State of the healthcare system in America: Let's discuss why it's failing

A "minor" headache, if you can call it that. My mother is diabetic and manages a daily regimen of about seven or eight different medications. My sister mentioned that according to the law, there is supposed to be a provision for recurring prescriptions—essentially a single script that covers six months—but apparently, the people actually running the show have no idea how to implement it. Theoretically, you could hit the pharmacy every few months for the same meds using one script, so one has to wonder: who exactly is ignoring the law??
She’s registered with a doctor in New York City, right in the heart of the downtown district, near a clinic that—unlike that local liquor store that shut down recently—has never once bothered to reserve even a single parking spot for patients. Today, that area was a total red zone. I won't go into too much detail about how infuriating it is to have to shell out $5.25, whether it's ten bucks in the city center or eight dollars in the suburbs, just to find a spot to pick up a prescription. Not to mention the parking garage near the hospital; if you’re trying to transport a patient with limited mobility, you’re forced to use the same garage and pay the premium just to get in.

With this new system, honestly, it’s better to park further away from the doctor's office; if you spend an hour navigating a red zone—assuming you even find a spot—it’s hard to actually get to the pharmacy window. But the absolute peak of absurdity happened today. I went to pick up my mother's scripts, and the doctor on the afternoon shift was covering for her regular physician, who is currently on vacation. I had been there two or three weeks ago, and regardless of the fact that Mom is currently at the beach, I couldn't get two specific medications because, according to the system, she still had about half a box left. To prevent the doctors from getting flagged by the auditors, they simply refuse to write them. So today, the doctor tells me: "Um... regarding this blood pressure medication, she picked it up on June 9th and still has three tablets left for the next three days." I told her: "No, she hasn't taken it since yesterday." She insists: "Yes, she has." I say: "No, she hasn't." She says: "Yes, the computer says so." I replied: "The computer can say what it wants, but she doesn't have them—and besides, what does it mean that she has enough for three more days!" Under this current setup, you’d practically need to visit the pharmacy every single day—one drug on Thursday, another on Monday, a third on Friday, and so on. Given that she is disabled—and even if she weren't—someone would essentially have to move in next door to the clinic. For a therapy that hasn't changed in six or seven years, you have to show up the exact moment you run dry. That's what the doctor said. According to Medicare: exactly.
Now, assuming she isn't just talking nonsense, is our healthcare system becoming increasingly "organized" in a way where, if you have a disabled family member, you might as well just quit your job? Because you'll be spending your life dealing with one prescription after another every single day. And do the people we fund to serve us have any inkling of what real life is actually like? Unfortunately, we have to pay them by decree, so they don't necessarily need to understand reality. In the real world, you work, and before you can even enjoy what's left, you've already paid them just so they can perform their jobs—jobs that you end up performing for them in the most convoluted way possible. Then, they'll take your money to hire some PR firm to explain to you how things aren't actually broken, but are instead functioning perfectly and logically.

Anyway, while I was tidying up my apartment, I stumbled upon some info on this forum about which kitchens to avoid, which doors not to buy, and so on.
So, I am calling on you—given that I unfortunately possess extensive, long-term experience with the American healthcare system—to join me in sharing your own experiences. Even if these services aren't officially "on the market" and we can't avoid them, perhaps through these small, incremental contributions, we can start fighting against being treated like we just fell off a turnip truck.
thanks

Maybe you’d actually appreciate all these medications more if you had to foot the bill yourself, rather than having Medicare cover everything from the prescriptions to the parking fees. Honestly, where does the human stupidity end?

Harold Ramirez49 said:Maybe you’d actually appreciate all these medications more if you had to foot the bill yourself, rather than having Medicare cover everything from the prescriptions to the parking fees. Honestly, where does the human stupidity end?

Man, when it comes to the healthcare system here in the US, the stupidity is pretty much endless...

Harold Ramirez49 said:Maybe you’d actually appreciate all these medications more if you had to foot the bill yourself, rather than having Medicare cover everything from the prescriptions to the parking fees. Honestly, where does the human stupidity end?

Given that I find it hard to believe anyone is quite dim enough to use a compass to navigate their way through a sentence and still arrive at such a ridiculous conclusion, I can only assume you're being paid to post this.
I have no idea where you got the notion from my post that Medicare should be picking up the tab for parking; the point was that parking shouldn't be an extra cost at all—it ought to be guaranteed and free, just like it is at any other medical facility in the country.
As for the medication costs—well, once they refund every single cent my mother has poured into the healthcare system over her thirty-five years of coverage, plus interest, I’ll be more than happy to take it.

copperfox28 said:Given that I find it hard to believe anyone is quite dim enough to use a compass to navigate their way through a sentence and still arrive at such a ridiculous conclusion, I can only assume you're being paid to post this.
I have no idea where you got the notion from my post that Medicare should be picking up the tab for parking; the point was that parking shouldn't be an extra cost at all—it ought to be guaranteed and free, just like it is at any other medical facility in the country.
As for the medication costs—well, once they refund every single cent my mother has poured into the healthcare system over her thirty-five years of coverage, plus interest, I’ll be more than happy to take it.

First off, I want to say it's clear to everyone here that your mom's situation is serious. Since she's on so many medications, I'm sure things are really tough for her right now. But believe me when I say this: Medicare is definitely spending AT LEAST $667 + every single month on exams, meds, and everything else related to a patient like her. Just grab a calculator and multiply those months by years. I really don't mean to be harsh or arrogant or anything like that, but you have to realize what the US provides. If you occasionally have to wait or pay for parking, I hope it doesn't feel like a huge burden. Because if Medicare were to refund all that money from the last 17 years plus interest (basically since the US was founded), trust me, that amount wouldn't even cover two years of treatment for a critically ill patient. Just as an example, in the US, people have socialized healthcare but also private options, so most citizens have both. Even for those with private insurance, specialist visits can run $1,000, and they still pay for both private and social insurance. Meds that might cost an extra 40-$17 in America can cost several hundred dollars every month in the US.
I hope you didn't take me the wrong way; I just wanted to point out what's available to you, since maybe you weren't fully aware!

Maybe you’re just missing the point here. If your mom already used up her dedicated health insurance funds, then figuring out how to pick up her prescriptions is on you—just like how dealing with a parking fee is a personal responsibility. Honestly, if you're that frustrated, why not start a petition to get Medicare to cover free parking? Who knows, maybe it might actually go somewhere!

Come on, guys, let's stay focused here! Parking is just one more thing that eats up my time—and honestly, a lot of work hours too—plus the cash, but it shouldn't be the reason we start tearing apart how healthcare is organized.

The whole situation with prescriptions is just exhausting and creates such huge hurdles for people living with chronic conditions. Take my eighty-year-old mom, for instance. She’s dealing with Parkinson's, neuropathy, heart issues, osteoporosis... she’s a fighter, but walking isn't easy for her anymore. So, having to trek out several times a month just because a bottle ran empty or some computer system glitched out? That's a real struggle.

And it’s not like I’m doing much better when I hit a rough patch with my systemic lupus. So, I didn't really see copperfox28 complaining as being "entitled." Even my doctors—and thank god I have plenty of them—complain all the time about the red tape surrounding medication protocols for chronic patients and those endless referral procedures...

Also, why do we keep comparing everything to the US? At least when people talk about them, they mention how "inhumane" and messy their healthcare system can be. That's what I hear in the news, anyway. How do the Scandinavians handle it? Or the Dutchmen? 🤷 All I know is that the poor organization of our own healthcare system drains energy I already don't have much of, being a chronic patient myself.

And reading about whether someone has "wasted" the money they paid into Medicare makes me feel uneasy. Maybe that's just real life, as people call it here, but... it's called health insurance for a reason. It's meant for when you're sick or in need. Now I'm supposed to feel guilty for using the coverage I paid for? What then? Just say goodbye to everyone and walk away? 🙂

(By the way, I actually turned down conventional meds for my SLE and try to manage things my own way, so I'm hoping there's still something left in my account...)

Medication costs are a massive headache across the whole system. For instance, a primary care doctor basically has a cap of about $80,000 a month for prescriptions. But they end up spending way more—I’ve got several medical colleagues who say they hit $110,000-$40000 a month just on scripts alone. Now, if doctors cross that magic threshold of $26667, Medicare actually hits them with financial penalties just because they were doing their jobs! On the flip side, if they don't prescribe certain meds, patients start coming at them, and they could end up facing a disciplinary board after the Secretary of Health and Human Services asks, "Why didn't you give them their medication?" It’s a total Sisyphean task. Plus, with all these insurance issues, patients flood the GP offices for no reason, creating huge crowds and stealing time away from people who actually need help. I guess a really simple fix would be to make the co-pay for a GP visit, say $33, and introduce mandatory co-pays for drugs; that would probably thin out the crowds and boost service quality.
Everywhere in Europe, medical services require some kind of co-pay. Like in Sweden, doctors might not even hand you a full box of pills; they might just give you enough for a week or two!
In other words, if you have a chronic condition, you’ll have to head back every month to pick up your prescriptions.

And honestly, the US has the best medical system in the world. The top experts are there, they pour the most money into research, and they have the best diagnostics and treatments. But I think Americans realized something a long time ago: healthcare isn't cheap. It's actually incredibly expensive, and it can't truly be free. Even though I agree their prices are way too high, the results speak for themselves.

I honestly can't tell who’s being the idiot here, but if we keep heading down this road, someone's definitely gonna get banned from the forum...☕...

Gregory Gomez45, I really have to hand it to you—I am right there with you on this one. You laid everything out so calmly and clearly, though I sometimes wonder if people here actually grasp the gravity of it all. Because our healthcare system is essentially "free" at the point of service, we’re stuck in this cycle where it’ll likely stay for a long time. That’s why we see so many expensive medications just tossed in the trash, why half the population ends up getting unnecessary checkups, and why about 80% of those CT scans end up being totally redundant.
As for the parking situation, that falls under the city's jurisdiction, not the hospitals.

Harold Ramirez49 said:Gregory Gomez45, I really have to hand it to you—I am right there with you on this one. You laid everything out so calmly and clearly, though I sometimes wonder if people here actually grasp the gravity of it all. Because our healthcare system is essentially "free" at the point of service, we’re stuck in this cycle where it’ll likely stay for a long time. That’s why we see so many expensive medications just tossed in the trash, why half the population ends up getting unnecessary checkups, and why about 80% of those CT scans end up being totally redundant.
As for the parking situation, that falls under the city's jurisdiction, not the hospitals.

That's what my medical colleagues tell me too. I'm a dentist, and I gotta say, things are WAY worse on our side. You guys at least have a budget for medicine, but we have to pay for supplies, nurses, equipment, and all that from the tiny $50 per patient we get each year. So when a patient shows up with their Medicare card, I honestly feel a sense of dread because I KNOW that by the time they sit in the chair, they've already burned through almost their entire annual budget without even opening their mouth.

I think you might be wrong about changes not happening; they're actually happening right now. Different insurance companies have started offering and selling private health insurance. Right now, UnitedHealthcare is doing pretty well, and my guess is that as the economy gets stronger, more and more people will start paying for private coverage. We're already seeing top-tier specialists migrating to those private clinics because they can actually afford to pay them properly. So eventually, public healthcare might just be left with people who are just finishing their residency or aren't skilled enough for someone else to hire them, while the best doctors will ALL be in private practice. And the main reason is that EVERYTHING IN PUBLIC HEALTHCARE IS FREE, and if you ask me, that’s exactly what’s going to destroy the system. The government simply CAN'T afford to fund it.

Gregory Gomez45 said:Medication costs are a massive headache across the whole system. For instance, a primary care doctor basically has a cap of about $80,000 a month for prescriptions. But they end up spending way more—I’ve got several medical colleagues who say they hit $110,000-$40000 a month just on scripts alone. Now, if doctors cross that magic threshold of $26667, Medicare actually hits them with financial penalties just because they were doing their jobs! On the flip side, if they don't prescribe certain meds, patients start coming at them, and they could end up facing a disciplinary board after the Secretary of Health and Human Services asks, "Why didn't you give them their medication?" It’s a total Sisyphean task. Plus, with all these insurance issues, patients flood the GP offices for no reason, creating huge crowds and stealing time away from people who actually need help. I guess a really simple fix would be to make the co-pay for a GP visit, say $33, and introduce mandatory co-pays for drugs; that would probably thin out the crowds and boost service quality.
Everywhere in Europe, medical services require some kind of co-pay. Like in Sweden, doctors might not even hand you a full box of pills; they might just give you enough for a week or two!
In other words, if you have a chronic condition, you’ll have to head back every month to pick up your prescriptions.

And honestly, the US has the best medical system in the world. The top experts are there, they pour the most money into research, and they have the best diagnostics and treatments. But I think Americans realized something a long time ago: healthcare isn't cheap. It's actually incredibly expensive, and it can't truly be free. Even though I agree their prices are way too high, the results speak for themselves.

But wait, isn't that exactly how it works now?

Gregory Gomez45 said:Medication costs are a massive headache across the whole system. For instance, a primary care doctor basically has a cap of about $80,000 a month for prescriptions. But they end up spending way more—I’ve got several medical colleagues who say they hit $110,000-$40000 a month just on scripts alone. Now, if doctors cross that magic threshold of $26667, Medicare actually hits them with financial penalties just because they were doing their jobs! On the flip side, if they don't prescribe certain meds, patients start coming at them, and they could end up facing a disciplinary board after the Secretary of Health and Human Services asks, "Why didn't you give them their medication?" It’s a total Sisyphean task. Plus, with all these insurance issues, patients flood the GP offices for no reason, creating huge crowds and stealing time away from people who actually need help. I guess a really simple fix would be to make the co-pay for a GP visit, say $33, and introduce mandatory co-pays for drugs; that would probably thin out the crowds and boost service quality.
Everywhere in Europe, medical services require some kind of co-pay. Like in Sweden, doctors might not even hand you a full box of pills; they might just give you enough for a week or two!
In other words, if you have a chronic condition, you’ll have to head back every month to pick up your prescriptions.

And honestly, the US has the best medical system in the world. The top experts are there, they pour the most money into research, and they have the best diagnostics and treatments. But I think Americans realized something a long time ago: healthcare isn't cheap. It's actually incredibly expensive, and it can't truly be free. Even though I agree their prices are way too high, the results speak for themselves.

Maybe if you actually watched Moore's "Sicko," you'd see the true wonders of the American healthcare system.

It’s an interesting observation, but in my experience, the biggest critics of our healthcare system are often the ones who never contribute a dime to it. They haven't invested a single cent into the system, yet they sure are the loudest when it comes to complaining. It’s always something—not enough referrals, not enough medication, or not enough specialist tests. Some of them can barely sign their own names, yet they walk around acting like all the medical professionals are incompetent while wandering aimlessly from one clinic to another. Everyone wants to claim their rights and demand service, but nobody seems to feel any responsibility toward managing their own health. Honestly, it’s like nobody has any clue, nor do they care, about the actual cost of a single diagnostic test or the medications they're prescribed. And don't even get me started on how much staff are paid; a doctor's hourly rate is $10, which is actually less than what you'd pay a local hairstylist or a plumber. It’s honestly pretty pathetic.
As for any major reorganization of the healthcare system, I don't see that ever happening. Any administration brave enough to try and overhaul the whole thing would probably be voted out of office overnight.

Jesse Ramirez8 said:But wait, isn't that exactly how it works now?

Maybe if you actually watched Moore's "Sicko," you'd see the true wonders of the American healthcare system.

I watched the movie. I guess things here aren't all that different, just handled in a slightly different way. I mean, if you ask me, where would I rather go for cancer treatment or heart bypass surgery—here in the States or somewhere else? It’s pretty interesting how all our politicians who get seriously ill end up traveling OUTSIDE the US for medical care. If the American system is so amazing, maybe someone can explain why politicians feel the need to cross borders just to get treated?

In the US, we see about 200,000 people diagnosed with colorectal cancer every year who don't even get surgery, let alone other essential treatments, simply because their health insurance won't cover it.

Gregory Gomez45 said:I watched the movie. I guess things here aren't all that different, just handled in a slightly different way. I mean, if you ask me, where would I rather go for cancer treatment or heart bypass surgery—here in the States or somewhere else? It’s pretty interesting how all our politicians who get seriously ill end up traveling OUTSIDE the US for medical care. If the American system is so amazing, maybe someone can explain why politicians feel the need to cross borders just to get treated?

I think you’re totally mixing up apples and oranges here. There is a massive difference between the administrative system and the actual quality of the doctors providing the care. My point was specifically that the American SYSTEM itself isn't necessarily the finest medical framework in the world. And regarding everything else you mentioned about science and research... well, isn't that pretty much the case with almost everything else in America?

Harold Ramirez49 said:In the US, we see about 200,000 people diagnosed with colorectal cancer every year who don't even get surgery, let alone other essential treatments, simply because their health insurance won't cover it.

quoting copperfox28: ...So I'm calling on you all... to join me in sharing your own experiences with this. Even if these things aren't officially on the market and we unfortunately can't ignore them, maybe through these small, tiny contributions and little steps, we can start fighting so they don't just treat us like we dropped out of a tree today...

From what I gathered, the person who started this thread was basically asking us to share our experiences navigating the American healthcare system, and then maybe follow up with some suggestions, advice, or tips... just so we can figure out how to best manage and feel okay within the current setup.

Anyway, I keep thinking back to those prescriptions. If my doctor is annoyed because she has to write out new scripts for "chronic patients" constantly—feeling like she's "wasting" them or causing the waiting room to overflow... and if the pharmacist is also grumbling about the paperwork... well, since everything is computerized now, I really don't think "reorganizing" how chronic prescriptions are handled should be some impossible mission. It's all right there on the screen!

As for what Harold Ramirez49 said above, I honestly think it’s a bit misplaced given the reality here in America. So many people (whether they're still working or retired) simply weren't in a position to contribute to extra retirement accounts or private savings—some due to age, others due to financial struggles that had nothing to do with being irresponsible—and because of that, they can't afford to pay for supplemental private health insurance either. I think it'll be a long time before anyone can look at someone and say, "Look, buddy, you didn't plan ahead for your health coverage, so don't act surprised that we're in a tough spot with your cancer." Life happens, you know?

Matthew Fox4 said:quoting copperfox28: ...So I'm calling on you all... to join me in sharing your own experiences with this. Even if these things aren't officially on the market and we unfortunately can't ignore them, maybe through these small, tiny contributions and little steps, we can start fighting so they don't just treat us like we dropped out of a tree today...

From what I gathered, the person who started this thread was basically asking us to share our experiences navigating the American healthcare system, and then maybe follow up with some suggestions, advice, or tips... just so we can figure out how to best manage and feel okay within the current setup.

Anyway, I keep thinking back to those prescriptions. If my doctor is annoyed because she has to write out new scripts for "chronic patients" constantly—feeling like she's "wasting" them or causing the waiting room to overflow... and if the pharmacist is also grumbling about the paperwork... well, since everything is computerized now, I really don't think "reorganizing" how chronic prescriptions are handled should be some impossible mission. It's all right there on the screen!

As for what Harold Ramirez49 said above, I honestly think it’s a bit misplaced given the reality here in America. So many people (whether they're still working or retired) simply weren't in a position to contribute to extra retirement accounts or private savings—some due to age, others due to financial struggles that had nothing to do with being irresponsible—and because of that, they can't afford to pay for supplemental private health insurance either. I think it'll be a long time before anyone can look at someone and say, "Look, buddy, you didn't plan ahead for your health coverage, so don't act surprised that we're in a tough spot with your cancer." Life happens, you know?

In America? Yeah, right. Fat chance. If they actually decided to fully utilize all the digital technology available to our public services, just imagine how many people would suddenly find themselves completely unnecessary.

Jesse Ramirez8 said:I think you’re totally mixing up apples and oranges here. There is a massive difference between the administrative system and the actual quality of the doctors providing the care. My point was specifically that the American SYSTEM itself isn't necessarily the finest medical framework in the world. And regarding everything else you mentioned about science and research... well, isn't that pretty much the case with almost everything else in America?

If you think those are different things, then I guess you're a bit confused. Quality comes from the system; you can't really separate the two. It's not like Americans just woke up one morning and decided to have the best doctors on the planet.

Here's a snippet from today's Wall Street Journal:

http://www.wsj.com/newsroom/example_link_207EFB74D2E9.2

WSJ: What should insurance holders expect?
MILINOVIĆ: There’s a chance we could take a portion of the health tax that the working population pays into Medicare and set it aside. That way, every employee, employer, or both could decide where to put it—say, maybe two percent out of the total fifteen percent health tax. So, thirteen percent would go to Medicare based on solidarity, while that two percent could be used to choose a different insurance provider. Employees need to have the right to actively participate in how their money is distributed and pick a company for specific parts of their coverage, excluding primary care. Under this model, Medicare would cover 80 percent of hospital budgets, and hospitals would earn the rest through the market via other insurance companies. With a good manager, they might even earn more than twenty percent on the market, which would allow for higher pay for those who work harder or specialize more.

WSJ: Medicare loses its monopoly, but also loses some funding.
MILINOVIĆ: True, but it also stops paying for a portion of the healthcare provided to workers, which currently costs Medicare 2.7 billion. In a market-based insurance model, expenses for treating the working population will likely be lower because there will be better control over spending. One of the strategic goals of this reform is also improving the status of doctors. The government, per collective bargaining, guarantees everyone a base salary—which is currently around $400—but the market and competition create opportunities for extra income. Those who treat patients better or perform more surgeries will be able to earn more. Private investment in hospitals will also open up, so the state budget won't have to spend as much on capital investments. I’m confident this can fix the healthcare system, and eventually, we can talk about lowering the fifteen percent health tax, which is among the highest in Europe, and that’s just not acceptable. It’s clear how much a lower tax would help the economy.

WSJ: How will patient co-pays be “reformed”?
MILINOVIĆ: Right now, we have co-pays ranging from 10 to 50 percent of the service cost, so in many cases, that ten percent doesn't even cover the cost of the paperwork. Instead of that 10 to 50 percent range, I’d propose a flat 20 percent co-pay for all services, from specialist visits to hospital stays. But we’d also implement a fixed minimum co-pay for everything. If twenty percent ends up being less than that minimum amount, the patient just pays the set minimum price for that service.
The reform won't financially burden low-income groups, and Medicare will still provide supplemental insurance.

Wait, that's weird, looks like the current administration is still in power.😁 See, this is EXACTLY what I told you guys.

Matthew Fox4 said:quoting copperfox28: ...So I'm calling on you all... to join me in sharing your own experiences with this. Even if these things aren't officially on the market and we unfortunately can't ignore them, maybe through these small, tiny contributions and little steps, we can start fighting so they don't just treat us like we dropped out of a tree today...

From what I gathered, the person who started this thread was basically asking us to share our experiences navigating the American healthcare system, and then maybe follow up with some suggestions, advice, or tips... just so we can figure out how to best manage and feel okay within the current setup.

Anyway, I keep thinking back to those prescriptions. If my doctor is annoyed because she has to write out new scripts for "chronic patients" constantly—feeling like she's "wasting" them or causing the waiting room to overflow... and if the pharmacist is also grumbling about the paperwork... well, since everything is computerized now, I really don't think "reorganizing" how chronic prescriptions are handled should be some impossible mission. It's all right there on the screen!

As for what Harold Ramirez49 said above, I honestly think it’s a bit misplaced given the reality here in America. So many people (whether they're still working or retired) simply weren't in a position to contribute to extra retirement accounts or private savings—some due to age, others due to financial struggles that had nothing to do with being irresponsible—and because of that, they can't afford to pay for supplemental private health insurance either. I think it'll be a long time before anyone can look at someone and say, "Look, buddy, you didn't plan ahead for your health coverage, so don't act surprised that we're in a tough spot with your cancer." Life happens, you know?

Ugh, looks like we’ll be waiting a long time for this to happen. 🙄

We shouldn't be surprised; healthcare is incredibly expensive, the current system isn't working and needs to change, and it looks like the current Secretary might actually trigger a landslide of changes.