-of-pocket if I proceed. I say WTF. Turns out the Insurance company recommended me to a Doctor who was In Network, but their procedure location is NOT in network.
Apparently, despite having a PPO insurance, there is "In Network" and there's "in IN network", since my insurance is through my wife's hospital plan. I have to have the procedure at an official hospital location that is part of my wife's hospital network.
I schedule an endoscopy at a 3rd location (1 month out again). Finally get an Endoscopy completed.
From initial referral to Gastro, until completion of Endoscopy, was 6 months. This was on supposedly good insurance (which was obviously a lie). We don't have that insurance anymore.
This kind of thing happens all too often. Going in for a surgery that your insurance will cover? Oops, we forgot to mention that the anesthesiologist is actually out of network, so you’ll have to pay out of pocket for that part.
Did you ever figure out what the problem was? I have a very similar issue and a very similar story though the endoscopy just said yeah you got GERD bro lol and I've been taking meds that barely work ever since
You’ve got my vote for M4A. My partner has all kinds of health issues and as I get older I’m getting more and more myself. It’s wild that most any diagnosis of any affliction is pretty much a financial death sentence for anyone but the wealthy. We are what I’d consider lower-middle-class and live very modest lifestyles. I feel like we live in bizarre-o world with how bad things are and everyone just keeps trucking along like everything isn’t coming apart at the seems.
What state are you in? I’m curious because I have long term medical issues and need frequent care and the cost is terrible but the care and physician availability is really good.
I’m in Minnesota, in the metro area so I’m sure that factors. I’ve just seen a lot of articles about healthcare and physicians in decline in the red and purple states lately.
I'm sorry you're experiencing this, it's terrible and should not be something you have to deal with. Not sure if this counts as medical advice but asking in case it's been overlooked, do you have access to telehealth options or have you sought a care coordinator through your insurance? Those may be helpful in finding a different doctor, it won't help with the existing debt though. I'm disabled and unfortunately very familiar with medical debt, if you'd like any information on ways to try to lessen that debt feel free to dm me. There's also a lot of organizing around medical debt, this group is one I've been involved with, if that's of any interest to you (or anyone else reading this).
You know, I would love a telehealth option, but only with a reputable doctor. I've seen a few websites where you can sign up for telehealth appointments with a gastro, but I don't trust them. I don't know that my insurance would cover it though.
Call your insurance company and ask them for options with telehealth.
They are the ones who make most of the significant medical decisions anyways in the U.S.
What Dr do you want to see? Better ask your insurance first who they cover.
What medication are you taking? Better check with the insurance first. If it's an expensive one, it will take approximately 6 weeks or more while you suffer to approve it via one vendor.
What treatment do you receive? Better check the insurance first to see if it's covered.
Only in the ER do they treat first. You get to pay whatever they charge. Oh and it might come from 4 different places that you've never heard of as every Dr has a different billing service.
As for what to do, well I live in a city of 250K. There's a specialist clinic 3 miles from my house but they suck really bad. So we drive 3 hours one way to see a specialist that has my wife's chronic condition under control.
It has been 50€ after refund in total to fix my ulcer. I don't know the full price of the two medical procedure to check for it and the meds shouldn't have cost too much.
I live in a city, near a hospital and sort of medical district, so do have easier access geographically than most; also as a legacy of the time when Florida was more rational the insurance has always covered dermatologist, gynecologist, midwife, not just annual visit to GP.
Even so:
Dentist must be scheduled 6 months out.
Dermatologist and almost any specialist 4-5 months wait (basically if you are going each year better to schedule a year ahead of you want to get an appointment).
And cost-wise, the cost in total of insurance and out of pocket cost is batshit insane. Just have to hope nothing happens. Broke my finger, surgery & rehab $5,000. Status migraine, turned away from urgent care, they said I had to go to emergency room, $4,000. If you are designing a system to move money up away from people it's working as intended.
And on top of the private insurance that only covers anything after I spend thousands of dollars in any given year, we also pay in taxes to cover the sickest and oldest. So insurers are cherry-picking populations. If we had ONE healthcare system it would be cheaper for us. But all my cost is someone's paycheck and those someones have lobbyists to keep their money coming.