But as a rule, I think my perspective and observations are very fair and realistic, even if they don't serve me. So, here are some observations:
Not all of our system is broken. I believe the US health care system is bloated, process heavy, and cumbersome for both the patient and the caring provider. It's no wonder the ACA (Obamacare) came into effect. I know many that have benefitted because they were without reasonable/affordable means for receiving healthcare.
Some of our problems -
Some administrative positions require high levels of education which call for decent wages when not needed. - I was inpatient at a hospital for a while. My room was right outside the nurses' station. There was a gal there that was in an administrative capacity that required an MS degree. So, she made a commensurate income. Sometimes she was a superstar and did her job very very well. Other times she got in a hurry and worked off of old or inaccurate information costing the patient either care or money or both. And moving that data so that the patients received the highest levels of care possible was her job. I happen to also know that was exactly what her boss expected. Beyond not always doing a good job, she would be the one to make Starbucks runs, etc. during the middle of the day. During the 2016 elections when a $15 per hour minimum wage came up, she was furious because of the percentage that was or what she made with her Master's degree. That screamed wrong motive to me. Now admittedly, I don't know everything that her job entailed, but I do know much of it. Her office was right off the nurses' station and her door was always open. As someone that isn't a big TV freak, especially broadcast TV, mine was never on. My room was quiet. I was awake all day most of the time and often just lay there and listened to everything outside my room. Her job and a part of what I had done as a side-job in my previous career were very similar. Except, I had no education in that area and it was not anywhere in my job description but was expected of me. Of course, I was coming from the world of industry where efficiency and cost were the only things that mattered. In other words, in another field, her job was important but an afterthought not a job that put someone in the top 25% of income earners in the area. BLOAT - Her job was required and everyone that I've known in her field has the same degree. So, they all can demand the same kind of income. Granted, some really earn it.
Because of the processes and complications of the insurance and billing systems, doctors are almost completely hands off when it comes to the financial side of things. They can't possibly know and handle all the ins-and-outs of billing for patient care and stay at the top of their game. So, many good doctors with great bedside manner and a high level of skill are so disconnected from the process that things spin out of control. We know of one clinic where the referrals department claims to have a backlog of 5,000 claims to process. And usually, they are running with one person because they can't keep qualified help. As an advocate for my wife, I have been largely stymied because I didn't know the magic language of billing codes. For whatever reason, the office has refused to give me this information. I have someone in another facility with the correct skill set that has offered to take over my wife's referrals. She just needs the clinical notes. They have refused. They told me that patients advocating for themselves helps, but won't crack their magic code book for me so that I can help. Friday, in a little over an hour, on one phone call, using a refusal letter, I was able to get the authorizations that the office hasn't gotten in 9 months. The doctor had promised a week tops. So, the system is so complicated that too much special knowledge is required. The funny thing about knowledge. I once was trained by a former Navy ET or Electronics Tech. One of his Navy instructors in his best drill instructor manner asked the class what ET stood for. They shouted, "Electronics Tech., Sir!" He did this at least three times in a row then screamed at them, "No, it means Everything Tech" because you know where to look for the answers." That was one of the best pieces of training I ever received. You see, I know that this referrals gal doesn't know all the codes off the top of her head (she's proven that by submitting the wrong ones multiple times) but she knows where to look. It doesn't need to be so complicated and it isn't as complicated as it is made out to be. INEFFICIENCY - an overly complicated system that bogs down many doctors preventing patients from receiving the care they need.
During my short 13 months overseas, I had a fair amount of exposure to a socialized medicine system. Now, admittedly, this was many years ago and I only saw what a tiny portion of what I would see today because I was barely an adult, not knowing anything about anything. But when my mother was in a large hospital dying, she complained of the lack of care. She complained that the nurses were laughing and joking and taking smoke breaks while she had a need. I was sure she was exaggerating. Now, mind you, this is the ONLY time I have ever seen this! But I did see it with my own eyes. I spoke with a good nurse about it and her answer was, "This is the best job these girls can get in this area and they're here to feed their kids.". LACK OF PURPOSE - What I remember my time overseas with the medical system was that everyone seemed to be there because they wanted to be. My guess has always been that in that system, there wasn't the kind of money to be had that it was just the best job around. It attracted the people who cared.
Job vs. Calling. (Here I am using the word colleague to mean any care giving professional.) I know most of my colleagues truly care but it is also how they feed their families and they draw lines when it comes to finances that I don't draw. Of course, I have a wife that has spent the better part of our 30-year marriage with a husband that was required to be on-call 24/7 or worked multiple jobs. Many years, I worked from 60 to 100 hours a week. Now, I still get texts and calls at all hours and I have to decide what is truly urgent and what can wait. Most of my colleagues don't function that way. And they aren't in position in life where they can. But many of them do their very best. Many stay over to do their "jobs" because patient care consumed their day. Many skip breaks and lunches and others go to the office on weekends and nights.
There isn't going to be an easy answer to change things here. And many will get hurt by anything we do. The ACA helped many and hurt others. For those on Disability, it is the definition of discriminatory. I don't believe for a second that this was deliberate. And at least Social Security made a somewhat weak effort at helping relieve part of the undue burden. But it's just an example of the pains we will go through, especially if we change a little at a time. But, whatever we do, something WILL give. Something or someone (millions) will break somewhere. We are definitely in an unsustainable position.