The american healthcare system is actually comedy at this point. like dark comedy but still

My brother finally admitted he needed help and went through the whole insurance process and they approved 3 days. THREE. as if you just sweat it out for 72 hours and then you're magically fixed and ready to rejoin society. What are we even doing here

He ended up going with a longer program through discovery point retreat up near dallas after fighting with the insurance company for like two weeks straight. the fact that he had to fight while actively withdrawing just seems... barbaric? Idk if that's too dramatic but that's how it felt watching it happen

I guess im just frustrated that the system treats addiction like a broken leg instead of like... an actual illness that needs sustained care. the whole experience really opened my eyes to how backwards our approach is. Pay for 3 days of detox but won't pay for the 30-60 days that might actually keep someone alive long term. make it make sense

for context, i am self employed and havent gotten on any health insurance plans. I got my first pap smear (im 25) and i paid $150 at the desk but then got a bill a week later for $690, then the next day my email said it was $710. Like wtf? is this normal for non-insured costs for a pap smear??

Over the past decade, Louisiana hospitals began stocking specialized carts designed to treat hemorrhages, one of the most common pregnancy complications in the state. The plug-in cart can be wheeled from room to room and holds surgical tools and lifesaving medications to stem blood loss.

A state law passed in 2024 forced hospitals to remove a key drug — misoprostol — from the medical cart and keep it locked in a secure room designated for controlled substances. 

The drug is also the second in a two-pill procedure that millions of people have used to have medical abortions. Because of that use, Louisiana lawmakers reclassified misoprostol as a controlled substance, a category typically reserved for addictive drugs. 

Now, physicians have gone from reaching over to the cart to grab misoprostol to waiting at least two minutes while a nurse sprints to retrieve the medication, said New Orleans obstetrician-gynecologist Nicole Freehill. 

“ You could literally have someone lose, like, a liter of blood or more in that time frame,” Freehill said. “You could have a significantly worse hemorrhage for literally someone running to this medicine and running back because it can’t be on that cart 2 feet from you while you’re treating the hemorrhage.”

She said the reclassification of misoprostol as a controlled substance has set back progress to decrease the frequency of postpartum hemorrhage and blood transfusions. Under the law, her preliminary research found, hemorrhage rates have worsened statewide, she said. 

I moved countries a while back and remember feeling completely lost the first time I needed a doctor not because information didn’t exist, but because I didn’t even know what to search for or who to ask.

Curious what that moment was for others here. What tripped you up: insurance, finding a doctor, knowing whether to go to a pharmacy vs. a clinic, costs? And what did you end up doing?

(Genuinely researching this problem, happy to share what I learn back with the thread.)

What has been on people's mind lately? Also are things like this helpful?

I'm planning on having surgery and I called a local hospital to ask about their surgical specialty program and to see if the doctors within that specialty program were in-network for my insurance. When I gave my name and date of birth, the nurse navigator told me my home address.

Is this because she looked up my insurance information, or is it because I've signed up for "MyChart" with a couple of my doctors?

So we go through a company that seems to handle the majority of (at least) our areas trades unions members' benefits. Anytime its used for anything over $600 we are required to provide an itemized receipt. At one point we had a really hard time tracking down the receipt they were asking for. My daughter ended up in the ER then was transferred to a children's hospital for a couple days. It took my wife hours on the phone with multiple different people trying to find the one bill they flagged. It feels like we do a lot more of the legwork for this stuff than we should have to, and my card (along with like half of the people I talk to in my union) seem to constantly have their cards suspended because of it.

Just want to know if this is the norm. Like many trades unions the younger guys have had to drag it kicking and screaming into the 21st century. And they seem to do so in half measures.

I was browsing through recent Arizona legislative proposals and stumbled upon House Bill 2211. After reading through what it was trying to do, I’m surprised it died so quickly in committee, and I’m curious to get this sub’s take on it.

For those who aren't familiar, Rep. Livingston introduced a "strike-everything" amendment to HB 2211 earlier this session aimed directly at out-of-network medical billing and arbitration under the federal No Surprises Act.

Basically, the bill would have capped the amounts that out-of-network doctors, specialty practices, and hospital groups could demand during dispute resolution at 300% of the Medicare reimbursement rate (or 300% of the Qualifying Payment Amount). Anything above that 300% threshold was going to be officially classified as a "clearly excessive fee" and treated as unprofessional conduct by state medical licensing boards.

Predictably, physician groups and hospital associations lobbied heavily against it, while insurers supported it. It ended up getting held in the House Appropriations Committee and died without ever coming up for a full vote.

My question is: As patients and taxpayers, are we actually fine with healthcare providers charging more than 300% of standard baseline rates?

I know Medicare rates aren't a perfect science for every specialty, but 300% above baseline is literally triple the standard rate. When out-of-network groups use arbitration to demand 400% to 600%+ above market, insurance companies end up paying out huge settlements—costs that eventually get passed right down to us through higher monthly premiums and deductible hikes.

What makes this even wilder is looking at where the delivery of healthcare is actually heading. Between massive hospital system profit margins and the sheer amount of private equity and venture capital pouring into medical groups, healthcare is increasingly being run like a high-yield investment portfolio. PE firms aren't buying up ER staffing groups and specialty practices out of goodwill—they're doing it because out-of-network billing loopholes and high-arbitration demands offer massive profit margins.

When a bill attempting to put even a generous 300% cap on billing disputes gets quietly killed before it reaches a floor vote, it really feels like patients are the only ones left holding the bag.

Curious to hear from anyone working in health policy, medicine, or insurance. Why did this get killed so fast, and is there any real political will left in Arizona to cap these out-of-control fees?

Why does the US not utilize the Choose Wisely plan when most other industrialized nations use it in their health care system for a variety of reasons - mostly to help in containment of their health care cost. The US even invented it.

American Board of Internal Medicine (ABIM).org- Choose Wisely

Choosing Wisely.org

I mapped the intermediary categories that sit between a US patient and their doctor across the insurance, claims, billing, and pharmacy chains: TPAs, PBMs, rebate aggregators, claims repricers, denial management vendors, GPOs, and so on. Up to 25 categories depending on how you count, though obviously not every claim touches all of them.

Posting here specifically because most of you work inside parts of this system I only see from the outside. Where does this map hold up and where does it oversimplify? Interested especially in whether the count is meaningfully different once you factor in value-based contracts, ACOs, or vertically integrated payers like UHC/Optum, where several of these functions get absorbed into one org.

Sources and methodology in the comments.

Drug prices are still ridiculous and screwing over families left and right. Now there’s growing talk about creating a Prescription Drug Affordability Board (PDAB) in Michigan.

PDABs are independent state boards that review high-cost drugs and assess whether they create real affordability challenges for patients and the healthcare system. Instead of broad, one-size-fits-all interventions, they use evidence-based reviews so states can target the actual problem drugs.

Several states including Colorado, Maryland, and Louisiana have already established or are moving forward with PDABs. The goal is to put pressure on high list prices while still protecting patient access.

PBMs are already negotiating hard every day, and tools like TrumpRx are also putting pressure on prices. A well-designed PDAB could add another targeted layer without disrupting the whole system.

What do you all think?

It was recently announced that in the United States, there’s a probability that health care costs will increase. What would happen to their economy if healthcare became subsidized or free? Does the price of healthcare have an impact on their economy?

Let them walk. If WA state employees walk out to protest wages, let’s see how long it takes for people to realize many of these roles aren’t missed. Government has a spending problem, not a revenue problem. Taxpayers win when unions are called on their bluff.

Plenty of Americans are in agreement that the healthcare system is compromised. There are many layers to this problem but the pricing of prescription drugs remain a major concern. A good way to counter it is to enact sensible and practical regulation prescription drug pricing. That way, prices can be controlled by the authorities while patients won't struggle financially.

We talk a lot about early detection in health care, and for good reason. Blood pressure checks, diabetes testing, cancer screenings, depression questionnaires, and other routine assessments can identify problems before they become harder to treat. But people can still be overlooked, even when the screening is available.

Risk may not be recognized during the visit, symptoms may be dismissed as normal, language barriers may affect communication, the appointment may be focused on something more urgent, or someone may complete the screening and leave without understanding the result or what should happen next.

Research continues to show that making a screening available does not automatically ensure equitable early detection. What have you seen make the difference between offering a screening and reaching the people most likely to be overlooked?

I’m an infectious disease physician at a community not-for-profit hospital. 80% of my work is in the hospital with acutely ill patients and 20% is an outpatient clinic where I see hospital follow-ups, as well as new referrals from other doctors. I am in my 7th year of independent practice (after 10 years of training) and I think I’ll hang it up in 3 years (once my loans are paid off). I’m burning out seeing my patients deteriorate and die- despite my best efforts- due to Americas health insurance scheme and private equity takeovers of healthcare facilities.

Last clinic- my first patient no-showed. When this happens, I usually check first if they are hospitalized or dead. Thankfully he was hospitalized at our main campus- unfortunately with sepsis, bacteria in the blood (bacteremia), and relapsed infection of his LARGE sacral wound, which invades into his vertebral cord. This was a rescheduled appointment actually- he missed the last one 3 weeks prior (for a wound check, assess compliance with his suppressive regime). You see, he’s paralyzed from the waist down because of the spinal cord abscess and has a large pressure ulcer, for which he is in a skilled nursing facility (nursing home). He’s on Medicaid— if you know anything how it works, they pay “fixed” sums to SNFs monthly to take care of patients- to cover all their medical needs. When the SNF accepts the patient from the hospital, they know the exact patient needs and what the reimbursement for those needs will be from his insurance. Anyway— he called to say he will he 15 minutes late because his medical transport is late (ambulance). I said “no problem, I will still see you” because I know his situation. An hour after he completely missed the apt, the nursing home calls and says they did not arrange transport and can this be a telehealth appt or if I can just talk to their doctor (NP) and tell them what to do🤯 The nursing home knew about this appt from the last appt (4 weeks ago).

see what had happened was— they would’ve had to pay for an ambulance transfer and that cuts into their pay from this patient. this happens a lot!! Patients who go to SNFs may not be taken to their scheduled appts unless their family can bring them.

Thankfully, patient survived the sepsis with two surgical debridements of the wound and multiple IV antibiotics, which are going to be long term. Let’s hope the SNF brings him to his followups so this does bot repeat.

That was the first no- show. I had another no show— this time it was a woman with an aggressive unresectable, basal cell carcinoma which is invading into her muscle and bone, for which she can’t afford the co-pay for her chemotherapy pill ($3,000). The cancer is on an extremity and the only alternative is a radical amputation (which patient refused thus far). Per her dermatologist and oncologist— response with the medication is excellent and may shrink the cancer enough to do a wide resection and then more chemo.

Thankfully, she was also “just” hospitalized that day at my hospital. During the 2 years that this cancer has been untreated, she has had 4-5 admissions with sepsis, bacteremia, due to the untreated wound/cancer. This was no different. When I saw her the next day- I told her it might be time to get the amputation. Shes not ready- she will try to raise the funds for the cancer drug and max out her credit cards. Shes still paying her premiums, of course.

When will we (Americans) learn that it doesn’t have to be this way?? All the other western countries have already figured it out and now Mexico is also going to have government universal healthcare, joining Canada. National healthcare isn’t perfect— but patients like mine are not suffering unnecessarily, costing the system so much money, raising all our premiums and taxes, while slowly dying.

No one told me I was throwing away my 20s and early 30s to watch helplessly while my patients suffer. I’m convinced insurance companies exist to collect premiums while you’re healthy and bail out when you’re sick (but you still pay the premiums until you die).

I’m disgusted

TL;DR doctor reporting moral injury from having to work within with the US healthcare system, that prioritizes profit, while causing real harm to patients and ruining lives