It’s rotting from the bottom-up. The collapse has already happened for the lowest income people, and in regions where incomes are predominantly low. If you don’t have enough money, or a reliable car, or the ability to take time off work, that means you simply don’t get professional medical service. For a lot of people, medical services have effectively stopped existing in the USA; you just ask your friends and family what sort of remedies you can buy at a corner drugstore, and do what you can. We’re at the beginning of the process of drugstores starting to pull out of certain areas as well, which will basically just leave local corner convenience stores as the last place where you can acquire actual medical supplies.

This collapse is slowly creeping up the income ladder. It’s been hitting middle income people hard for awhile, who are regularly foegoing some important medical treatments. It’s even starting to creep into the lower eschelons of high income people, who are being hit long waits for scarce services, and are also at risk for bankruptcy for some medical issues.

It’s a good example of how collapses happen. Not overnight, dramatic collapse of a structure. More like gangrenous flesh slowly rotting away until there’s nothing left. The collapse of US medicine comes in the form of “guess I’ll just die”

Commodification of health care was guaranteed to bring this sort of thing.

Yo if i ever am dying of an infection i’m sorry but i’m gonna be robbing a pharmacy. I already hate the pharmacy system and do not respect the idea that I need some dipshit with a degree sanctioning my ability to buy something, if i’m going to fucking die then yeah I’m taking what I need

Time and again I see people who have what I know to be fairly routinely urgent medical concerns that do get told by the ER that they have to wait for a specialist… 6+ months out.

Well, there goes my father’s reasoning against the universal healthcare that he wants. He keeps talking to all these retired Tory civil servants in anglophone countries and they always complain about the wait times. I keep saying to him: " We have the same wait times and we have to give them way more up front."

yeah, it’s crazy fucked. i have/have been on “good” US insurance plans for over a decade and my previous employer was also the hospital (a ranked university teaching hospital) and even being on the good insurance there, it takes several months to get an appointment after a referral for something that is generally regarded as serious/debilitating. the insurance and employer are always finding weird little ways to negotiate the insurance down and claiming to be cash strapped, but have constantly rotating fine art displays, a grand piano in the lobby with a professional musician during several of the working hours, and the finest recruitment displays, entire floors dedicated to billing/account specialists chasing payments, and god tier outsourced/fee based catering/food services. not to mention all the exec level people of this non-profit make absolutely unjustifiably huge salaries. also, no one could ever, ever tell you how much something was going to cost. it was always a mystery. i remember going through every hoop i could find to get prior authorization for oral surgery my in-network/in-house dentist said i needed. i spent days getting various offices to email things to each other and eventually the biller said the insurance company finally agreed to cover everything after my $75 outpatient surgical co-pay. what that means was, after i paid by $75 and got the surgery, months down the line i had to pay a bill for about $300. i called the surgery office and apparently that was a totally different fee that insurance never covers that nobody told me about. i complained to some friends and they all said that i got off easy and i must have really bothered them, because their “after action” bill was like $500-600 for the same surgery.

i bet if i hired a lawyer and sent threatening letters i could have gotten that taken off, but who the fuck has time, energy, and money for that? and what if the in-network provider/billing system decided to boot me because i engaged in legal action against them, then i’d really be fucked for everything else healthcare related.

i remember a friend of mine fucked his ankle up on the job and with this good insurance going through all the protocols, it took months to get his ankle imaged for a diagnosis. and THEN, the imagery was digitally sent to an outsource firm in south east asia (where M.D. labor is cheaper per hour) to get the diagnosis, which was then typed up and returned to the US where someone read it to him over the phone and scheduled treatment.

it would probably take 1000+ pages to identify all the ways in which any specific hospital in the US has been completely hollowed out from actually generating the value of public health and reoriented to the administrative bloat surrounding the pursuit of revenue streams.

After working at the adrenochrome factory I got a good look at how things are going in healthcare in the US. I wouldn’t be shocked if some crisis befell everyone. For work I wouldn’t feel comfortable having someone without a relevant degree doing, we were making less than some fast food workers. Not to denigrate them, but I would trust a respectful high schooler to be able to help with the responsibility of feeding people. That shit had corporate shifting everything around, we had clean rooms that would pop for fungus, and we were constantly on edge of running out of shit like ethanol and containers. We had turnover >50%. I know someone who had to file a complaint with the labor board to get their overtime paid out. Meanwhile someone was making money hand over fist about it. I was so upset with how society handled this service that any rational actor would believe a civilized society required and how they just mismanaged it for profit. The wonton disregard for the work that had to be done weighed my spirit down. I started going to lunch instead of meetings - I had trouble saying no to two attractive people instead of falling asleep during the meetings as my reputation had declared.

During the quarantine in the US, they had nurses wearing trash bags as PPE. Burnout was spreading as much as the virus. I’m sure with insurance money flying everywhere like a shell game for shell corporations all sorts of bullshit comes before making people better. If a hospital has that managerial browbeating flavor where in addition to helping people for 12 hours, you had to learn a new payroll system that some slick tongue in a suit sold them, I can’t imagine helping people is primary for the leadership. It all falls on people going the extra mile for people in spite of the incentives.

It makes my stomach wretch because I did follow the incentives. I work for the CIA monitoring leftist forum activity now. It’s decidedly less important than synthesizing adrenochrome. I’m much more like the payroll salesman. But now I have monetary hope for the future. When there’s work to be done I do it and I don’t pretend to be busy when there’s not. I take on a reasonable load of responsibility and I’m appreciated and compensated for it (most of the time, some people are assholes for whom contracts and laws don’t apply). I would go back and do a lot of jobs if the CIA went under, but I would be so distraught if I were in healthcare again.

I live rural, so that’s been going on a while, and to make matters worse they’re closing hospitals as well as pharmacies. The 6 month wait is the standard if not on the shorter side for most specialities, and just to be seen by an endodontist or psychiatrist locally is a 2 year long waiting list for the former, and 4 years for the latter, and that’s the wait for people with good insurance, people with standard or medicaid/care go without, or have to travel 2-3 hrs one way just to be seen. Because of the years long waiting lists local places refuse to take new patients.

Walgreens closed down last year and Riteaid is closing locations nationwide, which leaves a lot of the near towns with no pharmacies outside of Walmart, if lucky. For example, coworker of mine is both of the age and broke enough to qualify for medicare, she can only pick up medicines when she comes in to work now, which is a 40min drive for her. What few locally owned pharmacies we had had have long closed. I looked at vitamins at one of the closing Rite Aids and was stunned by some of the prices with 40% off, even vs GNC.

At a residency clinic, as a non new medicaid/uninsured patient its over 3 months to be seen for an appointment, so I end up going to urgent care for everything and never following up generally. I had a sinus infection in December that didn’t get fully addressed until May. Ironically, the residency clinic was and is one of the quickest places (best reviewed too) to be seen outside urgent cares or places that only accept good private insurance. Tbf understandable no one wants to be a guinea pig, especially for first years, who tend to have a rough touch and are awkward. Since covid19 the residents are getting btfo by terminal burnout faster and quit, so I get a lot of letters informing me ‘Dr. FirstorSecondyear left for other ventures, now you have Dr. OtherFirstorSecondyear as your primary care physician’, only to receive another letter a few months or even weeks later. This used to be a much rarer event, tbh I don’t even know what stressed AF resident is assigned to me right now.

I’ve been eying those remote scribe jobs I’ve seen online in attempting to leave retail, my sister who does something with medical claims says it isn’t a good idea right now since she expects a rural-like collapse to happen nationwide. She’s noted a lot of places have older medical professionals retiring/moving away and medical facilities are opting to go without replacement. When covid19 hit many medical workers left and also weren’t replaced.

This is a parallel tangent- I just had the price of one of the medicines I need very much go up 10x. I could afford it, but can’t afford it in the long run, and I called the insurance and they’re like 🤷”Nothing we can do. You could go to your Dr and see if they can prescribe another medicine.” But turns out the price depends on the manufacturer which changes depending on pharmacy, which I wouldn’t know until I had the Rx and called the pharmacy. And it’s hard enough to get into my Dr anyway. And I have decent insurance!! 😭

some friends of mine went to the ER recently, one of the things that stood out to me is they were being treated in a hallway because every room was full.

Yes.

Rural medicine has been in collapse for a while. Hospitals close and it is affecting pharmacies and primary care.

The problem right now is that people are choosing cultural war libertarian politicians over anyone who somewhat gives a shit about the people.

yeah that’s only the tip of the iceberg. things are going to get much worse the way large firms are swallowing things up

there are lots of health services it’s just they are all so woke only providing gender affirming care and abortions to children

that’s the impression i get anyway