We all have bad weeks. Mine recently made me marvel at the astonishing dysfunction of our health care system. In calling out the system I intend no disrespect to the talented and heroic overachievers in nursing, pharmacy, medicine and the other providers who fight the system every day on behalf of our patients.

Despite such efforts, the sad but undeniable fact is that our health care system — the way the U.S. distributes and pays for health care — makes it the most expensive failed enterprise in the history of human civilization.

Part of what set me off that week was a series of examples of my patients’ chronic struggles to access mental health services. After years of poor funding and a deluge of demand since the pandemic began, providers are in short supply. Scarcity is coupled with barriers imposed by insurance networks. Absent reasonable access to services, primary care doctors like me become the psychiatrists of first and last resort, pushing the bounds of our competence. But what else can we do?

A second part of the week’s grind was the latest obstacles to drug therapy. The costs are so high for so many medicines that even insured patients struggle. Take Ozempic. There’s no generic, and it’s a financial stretch at nearly $900 a month, but it helps my diabetic patients — until last week, when they couldn’t find it. Why? Because of its newly recognized use for weight loss. It’s suddenly so popular that pharmacies run out. How can a system allow wealthy individuals looking to shed a few pounds to use their cash to elbow aside diabetics who actually need the drug?

A third conspicuous failure of our health care system, looming in the background every week for physicians like me, is hospital funding. Hospitals have survived for years by collecting high fees from commercial insurers to subsidize losses from treating Medicaid and Medicare patients. With a rise in the cost of care, and a shift toward patients on government plans and away from private insurance, even the most prestigious and well managed hospitals, both locally and nationally, face an emerging flood of red ink. Many are cutting costs sharply to preserve solvency. In a rational system, the revenue that supports critical institutions like hospitals would not be subject to perennial financial crises.

These are only a few of the ways that the U.S. health care system’s failures now weigh on physicians. …read more

Source:: The Mercury News


Opinion: How has American health care gone so terribly wrong?

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