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

Thanks, Gregory Gomez45, for making that red copy/paste just for my eyes only! 😉.

But... I was reading the text while it was still black and white, and... honestly, I don't think that bit about crowds of patients showing up for no reason and causing jams really applies to people coming in with specialist referrals and prescriptions for chronic conditions. And let's be real, chronic patients—whether they want to or not—are the ones creating those waiting room bottlenecks. For instance, my mom has been going in every single month for five years now just to get her Effexor. If it's common knowledge that Effexor is meant for long-term use, I don't see why she couldn't just get one prescription for, say, three or six months at a time. Then she could just pick up her monthly dose once a month, which could easily be "noted" on the script and logged into the "networked" computer system.

Even though the whole limit issue isn't really the main topic, I'll touch on it anyway, just speaking from my perspective as a patient. As far as I know, regardless of whatever financial cap a GP has, they aren't supposed to deny a prescription for a chronic patient's medication (and I'm assuming that goes for acute cases too). We aren't here to debate whether prescribing certain meds is justified or not—that’s not the point of this discussion. Nor are we talking about trying to kick "fakers" out of the waiting rooms.

My doctor actually mentioned to me recently that when she's about to "hit the ceiling" on her prescribed medication budget, she writes to a specific Medicare committee. She explains exactly why it happened and asks for permission to spend a certain amount over the set limit. And you know what? My doctor is super helpful; she'll write two prescriptions where I can pick one up right away and the other after a certain date. I'm not totally sure if that's strictly how it works or not, but hey, I'm thankful for her. It saves both her and me so much time, and I think that's basically what copperfox28 was looking to hear. Maybe it doesn't align with your view that a chronic patient should have to trek to the clinic every week or two just for their meds and pay a co-pay for the visit, but it makes my life so much easier. Now, whether the healthcare system loses out because of this, I haven't a clue. Personally, I'd even be willing to pay for two separate visits just to get two scripts if it meant I didn't have to spend half my life sitting in a waiting room.

Just to reiterate, if I understood correctly, copperfox28 wasn't asking for opinions on reforming the entire healthcare system (which, for the record, definitely needs a makeover), but rather how to "swim" within the system as it exists right now.

And as for Sweden, I'm actually pretty curious how they distribute that Effexor (assuming they haven't already swapped it for something more effective).

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.

In any other country, the distinction regarding parking might actually hold water, but talking about such a clear-cut division here is almost laughable—when certain people need something, the federal government and the local city administration just cooperate seamlessly to make it happen.
But that’s beside the point. I am surrounded by doctors—some working within the public system and others in pharma—and roughly 90% of them believe there is sufficient funding within the system; the issue is purely organizational. Even among dentists, it's the same story. It isn't just that 80% of CTs are unnecessary; it's that nearly 50% of radiological reports and blood tests are never even picked up. Not that these facts don't reinforce my previous point. Returning to the core issue: the system is structured so that those who desperately need financial support waste their time waiting on prescriptions, while primary care physicians waste both time and money issuing them. The fact that they have been reduced to mere bureaucrats rather than actual clinicians is a systemic failure, and it is undoubtedly linked to the massive amounts of capital being mismanaged.

Given that I was just slightly patronized... let's look at my mother's medical history. No, we all know how things work in this country—if she had relied solely on the public healthcare system, she would be blind by now, because the wait times alone would have been catastrophic. Consequently, about 70% of her various exams and surgeries were paid for through private providers—all of which added up, on top of the significant premiums she has been paying into Medicare for the last 35 years.

My apologies, I made an error—let me pick up where I left off.

That entire 70% regimen, including the surgery and everything else, ran about $100, $0.00 so I have some firsthand perspective on how much treatment costs within the American system versus what it might cost elsewhere. It isn't even that pharmaceutical companies set their prices in the US the same way they do in other markets.

As for the States, well, it’s a mixed bag—but the real struggle is for those who contribute just a little to the healthcare pool. If you're unemployed or have zero income, Medicaid and Medicare essentially cover everything. For instance, you can give birth in a university hospital with an epidural infusion, stay in a private room that includes a sofa for a spouse or partner, a TV, and a direct line—all while having a smooth delivery—completely free of charge. Meanwhile, someone paying modest premiums might only be entitled to a midwife visiting their home for a natural birth.
The system pays its doctors astronomical sums, but what American physicians often point out as a primary reason for these skyrocketing costs is the sheer scale of malpractice settlements being paid out to patients.

And while money is obviously a massive factor, it isn't the only one. In America, doctors—and this isn't their personal fault, but rather a systemic issue—are part of a structure where everything is handed to them on a silver platter during their education. Consequently, what actually strains the healthcare system and what doesn't—take information access, for example—is managed through rigid algorithms and very strictly defined hierarchies.

I am surrounded by medical professionals—some in the public sector, some in private practice, others in pharma—and they all reach the same conclusion: there is plenty of money involved. Perhaps not at the extreme levels seen by those with massive wealth or those with none at all, but certainly far more than what we are dealing with here today.

I am fairly certain that the example I'm trying to recall—something regarding a Scandinavian country, I believe—about a doctor not dispensing a full box of medication, was likely referring to acute illness rather than chronic conditions.
Since we agree that money is being wasted needlessly, I assume you'll also agree that requiring a chronic patient to visit the clinic once or twice a month—as this system dictates—is a double expense. It’s a drain on both the individual funding the system and the primary care physician themselves. A six-month prescription doesn't mean you get a six-month supply; it means you have the authorization to return every single month to pick up that one small box. You don't solve the issue of medication hoarding through such methods; you solve it through education—which is consistently underfunded—while the budget is instead poured into these inefficiencies. This approach only reinforces the idea that primary care physicians are merely functionaries rather than practitioners. The fact that 80% of CT scans are unnecessary, or as I heard recently, that perhaps 50% of blood work and radiology results are never even picked up, isn't a failure of the patient—it is a failure of the system itself.
And by the way, regarding those seven medications—half of which are on the generic list—they are spending $50 a month on them; they aren't just throwing them away or swallowing them for the sake of it.

My apologies once again for the repetition—I suppose time just does its thing and things tend to cycle back around...

Anyway, setting aside all this back-and-forth you guys are having, I was wondering... how is it that you can't just get more boxes of your meds on a single prescription? It works differently for me. For instance, my doctor writes it right there on the script so I can get two boxes at once. Just yesterday, I picked up two boxes of Percocet, and not too long ago, I grabbed two boxes of antibiotics at the same time. I’m not sure if that's the rule for every single medication out there, but honestly, maybe try asking your doctors about it? It might make things a little easier on you if they can swing it.

Sam Hughes5 said:Anyway, setting aside all this back-and-forth you guys are having, I was wondering... how is it that you can't just get more boxes of your meds on a single prescription? It works differently for me. For instance, my doctor writes it right there on the script so I can get two boxes at once. Just yesterday, I picked up two boxes of Percocet, and not too long ago, I grabbed two boxes of antibiotics at the same time. I’m not sure if that's the rule for every single medication out there, but honestly, maybe try asking your doctors about it? It might make things a little easier on you if they can swing it.

That's actually illegal. One valid reason would be if a patient legitimately needs that much within a month. If they don't, and an inspector finds out, that doctor would get hit with a massive fine immediately.

It really comes down to the specific medication—some prescriptions allow you to pick up two boxes at once, while others don't; however, if you're in that first category, you can just grab both boxes right then and there. That isn't quite the same thing as a recurring prescription, where you'd return multiple times using the same authorization. I find this whole antibiotic thing a bit odd, though—they're typically packaged so that a single box covers the entire course. For instance, if you're taking one pill a day for three days and there are three tablets in a box, it works out perfectly; similarly, if you take two a day for seven days, you'd expect to see fourteen in the box.

copperfox28 said:It really comes down to the specific medication—some prescriptions allow you to pick up two boxes at once, while others don't; however, if you're in that first category, you can just grab both boxes right then and there. That isn't quite the same thing as a recurring prescription, where you'd return multiple times using the same authorization. I find this whole antibiotic thing a bit odd, though—they're typically packaged so that a single box covers the entire course. For instance, if you're taking one pill a day for three days and there are three tablets in a box, it works out perfectly; similarly, if you take two a day for seven days, you'd expect to see fourteen in the box.

I had a similar experience with Silenor, getting two bottles of 30. And just yesterday, I picked up Percocet, two bottles of 20. But since that's twice a day, those 40 pills only last about 20 days... which is way less than a month. If there isn't even a 30-day supply option available, I guess it's technically against the rules if the treatment is meant to go longer.
I mean, I assume the pharmacist would speak up if anything seemed sketchy.

No, I’ve said it before—you might be able to get two at once depending on the medication, but this business with the Sylapen? I don't follow; that would be dual therapy. There is absolutely no way my primary care physician would just hand me an antibiotic like that unless there was a serious issue. I'm no doctor, obviously, but why on earth is such a long course required?
Certain medications simply cannot be listed together on a single prescription—or so they claim. Unless they are intentionally misleading me, which I see no reason for, as there is no benefit in it for me or for them.

And regarding the suggestion that one should pay for a consultation every single time a prescription is needed—what consultation? Such a thing doesn't even exist. Even if they were allowed to charge for it, what would they actually do? A GP examining a diabetic's eyes or deciding on a specific combination of drops for someone with high ocular pressure? Frequently, I must repeat, through no fault of their own, these doctors have no idea what kind of specialized medications they are dealing with.
Gregory Gomez45 and Harold Ramirez49, it is painfully obvious that your experiences from the patient side of things—to your good fortune—are extremely limited. You might think that because you are part of the system, everything will run smoothly when you finally need it, but that is nothing more than a delusion.
It honestly sickens me—for instance, we move away from mechanics, who are already expensive and prone to overcharging, only to hear a notary explaining that their fees are high because of their extensive education and the "responsible" nature of their work. Meanwhile, my sister has to work a month's worth of overtime shifts just to cover the cost of $4000 certifying a mortgage application—a process that takes twenty minutes. It seems if doctors aren't required to undergo more training than a notary, their job won't be considered any more responsible, and they won't be doing any more than they already do. But none of that is relevant
to what I wrote. And yes, it also weighs heavily on her, even though she is a physician, having to rush out of work because her father took her mother to the pharmacy; she had to stop by to grab something to eat because nobody accounted for the fact that under this new system, she'd be stuck there from ten in the morning until two in the afternoon. Diabetics can't exactly skip meals when they need insulin, and then she has to leave work to pick her up or provide $33 for a taxi. It also deeply affects her how her mother has had to struggle to get her prescriptions over the last few years, and the fact that being a doctor provides her absolutely no help or sympathy whatsoever.

copperfox28 said:No, I’ve said it before—you might be able to get two at once depending on the medication, but this business with the Sylapen? I don't follow; that would be dual therapy. There is absolutely no way my primary care physician would just hand me an antibiotic like that unless there was a serious issue. I'm no doctor, obviously, but why on earth is such a long course required?
Certain medications simply cannot be listed together on a single prescription—or so they claim. Unless they are intentionally misleading me, which I see no reason for, as there is no benefit in it for me or for them.

And regarding the suggestion that one should pay for a consultation every single time a prescription is needed—what consultation? Such a thing doesn't even exist. Even if they were allowed to charge for it, what would they actually do? A GP examining a diabetic's eyes or deciding on a specific combination of drops for someone with high ocular pressure? Frequently, I must repeat, through no fault of their own, these doctors have no idea what kind of specialized medications they are dealing with.
Gregory Gomez45 and Harold Ramirez49, it is painfully obvious that your experiences from the patient side of things—to your good fortune—are extremely limited. You might think that because you are part of the system, everything will run smoothly when you finally need it, but that is nothing more than a delusion.
It honestly sickens me—for instance, we move away from mechanics, who are already expensive and prone to overcharging, only to hear a notary explaining that their fees are high because of their extensive education and the "responsible" nature of their work. Meanwhile, my sister has to work a month's worth of overtime shifts just to cover the cost of $4000 certifying a mortgage application—a process that takes twenty minutes. It seems if doctors aren't required to undergo more training than a notary, their job won't be considered any more responsible, and they won't be doing any more than they already do. But none of that is relevant
to what I wrote. And yes, it also weighs heavily on her, even though she is a physician, having to rush out of work because her father took her mother to the pharmacy; she had to stop by to grab something to eat because nobody accounted for the fact that under this new system, she'd be stuck there from ten in the morning until two in the afternoon. Diabetics can't exactly skip meals when they need insulin, and then she has to leave work to pick her up or provide $33 for a taxi. It also deeply affects her how her mother has had to struggle to get her prescriptions over the last few years, and the fact that being a doctor provides her absolutely no help or sympathy whatsoever.

You mentioned your sister is a doctor, so do doctors have special scripts they can use to pick up meds at the pharmacy? Like, could she just go in and grab them? Some guy I know mentioned something like that, but I never really understood it.

First things first—I’m not here to bash the system I work in. That’s not how lawyers or professors behave, and it's not how I do. Now, don't get me wrong, there are certainly irregularities, especially at the primary care level. In the US, we see about 30% of patients handled through outpatient clinics while 70% end up being treated within hospitals, which is actually the opposite of what you typically see in the broader European situation. Part of this setup comes down to legal regulations, but honestly, it's also about convenience for family doctors. They don't feel the need for extra training, nor do they want to deal with the added overhead. I won't get bogged down in the weeds here, but I truly believe there isn't a better healthcare system than ours. When I see people living in places like Switzerland, Sweden, or Denmark coming in for checkups here in the States and picking up their prescriptions, they are often using medications that we haven't even prescribed here for twenty years. And where else in the world does an ambulance drive a patient 50 miles just for a routine injection or a simple bandage change? Sometimes it happens daily! Or look at how many hospitals have essentially turned into nursing homes, where neglected, dehydrated seniors are dropped off by "concerned" sons and daughters who only show up because they were threatened with being sent back to their hometown if they didn't hospitalize their parents. It’s a real issue; we even have instances where, upon discharging these elderly patients, we have to call the police to track down relatives because the address provided doesn't even exist. If there's one thing, though, it's that in this country, doctors are pretty much the only profession without strong professional organizations to look out for their interests and protect their rights.
One more thing: my mother spent three whole hours last week waiting for a referral for a follow-up, and that was despite her daughter being a doctor. So, before anyone tries to lecture me about "connections" or favoritism, let's get that straight.

Sam Hughes5 said:You mentioned your sister is a doctor, so do doctors have special scripts they can use to pick up meds at the pharmacy? Like, could she just go in and grab them? Some guy I know mentioned something like that, but I never really understood it.

They use private prescriptions, which let them go straight to the pharmacy to buy medication without going through Medicare. It’s the same deal for anything a general practitioner is authorized to prescribe, as well as things reserved specifically for specialists—for instance, certain eye drops might be within an ophthalmologist's scope, but a psychiatrist wouldn't be allowed to write those.

Lescolxl, the fact that lawyers aren't complaining is perfectly normal; their compensation is significantly higher, and unions there actually represent them more effectively than their counterparts in Germany. Professors, on the other hand, are clearly dissatisfied with the system, though I fail to see how pretending that everything is fine helps anything—even if things are objectively worse elsewhere. Scandinavians have longer life expectancies than we do; whether that's because they smoke less, move more, or simply eat better, I couldn't say, but it's evident their medications are effective given the end results. Besides, I doubt they suffer from higher rates of disability, chronic illness, or sick leave than we do.
About fifteen years ago, I cut my finger—it just wouldn't stop bleeding—so I went to the urgent care clinic at the local health center in a residential neighborhood. I walked into the exam room with a bandage that was completely soaked in blood, and the moment the doctor saw me from three feet away—before she even had a chance to get close enough to actually examine the wound—she sent me straight to the emergency room at the General Hospital. They ended up stitching me up there, and they made a point to tell me to tell her to actually start doing her job.
Three years ago, during a weekend, I was diagnosed with strep throat at an infectious disease clinic, and they prescribed penicillin injections. The doctor was actually terrified to administer them, fearing I might develop an allergy on the spot and go into anaphylactic shock right there in front of her. I took Silapen, but the infection flared back up four more times over the next six months. In fact, I ended up diagnosing the last two instances myself using a magnifying mirror, and a nurse from a former colleague's firm brought me antibiotics, since having tonsils removed in my 30s wasn't exactly a priority for me at the time. That finally settled it. Still, it's difficult for me to pin the blame entirely on doctors; if I were the one spending all day writing out prescriptions and referrals, I imagine I'd also be terrified of someone having an anaphylactic reaction on my watch.
A friend of mine is currently doing her residency in internal medicine in the US. She's been in it for three years now, and they feel identical to the first three years of training. I might be wrong, but when you look at the big picture, I think this approach is actually more cost-effective than our current model—especially if those three years were actually utilized meaningfully.

I noticed people were talking about something similar on the forum, so I figured I’d start this thread—hopefully in the right spot. I’m trying to figure out if what happened to me today is just a freak occurrence or if this is just how things work around here now.

So, I called today to try and schedule a UTZ abdominal scan, and I basically got treated like a recruit in basic training. They told me to just leave my name and number, they'd put me on a waiting list, and then they'd call me when they have an opening—but warned me it wouldn't be within the one-month window before my referral from the primary care doctor expires. When I mentioned that I'm rarely home to pick up the phone, I got this blunt, dismissive response that I should just save their number and call them back myself. I honestly can't believe it! What do you guys think? Has anyone else dealt with this, or has your experience been even worse?😠

jadewalker13 said:I noticed people were talking about something similar on the forum, so I figured I’d start this thread—hopefully in the right spot. I’m trying to figure out if what happened to me today is just a freak occurrence or if this is just how things work around here now.

So, I called today to try and schedule a UTZ abdominal scan, and I basically got treated like a recruit in basic training. They told me to just leave my name and number, they'd put me on a waiting list, and then they'd call me when they have an opening—but warned me it wouldn't be within the one-month window before my referral from the primary care doctor expires. When I mentioned that I'm rarely home to pick up the phone, I got this blunt, dismissive response that I should just save their number and call them back myself. I honestly can't believe it! What do you guys think? Has anyone else dealt with this, or has your experience been even worse?😠

Well, what did you expect? Unfortunately, that's just the way things work around here.🙄

If you actually manage to get an appointment within three months, consider yourself lucky.

jadewalker13 said:I noticed people were talking about something similar on the forum, so I figured I’d start this thread—hopefully in the right spot. I’m trying to figure out if what happened to me today is just a freak occurrence or if this is just how things work around here now.

So, I called today to try and schedule a UTZ abdominal scan, and I basically got treated like a recruit in basic training. They told me to just leave my name and number, they'd put me on a waiting list, and then they'd call me when they have an opening—but warned me it wouldn't be within the one-month window before my referral from the primary care doctor expires. When I mentioned that I'm rarely home to pick up the phone, I got this blunt, dismissive response that I should just save their number and call them back myself. I honestly can't believe it! What do you guys think? Has anyone else dealt with this, or has your experience been even worse?😠

Maybe this will catch your eye. Spread the word to everyone you know and get involved!

Jerry Booth10 said:Well, what did you expect? Unfortunately, that's just the way things work around here.🙄

If you actually manage to get an appointment within three months, consider yourself lucky.

Look, I get that there's a wait—I really do—but the whole process is just ridiculous. They won't even give me a date. Instead, I’m stuck playing this waiting game where they'll call me out of the blue, and then I have to play detective just to recognize their number so I can actually pick up. And don't even get me started on the tone they used when they broke the news to me... absolutely unprofessional.
😲

What can I even say? They tested me on a medication that made me pass out right in front of the doctors, just as I was about to be discharged. Then they prescribed an alternative that isn't even registered here in the States because only the specific drug they tested me on is approved. I waited three months for my discharge papers, and during that time, I was essentially buying medication illegally just to get by. They promised me they would submit a request to the hospital for the drug to be approved and covered by insurance. Fast forward a year later to my follow-up appointment, and it turns out the request was never even filed. Why? Because the department head refused to budge; he insisted I take the very medication that caused me to lose consciousness right before his eyes. The worst part is, if they had actually given me that initial prescription, I would have been taking it three times a day—meaning I would have been passing out three times a day. Once again, they gave me the same empty promises, but I highly doubt anything will ever come of it. In the US healthcare system, it’s clearly more important to cut costs than to care about how patients actually feel. So now, for a year and a half, I’ve been traveling every two months just to pick up a $90 medication. And I'm only seventeen.

If anyone here works in healthcare, please reach out. I have a few questions I need to ask.

They aren't thinking straight.

So, here is the situation... I have been lying in a hospital here in the States for eight days now, dealing with sudden weight gain and massive water retention. I assume they’ve drawn about a liter and a half of blood from me over these last eight days. I managed to put on 30 pounds within a single year without changing my diet at all. Fortunately, I can still manage to burn some of it off...
I just hide my stomach and use some blush to mask the puffiness, and then I can tolerate being around people. But it is taking a toll on my health. I have stretch marks on my abdomen, high blood pressure, breathing issues, exhaustion even with minimal movement, and moments of fainting...

And while I have to wait a month or two for the hormone results, the doctor's diagnosis is simply that I am "healthy overweight."

I truly cannot believe it.😲

Please, I am asking for your help.
I need to get this fluid out of my system. And honestly, I'm exhausted...

Brenda Rodriguez said:They aren't thinking straight.

So, here is the situation... I have been lying in a hospital here in the States for eight days now, dealing with sudden weight gain and massive water retention. I assume they’ve drawn about a liter and a half of blood from me over these last eight days. I managed to put on 30 pounds within a single year without changing my diet at all. Fortunately, I can still manage to burn some of it off...
I just hide my stomach and use some blush to mask the puffiness, and then I can tolerate being around people. But it is taking a toll on my health. I have stretch marks on my abdomen, high blood pressure, breathing issues, exhaustion even with minimal movement, and moments of fainting...

And while I have to wait a month or two for the hormone results, the doctor's diagnosis is simply that I am "healthy overweight."

I truly cannot believe it.😲

Please, I am asking for your help.
I need to get this fluid out of my system. And honestly, I'm exhausted...

How much do you weigh and how tall are you?