America doesn’t have a health care system

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  • #297150

    • Total Posts: 5,341

    I’d like to say this event was an aberration, but in my 26 years as a patient in American hospitals, I’ve experienced rationing of all kinds. Bed shortages, medications being out of stock, nurses given too many patients, a single specialist available for an entire inpatient population. Which is why, in early March, as reports came in from Italy of hospitals buckling under the strain of coronavirus patients, I realized that regardless of the true scale of the pandemic in the U.S., New York was likely to experience the same fate. Despite being in a high-risk demographic and having a history of pneumonia and heart and lung disease, my concern wasn’t about the virus itself or my ability to survive it. What panicked me was visions of overrun ERs, full intensive care units — a world where I was sick and insured and still couldn’t be treated, because I had already experienced those things in smaller ways many times. I wondered how our country’s hospitals could handle what was coming when I knew they could hardly handle what they already had. To be sure, I called my medical team, who told me without hesitation that, yes, if I had the ability, the safest place for me to be was pretty much anywhere but New York.

    In comparison with other major countries, the U.S. has a staggeringly low hospital bed density (measured as the number of hospital beds per 1,000 people). And in a 40-year period measured up to 2015, the number of hospital beds in the country shrunk by a third — losing a half-million total beds even as the total population grew in the same period by more than 100 million and as life expectancy increased. Some of the bed loss can be explained by advances in treatment that allow for shorter stays, but much of the decrease has also been to rein in cost. This reduction has meant many communities in rural areas are now totally without hospitals, while even as some systems are expanding in major cities, the supply in those dense areas still can’t keep up with the outsized demand.

    “It started with health insurance not wanting to pay hospitals for an inpatient stay when the patients really weren’t acutely ill,” Zane said. “Insurance companies started to develop benchmarks of how long a patient should be in the hospital for an appendectomy or heart surgery, and then they would … essentially cap the hospital [reimbursement] for the stay, irrespective of how long the patient remains in the facility. So through the years, it encouraged more and more low acute patients to get their care as outpatient or as short stay patients.”

    With hospitals getting paid less by insurance, it became harder for them to stay in business. In some places, this led to reductions of beds or other cost-cutting measures targeting supplies or staff, while in other areas, such as rural communities, many hospitals had to close altogether. An added wrinkle was the refusal of many governors, particularly in Republican states, to expand Medicaid, which had previously been a big source of reimbursement for hospitals. “I think there is significant egg on the face of any governor of any state who didn’t expand Medicaid. Because what those governors were doing is they were looking at their own constituents, their own stakeholders, their own hospitals and saying, ‘suck it up,’” Zane told me. “So if they politically refused to expand Medicaid and there is a high and growing Medicaid population in the state, those people still get sick. … In my view, it was ignorant to do that.”

    Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

  • #297187

    • Total Posts: 2,480

    America has a health scare system.

    All governments lie to their citizen's, but only Americans believe theirs.

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